Write case study including background of the study, predisposing, precipitating, perpetuating, protectice factors, key theories /model of health to explain the above factors ?
Addiction Case Study
Ebony-Anne Merici
Ebony-Anne Merici is 30-years old and has recently been placed on probation. She spent two years incarcerated following being found guilty of theft in order to finance her alcohol addiction. She had been an addict for around 5 years before the incident.
Interview with Ebony-Anne (30/01/2017)
When asked if she can recall life before her addiction, Ebony-Anne sighs and admits that she remembers how it all began. She had always been quite focused and routine-oriented in her daily life. She loved to be in control – and this had led to high levels of achievement. In only two short years, she had found herself in a management role within her law firm. Yes, she drank, but she had always been able to control herself and to stop drinking after one or two glasses when socialising with friends or after one drink with dinner at home. That was before entering into the management role. It was an intensely high-pressure job that included a lot of travel – her dream job.
The pressure was manageable at the start, but then came the trouble getting to sleep. She forced herself to deal with it by just getting more organised, but she continued to be increasingly mentally and physically exhausted and having to travel frequently meant she was away from her family and friends. Her colleagues seemed to be functioning well, and that only put her under more pressure. One night was quite bad – she had a deadline coming up and had been struggling with sleep, she was exhausted and couldn’t focus very well. At dinner, she had two extra glasses of wine – she was so overwhelmed. The wine worked! She slept well and she was so much more productive the next day for being fully rested. She slowly found herself drinking a bit more at dinner – it helped her to calm her nerves and get to sleep easier. Then she moved to finishing a bottle of wine every night.
It took Ebony-Anne a long time to think she may have a problem. She was always able to convince herself that nothing was wrong. Her mum had had an alcohol problem – she would drink loads and then get into fights, and sometimes be violent. She knew alcohol addiction was a serious problem with serious consequences, and required treatment. She had taken an elective course in University, and knew about the successes of the various therapies such as cognitive behavioural therapy. She knew a lot of what there was to know about alcohol addiction. However, she was nothing like her mother. Sometimes, yes her family did express concern, but Ebony-Anne always convinced them that nothing was wrong. She felt in control of her drinking, and had always been able to be in control – and to manage everything. She was a successful lawyer who was very good at her job – she gave all her effort to prevent herself from failing at anything and this is how it was always going to be. She just used drinking to relax – it was so soothing, and the calm feeling felt so good compared to how pressured the rest of her work day had been. There were rumours around the office that people did whatever it took to keep doing well, so it seemed like the norm in order to keep up with the job demands – all the women were doing it too. She did not have a problem.
However, eventually she felt the need to drink more than a bottle in order to relax. Sometimes she felt guilty and made an attempt to cut down, but it seemed almost impossible to accomplish – every time she tried to reduce, she ended up drinking more; and was worrying more and more about it. Funnily enough, although she had started drinking to help with work, it now started to prevent her from being able to work well. It was almost as though beginning work automatically triggered her need for drinking. She was experiencing such intense cravings, and her anxiety was higher than ever before when she wasn’t drinking. Then she started having problems with her family – she got frequently irritable with them, and began acting more and more like her mother but she couldn’t seem to stop.
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Interview with Ebony-Marie (24/02/2017)
Ebony-Anne recalls with difficulty how she eventually came to be incarcerated. It took her some time to admit that she had a problem. She felt guilty and ashamed because she knew that the person she was becoming (one who seemed to need alcohol to function) was not the person she ought to be. She knew who she was based on her beliefs and her responsibilities to herself and her family, and her regret was intense. It was important for her to be a provider, and to be responsible – so she needed to do admit something was wrong.
She recalls her other thoughts at the time. She had had a dependency on alcohol at that point for over 2 years, and probably would struggle with it for life. She recalls thinking about her mother and her feelings relating to her high-stress job, as well as her beliefs that she needed to control everything and to be perfect. She knew the benefits of CBT and how it may help. She knew not seeking help may ruin her family – and her life. Facing her possible label as an alcoholic made her feel extremely anxious and severely worried. However, she could no longer avoid doing something – she needed to change, because her problems were only getting worse.
It was because of this that she finally decided that maybe she needed to admit that she had a problem. Ebony-Anne thought about going to her GP, but was still anxious. Would seeking treatment mean that she would have to live with the shame of being labelled an alcoholic – especially risking being made fun of? She was worried that she might lose her job if people found out she was an alcoholic as her job came with such responsibility. She felt tormented – whenever she thought about getting help, her heartbeat would accelerate; she would sweat more profusely, and feel as though she was getting a heart attack. She was lashing out at her family, and her colleagues didn’t seem to want to work with her anymore. She’d overheard them in the staff room saying how irritable she was and how they could never seem to say the right thing without being snapped at. Eventually, it all got so unbearable that she decided to try going to her GP.
Interview with Ebony-Marie (14/05/2017)
Ebony-Anne began CBT within a month of seeing her GP. She learned better stress-management strategies, and her therapist also tackled her perfectionism. For some time it seemed that she would be able to manage her alcoholism. Her relationship with her family improved – and they were always there to support her, encouraging her to put into practice all she learned in therapy.
However, she then returned to work – in the midst of a very high profile case – and she felt her cravings slowly begin to overwhelm her. One day she caved and drank. Her husband saw the suspicious withdrawal on the bank statement and linked it to her recent changes in behaviour. He accused her of drinking again; he gave her an ultimatum – either go back to therapy or move out. Her therapist tried to deal with it by focusing on strategies for relapse prevention. However, it all was too much. She didn’t understand how this treatment would work when it hadn’t previously. How could she do her job and tackle her alcoholism? The two sides of her seemed completely incompatible. Her therapist tried to encourage and support her, but she didn’t feel very reassured. She felt like her therapist didn’t truly understand what her situation was like – how her cravings overwhelmed her; how hopeless she felt. She didn’t feel as though she could really open up to her therapist; so instead she just silently continued feeling like a failure, and it all was overwhelming her. She needed the alcohol but she didn’t want her family to know, and she couldn’t speak to her therapist about it. She felt that she wouldn’t get caught if she didn’t use her bank card. She thus decided to get it the illegal way – and she got caught.
Interview with Ebony-Marie (19/07/2017)
When asked about her feelings toward treatment now that she was on probation, Ebony-Anne suggested that she was optimistic. In prison, weirdly she had found a group of people who had helped her greatly. They were all extremely determined to change their behaviour upon their release – and to work on building better relationships with their families. She planned to continue on with these friendships as some of them had already been released from prison. She hoped that they, combined with therapy, would help her maintain her resistance to alcohol. That was the most she could hope for – to try day by day to change her behaviour and to make the use of the support systems she had and new skills she would learn, as well as to keep in mind the costs that choosing alcohol had had on her life.
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