Psychology

There is a general consensus that the use of alcohol beverages has been with us since times immemorial. Across the globe, alcohol has over the time grown to play an important role in the lives of people for one reason or another. To this end, the consumption of alcohol has undoubtedly become fully integrated in our lives. For instance, it is usually consumed with meals as well as used for religious or medical purposes. Alcohol has at the same time been used during celebrations in several special or important occasions in addition to being used as a tool for social facilitation. A closer look into the countries alcohol consumption trends reveals that its consumption per capita is arguably the highest across the globe.

Additional statistics with particular reference to the trend of alcohol consumption is based on age indicate that it is increasing sharply during early teens all the way to mid-twenties. This is then followed by a decline thereafter as it is presented by NIAAA (2000). In one of the surveys conducted by Michigan University, it was found out that there was, indeed, a positive correlation between the age and the rates of intoxication as well as lifetime amongst students in high schools within the country, according to Johnston (1998). In comparison between other drugs and alcohol, it was revealed that the latter is the most and widely consumed substance within America just as it is the case with respect to dependence prevalence (SAMHSA, 1999a).

Alcohol Related Problems in the U.S.A
Risky situations in the context of the use of alcohol refer to the drinking pattern and behavior that is characterized by blood alcohol concentration levels just below 0.08 gm. This is normal, given the much needed impetus by frequent drinking pattern, whereby an individual consumes not more than five portions of a drink at one time. Under this drinking behavior, the person normally drinks at least once during the week. It is imperative to note that this type of drinking behavior is highly risky, owing to the fact that it usually culminates into binge drinking pattern. In this regard, risky situation with respect to the consumption of alcohol is attained when the blood alcohol concentration of the drinker ranges from 0.05 gm to 0.08 gm. According to NIAAA, binge drinking behavior is attained when the blood alcohol concentration (BAC) is 0.08 gm or above. Binge drinking is normally brought to the fore when an individual consumes more than five drinks within a time span of less than two hours. If not controlled, binge drinking usually results into one becoming a bender or heavy drinker that it is characterized by an individual drinking heavily for two or more days.

Low-risk drinking pattern, on the other hand, encompasses both abstinence and low frequency of alcohol consumption. In particular, this refers to the instance when one drinks less than half an ounce of alcohol or none at all in the case of an abstainer. With regard to the age, older persons have been shown to require fewer number of drinks in order to reach binge level of drinking thus are usually at high risk. The same applies to women that have been reported to require four or more drinks to reach the said level. On a different note, data from SAMHSA, (1999a), shows that alcohol consumption rates, binge drinking as well as heavy drinking are comparatively high amongst men against women. The scenario is similar in relation to young adults in comparison to older ones. Moreover, this data indicates that young men are normally highly predisposed into turning out to become both binge drinkers and benders in the event that they drink alcohol.

In this study, it was found out that 67 percent of males within this group of age had reported as to being binge drinkers or benders in comparison to less than 50 percent of men and women that were above 26 years. Majority of women that were above 26 years old on the other hand were captured as to being abstainers, although upon opting to consume alcohol, they end up using significantly lesser amounts in comparison to their male counter-parts within the same age group. Additional findings presented by SAMHSA, (2000a), indicate that the risk of alcohol abuse varies subject to ethnic differences despite the fact that it has a positive correlation with age.

Among the young people, there is a high alcohol consumption rate among the whites according to this 2000 alcohol use study.  Asian and black respondents, on the other hand, reported the lowest consumption of alcohol rates. That not withstanding, this survey revealed that there was a high rate of binge drinking amongst American Indian as well as Whites closely followed by the Hispanics. Heavy drinking on the other hand was reported to be highest amongst the Whites and followed by Hispanics and American Indians. With regard to persons of the age of 18 to 25 years, the Asians and Afro-Americans were captured as to having lowest heavy drinking rates. In the overall, this survey found out that the American Indians accounted for the greatest proportion of both binge and heavy drinking. Furthermore, the family stability and the social class certainly play an important role in the drinking behaviors of persons. Individuals growing up or under the care of less stable families are highly predisposed to the risky alcohol consumption. This might be complicated by the high social class status, since one has the access to high amounts of disposable income. Unlike the two, disability tends to reduce this risk since it acts as a limiting factor as far as social interactions is concerned. The risk might be increased in the event that a person consumes alcohol though heshe has a medical condition. Religion, just as disability greatly reduces this risk owing to the fact that consumption of alcohol is usually prohibited in almost all the religions across the globe.

With regard to policy implications and social work subject to the relationship between violence and alcohol, it would be imperative to come up with policies or legislations that restrict the amount of alcohol that is consumed by any one person. This would take the form of the government regulating the alcohol percentage concentration by volume at the point of manufacture. The other feasible policy option would be in terms of restricting the number of drinks that an individual might be allowed to take at any given time or period. These policy implications options stem from the positive relationship between the use of alcohol and violence. Perhaps it is imperative to note that use of alcohol does not only encourage aggressive behavior, but rather victimization could also lead to excessive consumption of alcohol. According to NIAAA, (2000), it is found out that alcohol-related violence is very common within America in comparison to that associated with use of other drugs.

On a positive rejoinder, Roizen (1997), found out that the majority of offenders were usually intoxicated at the time of committing the various crimes. There is a positive correlation between the use of alcohol and domestic violence among intimate partners according to Greenfield and Henneberg, (2001). It is estimated that approximately 45 percent of all domestic violence cases involve men that were drunk at the time of this offence as it has been put forward by Roizen, (1993). Against this backdrop, it would be prudent to come up with a policy of regulating use of alcohol at homes with specific emphasis on young couples to reduce this risk. At the same time, there is need for policy that compels one of the affected partners to report incidences of alcohol-related domestic violence to reduce additional risk at home. The positive correlation between the use of alcohol and accidents also calls for stringent policy measures aimed at restricting consumption of alcohol by the motorist. In this regard, social work efforts should be directed towards sensitizing the wider public on the need to avoid alcohol all together as the surest way of curbing the increasing rates of alcohol-related accidents. With regard to the use of alcohol and health, there is the urgent need to control the amount of alcohol that one can take at any sitting. In the overall, the above policy implications would be complicated by intensified sensitization or awareness on the dangers of alcohol in general across gender, ethnicity and age.

Alcohol and the Family
Social learning constructs with respect to the use of alcohol lay significant emphasis on the cognitive constructs for example self-efficacy, expectancies, as well as attributions as pathway mediation to the use of alcohol from stimuli as response mechanism. Expectancies with regard to positive effects that are derived from alcohol use have been known to develop to become conditioned cognitions. This is normally brought about by operant parings or repeated classical as a result of alcohol use based on positive experience. Self-efficacy on the other hand, entails individual expectations that heshe would successfully be able to perform a given coping behavior subject to certain situation and that such behavior would be reinforced. Against this backdrop, the social learning construct is founded on the premise that alcoholism is brought about due to failure to cope by an individual.

Hence, the self-efficacy is significantly low among individuals that consume alcohol. Faced with this challenge, such persons therefore depending on alcohol due to continued use of the same. In relation to one of the social learning theories by Petraitis (1995), for the adolescent experimentation, it was found that individuals usually have a range of positive expectations from using alcohol. In this regard, several studies under the social learning theories are focused on indentifying the ability of alcohol to actually influence given types of behaviors for example aggression induction, sexual arousal, increase in addition to reduction of tension among others. Of importance to note is the fact that the said laboratory or experimental studies assume cognitive-related influence that is brought about by the use of alcohol. As a result, a number of alcohol use-related expectancies amongst users have been indentified. These are increase in aggression as well as personal power, tension reduction and relaxation, sexual performance enhancement and pleasure and social facilitation. The other expectancy that is usually attached to the consumption of alcohol is the need for a positive outcome in general which might be brought about by drinking.

With this in mind, several instruments have been developed in order to assess such expectancies in the wake of the use of alcohol by someone in the context of its effects. It should be emphasized that these expectancies are not usually limited to an individuals experience with alcohol but rather encompass influence towards them due to the exposure to alcoholic beverages through advertising. In addition, these expectancies might be given the much needed impetus through observation of other people drinking an aspect that can occur both in real life situation and through the media models in this regard. It is possible that this process of modeling can begin during the early stages of an individuals growth (Miller et al. 1990). In one of his study, Miller together with fellow social researchers, found out that positive alcohol use expectancies tended to increase as one becomes old especially amongst children aged between 8 and 10 years. On a positive rejoinder, Stacy (1990) and Christiansen (1989), argue that a number of additional studies have revealed that it is possible to predict to ones initiation into drinking, drinking intention as well as the rate of drinking amongst college and high school students with respect to the effects of alcohol.

Though it was originally believed that these expectancies were directly linked to beliefs and attitudes in relation to the alcohol reinforcing properties, it has emerged that they are in fact closely related to the processes of memory. In this way, positive expectancies are usually brought about due to the usual process of drinking. Furthermore, the said expectancies are easily retrievable from an individuals memory during subsequent alcohol drinking. This is attributed to the fact that such positive expectancies have been found to be closely related to the usual process of drinking. Negative expectancies on the other hand, have been found to be brought about by unpleasant drinking experiences or situations. Therefore, such experiences tend to be less associated with the usual practice of drinking. However, there is a high possibility that they are brought about due to heavy drinking practices. In this respect, light to medium alcohol drinkers are least likely to experience negative alcohol expectancies with regards to the effects of alcohol. At the same time, they might act as inhibiting factors during the usual drinking practices. Based on the social learning theories, it is justifiable to state that a lot of emphasis is usually placed on the sources of modeling with specific reference to the young ones. Also, through alcohol use expectancies, it is possible to determine the drinking practice of an individual and thus be able to come up with an appropriate control as well as a treatment regime.

The family system most certainly plays a very crucial role as far the initiation into alcohol use by other persons within the family is concerned. This can be attributed to the fact that the family system that is founded on alcoholism has the effect of providing a steady supply of alcohol to its members. In this way, it becomes much easier for one member to be initiated into alcoholism owing to the fact that alcohol is used as a means of maintaining the balance within the family. Under such instances, the use of alcohol tends to become a natural practice. Thus, family members grow to accept the fact that the use of alcohol is indeed a natural practice or element of life without however paying attention to the danger of alcoholism. In particular, this is usually given an impetus since the family normally opts to maintain this problem against the expected cost of changing the status quo. The main reason in such instances is usually founded on the assumption that accepting the use of alcohol is relatively less demanding and also enables the family to avoid tackling more disturbing issues.

A family system that is based on abstinence to alcohol or responsible drinking practices tends to offer a very strong resistance and resilience to alcoholism. By limiting the amount of alcohol within the family or restricting the same, family members tend to be less exposed to the risk of alcoholism. Furthermore, such a family system acts as an effective support mechanism to the other family members that might be affected by alcoholism.

Client Case Study

Introduction
Born in a family of four, Martin grew up knowing that alcohol was as natural as any other element of life. Being the youngest, he had seen his father come home drunk every night from work. The mother was no exception to the problem of alcohol abuse as well, although she was a light drinker and thus preferred to have her drinks during the weekends and occasionally after meals during the week. From as early as the age of eight, Martin was forced to accept the fact that alcohol was inseparable to his family. Evidently, his father had gone a step further to ensure that the family shelf was adequately stocked with his favorite whisky brands. As it was expected, the mother also had a similar stock of her spirit and whisky brands an aspect that consumed a significant proportion of the family finances. It was not uncommon for the utility bills to be accumulated at the expense of ensuring a steady supply of alcohol in within the family.

Just as it was the case with his immediate elder brothers, Martin was introduced to drinking by his elder brother. In particular, this was occasioned as a way of enabling them to cope with the constant physical abuse from the father whenever he came home late in the evening. Resigned to the fact that nothing would be remedied, his mother opted to take up drinking to save the family as well as try to get close to their father with the view of keeping peace in the family. She did not have a steady job which further complicated things. In this way, everyone in the family had to contend with the violence from the family head. A couple of years later, the parents were able to undergo the recovery process, albeit with a lot of challenges. One year later, his two brothers followed the parents example, although they had not yet fully recovered from the same problem. With a background of six years in drinking all the way from high school and now in a business school, Martin is in a desperate need for help with regard to quitting alcoholism. Faced with the risk of losing focus in his studies, Martin finally came to the realization that perhaps it was time he quit taking alcohol which had become a part of his life for quite a long time. With the help of his brothers, Martin gathered the courage to come to our centre for assistance out of alcohol addiction.

Theory of Addiction
From the above case study, it is evident that that Martins case best fits within the family system theoretical perspective. The family system model with respect to addiction is founded on the premise that development of alcoholism is greatly dependant on family interaction. This is a socio-cultural model that carries with it an intricate interconnectivity between personal, genetic, environmental as well as other closely related factors. According to Bennett and Wolin (1990), the family system model recognizes the fundamental fact that persons within a given family can best be understood as an integral component of their respective families. In this way, emphasis is usually put on the need to consider individuals to be part of the larger family but not in isolation. In the context of alcohol or substance abuse, this family systems model centers on the way family members behave with regards to drinking.

In this way, the role played by the spouse or origin of the family as it has been put forward by OFarrell and Fals-Stewart (1998). One of the fundamental assumptions of the family system model is that alcohol use normally takes centre-stage within the family. In particular, this is used by the family members as an effective way of promoting relationship amongst members. Therefore, this results to alcohol being elevated into becoming the primary facilitator of interactions within and without the family. Based on this model, the cost benefit analysis in terms of any problem within the family is usually looked at from the standpoint of being too costly or more demanding. Thus, the family becomes resigned to use alcohol as a means of maintaining the status quo within the family as well overcome family problems. A closer look at Martins family reveals that alcohol had become a source of maintaining the equilibrium within the family and thus the cost of addressing the problem of lack of stability and physical abuse to the children was too great to be born.

Martins parents in this regard were of the viewpoint that addressing such challenges would require more effort in comparison to alcohol related problems. Probably this is due to the notion that alcoholism within this family would not be tackled other than through the use of more and more alcohol. By so doing, everyone within this family would be in a comfort zone and thereby being able to avoid facing more disturbing problems facing such family. The other model that describes the above stated case study is the behavioral theory. In principle, this model pays special attention to the behaviors of individual members within a given family, especially the parents. Behaviors of family members are in this regard perceived to be the ones to reinforce and antecedents addiction to alcohol as well as substance abuse by other family members. It is believed that these responses provide the ideal platform and environment towards the development and maintenance of alcoholism within the family. According to Bennett and Wolin, (1990), there is a positive correlation between increase in alcoholism rates among off springs and interaction with their alcoholic parents. From this case study, it is clear that Martins addiction was given the much needed impetus by his parents continued dependency on alcoholism. His brothers on the other hand reinforced this when they attempted to fill the vacuum that had been left by their parents.

One of the tenets of behavioral model with regards to alcoholism is that consumption of alcohol or any other substance is usually learned. Upon learning, it is then maintained through operant or classical conditioning. Classical conditioning in this case is based on the principle that learning or development of the drinking behavior by an individual is subject to repeated pairings. These pairings include conditioned stimulus for instance a given person and unconditioned stimulus, for example a given time or location. The presence of alcohol can not be ignored in this regard. The exposure to repeated pairings usually leads to the development of conditioned stimulus and thereby resulting to the development of drinking behavior. The behavioral model therefore argues that substance abuse by an individual is normally learned.  Secondly, this model advances the view that the use of substances is in fact maintained by conditioning mechanism. The initial development as well as maintenance of alcoholic craving is caused by antecedent stimulus as response mechanism.

From the above case study, it is indeed justifiable to state that alcoholism within this family was initiated and perpetuated by the parents although his older brothers played an important role towards creating antecedent stimulus. Alcoholism within this family was also reinforced by the apparent lack of stability and control from the parents since it they paid attention on meeting the bare minimum requirements in order to keep the family together. This served to provide a reinforcing effect against the antecedent stimulus as every one within this family used alcohol as a means of getting relieved from anger or physical pain. Hence, drinking is most likely to increase due to the perceived hope of getting positive effects of alcohol or lessening negative reinforcing effect of alcohol. According to the behavioral family theory, it is thought that families that engage in rituals for example, celebrating holidays with all members, having dinner together, help to protect their children from being drawn into alcoholism. Of importance to note is the fact that the behavior of family members especially parents or older siblings are very critical towards ensuring that other members who may be alcoholic give serious consideration to changing. The conduct of family members may also help the alcoholic person to act towards change as well as maintain this change or perhaps relapse into drinking. Growing up in an alcoholic family, Martin was in doubt greatly influenced by the family members from the parents all through to his two older brothers.

At the same time, interacting with the same family members that have successfully gone through alcohol recovery program, Martin is definitely motivated to change. The possibility of maintaining the said change is high owing to the fact that all the family members had transformed from being alcoholics despite facing challenges as a result. Therefore the family would act as support mechanism for his successful recovery since he would be able to relate to any one in the event of any challenges thereafter. However, this theoretical perspective does not explain the role that is played by personality as far as alcoholism is concerned. Growing around alcoholic people would not influence any one to be an alcoholic in the event that ones personality did not appreciate consumption of alcohol. Behavioral influence is also dependent on the personality of would- be alcoholic upon which his or her personal ideals are usually founded. Furthermore, this model does not give an explanation of how the father was initiated into alcoholism considering the fact that he was initiated into alcoholism at a much later stage in his life. In this regard, environmental factors are ignored although they have significant influence in the ultimate development of alcoholism. In the overall, the above theoretical perspectives are founded on the social learning constructs since it is facilitated by interaction.

Treatment
Within the medical fraternity, there is the general consensus concerning the fact that there is no known medical cure for alcoholism. Recent developments from the scientific community have only managed to come with medications that serve the purpose of reducing an individuals craving for alcohol. By so doing, they greatly benefit the affected person since they help to reduce the risk of dependency or facilitate alcohol dependency recovery process. From the above case study, it is evident that individuals develop addiction due to social learning. In particular, this is usually facilitated by interaction amongst the family members as well as the expected benefits. In this way, persons become initiated and maintained into alcoholism by repeated pairings and conditioning. From the above case study, the most appropriate method of dealing with Martins problem is through the use stages of development approach. Though it was recently developed, this trans-theoretical approach as it is commonly known emphasizes on the role that is played by a client towards hisher successful recovery.

In a nutshell, it is the clients readiness to change that determines the efficacy of any treatment regimen that might be put in place. Understanding the readiness of an addict to change usually helps treatment providers to be able to overcome any potential or emerging barriers to the success of such treatment plan (Joseph, 2004). Also, it helps the client to anticipate relapse in addition to lowering both provider and client frustration with the overall treatment process. Improvement in the satisfaction by the client is the other benefit of this model of addressing alcohol dependency which in turn leads to a successful recovery program. Social learning and stages of change are interconnected by virtue of the fact that addition is usually as a result of social-cultural factors within the addicts environment. An individual usually considers changing and taking up drinking based on the expectancies that are in fact developed from observing the behavior of other people around him. This, together with personal experience from alcohol usually acts as a motivation towards drinking. It is worth noting that such decision is normally determined by the persons readiness to take up drinking. On the other hand, it is this readiness to change from being dependent on alcohol that forms the basis of recovery process and treatment regimen.

From the above stated case study, it is justifiable to state that the client is at contemplation stage of change. The said stage tends to be characterized by uncertainty, conflicted emotions and ambivalence. Just as it is the case with Martin, persons at this stage of change normally become aware of any risk that might be associated with such alcoholic behavior. This is usually informed on the fact that such persons become more aware of the expected or potential benefits of making such change in the first place (Joseph, 2004). Though Martin is desperate for change away from alcohol dependency, there is a high possibility that he is ambivalent about making this change since it shall amount to giving up his most enjoyed behavior. The mere prospect of giving such behavior creates a sense of feeling lost despite their awareness of the possible benefits of making such change in their drinking behavior. Addicts who are at this stage are also known to have difficulties in appreciating the perceived obstacles to the recovery and treatment for example, fear, hassle, time or expense.

Clients who are at this stage are able to benefit from the much needed professional help with respect to weighing merits and demerits of their behavioral change. Receiving the encouragement towards developing their confidence regarding them being able to change is the other help that individuals at this stage receive. Thirdly, addicts are able to get help towards the determination of the best way of overcoming any potential barriers or challenges towards their treatment and recovery. The fundamental questions that addicts at this stage are usually faced with are what is the primary reason for the change in the first place Are there challenges that would hinder this change process The third most important issue of concern is the identification of other things that would be of help towards making this change. Before an individual moves to this stage, they are usually under the pre-contemplation stage.

This stage of recovery is largely characterized by ignorance as well as denial of the problem by the addict. People who are at this stage do not even think about the need for them to change in the first place. To them, changing does not seem to be a feasible or palatable option as far as their behavior is concerned. Clients at this stage usually stand to benefit in terms of getting encouragement to take a critical look into their behaviors with the view of changing. Furthermore, clients are educated regarding the potential long and short term repercussions as well as risk that are associated with their behavior. Such addicts also get additional help towards enabling them to conduct self analysis with regard to development or addiction to alcoholism.