This article focuses on alcohol abuse by Quentin McCarthy. It uses the Michigan Alcoholism Screening Test (MAST) to evaluate McCarthy’s stage of dependency and provides possible interventions for recovery. Overall, the article shows that McCarthy must receive an appropriate diagnosis, placement options, and treatment modalities.
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According to McCarthy’s wife, McCarthy used to drink to have good time, but today, he drinks because he needs alcohol. This makes McCarthy a good candidate for health care professional evaluation and intervention because his condition shows hazardous drinking and alcohol dependence.
Screening instrument: the Michigan Alcoholism Screening Test (MAST)
MAST developed in 1971 by Selzer is the most commonly used yes or no questionnaire that has 25 questions, which consist of true or false options (Zung, 1982). These choices are of significant concerns on “legal, medical, and psychosocial problems, control of alcohol intake among people with alcohol problems” (Zung, 1982).
The aim of MAST is to determine the extent of alcohol consumption based on responses provided and formulate strategies of helping the agent with regard to excess consumption of alcohol.
One can easily administer the MAST as a form of semi-structured interview or survey questionnaire. The process is simple once the agent has taken the survey. It involves summation of all the scores of the items in the survey. Items may have unique weight assigned in order to rate the extent of the problem.
The evaluator can obtain the aggregate score and decide on the suitable recommendation for the patient or he can be the scores on a given cut-off points when screening alcoholism. Previous studies have indicated the need to improve the MAST based on the length of the questionnaire and different conditions that may influence the respondent (Zung, 1982; Shields, Howell, Potter and Weiss, 2007).
All the items in MAST focus on “symptoms of problematic drinking and negative consequences associated with the use of alcohol” (Shields et al.,2007). Respondents who get high scores indicate high rates of alcohol problem, which requires intervention.
The MAST provides advantages to users because it offers multidimensional approaches to the evaluation of alcohol problem. However, scholars do not agree on the exact number of such factors (Shields et al.,2007).
Evaluators who use the MAST believe that it relies on a single aggregate score, but there are some minor changes to questions. This makes the approach to provide uniform results of respondents. The MAST solves the challenge of defining alcoholism conditions in different stages, which has been a major source of concern to evaluators.
Hence, evaluators have relied on the MAST and other test scores to gauge alcohol problem and provide their professional opinions after diagnoses. The MAST is a simple tool that overcomes challenges of rating alcohol problem.
Diagnosis (a complete 5-axis diagnosis). McCarthy’s alcoholism diagnosis using axes
McCarthy displays alcohol–related psychiatric conditions. Clearly, heavy use of alcohol has affected and altered brain chemical and hormonal systems, which affect the development of many mental disorders related to mood and anxiety. One can observe these symptoms and sings.
The client also has alcohol–induced psychiatric syndromes. These conditions (mood, anxiety, and psychotic disorders among others) have resulted from the broad range of alcohol psychological effects associated with heavy drinking.
Axis I: Clinical Disorders
Although anxiety disorder may be present in the general population, McCarthy has developed anxiety disorder due to dependence on alcohol. This is an alcohol-induced depression. The onset and the course of McCarthy’s anxiety disorder follow patterns associated with the temporary alcohol withdrawal.
Studies have shown that bipolar disorder, which is mainly mania or manic–depressive illness is the second disorder after anxiety disorder in axis I disorder. Bipolar disorder results from heavy drinking and alcohol dependence. McCarthy is a maniac patient who has become a heavy consumer and dependent on alcohol.
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Diagnosing this condition can present considerable challenges. This may occur due to underreporting of symptoms or incorrect answers in the survey, complex mood changes from alcoholism, limited diagnostic accuracy, related conditions with similar symptoms, and involvement in pleasurable activities with friends to get business in return (common among manias).
McCarthy did not depend on other drugs other than alcohol. This has not complicated his condition and the diagnosis process. In other cases, accurate diagnosis is necessary through a careful analysis of the patient history in order to discover past tendencies and chronological order of alcoholism because several patients with bipolar disorder also abuse other drugs other than alcohol.
Independent Major Depression
Past studies have shown that many treatment-seeking alcoholic patients experience mood disturbances. Although mood disturbances may not be severe disorder, it is common among people with alcohol problem because mood disorder affects most alcoholics at some points during their drinking period. McCarthy’s mood disorder falls in the following three categories.
- Abrupt and short effects of alcohol depressant on his cognitive functions
- An organized series of symptoms and signs that indicate alcohol-induced disorder with depressive signs
- A major disorder that exists alongside other mental problems prior to drinking periods
A careful analysis and classification of depressive conditions in McCarthy reveals that he suffers from a comorbid depressive conditions.
Although there are contentious issues about the exact cause- and-effect association between alcoholism and depression, depressive cases may predate early before patients start alcohol consumption. Alcohol causes alcohol-induced mood disorder among people with alcohol problems.
It is possible that McCarthy also experiences depressive cases of a major depressive disorder. In other words, he used to suffer depressive order before starting to consume alcohol, and then later fueled the depressive disorder with alcohol. This condition may persist even for a long period after abstinence.
Some studies have established that forms of depressive disorders differ among patients. There were cases of alcohol-induced depression and independent depressive disorder having diverse characteristics. A further analysis of the patient history, social relations, drug use, alcoholism treatment, and suicide attempts could show variations in disorders.
Axis II: Personality Disorders and Mental Retardation
McCarthy shows several signs of alcohol dependence and psychiatric disorders. Alcoholism dependence relates with many forms of psychiatric disorder, which may develop irrespective of alcohol consumption and abuse. These independent disorders made McCarthy to be prone to alcohol abuse and other related problems.
McCarthy displays one of the most common disorders among people with alcohol problem. He has antisocial personality disorder (ASPD), which is within the second axis. Although McCarthy kept his fights to a moderate level, he was still anti-social. Moreover, he only drank with people in order to sell them insurance policies.
McCarthy also shows signs of obsessive or compulsive disorder in the manner he consumes alcohol. As a result, McCarty has developed a long and consistent pattern of irresponsibility and abuse of his business associates’ rights.
McCarthy can no longer sell insurance to his clients because of the compulsive disorder to consume alcohol consistently. In short, McCarthy’s business associate was not comfortable because her husband was “doing business with a lush”.
Axis III: General Medical Condition
These are mainly physical medical problems, which people with alcohol problems exhibit. They are critical for understanding the mental conditions of a client or in controlling the client’s mental disorders. For instance, McCarthy’s doctor informed him that the constant pain above his navel was an ulcer. Hence, McCarthy had to stop drinking for the sake of his health.
Axis IV: Psychosocial and Environmental Problems
McCarthy has experienced several challenges related to his job. Many customers have deserted his insurance business blatantly. However, one long-time client of the agency left the business after his wife commented that she was not comfortable that he was “doing business with a lush”. This departure injured McCarthy’s pride and his business.
Axis V: Global Assessment of Functioning
McCarthy already faces problems related to economic or loss of customers, occupation, and social issues due to alcohol dependency.
Forty: McCarthy shows severe impairment in areas related to work, job, and social relations, judgment, mood, and anxiety.
Treatment placement options
McCarthy has been postponing his decision to get help from professional because of alcohol problem. Interventions from the family and social networks of people with alcohol problem may help them to recognize that they have alcohol problem. However, professional advice is the best advice for people with alcohol problems. Hence, McCarthy will require such help.
Given the severe impairment that McCarthy experiences in various areas, such social, economic, psychological, and occupational, multi-treatment strategy is the best approach in his case. These may include brief intervention, counseling, and residential programs among others.
Obviously, McCarthy has a serious alcohol problem. He has already lost control on alcohol consumption. The aim of the intervention is to stop his drinking habit and enhance quality of life. McCarthy requires a multidisciplinary approach in order to tackle his alcohol dependency.
Detoxification and withdrawal
The initial treatment for McCarthy would be detoxification. This process may not exceed seven days. The client may need to get sedating drugs in order to eliminate chances of uncontrollable shaking delirium, confusion, and other symptoms associated with alcohol withdrawal. Detoxification procedures require McCarthy to be in the inpatient department for effective treatment.
The alcohol treatment specialist must establish skills and learning plan for McCarthy. McCarthy and the specialist must set goals, identify behavior change methods, effective self-help manuals, counseling seasons, and follow-up treatment strategies.
McCarthy has severe psychosocial problems due to alcoholism. Counseling for McCarthy would be an effective approach. This would allow the client to comprehend his alcohol challenges and acknowledge recovery programs from psychological perspectives. He may also attend group counseling.
McCarthy can also attend couple therapy and counseling because he has a wife. The wife must recognize that her role is critical in helping McCarthy to stop drinking.
Alcoholism treatment also involves oral medications. Certain drugs (disulfiram) normally stop people from alcohol consumption. However, they are not instant solutions to alcoholism because of compulsive or obsessive disorder among alcohol addicts. This drug works by inducing unpleasant feeling whenever one takes alcohol. These may include nausea, flushing, severe headache, and even vomiting.
Another oral drug is Revia or Naltrexone. This works by inhibiting good feelings and ideas associated with drinking alcohol. It lessens the urge to drink and prevent addicts from alcohol consumption. In addition, Campral lessens craving for alcohol. This drug does not induce nasty feelings and sickness after administration. Oral treatment may be effective for McCarthy.
McCarthy may also consider injected medication for his alcohol problems. There are many injected drugs for people with alcohol dependency problems. Injection may be once in a month by alcohol recovery specialists. There are oral versions of these drugs, but injection may be effective for McCarthy because of consistency that the recovery process requires.
McCarthy also requires continuing supports during and after the program. The major roles of support programs are to help rehabilitated alcohol addicts to improve, recover, stop alcohol consumption, control cases of relapse, and adjust to normal lifestyles and diets. McCarthy will require psychological support groups, medical care, or get help from Alcoholics Anonymous.
Intervention for psychological challenges
McCarthy has several and severe mental health disorders because of alcoholism. These also require effective therapies, which may include counseling, psychotherapy and psychological interventions, and antidepressants. Behavioral therapy and anti-depressants may help McCarthy to alleviate depression, anxiety, and other challenges associated with mental conditions due to alcohol dependency.
Treatment for other conditions
McCarthy has already developed ulcer and constant pain in his abdomen. These are serious conditions, which require immediate medical attention. In addition, excessive consumption of alcohol may also cause liver problems, high blood pressure, heart problems, and high glucose levels.
In addition, McCarthy must note that he will experience several health problems related to withdrawal from alcohol consumption. Hence, aftercare must account for these conditions and treatment.
McCarthy would require different treatment modalities in order to cope with withdrawal challenges.
This has been the most popular form of alcoholism treatment modalities. Besides, the modality is popular among scientists and researchers. Professionals that tackle alcoholism provide brief interventions to their clients.
A brief intervention is a process that involves evaluation of a client’s alcohol consumption tendencies in order to ascertain whether such habits are harmful to his or her health and lifestyle. A brief intervention for McCarthy would show that alcohol dependency has negatively affected his life. McCarthy would require a referral to a thorough treatment.
This modality may be appropriate for people who have alcoholism challenges because of several repeated interventions. Hence, it may be effective than other modalities. Several and fast evaluations by a professional would reveal whether McCarthy has the ability and readiness required to change his drinking habits.
Brief Motivational Enhancement
Professional therapists and psychologists conduct this modality for people with alcohol problem. This modality aims to improve a client’s motivation in order to alter his or her drinking habits. In the case of McCarthy, the therapist would focus on his inner abilities to change. The approach does not depend on pressure from external factors. The evaluator must discover the underlying factors that influence McCarthy to continue drinking alcohol. The aim is to solve the indecision, but McCarthy must make the decision as an individual.
This modality does not rely on direct persuasion because direct persuasion does not work for people with alcohol consumption. Instead, the evaluator must create a condition in which the client may feel comfortable. In addition, the evaluator must not be judgmental. The aim is to get the client to make the necessary changes.
One must note that the desire to change one’s drinking habits requires personal commitment. Overall, it requires effective interaction, communication, empathy, and evaluation of the problem by the interviewer.
Acamprosate: a GABA Agonist
This is a relatively new modality for alcohol problem intervention. The modality has been in use since 2004 when the US authorized it. A GABA Agonist causes alteration in chemicals within the clients’ brain in order to reduce alcohol consumption. However, this modality has side effects. The modality causes allergic reaction in some people, changes in blood pressure, heartbeats, impotence, or possibly insomnia.
Naltrexone works by inhibiting opiate receptors in the brain. This process results in impairing the desire to drink alcohol. Such modalities may work best alongside other interventions, such as behavioral therapy.
Community Reinforcement Approach
Therapists and psychologists believe that their clients can recover quickly with the help of families, friends, and the community. Therapists want patients to stop drinking by ensuring that they acquire the right motivational level, achieve sobriety, understand their own drinking tendencies, seek for positive support, and acquire new skills in order to adjust to new lifestyles.
This modality goes beyond the professional’s office, and it requires effort and coordination of all friends, families, and the community.
Although self-help manuals do not seem like the best approaches for people with alcohol problems, they are also effective modalities alcoholism. Clients must make effort and attend the recovery intervention modalities like Alcoholics Anonymous sessions. These are sources of interactive sessions for such people.
A Smorgasbord of Modalities
Researchers believe that evaluators should use any modalities based on their effectiveness on specific clients. Hence, the approach to modality selection should be eclectic.
In this respect, evaluators should base their decisions on informed choices, and they must understand how different clients react to various modalities. Moreover, it is imperative to inform people with alcohol problem and their families about possible prolonged struggle with alcoholism in order to avert the possibility of destroying social, economic, and personal health.
Conceptualization of the etiology of the client’s addiction
One must understand etiology of McCarthy’s drinking problem by focusing its root and origins. For instance, McCarthy was hyperactive and the class clown in early days, poor performance at school, and a sense of guilt.
Several factors shaped the development of McCarthy’s drinking problems. While in the army, McCarthy started to drink moderately, he fought, and avoided troubles. McCarthy claims that he started during in order to sale his policies for people.
Finally, McCarthy’s drinking problem got severe after he became the sole owner of the business. McCarthy drank with his customers, made a lot of money, and had ready access to alcohol, failed attempts to stop, including failure of the Alcoholics Anonymous.
Initially, McCarthy drank to have a good time, but he later became an addict who needed alcohol to keep going.
McCarthy’s alcohol problem evaluation using the MAST shows severe symptoms of anxiety, depression, antisocial and business behaviors, psychosis, and physical pain. Hence, McCarthy needs multidisciplinary approaches in order to manage his alcohol problem. Such strategies would help McCarthy to struggle and stop drinking.
Shields, A., Howell, R., Potter, J., and Weiss, R. (2007). The Michigan Alcoholism Screening Test and Its Shortened Form: A Meta-Analytic Inquiry Into Score Reliability. Substance Use & Misuse, 42, 1783–1800.
Zung, B. J. (1982). Evaluation of the Michigan Alcoholism Screening Test (MAST) in Assessing Lifetime and Recent Problems. Journal of Clinical Psychology, 38(2), 425-439.