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Case reports

2002 Volume 21, Issue no. 1

When Ms G was first seen by the substance misuse team, she was drinking alone in her room and consuming about one hundred and twenty units a week. She had approached a chaplain for help who recognised the need for speedy intervention and referred her to the local psychiatric service who in turn referred her to the substance misuse team. She was twenty three years old and had been employed in the armed forces for the past four years. Having survived a very troubled adolescence she had made a successful start on a service career and hoped to achieve officer status. All was going well until her boyfriend, who was also in the services, was posted abroad. At this point she became distressed and her heavy social drinking escalated.

At assessment she displayed symptoms of dependency. She was admitted for detoxification, which was uneventful apart from some withdrawal symptoms. However she continued to experience craving for alcohol and tended to rationalise her behaviour by reference to previous problems in adolescence. She was therefore referred to the clinical psychologist with a possible diagnosis of depression and personality issues.

At interview she gave a clear history recalling the unpleasant divorce of her parents when she was a child, her turbulent development and difficulties with relationships before joining the services. Despite these difficulties she had passed several GCSEs had good relationships with most of her colleagues and was planning to marry in the future. Despite her high level of consumption and symptoms of dependency, her alcohol abuse had been of short duration and she agreed with the clinical psychologist that priority should be given to addressing this problem.

The clinical psychologist in three one hour sessions of motivational interviewing discussed with Ms G the pros and cons of using alcohol as a strategy for dealing with difficult situations. Ms G appreciated that while drink had immediately "blotted out" the negative emotions it had also impaired her function at work and hindered her ability to come to terms with the situation. She was able to identify high risk situations and to develop plans to deal with these. Her stated aim was an initial period of at least three months abstinence followed by a return to controlled drinking. She was loaned a self help book ("Lets drink to your health" by Heather and Robinson). She was discharged back to her unit with arrangements to join the next Alcohol Education/Treatment group in four weeks time.

Back in her unit Ms G avoided heavy drinking situations, planned strategies to cope with difficulties such as approaching a sympathetic Commanding Officer, enlisting the help of friends and planning social events. She also discussed her alcohol abuse with her boyfriend and made plans to take up further education. In this way she stayed abstinent except for one evening in which she drank four units in company with friends.

In view of her progress she felt that attendance at the Alcohol Group would no longer be helpful. Follow up by a community psychiatric nurse and phone calls from the substance misuse team were arranged. She will continue to be followed up but after several months there have been no further episodes of alcohol abuse.

Comment

Quick referral early in the history of alcohol abuse contributed to what is likely to be long term success.

Brenda Coldwell, Consultant Clinical Psychologist
Substance Misuse team, Duchess of Kent Psychiatric Hospital, Catterick

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last modified: 28th April 2002