INTRODUCTION

The consumption of alcohol is not a new concept; its a problem all over the world.
Problems related to alcohol abuse have been associated to different factors, regardless of the
causes attributed to the phenomenon. The fact that alcohol consumption and dependence increase
the risk of social, work, family, physical, legal and violence-related problems deserves attention
and is by itself considered a public health problem.
Problems related to alcohol abuse have been associated to different factors, regardless of
the causes attributed to this phenomenon. Alcohol consumption and dependence is considered a
public health problem and deserve attention because of the social, work, family, physical, legal
and violence-related risks it represents. This study aimed to identify the effects of alcoholism on
family relations and, by means of case management, to encourage the recovery of these
relationships. The results show that the problems caused by alcohol abuse impose profound
suffering to family members, which contributes to high levels of interpersonal conflict,
domestic violence, parental inadequacy, child abuse and negligence, financial and legal
difficulties, in addition to clinical problems associated to it.

BACKGROUND
Alcoholism can be defined as a chronic disability manifested by persistent drinking. It is
a chronic illness characterized by habitual drinking of alcohol to a degree that it interferes with
physical and/or mental health or with normal social or occupational functioning. Among the
Nandi community, alcohol was brewed mainly at home for family consumption and,
occasionally, for celebrations or ceremonies like weddings, initiation and even during naming of
children where beer had a symbolic function, that of blessing. It was drank at home and only
after work, apart from special occasions. It was most unusual for people to drink in the morning.
When taken in the morning, ones judgment is impaired, reducing productivity and
interfering with efficiency because an inebriated person is whimsical and incapable of
sustained attention and concentration. Women, young men and children were not allowed to
consume alcohol. But, today, this has changed: the once valued abstinence among women and
men has decreased dramatically.
BODY
Karen
Karen is a 37-year-old woman who started drinking regularly in high school. There is a family
history of alcoholism, and Karen's paternal grandfather was killed when he fell off a ladder,
which her family believes was likely because of his drinking. Karen's adult life revolved around
drinking, as her husband, his family, and several of their friends also drank heavily. For Karen
alcohol was performance-enhancing because she was usually shy, and alcohol allowed her to
socialize better, a trait that helped her work in sales. Her ability to drink large amountsa 12pack of beer a night, or three to four bottles of wine, or beer plus six to seven mixed drinks
became almost a source of pride.

About four years ago Karen's employer suspected she had a drinking problem, and voiced
concern to her. Subsequently, Karen tried to stop drinking on her own but became very sick. She
returned to drinking but was embarrassed, as indicated by her special efforts to get rid of the
evidence of her drinking. She passed out one night and left her dog outside, and in the morning
yelled in frustration at her dog for being outside all night. Karen felt she had hit bottom.

Karen had become so tolerant of alcohol that when she drove to the treatment center the day after
a night of heavy drinking, her blood alcohol level was 0.4%. She underwent detoxification and
began outpatient counseling, which consisted of group therapy three to four times a week and
individual therapy when Karen desired it. She also started 12-Step therapy, initially five to six
times a week and later once per week.

About two to three months after detoxification, Karen was offered acamprosate because of its
track record in some European studies and its recent approval in the United States. Karen had
had difficulty controlling alcohol cravings that were triggered by her environment. Certain cues,
such as the sound of a popping bottle or beer can, smells, and associations of alcohol with certain
meals and daily activities, were all positively associated with alcohol. Hearing stories of alcohol
at 12-Step therapy meetings even stimulated cravings. In an effort to curb cravings cued by her
environment, Karen had moved furniture around in her home to make it look like a new place.
With the use of acamprosate, though, Karen said cravings and thoughts of alcohol stopped
entering her mind, and her surroundings no longer made her desire alcohol.

Karen stressed that acamprosate was helpful to her only in combination with counseling. She
cited a time when she was unable to have acamprosate for several days and was tempted to drink,
but the coping skills she developed in therapy helped her overcome her temptations. On the other
hand, Karen said acamprosate also improved her ability to attend group therapy, because hearing
about alcohol was no longer a trigger while taking medication.

During group therapy, Karen faced peers who thought medications were a form of cheating,
and she recommended that no one think of medications as a magic bullet that alone can cure
addiction. Karen had little difficulty taking acamprosate, though she occasionally missed her
midday dose of medication (dosed three times a day). She currently keeps different pill bottles in
different locations in case she forgets a dose. Karen has not experienced any side effects, but she
noted she felt more irritable and less able to handle stress when not taking the medication. She
has recently celebrated her first anniversary of sobriety.

When one realizes that no matter how much they may know about theoretical drug problems and
alcohol problems, it is still possible to be staring in the face of a full on alcoholic and not know it
until after the fact. Alcoholism and drug problems, much like other chronic illnesses, are not
things one can identify just by looking at someones face. However, if one pays attention there
are probably warning signs that are indicative of a substance abuse problem. However subtle the
signs may be, they are usually consistent. A story, with not so subtle signs, may be in order to
properly illustrate the point:

George is a 30 year old junior marketing executive. He shares an apartment with his brother and
is not in a relationship. George has a very active social life. Almost every night of the week,
George can be found at some sort of festivity that is at a bar, club or restaurant. At all of these
occasions, liquor is present. George often jokes about how he must look like an alcoholic
because in most pictures he is holding a drink. In addition, the woman he has begun a flirtation
with finds that every time she calls him he is drinking. She thinks nothing of it, since this man
must just enjoy one or two social drinks. The fact that he drinks every night does not flag him as
an alcoholic in her eyes. They have spoken on the phone scores of times, spent time together and
been in constant communication for a two month period. In addition, he really is such a nice guy.
He casually mentions that his mother has asked him to promise not to drink. They laugh about
how parents often refuse to view their children as adults.

One night before George goes out with his new lady friend, he tells her a few stories. One
included waking up one morning after a night of drinking with blood on his shirt. The caveat
being he had no idea where the blood came from. On another occasion, upon being shoved by a
young woman in a club after drinking for a while, George pushed her back and the woman went
flying across the room. George admits that at this point, he realized he did not know what his
alcohol limit was. He stated this in past tense; these events had happened about a year prior and
since then, George had allegedly altered his drinking habits. This statement was made as George
pulled out two small bottles of vodka. One was for himself one for his lady friend. When she
declined the offer of drink he downed both bottles himself.

Two hours later at the club the couple had gone to George has drunk two beers and was ready for
a shot of tequila. He at this point is holding his liquor well. However; once the shot of tequila

comes into play George succeeds in alienating his new friend. He spills salt all over the bar then
begins dancing sloppily and says more than a few insulting things to his date. By the end of the
evening the young lady wants nothing more to do with him. George cant understand why.

George is in a state of denial about his drinking problem. The main issues here include the
following:
An inability to stop drinking
Inability to see conflicts arising subsequent to drinking
Spending excessive money on drinking to the point of putting oneself in a financially precarious
position
Jeopardizing existing relationships
Damaging potential future relationships
Does not correlate his poor decisions with the outcomes they procure
Not understanding the concern those around have for him and his poor behavior

George continues to drink excessively, regardless of the concern expressed by his family and
friends. He holds that he does not have a problem and does not seek help. In the long term,
George is never able to find a more secure job position or maintain a serious romantic
relationship with any woman he meets. The issues here are many. Georges inability to stop
drinking will also eventually erode his body functioning. This will result in a financial strain both
on George, his family and society. The most common health risks for alcoholics include strain on
the liver and kidneys.

Should George ever decide he wants to stop drinking, what he may not realize is detoxification
from alcohol unsupervised can be life threatening. The purpose of writing down Georges story is
his experience may be able to help someone you know. If you read this anecdote and see a bit of
yourself in it, or someone you know please contact someone who can help you.

Conclusion
Medication may not be a viable option for some patients or patterns of drinking. However, these
examples indicate clearly that currently approved medications can assist alcohol-dependent
individuals to achieve and sustain sobriety. While all of these patients acknowledged medications
helped them achieve sobriety, they all said medications would not have worked without
counseling. Working with a counselor, psychiatrist, psychologist, and peers helped each patient
learn how to deal with her cravings and change her behavior so that alcohol and drugs were no
longer an unhealthy coping mechanism for day-to-day problems.

Although each of these patients largely credits her success to the support she received, all of
them share a persistent commitment and determination to change their unhealthy behaviors. This
motivation and strength were vital to their recovery and are necessary for all dependent
individuals to achieve sobriety. I want to thank Nikki, Jennifer, Karen, and Nancy for sharing
their experiences, and hope you find their experiences instructive to your own practices.