Question

Case Study 10 Alcohol use disorder and Marital Distress:

There are 3 question to answer after reading the case study:

1. Describe Kirk’s addiction using the multipath factors.

2. Why did Kirk’s wife, Michelle, not think of Kirk’s drinking as a problem at first? When and why did that change?

3. Give examples of tolerance and sensitization in Kirk’s case.

Case Study:

Kirk was never a moderate drinker. He began drinking in high school and right from the start consumed large amounts of alcohol. Throughout high school, he limited his drinking to weekends. He and his friends would get a case of beer and a couple of bottles of scotch or rum and then drive to a wooded parking area in the suburbs. There they would turn on the radio, open the car doors, sit out in the open, and get what Kirk described as blissfully buzzed.

Kirk generally returned home from these parties after his parents fell asleep, so they never fully appreciated the extent of his drinking. They themselves were just social drinkers, and it never occurred to them that their son’s drinking might warrant attention. Moreover, Kirk and his friends never got into any trouble as a result of their drinking.

Kirk Drinking on the Rise:

In college, Kirk joined an off-campus fraternity, and he continued his high school drinking pattern, only it became more regular. Almost every Friday and Saturday night, the fraternity brothers would get together for free-flowing beer and liquor. At least a couple of other fraternity brothers equaled or exceeded Kirk’s sizable capacity for alcohol, so the young man felt more and more at home with his own drinking.

Upon graduation, Kirk married Michelle, whom he had been dating since high school. Michelle herself enjoyed an occasional drink but always stopped at one, since she did not like feeling light-headed. She was aware that Kirk drank heavily, but she assumed that all college men drank as he did and she expected his pattern would change when he later took on the responsibilities of a family and a career. The pattern did later change. But rather than drinking less, Kirk began drinking more.

Soon after graduation, he obtained a good job in a prestigious telecommunications corporation. His new job afforded him an opportunity to drink almost every day, both at lunches and at parties with colleagues and clients. In addition, the young man would “reward” himself after each workday by pouring himself expensive scotch and rum at home. Within a few months of joining the work world, he was averaging 12 drinks daily. This pattern continued for the next 17 years.

In spite of his high level of drinking, Kirk received positive work evaluations and promotions throughout the 17 years. Nor did he have any legal problems due to drinking. Although he regularly drove with a blood alcohol level over the legal limit, he had not had any accidents or arrests.

Michelle Awareness on the Rise:

What Kirk could not ultimately avoid was the toll his drinking took on his marriage. For the first several years, Michelle tolerated her husband’s drinking, not recognizing it as a problem. A man with a drinking problem, to her way of thinking, was someone who couldn’t hold a job, got into fights, stayed out all night in bars, or beat his wife while drunk. Kirk, however, came home every night and enjoyed a quiet dinner with her either at home or at a restaurant.

This was the pattern for the first 8 years of their marriage. During this time, Michelle worked as an office assistant. However, when she gave birth to their daughter, she quit her job to become a full-time stay-at-home mother. Four years after that, their son was born.

When their daughter entered school full-time and their son was a toddler, Michelle began to do child care at home, 5 days a week, for several preschoolers. Although it was demanding, she enjoyed the work, and the extra money helped. However, after a while, she began to feel a need for more adult contact. In addition, she began to feel the effects of Kirk’s drinking, as he was unable to provide much companionship or assistance in the evenings. To compensate, Michelle began joining volunteer organizations in her community. Before long, she was going out every weeknight to attend one volunteer function or another. Kirk responded by withdrawing into his drinking even more.

Alcoholism and Marriage Don’t Mix:

At age 40, Kirk seemed to be the picture of success—on the surface. The father of a 9-year-old daughter and a 5-year-old son, he was vice president in charge of sales for his company, earning a high salary and regular bonuses. He supervised 20 individuals and was respected for his business acumen. He arrived at work consistently at 9:00 A.M., rarely missed an important meeting, and usually met his deadlines and sales quotas. Moreover, he was providing comfortably for his family.

At the same time, Kirk was continuing his long-term pattern of having 12 drinks a day, mostly scotch or rum, along with a few beers. He usually took his first drink of the day at lunch, when he went out to eat with colleagues or clients. To start off, the businessman would have a couple of scotches while waiting for his meal. When his food arrived, he would order a couple of beers to go with the meal. Kirk was under the impression that he was drinking no more than his lunch companions. However, he was actually doubling their consumption—not that they took special notice of his drinking. Although outgoing and gregarious at these lunches, Kirk’s general behavior didn’t differ much from that of the others. His heavy drinking over the years had caused him to develop a tolerance to alcohol, so his four drinks affected him no more than one or two drinks might affect someone else.

At least 2 days a week, Kirk had another work-related drinking opportunity. This was at a private club where his company entertained important clients. The club had an open bar, with waiters who took drink orders and automatically brought refills as soon as an empty glass was detected. It would be hard not to drink in such a place, Kirk once reflected. And of course he had no intention of making any such effort.

The purpose of the parties was to entertain visiting clients. The idea was to build relations with them on a personal as well as business basis. Kirk’s company was looking for every edge possible, and if this meant spending several hundred dollars on a party that would help to secure accounts worth millions, it was considered well worth the investment.

Kirk was acutely aware of the pressure to be friendly, jovial, and well-liked at these parties. In fact, the parties were a trial for him. There were high expectations for him to be entertaining, and each time, he was doubtful of his ability to carry it off. The alcohol took an edge off his anxiety, loosening him up and allowing him to mix freely. It took at least three drinks for him to reach this point and at least another two to keep the feeling going for the rest of the party.

Once home from work, whether on a party night or not, Kirk felt the need to unwind. One Tuesday evening was typical. He came home and had a couple of scotches before having dinner with his wife and their two children. He had planned to drink nothing more, aside from two beers with dinner, for the rest of the evening. But as usual, things went well beyond that. After dinner, Michelle had to go to a PTA meeting, and when she left, Kirk felt neglected and bored. He knew that his wife would like him to do the dishes or entertain the kids while she was gone, but looking at the pile of pots and pans in the kitchen did not inspire him. Anyway, the kids seemed perfectly satisfied watching television in the living room. He made a half-hearted effort to ask them if they wanted to play a game or listen to a story, but they barely looked up from their show.

Feeling he had done his duty, Kirk poured himself a drink and retired to the den to watch television. He sat there watching sports for the next hour and a half, pouring himself another couple of scotches along the way.

When Michelle returned, she found a quiet house with two television sets glowing—one with cartoons, the other with a basketball game—and felt her usual resentment. The dishes in the kitchen were untouched and the kids were still dressed and nowhere near ready for bed. And as usual, Kirk was drinking. Some nights, Michelle would just ignore the situation, get the kids ready for bed herself, and do the dishes. But that night she tore into her husband, telling him he was lazy, irresponsible, and self-centered. Kirk seized on the “self-centered” part and told his wife she should try applying the label to herself. She was the one who was out every night pursuing personal interests, not he. Michelle asked what point there was in staying home to watch television with a drunk. For his part, Kirk denied he was drunk, saying he had every right to have a couple of drinks to unwind. What did she care anyway, since she wasn’t even home?

Then the phone rang and Michelle went to answer it. It was one of Kirk’s colleagues. Michelle didn’t even consider turning the phone over to her husband; she carried out her usual policy of shielding him whenever he got calls this late in the evening and this deep into his drinking. She simply told the caller that he was out visiting a friend. After hanging up, she decided just to drop the whole matter and get on with things. Why waste any more time banging her head against a wall?

Arguments such as these left Michelle feeling increasingly unhappy with their life together. Indeed, she and Kirk now barely had any life together. In the evenings, they went their separate ways. On weekends, they—mainly Michelle—did household errands. For recreation, she would attend activities tied to her volunteer work; he would watch sports on television while drinking himself into isolation. The children would either tag along on Michelle’s errands or hang around the house, receiving only limited supervision from Kirk. Over time, Michelle began to consider leaving him.

The Incident:

Kirk and Michelle sat down one evening to do some paperwork for their taxes. As usual, Kirk had been drinking throughout the evening, but he was still quite alert and had no problem in sorting receipts, organizing records, and carrying out calculations. It was a 2-hour project, and the couple actually worked effectively together, chatting and even joking throughout the task. It was one of their rare periods of togetherness; how ironic, Michelle thought, that it should come over an activity like taxes. They got the whole job done that night and both went to bed in good humor.

The next morning, however, Kirk said something that floored his wife. He asked her when she wanted to get together to do the taxes. She stared at her husband in disbelief, but soon realized he was absolutely serious; he had no recollection of having completed the paperwork the night before. Michelle told Kirk that they had already done the taxes, and he didn’t believe her. “How could I forget doing taxes?” he asked. At this, Michelle ran to get the evidence, the paperwork from the night before. Kirk was shaken. Michelle was right. He had done the taxes, but for the life of him he could not remember it. It was as if somebody else had done the whole thing for him.

Truly upset, Kirk decided that from then on he would have no more than a couple of beers in the evening. However, after a few days, his determination broke down and he returned to his usual pattern of drinking.

After the incident with the taxes, Michelle took to quizzing Kirk routinely about events from the day before, and it soon became clear that the tax affair was not an isolated event. There were many mornings when he could not recall details from the night before. Michelle finally persuaded her husband to seek professional help with his drinking problem. She had seen an advertisement describing a community clinic that specialized in treating alcohol use disorder and related marital problems through the use of marital therapy. Michelle called for information and then, with Kirk’s agreement, arranged an appointment for them.

Answer 1

1. Describe Kirk’s addiction using the multipath factors.

Kirk began drinking in high school and used to consume large amounts of alcohol. He and his friends would get a case of beer and a couple of bottles of scotch or rum and then drive to a wooded parking area in the suburbs.

Kirks parents were social drinkers, and it never occurred to them that their son’s drinking might warrant attention.

In college he continued his high school drinking pattern, with the fraternity brothers by having free-flowing beer and liquor. At least a couple of other fraternity brothers equaled or exceeded Kirk’s sizable capacity for alcohol, so the young man felt more and more at home with his own drinking.

While on his graduation, Kirk married Michelle, and he began drinking more.

His new job in a prestigious telecommunications corporation afforded him an opportunity to drink almost every day, both at lunches and at parties with colleagues and clients. In addition, the young man would “reward” himself after each workday by pouring himself expensive scotch and rum at home. Within a few months of joining the work world, he was averaging 12 drinks daily. This pattern continued for the next 17 years.

Kirk continued his drinking after having two childs.

At age 40, Kirk seemed to be the picture of success on the surface. At the same time, Kirk was continuing his long-term pattern of having 12 drinks a day, mostly scotch or rum, along with a few beers. His heavy drinking over the years had caused him to develop a tolerance to alcohol, so his four drinks affected him no more than one or two drinks might affect someone else. The alcohol took an edge off his anxiety, loosening him up and allowing him to mix freely. It took at least three drinks for him to reach this point and at least another two to keep the feeling going for the rest of the party.

2. Why did Kirk’s wife, Michelle, not think of Kirk’s drinking as a problem at first? When and why did that change?

Kirk married Michelle, whom he had been dating since high school. Michelle herself enjoyed an occasional drink but always stopped at one, since she did not like feeling light-headed. She was aware that Kirk drank heavily, but she assumed that all college men drank as he did and she expected his pattern would change when he later took on the responsibilities of a family and a career. A man with a drinking problem, to her way of thinking, was someone who couldn’t hold a job, got into fights, stayed out all night in bars, or beat his wife while drunk. Kirk, however, came home every night and enjoyed a quiet dinner with her either at home or at a restaurant. So she felt Kirks drinking is not a problem since he was taking care of her with full responsibilities.

Later, she felt his drinking is a problem. Because he starts consuming more than before. His new job afforded him an opportunity to drink almost every day, both at lunches and at parties with colleagues and clients. In addition, the young man would “reward” himself after each workday by pouring himself expensive scotch and rum at home. Within a few months of joining the work world, he was averaging 12 drinks daily. This pattern continued for the next 17 years.In addition, she began to feel the effects of Kirk’s drinking, as he was unable to provide much companionship or assistance in the evenings. To compensate, Michelle began joining volunteer organizations in her community. Before long, she was going out every weeknight to attend one volunteer function or another. Kirk responded by withdrawing into his drinking even more.

3. Give examples of tolerance and sensitization in Kirk’s case

At age 40, Kirk seemed to be the picture of success on the surface. He was vice president in charge of sales for his company, earning a high salary and regular bonuses. At the same time, Kirk was continuing his long-term pattern of having 12 drinks a day, mostly scotch or rum, along with a few beers. He usually took his first drink of the day at lunch, when he went out to eat with colleagues or clients. His heavy drinking over the years had caused him to develop a tolerance to alcohol, so his four drinks affected him no more than one or two drinks might affect someone else