Addiction
Read the following case study describing Roberto’s experience with addiction and then answer the question parts (a), (b), and (c). (Please note that ‘Roberto’ is not a real person, and the experiences described are based on a combination of case studies.)
To demonstrate good academic practice, you should include citations for your sources of information in all parts of this question. You can provide references after each question part, or in one list at the end of all your answers to this question.
Case study: Roberto
Roberto is 70 years old and has had an addiction to alcohol from a very young age. He lives with his wife, Lola, who has taken care of him for many years, but she is now ill. From the age of 12 years, Roberto started to help his parents and older siblings to collect grapes and other fruit for a rich family. Roberto states that at that time it was very common for poor families to start working at a young age as education was not a priority.
Roberto’s parents thought that a bit of wine after lunch was healthy for all ages, so he was given a small glass after lunch from the time he started to work with his family, a habit he could not stop as he grew up. He still consumes wine after lunch every day (although the amount and timings of consumption have escalated).
Roberto is the only sibling to develop an addiction. His two siblings were older than him when they helped in the fields (in their early twenties) and he cannot understand why he is the only one affected as they also had the daily glass of wine.
From the age of 26 to retirement, Roberto worked in a tile factory. He reports that he went to work every day after drinking 3 to 5 glasses of “Sol y Sombra” (a common breakfast alcoholic drink in Spain) in a nearby bar, but that no one noticed as his body got used to large amounts of alcohol and he was barely ever seen intoxicated. He occasionally headed out of work to get these drinks if he had not had time to get them before working hours, or after an unsuccessful attempt to skip his early morning drinking routine. This put him in trouble on repeated occasions at work, but it did not stop him from doing it. He was also involved in several minor accidents at work. Although he denies that they were due to alcohol intoxication, he was suspended several times and referred to a detoxication unit as a condition of keeping his job.
Roberto’s wife Lola reports repeated episodes of aggressiveness at home when she has tried to prevent him from drinking. She has thought about divorcing him more than once because of these episodes, but despite her threats to leave him, he has not stopped drinking. They have two sons who have stopped visiting because of Roberto’s “drinking problem” although they occasionally go home to check on Lola.
Roberto and Lola decided to visit a psychologist at an addiction treatment center, as Roberto needs to be in good shape to take care of his wife while she is ill. He came to the clinic looking unhealthy with some signs of malnutrition. This is commonly seen in people with severe alcoholism who allocate more time to drinking than to other important activities such as eating properly. This is a transcript of three minutes of a recent interview between John, Lola, and a psychologist at the treatment center:
| Psychologist | Roberto, I’ve seen in your medical history that the last time you visited a treatment center was 15 years ago. Could you tell me why you have decided to come to a center again and why you did not come before? |
| Roberto | Well, I didn´t feel the need to come before as I learned to drink in a way that didn’t make me feel drunk and I could keep on with my normal life as usual. When I was younger, I felt dizzy after 2 cups of wine but now I can drink tons and feel relatively well. Now I am here because my wife is ill and I need to take care of her. |
| Lola | He can’t carry on with his normal life as his normal life is being in the bar all day… |
| Psychologist | You say you can drink tons. How much have you drunk today? |
| Roberto | This morning I went to the bar and I played cards with my friends… I think I drank 5 cups of different liqueurs. I didn´t want to drink that much but I couldn’t resist. Then at home, I drank a bottle of wine while having lunch. |
| Psychologist | Where do you normally drink alcohol? |
| Roberto | In bars, sometimes with friends, and during lunch at home. I could not be in the bar without drinking or survive without my wine during lunch. I need it. |
| Psychologist | We will talk about this later, but I need to warn you that as part of your treatment, I will ask you to avoid visiting bars, and any friends you drink with, and to go for a walk immediately after having lunch. Did you drive here? |
| Roberto | I couldn´t because my sons took my keys two days ago, but I think I can drive, I´ve been driving all my life. |
| Lola | You were a danger! |
| Psychologist | In the last 15 years, has there been any period in which you stopped drinking? |
| Roberto | Yes, when Lola blocked my credit cards and hid my bottles for two days. I thought I could do it but after some hours I got very sick. I had a big pain in my chest, I was sweating and shaking. The second day I thought I saw insects running under our couch, but Lola told me I was hallucinating. There was nothing I could do to handle it. When I was in my 40s I tried to quit drinking a couple of times. Before that, I was sent to detoxication units several times, but all my attempts were unsuccessful. |
(a)
With reference to Table 1.3 in Topic 5, Section 1.3, identify three pieces of evidence in Roberto’s case study that would meet three different criteria for a substance use disorder as described in the DSM-5 (one piece of evidence for each criterion). In your answer, describe the evidence from the case study and briefly justify why you think the evidence matches the chosen criterion.
Word limit: 200 words
(6 marks)
(b)
How do you think Roberto’s age when he started drinking affected his vulnerability to alcoholism compared with his siblings who did not develop an addiction? Mention two areas of Roberto’s brain that were likely to be undergoing changes when he started drinking and briefly describe their function in relation to addiction.
Word limit: 150 words
(4 marks)
(c)
As part of his treatment, Roberto was recommended to avoid bars and people he drinks with. Why do you think the therapist wanted to prevent Roberto from seeing cues associated with his drinking behavior? Explain your answer based on what you have learned about reward-related learning and cue-evoked relapse, using terminology related to conditioning in your answer.
Word limit: 150 words
