Category: Alcoholism

Introduction

Alcoholism is one of the issues that have affected mankind for a long time. Millions of dollars have been spent on alcohol and alcohol related issues. Thousands of families have been adversely affected, not to mention the talents that have been lost or not fully exploited due to taking of too much alcohol.

We are not in a position to measure all the impacts that indulgence in alcohol has on mankind. The society understands the weight this issue has and different approaches have been taken aiming at helping the people who are struggling to stop taking alcohol. Scientists, theoreticians, philosophers, doctors and counsellors have all come up with suggestions meant to help people struggling to stop taking alcohol.

Many theories have been developed in an attempt to find strategies which can help alcohol users to quite taking alcohol. Motivational theories are widely used to explain how motivation can be used to address the alcoholism issue. Motivational theories have been developed by different psychologists over time and most of the alcohol recovery programs indeed use at least one or a combination of motivational theories to help victims recover from alcoholism.

Alcoholic Anonymous is one of the widely renowned alcoholism recovery programs operating in almost 200 countries and helping millions of alcohol addicts recover from alcoholism. This paper discusses Alcoholics Anonymous (AA) motivational program, motivational theories and then analyses how successful or not the AA program has been basing on the motivational theories.

Alcoholics Anonymous (AA)

The history of AA can be traced from a group called the Oxford Group which was a Christian organisation. Its purpose was to help men struggling to quite taking alcohol possible. It is believed that their concept of dealing with alcoholism was more of a spiritual approach as they believed that surrendering to God would help solve the sinful nature of alcoholism.

AA is said to have been formed in 1939 by Bill Wilson who borrowed most of the ideas from the Oxford Group and broadened the concept to include psychological and physical treatment as well. Since then the membership has increased and the program has increased its boundaries from America and Canada, where it was originally based to different parts of the world (Kurtz, 1979).

How AA works

AA motivational program works on a voluntary basis whereby whoever is willing to quite taking alcohol join the group. In order to encourage alcoholic victims to join the program and at the same time protect them from public ridicule the program calls for anonymity of the members hence the name alcoholics anonymous. The program not only helps alcoholics but also people struggling from other forms of addiction as well.

It is worth noting that the program is self-sustaining with no any external financial help, but works from voluntary contributions from its members and literature sales. There are no employed workers but rather the counselling is carried out by the previously recovered individuals through the mentorship program which is also voluntary. AA believes that the only qualification for membership is the decision and will to quit taking alcohol (Kurtz, 1979).

There are meeting centres distributed over 200 countries and a willing member is expected to join in any of the AA group meetings close to them. Once in the group, one is expected to confess and share personal experiences as an alcoholic with other members within the group and this would thus mark the beginning of the healing process (Kurtz, 1979).

Sponsorship can be seen as a mentorship program whereby members who have undergone much of the recovery program have the responsibility of mentoring and helping new entrants into the 12 principles of AA treatment program. This works both ways, the new members are able to learn from the already experienced members and on the other hand the sponsors are able to improve on their recovery process by helping the new individuals.

The basic principle of AA motivational program is that the victims of alcohol addiction must admit that there is a higher power, that is, God for those that believe in him or just any higher power for those that may not believe in God. By submitting oneself to this higher power instead of working on self-reliance, the high power will somehow give them assistance as they try to recover from their addiction (AA, 2008).

It is worth noting that AA takes the approach of self-involvement whereby there are no organisational structures, no managers neither CEO’s.

There are no documentations or regulatory official requirements but rather the organisation is only accountable to its members. One unique characteristic of AA is the fact that individuals are not assessed by qualified experts but rather every individual does personal diagnosis and checks the progress from the 12 stepwise procedures (Dick, 1998).

The course of treatment at AA is based on giving in to external greater power rather than relying on personal will and strength. In contrast to the mostly used approach of working towards improving on self-esteem, AA takes a different approach of exercising humility and submission to a greater power.

According to AA, if the alcoholic just follows the simple plan that is suggested then he/she would have more chances of recovering (Galanter and Kaskutas, 2008, p. 10). In addition they believe that there is no free will in alcoholics since the alcoholic has already lost personal control to alcohol. AA, according to Galanter and Kaskutas (2008), defines alcoholism as:

Spiritual, mental, and physical illness and recovery requires healing all aspects of the illness; abstinence from alcohol in and of itself is regarded as “being dry” and is insufficient because alcoholism is but a “symptom” of underlying character defects. (Galanter and Kaskutas, 2008, p. 10)

The success or failure of AA recovery program can arguably be attributed to the strength of an individual to undergo total change in the way of thinking. The expectation of change of thought to surrender to an external powerful authority is expected to help the person quite taking alcohol. Simple suggestions are made to new individuals especially those who want to take drastic changes at a go. AA believes that the simple and few steps will help someone to stabilise before making tougher decisions later.

It is claimed that one of the strengths of AA is its cognitive approach to dealing with alcoholism. “AA meetings provide an atmosphere in which cognitive restructuring can take place” (Galanter and Kaskutas, 2008, p. 10).

In addition the AA’s12 steps, attendance to meetings and being a mentor or sponsor all works positively towards mental restructuring. Self-diagnosis is one of the most important elements of the program as individuals can develop their own alcoholic individuality which, according to psychologists, creates self-recovery on one’s inner self.

Motivational theories

Motivational theories are thoughts and assumptions that attempt to explain the nature of a human being in terms of what prompts or triggers actions towards a certain direction.

Huitt (2001) defined motivation as “internal state or condition that activates behavior and gives it direction, or desire or want that energizes and directs goal-oriented behavior, or influence of needs and desires on the intensity and direction of behavior” (Huitt, 2001, p. 1). The AA program uses the ideology of motivation to help alcoholic victims recover from their alcoholic behavior.

Biological motivation

Biological motivation is based on the fact that human actions may be driven in such a way to satisfy an internal biological need such as need to satisfy hunger or thirst. It is believed that there are internal subconscious drives that make a human being behave in a certain way (Bernstein & Nash, 2006).

Drive reduction theory explains how human actions are biologically motivated in order to reduce the causative agent inside the human nature.

This theory is based on the fact that inside any organism are physiological or biological needs and requirement such as hunger, thirst, sexual desire, among others which, unless met, will trigger and maintain an unstable state of body which is believed to increase with time if the need is not satisfied in time (Bernstein & Nash, 2006). The process can be viewed as a feedback mechanism (Deci and Ryan, 2008).

When the physiological need is satisfied the organism will go back to the normal or stable state. When the physiological need is met either directly or indirectly then, there is a reduction of the drive. Arousal theory explains that it is in human nature to sustain a definite degree of arousal that makes us feel stable and comfortable. It can mean emotional, rational or even physical activity (Shah & Gardner, 2008).

The AA program certainly uses biological motivation though in a simplistic approach. The program appreciates the fact that total abstinence at once may never give any desirable results. This is because a sudden stop of use of alcohol especially for addicts will definitely trigger one of the strongest biological needs to quench the alcoholic thirst. The biological motivation principle of maintaining the physiological homeostasis will be triggered by sudden cut off of alcohol.

What the program advocates is continual gradual reduction in the amount of alcohol taken which will eventually reduce to manageable level where total cut off can be done. In addition the AA principle of relinquishing oneself to a higher power to take over the alcoholic problem can arguably be seen as a diversion of the alcoholic biological motivation to an external agent and in that way, the biological drive and arousal are somewhat compressed. This is likely to enable the alcoholics recover quickly.

Cognitive/social motivational theory

This theory explains how behavior patterns of individuals are influenced by, among other factors, physical environmental, people and situations. This theory connects between the individual, environment and the behavior. The environment can be seen as a combination of all the external factors that are likely to influence a person’s behavior (Deci and Ryan, 2008).

The person’s perception about the different aspects of the environment is believed to influence the person’s behavior. The behavior can also be influenced by a person’s perception of other people’s behaviors through either watching them or even when interacting with them.

Tolman Purposeful behavior theory

Tolman was one of the social cognitive theorists. Through his numerous experiments with rats and mazes he came up with the theory of purposeful behavior. According to Dalton“ Tolman proposed that learning could occur without reinforcement and without an observable change in behavior.

In addition, Tolman found that behavior is affected by an organism’s expectations, often resulting goal-oriented, purposeful behavior” (Dalton 1). This is arguably one of the most applicable motivational theories in the AA program. The success or failure of any given case in the AA program depends, to a large extent on the expectation of the individual. If the individual has a predetermined mind about recovery his behavior in the AA program will certainly lead him to recovery.

Asch attribution and conformity theory

Solomon Asch presented his theories conformity and attribution. According his attribution theory, individuals attribute actions in life to an agent either external or internal. Alcoholics may attribute their drinking habit to lack of self control. AA program counter attacks the different attributions by offering a supernatural, powerful being in which the drunkards can attribute their weaknesses and hence relinquish their inner self to the power.

In addition his conformity theory which revolves about voluntary yielding to situations despite personal preferences also applies. Being in the presence of a group of similar individuals in the AA meetings creates a favorable condition for conformity to the behavior of the group. This does help in motivating the alcoholics towards recovery.

The physical environment such as the condition of a house or a class may play a significant part in motivating someone. The physical environment may also be a source of materials, opportunities or even societal support; this is one of the motivation strategies employed by the AA program. The fact that members meet in places far away from public ridicule and in the presence of other like members makes the environment conducive for the recovery program (Bernstein & Nash, 2006).

A given situation may either motivate or discourage someone to behave in a certain way. In addition how an individual perceives a given situation may have an effect on the course of action to be taken depending on whether the situation was perceived as encouraging or discouraging. AA uses this technique to make the newcomers feel comfortable in the knowledge that they are in the presence of people who have gone through a similar situation and this is actually a motivation for new members to continue with the recovery program (Bernstein & Nash, 2006).

Expectancies which can be viewed as valuable or the importance an individual places on the expected results or rewards may have a great impact on the level of motivation for that person. People who place a higher value on the outcome are more likely to be more motivated than those who do not value the outcome as much.

In AA the 12 principles places a lot of importance to the kind of life one is likely to enjoy after recovery from alcoholism. The new members actually get a chance of interacting with the already recovered members and this is a motivation enough to make them stick to the program however difficult it may seem to be.

Self-control plays a very important role in motivation. People who have the internal strength of self-control may exhibit a result oriented behavior and as such they are likely to be more motivated if they are presented with conditions or situations that will demand determination or control in order to achieve the desired results.

The AA program calls for determination to accept one’s alcoholic condition and surrendering to a higher authority which has the power to heal the spiritual and psychological sickness. They advocate for stepwise self-control whereby one is not required to automatically quit drinking but rather practice self-control for short durations which can then be extended to achieve the desired results. This is likely to motivate self-controlled individuals (Dick, 1998).

There are individuals who learn from others and are more likely to be motivated not because of what they are doing or capable of doing but by simply admiring what other people around them are doing. Individuals who are addicted to alcoholism can be motivated by being exposed to individuals who have already quite taking alcohol.

AA program offers the best opportunity for the individuals struggling with alcoholism to interact with the recovering or the already recovered individuals, otherwise known as sponsorship. Through sponsorship individuals are able to associate and take after their sponsors. This can be the best method of motivation for some of the members (Dick, 1998).

Self-efficacy is also believed to influence the level of motivation in a person. Some people are more motivated in the belief and knowledge that they have what it takes to complete the given task.

By understanding how different people are in terms of how they are motivated, then it becomes easier to help them achieve their goals and objectives. This is best applicable in the AA program whereby alcoholics are made to believe that the desired outcome can only come from their personal will to give up themselves to a greater power for healing (Dick, 1998).

Eclectic theory

Eclectic theorists try to explain motivation and behaviour of people by taking on pieces of what they believe to be the best from other theories. They claim that the human nature is so complex and as such not one approach may suffice to explain the relationship between motivation and human behaviour. The 12 principle AA motivational program employs all the methods as a mixture in order to achieve the desired results.

Strengths of AA program

Galanter and Kaskutas (2008) claimed that “AA program is complex, implicitly grounded in sound psychological principles, and more sophisticated than is typically understood” (Galanter & Kaskutas, 2008, p. 10).

Although much criticism has been thrown over the program, it can be claimed that such criticism may be due to the misunderstanding of the whole idea behind the program. In addition, the fact that the program works under anonymity makes it difficult and tricky to research, analyse and document success or failure of the program.

We can arguably say that the program has achieved success as compared to other programs offering the same type of service. From basic knowledge the program started in 1935 and has only grown, gaining membership every year.

Then we can claim that if there was no any considerable success then the program would have died long time ago. It is also claimed that “an increasing number of DUIs are court ordered to AA” (Galanter and Kaskutas, 2008, p. 13) arguably for a simple reason, the judicial systems have confidence in the AA program.

Success can also be based on the methodology of the program. The program employs a self-healing process where the victim plays the major role in initialising and maintaining the recovery process with the help of other members of the group (Deci & Ryan, 2008). The fact that the program allows for personal participation, motivational environment and a chance to put into practice what one has learned by sharing with others and mentorship program suffices that a degree of success is likely to be achieved (AA, 2008).

The fact that the AA program seeks to change the way of thinking of the alcoholics and not merely helping them stop the drinking habit implies that the impact of the program will be astounding. AA defines alcoholism as “spiritual, mental, and physical illness and healing require healing all aspects of the illness” (Galanter & Kaskutas, 2008, p. 14).

This posits that either 100% success may be achieved when an individual has fully recovered from alcoholism and thus in a better position mentally, spiritually and physically or at least some degree of success when one is not able to recover in all aspects (AA, 2002).

Another point worth noting is that AA provides a program that is fit and comfortable for everyone, both spiritual and non-spiritual. Each person can customise the recovery program according to personal preferences “the house that AA helps a man build for himself is different for each occupant because each occupant is his own architect” (Galanter & Kaskutas, 2008, p. 18).

Atheists, believers, radicals as well as conformists can fit in the program and that is arguably the greatest achievement of the AA program. Other recovery programs such as religious sponsored institution are not compatible to such a wide variety of individuals.

A statistical approach to the question of the success of the program indicates that the program has met and even exceeded expectations. A report carried out to determine success rate claimed that:

A total of 68% of the women in the survey reported that they had stopped drinking within a year of their first meeting as compared with only 63% of the men. At the same time, 74% of those under thirty reported they had stopped drinking within a year of attending their first AA meeting, compared with 63% of those over thirty. (AA, 2008, p. 6)

One of the strengths of AA is in the structure. AA works as a community though anonymous. A community of people with a common challenge in life and this is perhaps one of the greatest advantages members have, to work and share with people who have or are already undergoing what one is going through. When a new person hears the testimonies of other members who have experienced to be AA community then they get encouraged that all is not lost for them (Medvene, 1989).

Another advantage of the AA program lies in the fact that individuals who have the will to stick around for some time get a chance to accelerate their recovery through mentoring the young members in the group. This can be seen as a helper therapy which is believed to help mentors affirm the need to quit alcoholism. A research done to confirm whether indeed this was true found out that “those helping other alcoholics were less likely to relapse (60%) than those who did not help their peers (78%)” (Galanter & Kaskutas, 2008, p. 24).

The element of reciprocity in AA gives it an upper hand over other programs. Since the program works on the principle of self-help with the help of others and that there is no any monetary payments to be made, then the only way members can give back is by doing good to themselves by quitting alcoholism. It is claimed that “many follow moral norms or reciprocity found in society at large and believe that they should give back, if not to their immediate benefactor, to some generalized other in the future” (Galanter & Kaskutas, 2008, p. 25).

AA weaknesses

It can be argued that one of the greatest weaknesses of AA lies in its structure. The fact that there are no any official or managerial structures makes the program vulnerable to abuse and expression of personal interests, for instance it is claimed that, at times “members of AA groups may dispel disruptive drunk attendees or treat newcomers in such a way that they feel unwelcome” (Galanter & Kaskutas, 2008, p. 13).

This may not be the case if there was some kind of management that may regulate the response and reaction of other members towards newcomers.

The principle of freewill entry to anyone including disruptive drunkards may also be one of the disadvantages. Disruptive drunkards may be more of a discouragement than a motivation to others who may be trying to concentrate on their recovery program (Dick, 1998).

The fact that the program is based on a spiritual background may not work for people who do not have any spiritual relation. The success of the program depends on the individual willingness and strength to change the way of thinking. This may be a goal hard to achieve given that the drunkards, in their state of drunkenness, have already given up and may not have the inner drive to change their way of thinking (Medvene, 1989).

Conclusion

The effect of alcohol on our community is such a great issue that it can simply not be ignored. The community always finds a way of helping those of us struggling with alcoholism and other forms of addiction. Alcoholic people need a lot of motivation in order to encourage and help them out of the alcohol menace.

Different kinds of motivational theories such as biological, eclectic, social/cognitive do exist and their applicability in motivating alcoholics to recover is very instrumental. AA is one of the most widely used alcoholic recovery programs and its efficiency in its task mostly lies in the motivations that do exist in different aspects of the program. Though there has been much criticism about the program, it appeals to many and its strengths may far outweigh its weaknesses.

References

AA. (2002). The Twelve Steps Of Alcoholics Anonymous. Web.

AA. (2008). Alcoholics Anonymous Recovery outcome Rates. Web.

Bernstein, D & Nash, P. (2006). Essentials of psychology. New York, NY: Cengage Learning.

Dalton, S. (n.d.). Synopsis Paper #2. Web.

Deci, E & Ryan, R. (2008). Intrinsic motivation and self-determination in human behavior. New York, NY: Springer.

Dick, B. (1998). The Oxford Group and Alcoholics Anonymous. New York, NY: Good Book Publishing Company.

Galanter, M & Kaskutas, L. (2008). Research on alcoholics anonymous and spirituality in addiction recovery: the twelve-step program model. New York, NY: Springer.

Kurtz, E. (1979). Not-God: A History of Alcoholics Anonymous. Minnesota: Hazelden Publishing.

Medvene, M. (1989). Foilrigami. New York, NY: Astor-Honor Inc.

Shah, J & Gardner, W. (2008). Handbook of Motivation Science. New York, NY: Guilford Press.

Discussion Board Posting

Brief Description of the Group Observed

The group that I observed comprised of alcoholics who were members of Alcoholic Anonymous. These alcoholics were clients at the local rehabilitation center where they received psychotherapeutic and medical treatments. Alcoholics usually meet weekly on Wednesdays to receive counseling services and review their progress in line with the program of Alcoholics Anonymous. On the day of visitation, the group constituted of 10 alcoholics who were mainly male students from the college. Specifically, the group had seven males and three females who participated actively in the program of Alcoholics Anonymous.

The members of the group were young adults because their ages ranged between 20 and 25 years. Owing to the alcoholism, members struggled to lead ordinary lives because their friends and classmates perceived them as social outcasts, making them endure shame and stigma in college. Moreover, these members suffered from depression that compelled them to indulge in drinking while sustaining suicidal feelings. Leaders of the group apply the program of Alcoholics Anonymous to elicit promising psychological, spiritual, and emotional changes, which are essential in supporting abstinence from alcohol. Members happily attend weekly meetings and therapeutic sessions for they have found them enriching and beneficial to the process of addiction recovery.

Psychotherapeutic Techniques

The exploration of the therapeutic process shows that the group undergoes the cognitive-behavioral therapy (CBT). In adherence to the program of Alcoholics Anonymous, a psychotherapist utilizes CBT to change cognitions, regulate emotions, and transform behaviors of alcoholics. CBT aims to empower alcoholics to identify predisposing situations, overcome compelling stressors, and cope with problematic behaviors (Kelly, Humphreys, & Ferri, 2017). Usually, the interaction between emotions, thoughts, and behaviors play a central role in behavioral change. Disseminated principles and concepts highlight the theory of CBT employed in the group. CBT recognizes alcoholism as a behavioral impairment that limits the ability of an individual to abstain from drinking (Kelly et al., 2017). To overcome addiction, group members have to acknowledge that they require assistance from others and adopt a positive belief system. Mindfulness meditation enables alcoholics to commit to the therapeutic process and transform their lives. Since alcoholism thrives in secrecy and isolation, regular meetings of the group allow members to share difficult behaviors, thoughts, and emotions. Mindfulness meditation facilitates the review of aberrant behaviors and analysis of damages on personal, professional, and societal facets. The use of meditation techniques and behavioral changes are integral in creating and developing a positive belief system that overwhelms the urge for addiction.

Importance of the Group

If I had the same problem of alcoholism, I would have found this group helpful because it empowers alcoholics to manage challenging passions, behaviors, and beliefs. The examination of therapeutic techniques employed in the program of Alcoholics Anonymous demonstrates that they are significant in guiding and helping alcoholics to control and cope with alcoholism. According to Marcovitz, Cristello, and Kelly (2017), Alcoholics Anonymous offers a comprehensive framework and process that enhances the usefulness of therapeutic interventions. In this case, CBT expertly fits into the program of Alcoholics Anonymous since the group exploits and applies various principles and concepts. As alcoholism flourishes in isolation and secrecy, therapeutic group sessions permit alcoholics to explore and share their experiences (Wolgensinger, 2015). Additionally, the use of mindfulness meditation and the adoption of a positive belief system boost the ability of alcoholics to coping with predisposing behaviors.

Responses to Peers

Response to Peer 1: Christopher Court

The analysis of observations we have made reveals some similarities and differences in the CBT technique employed in the treatment of group members. Your group (LGBTQ) comprised of three clients, namely, transgender, lesbian, and gay, who experienced similar social and psychological challenges. In contrast, my group was composed of seven males and three females who are students in the college. The apparent differences in demographic attributes of members of each group reflect the dynamic nature of their psychotherapeutic needs. In your group, it is apparent that psychotherapists incorporated CBT into the treatment regimen by using mindfulness exercises as a means of committing members to the therapy. Mindfulness exercises are dependable in alleviating depression and anxiety because they cause a quick and enduring change in behavior (Corey, Corey, & Corey, 2018). Shame-attacking exercises liberated members and improved their ability to express sexual identities. In the same manner, my group applied mindfulness to promote the engagement of members in therapy and adopt a positive belief system.

In contrast, my group utilized mindfulness meditation in enabling alcoholics to participate actively in the therapeutic process. Essentially, mindfulness meditation is an intensive form of meditation aimed at improving the concentration of the mind to the present moment, relieving stress, and exciting cognitions (Corey et al., 2018). As mindfulness exercise is quick and easy to perform, it is appropriate for your group because they have unique social dynamics. Contrastingly, mindfulness meditation fitted my group because it is slow and intensive to execute. Although forms of CBT applied to LGBTQ members and alcoholics are different, they are effective in the treatment of anxiety, depression, and nervousness.

Response to Peer 2: Tania Lynn

Observations made on your group of transgender and mine of alcoholics showed some differences and similarities on the issue of the therapeutic process. One of the significant differences is evident in the demographic characteristics of clients. While your group composed of young individuals aged above 60 years, my group of alcoholics had students aged between 20 and 25 years. Differences in age and psychiatric needs explain varied therapeutic approaches employed in the treatment of members. Individuals in your group exhibited depression, trauma, and anxiety associated with sexual orientation (Lerner & Robles, 2017). In contrast, members of my group depicted depression, anxiety, and social stigma related to alcoholism. Another apparent difference is that your group focused on hormone therapy rather than psychotherapy, which is useful and reliable in the treatment of depression and trauma. Comparatively, the group of alcoholics employed Alcoholics Anonymous and CBT in empowering alcoholics to manage addiction.

The similarity between the two groups is that individuals struggle to accept their debilitating conditions because they have limited powers to influence and cause favorable behavioral changes. The problem of the two groups, transgender individuals, and alcoholics, lies in the psychological and social spheres. In the psychological aspect, individuals strive to understand their conditions of sexual orientation and alcoholism in groups of transgender and alcoholics respectively. From the social perspective, individuals in both groups aim to achieve social acceptance in the society that perceives them as outcasts with anomalies in their behaviors, thoughts, and emotions. Therefore, both therapies sought to promote the expression of feelings and beliefs and identify with diverse social groups of interests.

References

Corey, M. S., Corey, G., & Corey, C. (2018). Groups: Process and practice (10th ed.). Belmont, CA: Brooks/Cole publishing company.

Kelly, J. F., Humphreys, K., & Ferri, M. (2017). Alcoholics Anonymous and other 12-step programs for alcohol use disorder. Cochrane Database of Systematic Reviews, 1(11), 1-12. Web.

Lerner, J., & Robles, G. (2017). Perceived barriers and facilitators to health care utilization in the United States for transgender people: A review of recent literature. Journal of Health Care for the Poor and Underserved, 28(1), 127-152.

Marcovitz, D., Cristello, J. V., & Kelly, J. F. (2017). Alcoholics Anonymous and other mutual help organization: Impact of a 45-minute didactic for primary care and categorical internal medicine. Substance Abuse, 38(2), 183-190.

Wolgensinger, L. (2015). Cognitive behavioral group therapy for anxiety: Recent developments. Dialogues in Clinical Neuroscience, 17(3), 347-351.

Introduction

This paper looks at the application of counseling theories in the management of alcoholics. Alcoholism is defined as a primary disorder in which a person loses control over drinking and is habituated or addicted to alcohol (Gifford, 2010). If a person continues to drink even when the drinking affects his/her physical, mental and social health or compromises job and/or family responsibilities he/she is said to be an alcoholic (Clinebell, 1990). An alcoholic has physical dependence on the alcohol and the person may develop withdrawal symptoms should the alcohol be withheld from them. Genetic factors, psychological factors, and cultural influences contribute to the development of alcoholism (Clinebell, 1990). Alcoholics need counseling to help them stop the dependence and get their lives back.

The case of John M

John M., a twenty nine year old man, presents with a drinking behavior which his friends think is alcoholism. He reports to have started drinking at the age of sixteen years. His father, who drinks daily, was the one who introduced him to alcohol (Bryant-Jefferies, 2001, p 35). There was a constant stock of alcohol for his father at home and he could drink anytime since his parents never objected. His peers were also into drinking alcohol and john was under pressure to start drinking so as to fit in. John then joined his peers in their drinking exploits and he has never stopped drinking since then. He reports that he takes at least six drinks per session on several occasions in a week (Gifford, 2010). The amount of alcohol he needs to get drunk has been increasing over the years and he spends much of his income on alcohol. Currently he experiences episodes of shaking on mornings after a night of drinking and he has to take some alcohol to calm down. Whenever his friends tell him to reduce his alcohol intake he reacts angrily and can even get violent. John cannot sustain a relationship for long and he says that the break-ups are due to his excessive drinking habits. He even feels sorry for himself at times and wishes that he could stop drinking but according to him it is beyond his control. His boss at work has cautioned him severally for going to work while drunk and failing to carry out his duties but he has continued to drink despite his job being at risk. Though initially he used to drink with his friends currently he drinks alone and even avoids them because he feels they distaste his excessive intake of alcohol. He does not get involved in activities with others but prefers to sit alone and drink. John drinks even at the expense of food and this has affected his physical health. He has been admitted twice in a hospital on account of alcohol intoxication. His drinking has become so bad that he needs a drink daily to get him started (Gifford, 2010). He cannot function well without alcohol. He has had to make excuses on several occasions at work to go and drink. John reports of blackouts after episodes of heavy drinking.

John M. belongs to a group of people who grow up in social settings with high acceptance of alcohol use. Easy access to alcohol and peer pressure also contributed to the development of his drinking habits.

Theories of psychotherapy for treating alcoholics

Psychotherapy is defined as a practice of treating sick people by influencing their mental life and it entails techniques which are believed to help solve or cure behavioral and psychological problems (Mnsterberg, 2010, p. 1). These techniques involve direct contact between the therapist and the patient. The contact is mainly through talking and thus issues to do with client confidentiality and also patient privacy have to be observed (mnsterberg, 2010, p. 1)

Many theories on psychotherapy and counseling have been advanced and used for therapeutic purposes. These theories include; psychoanalytic, analytical/Jungian, adlerian, self-psychology, time limited dynamic, client-centered, existential, gestalt, behavioural, cognitive, reality, family systems and biofeedback (Chan, Berven, & Thomas, 2004). This paper looks at two theories of psychotherapy suitable for treating alcoholics. These theories are client-centered theory and psychoanalytic theory.

Client-centered theory

It is also called the Rogerian theory. This theory requires that the psychological recovery process is directed by the client (Peele, 1984). It is centered on self-esteem enhancement, expansion of self awareness and increased self-reliance. The client is valued for what they bring to sessions and is regarded as expert. The therapist guides sessions non-directly. Heavy emphasis is put on not telling the client what to do but enabling and empowering him/her to discover his/her own solutions. With a proficient therapist using this approach, clients feel understood and thus drop their guard and talk (Peele, 1984, p. 415). This theory draws from the postulation that ‘if I accept myself just as I am, then I can change’. In this theory, therapists use reflection mirroring back to the client to see if his/her words capture what the client feels. The therapist should have non-possessive warmth, a process in which the therapist cares and values the client without imposing their will or passing judgment on them, and they should also have empathy and hence see life from the perspective of the client (Gray, 2007, p. 73)The client needs to achieve self discovery and actualization. The client centered theory has been useful in treatment of drug addictions and in alcohol rehabilitation centers (Gray, 2007, p. 96).

Psychoanalytic theory

The psychoanalytic theory is based on a concept that states that individuals are not aware of the factors that lead to their emotions. It is an interpretive discipline and the work of psychoanalysts is usually linked to patient’s relations and interactions with other people. In psychoanalysis, the patient talks to someone, the psychoanalyst, and his/her relation with and understanding of that person to whom he/she is talking shapes his/her communication (Greenberg & Mitchell, 1983, p. 9). In psychoanalysis, the objective of treatment is for both psychoanalyst and patient to bring out the constituents of relational ties which lead to their psychological state and reformulate them for recovery (Greenberg & mitchell, 1983, p. 9). Seen in this light then, the needs for treatment of alcoholics can be met by the psychoanalytic theory. The analyst’s interventions involve confrontation and clarification of a patient’s pathological defenses.

Treatment plan for John M

The goal of treatment of alcoholism is to achieve abstinence or moderation (Gifford, 2010). To achieve total abstinence, family support and a social background which is very strong are necessary. These will help the patient avoid high risk situations which may tempt him/her to take alcohol. Moderation is simply reduction of the amount of alcohol that the patient takes (Gifford, 2010). Psychotherapy and alcoholism counseling are useful in the treatment of alcoholism (Maltzman, 2008, p. 25-26). Both the client-centered theory and the psychoanalytic theory can be used in the treatment of alcoholics. The treatment of John M. who is an alcoholic can be achieved by any of the two theories. This is to be achieved through group therapy sessions and sessions between John and the therapist. During the group therapy sessions, Psychoanalysis will be used to try identifying the psychological ties which would have lead to alcoholism and then reformulating them to suit recovery from alcoholism.

The client centered theory comes in as the therapist lets John guide his own process of recovery (Client-centered therapy, 2010). This is done during sessions between john and his therapist where the therapist listens to and reflects what John says (Client-centered therapy, 2010). In these sessions the client comes up with his own solutions which are not imposed on him by the therapist.

John’s cultural background is essential in formulating the treatment plan as drinking styles and attitudes towards alcoholism vary from culture to culture (American psychologist, 1984). Disparities in race and ethnic groups affect alcoholism treatment as they may give an idea as to the need of, access to, appropriateness and quality of care (Schmidt, Greenfield and Mulia, 2006). The counselor’s own cultural perspective may influence his/her perception of the progress and response of the patient to treatment (Chapman, 1988). Coupling the counselor’s sensitivity to cultural issues affecting the client with professional skills, proficiency at his/her work, appropriate technique and a good understanding of the patient’s needs best serves the interests of doing therapy to a patient who is culturally different from the therapist (Chapman, 1988). John M will therefore be managed in group therapy sessions and visits to a therapist who understands his cultural background.

Reference list

Bryant-Jefferies, R. (2001). Counselling the person beyond the alcohol problem. Philadelphia: Jessica Kingsley Publishers.

Chan, F., Berven, N. L., & Thomas, K. R. (2004). Counseling theories and techniques for rehabilitation health professionals. New York: Springer.

Chapman, R. J. (1988). Cultural Bias in Alcoholism Counseling. Alcoholism Treatment Quarterly, 5, 1-2.

Client-centered therapy. (2006). The Harvard Mental Health Letter / from Harvard Medical School, 22, 7, 1-3.

Clinebell, H. J. (1968). Understanding and counseling the alcoholic: Through religion and psychology. Nashville, Tenn: Abingdon.

Gray, P. (2007). Sober for the health of it: A nutritional approach to the treatment of alcoholism. Bloomington, Ind.: Trafford.

Greenberg J. R and Mitchell S. A (n.d.). Object relations in psychoanalytic theory. P. 9.

Maltzman, I. (2008). Alcoholism: Its treatments and mistreatments. New Jersey: World Scientific.

Gifford, M. (2010). Alcoholism. Santa Barbara, Calif: Greenwood Press/ABC-CLIO. Mnsterberg, H. (2010). Psychology and social sanity. S.l.: General Books.

Peele, S. (1984). The cultural context of psychological approaches to alcoholism. Can we control the effects of alcohol? The American Psychologist, 39, 12, 1337-51.

Schmidt, L., Greenfield, T., & Mulia, N. (2006). Unequal treatment: racial and ethnic disparities in alcoholism treatment services. Alcohol Research & Health: the Journal of the National Institute on Alcohol Abuse and Alcoholism, 29, 1, 49-54.

Introduction

Diseases have a negative impact on our socio-economic well- being. Treatment sometimes does not entail chemotherapy alone but other interventions that require patients to abandon unhealthy habits. Healthcare providers use behavioral models to ensure the success of other medical interventions such as physical activity, drug, and alcohol recovery sessions. Doctors use a combination of chemotherapy and other medical interventions in the treatment of alcoholic hepatitis. Therefore, this essay examines the case study of alcoholic hepatitis with a view of evaluating models of health promotion and disease prevention, identifying client needs, and creating a treatment plan.

Background Information of Alcoholic Hepatitis

Alcoholic hepatitis is a clinical syndrome whose symptoms include jaundice and failure of the liver due to prolonged overindulgence in alcohol consumption (Thursz et al., 2015). The severity of the disease is determined using the Maddrey’s discriminant formula, which classifies patients having values of 32 and above as having severe forms of the disease. Patients with severe hepatitis have 30-40% chance of succumbing to the disease (Singal, Kamat, Gores, & Shah, 2014). Alcoholic hepatitis is a form of alcoholic liver disease (ALD) coupled with liver cirrhosis (Basra & Anand, 2011). In the prophylaxis of the disease, prednisolone and pentoxifylline are the most widely used pharmacological agents with empirical evidence indicating that they have disparate results in the management of the severe form of the disease (Thursz et al., 2015). Pentoxifylline does not increase survival of patients with alcoholic hepatitis while Prednisone reduces death by 28 days; however, with no significant change after 3 and 12 months, respectively. The cause of the disparity is still under investigation.

Evaluation of Models

The major strides made in medical research made in the 20^th century have resulted in decreased infant, child, and maternal deaths. Longevity has a positive impact on the social and economic well-being of most countries. The approach employed in combating diseases is that of treating each disease individually using behavioral models, which play a key role in the effective management of diseases. John’s relapse with alcohol abuse is the causative factor for alcohol hepatitis. Therefore, imperative in his treatment and recovery are the trans-theoretical, health belief and relapse prevention models.

The trans-theoretical model holds that for people to embrace healthy behaviors and abandon bad ones, they have to undergo different stages that entail pre-contemplation, contemplation, preparation, action, and maintenance (Howard, Schembre, Motl, Dishan, & Nigg, 2013). The health belief model avers that a patient’s perception of disease threat and benefits of a given intervention must override the impediments to the same intervention if a patient is ever to adopt a new treatment. The key concepts of the model include perceived susceptibility and severity, supposed merits of an action, potential impediments to an action, motivation to an action, and self-efficacy by setting tenable behavioral objectives (Orji, Vassileva, & Mandryk, 2012).

The relapse prevention models hold that persons commencing physical activities may need interventions that make them expect factors that contribute to relapse (Hendershot, Witkiewitz, George, & Marlatt, 2011). Key concepts of this model include skills acquisition via training, mindset reframing and lifestyle re-adjustments. The major aims of the relapse prevention concepts are to prepare a patient psychologically for an eventuality of re-encountering the same challenges that made the patient engage in unhealthy behavior. A secondary exposure will not have the same impact as the initial one, and so, a person is better equipped to tackle them.

Though these behavioral models seem appropriate, they are not without downsides. The health belief model does not consider attitudes and beliefs that motivate a patient to embrace a health behavior. The model also does not take into account habitual behaviors that inspire the decision to pursue recommended activities. Furthermore, the model assumes that motivations to act are common, and thus, it holds that health actions are the main objectives of health promotion. The trans-theoretical model overlooks the social context in which change occurs. Moreover, the model has no predefined period for each phase, and it assumes people make rational decisions, which in most cases is not true. The relapse prevention model has the demerit of assuming that the interventions employed will introduce the person to potential causes of relapse.

Needs of the Patient

Predicating on the behavioral models above, it is highly likely the patient’s relapse into alcoholism and drug abuse emanates because of a failure to maintain abstinence from drugs and alcohol. A plausible explanation for this could be that the patient experiences stress. The stress systematically creates a carefree attitude, which makes the patient trivialize the effects of drug abuse and alcohol, and the subsequent consequences. The stress also creates a sense of hopelessness, which makes the patient prone to relapse for he feels that his life is useless, and he has everything to lose.

The confession that his job is at stake and the fact that his wife is about to abandon him confirm that he is a deeply worried man who is already on the verge of depression. Furthermore, stress makes the patient develop withdrawal attitude, probably due to disillusionment. Evidently, John does not easily disclose information about his personal life to people because he probably does not see the benefits of disclosure. The overall contribution of stress in John’s life is that it has left him a shell of a man.

Analysis of the case shows that the mind-body connection of the patient is weak. The weakness is attested by the fact that the client is physically weak for he lost much weight. Moreover, John is mentally feeble because he has relapsed into heroin and alcohol use. The effects of heroin and alcohol put the patient in a mental state that makes him forget his problems transiently and neglect his bodily needs such as food and exercise. After the effects of drugs and alcohol wear off, the client then faces the realities of life again. Over consumption of alcohol also has the far-reaching effect of damaging his liver resulting in jaundice and alcoholic hepatitis. Alcoholic hepatitis disease wears the body down contributing to the overall state of the malaise of the patient. Physical and mental states are inextricable and collectively contribute to overall well-being.

Treatment Plan

In light of the above discussions, the patient needs alcohol and drug therapy sessions, immediate chemotherapy for hepatitis, treatment of flu and swollen thyroid glands, anti-depressants and stress counseling sessions, and exercise, in this order. The treatment plan, captured in the table below, will aid in the achievement of these interventions.

Table 1: Treatment Plan

The treatment plan is appropriate in that it ensures the respective healthcare providers meet the patient’s needs. It does so by identifying ways of fulfilling each of the needs. Alcohol and drug abuse therapies will ensure that John abstains from drug and substance abuse, which have contributed to his poor health. Treatment for swollen thyroid glands is to ensure the patient is in the right physical state to pursue exercises and counseling sessions. The stress management session is for alleviating stress in a bid to return the patient to normalcy. Physical exercises will keep the patient healthy and contribute immensely to stress alleviation. Physical exhaustion has a way of deviating a person’s thoughts from everyday worries. However, exercises must go hand-in-hand with healthy feeding habits. Cumulatively, the needs will contribute to the patient’s overall well-being.

Table 2 Steps and goals

Conclusion

The successful management of diseases requires careful planning to ensure health care providers meet the patients’ needs. The analysis of case study shows that the treatment and recovery process of John requires chemotherapy and counseling. Moreover, the case study shows that planning of treatment requires the application of the models of health promotion and disease prevention such as the trans-theoretical model, health belief model, and relapse prevention model. Overall, treatment plan plays a vital role in the treatment and recovery process of John.

References

Basra, S., & Anand, B. (2011). Definition, epidemiology and magnitude of alcoholic hepatitis. World Journal of Hepatology, 3(5), 108-113.

Hendershot, C., Witkiewitz, K., George, W., & Marlatt, G. (2011). Relapse prevention for addictive behaviors. Substance Abuse Treatment, Prevention, and Policy, 6(17), 1-17.

Howard, C., Schembre, S., Motl, R., Dishan, R., & Nigg, C. (2013). Does the Trans-theoretical Model of Behavior Change Provide a Useful Basis for Interventions to Promote Fruit and Vegetable Consumption? American Journal of Health Promotion, 27(6), 351-357

Orji, R., Vassileva, J., & Mandryk, M. (2012). Towards an Effective Health Interventions Design: An Extension of the Health Belief Model. Online Journal of Public Health Informatics, 4(3), 1-32.

Singal, K., Kamat, P., Gores, G., & Shah, V. (2014). Alcoholic Hepatitis: Current Challenges and Future Directions. Clinical Gastroenterology and Hepatology, 12(4), 555-564.

Thursz, R., Richardson, P., Allison, M., Austin, A., Bowers, M., Day, C.,… Forrest, E. (2015). Prednisolone and Pentoxyfylline for Alcoholic Hepatitis. The New England Journal of Medicine, 372(16), 19-28.

Alcoholic people spend most of their time in pubs, nightclubs, casinos and other entertainment joints that sell alcohol. The atmosphere in these places is very noisy as a result of loud music that is normally played as well as the noise made by those taking alcohol. Some alcoholics are always noisy in the course of their interactions under the influence of alcohol.

The crazy atmosphere has left many communication experts wondering how this group of people is able to interact and socialize within its context. Observing alcoholics from a distance paints a picture of normal people going about their normal business, but that is not exactly the case. The mode of interaction of alcoholics is different from that of non-alcoholics because the two categories of people operate in different states of mind.

There have been conflicting opinions on whether alcoholics interact in a different way compared to non-alcoholics. Some communication experts argue that there is no difference in the way alcoholic people interact but this has always been a bone of contention. In order to understand how alcoholics interact, it is important to first of all understand the effect of alcohol on a person the moment they start drinking.

To begin with, alcohol weakens the communication between the cerebellum and the frontal lobes of the brain. These two parts of the human brain enable a person to make decisions and judgments. Many alcoholics appear very excited after drinking because a good number of them drink alcohol to escape from the realities of life.

Some people become very talkative after taking alcohol compared to instances when they are sober. The difference in conduct, communication and judgment between an alcoholic person and the one who is sober tends to justify the fact that alcoholics interact differently. This paper will explain why the interaction between alcoholics is different from the way non-alcoholics interact.

Alcoholism affects the communicative norms of a person in many different ways. Alcohol makes a person gather a lot of courage to talk to everyone within the entertainment joint without any fear. This false kind of courage disappears immediately the person becomes sober. This is a communicative norm associated with many alcoholics especially in the entertainment joints.

The ability to talk to everyone makes them able to form a lot of friendships. Many alcoholics tend to be very arrogant and vulgar after drinking because their judgment becomes very poor. This communicative norm is what causes a lot of fights in nightclubs and other places where alcohol is sold. The violent interactions are normally stimulated by alcohol and many alcoholics extend this type of behavior to their families.

The communication tone of an alcoholic is very different from that of non-alcoholics. The noisy and almost chaotic atmosphere is brought about by the tone of voices of the people present there. Alcoholics speak in loud voices because they believe that they can only be heard and given attention if they shout.

Poor judgment also contributes to the shouting. Some psychologists believe that alcoholics speak in loud tones to release their frustrations. Alcoholics are motivated to drink by different reasons and this is often reflected in their behavior after drinking. What alcoholics speak and how they speak can enable a person realize the reason behind their drinking.

Those alcoholics who are very frustrated with life will tend to be very violent and moody compared to those who go to drink for enjoyment.

Alcoholics who are led to drink by stress will always want to pick up fights with everyone as a way of venting their frustrations. Some of the violent scenarios experienced in entertainment joints are caused by different reasons. Some alcoholics are provoked to fight while others just engage in fights to demonstrate their superiority and fighting prowess.

Apart from some violent cases experienced in entertainment joints, there are other instances where alcoholics demonstrate friendship and generosity. Some alcoholics interact in a friendly manner by other alcoholics in entertainment joints despite their state of alcoholism. The alcoholics can engage in friendly conversations as they discuss and argue about different matters such as politics, relationships and sports.

Some businessmen find drinking joints as appropriate places to strike business deals. Alcoholics always show solidarity with one another and this is normally seen when one of them is attacked. Alcoholics will go out of their way to defend their colleagues no matter what. Some people become very generous after taking alcohol compared to when they are sober.

This new found generosity comes as a result of poor judgment and need to show off to colleagues. Alcoholics will go out of their way to buy drinks for fellow alcoholics even if it means spending the last penny they have. Alcoholic people feel that they own the entire universe and that there is nothing they can not afford.

This is the reason why many alcoholics spend a lot of money on buying alcohol for fellow alcoholics at the expense of their families. It can be very surprising to find out that some alcoholics interact more freely than sober people.

Although a person who is drunk may not speak clearly, he or she is always understood by fellow alcoholics. The reasoning capacity of alcoholics is always affected by alcohol and therefore what they say and discuss in their conversations may not be appropriate and civil.

Alcoholics in drinking joints interact freely with every person without fear and self-depreciation. Alcohol gives a person a false sense of courage that disappears the moment they become sober. The immorality experienced in many entertainment joints is often caused by alcoholism.

Poor judgment and decision making combined with the false courage brought about by alcohol may push a person to commit some immoral acts that they often regret after they become sober. Prostitutes in entertainment joints take advantage of this weakness to lure alcoholics. The courage gained from alcohol makes some alcoholics to even seduce women that they could not speak to while sober.

Many alcoholics become very social and interactive only after drinking. Strip clubs are the worst of all the entertainment joints because the mind of alcoholics is often corrupted by the nude women that dance before them. This kind of persuasion in a way affects the way alcoholics interact in different joints.

Many alcoholics have poor judgment and will therefore engage in a sexual relationship with any man or woman without any rational thinking. Some of these relationships only last when a person is not sober. Alcoholics tend to have multiple sexual partners compared to non-alcoholics due to the influence they get from entertainment joints. The other thing worth mentioning is the level of interaction among alcoholics.

Any two people who are drunk interact and communicate at the same level regardless of their socio-economic class. Alcohol puts people in the same frame of mind and therefore class does not matter in this state of mind.

A person who is considered low class can interact freely with celebrities and other prominent people without feeling intimidated. A person under the influence of alcohol does not fear anyone and will always speak freely to any person without fear. On the other hand, celebrities tend to forget their position in the society and in turn interact freely with other alcoholics without caring.

The issue of class only comes when the two categories of people become sober. Alcohol in a way breaks the socio- economic barriers that hinder socialization. Despite the different classifications in entertainment joints, interaction among alcoholics has never been affected. The VIP section in many entertainment joints does not really matter if alcohol is sold there.

What prevents celebrities from interacting with the common people in entertainment joints is their security detail that tries to protect them. An alcoholic celebrity interacts and behaves in the same manner as other alcoholic people.

Alcoholic men and women interact, communicate and behave in the same manner as men. The number of women who are becoming alcoholic is increasing by the day because the modern woman feels more liberal.

The number of women that frequent entertainment joints has gone up and therefore affects the interaction patterns in entertainment joints. Alcoholics understand each other in the course of their interactions that a sober person. Alcoholic people have different communication signs that they use to communicate and the signs can not be understood by a sober person.

Alcoholics like company and that is why they go to entertainment joints to enjoy the type of company they crave for. Many alcoholic people do not like taking alcohol in isolation and, therefore drinking joints are always full to the brim. Entertainment joints are places for alcoholics to break their boredom and loneliness by interacting with other people. Alcoholics become very honest the moment they start getting drunk.

Entertainment joints are perfect places for alcoholics to vent out what is in their hearts. Some people speak out their problems loudly while others just share with their friends. Alcoholics are always reluctant to share their problems in their sober minds. Some alcoholics find entertainment joints as a perfect place to interact freely by sharing problems.

In conclusion, it is always difficult to understand what takes place inside entertainment joints if a person has never been there. The atmosphere in entertainment joints is very complicated and requires careful observation to actually understand what actually takes place in those places.

Alcoholic people interact differently from sober people and it is often difficult to comprehend their communicative norms without having observed them closely. The influence that alcohol has on a person makes them communicate and interact in a different manner compared to sober people. Alcoholic people operate within a different state of mind that is far from reality and, therefore alcoholics always interact differently.

The behavior of alcoholic people is never dependent on the sex, age and socio-economic class of a person. Alcoholic people understand each other very well because they have unique communicative norms associated with them. The discussion in this paper confirms that alcoholic people interact and communicate differently from non-alcoholic people.

Cirrhosis, the eighth leading cause of death in the United States with a prevalence rate of 0.27%, is the end result of a hepatocellular injury that leads to both fibrosis and regenerative nodules throughout the liver. In its advanced stages, it is often considered to be irreversible. Nevertheless, specific medication aimed at the fundamental cause of liver disease may enhance or even reverse cirrhosis at earlier stages.

Causes of cirrhosis include chronic viral hepatitis; alcohol; drug toxicity; autoimmune and metabolic liver diseases, including non-alcoholic fatty liver disease; and miscellaneous disorders (Papadakis & McPhee, 2019). Celiac disease appears to be associated with an increased risk of cirrhosis. Many patients have several risk factors, for example, hepatitis and alcohol use; regarding the pathophysiology of cirrhosis, there two primary components: hepatic fibrosis and regenerating liver cells. Cirrhosis is a diffuse process in which the normal lobules are substitute by architecturally abnormal nodules separated by fibrous tissue (Muriel, 2017). The nodules are usually caused by regenerative hyperplasia following hepatocellular injury (Muriel, 2017). Such nodules are functionally less efficient than normal hepatic parenchyma, and there is a serious disturbance of vascular relationships (Muriel, 2017). The clinical manifestations of cirrhosis are the consequences of hepatocyte dysfunction, portosystemic shunting, and portal hypertension. Cirrhosis may have no signs or symptoms until liver damage is extensive. The common symptoms are fatigue, muscle cramps, and weight loss. When cirrhosis is advanced, anorexia is usually present, with associated nausea and occasional vomiting.

Patients diagnosed with cirrhosis should be informed about the necessity to refrain from alcohol, keep to a low-salt diet, eat sugar and fat in moderation. The diet should be palatable, with adequate calories and protein, and, in cases of fluid retention, sodium restriction. General treatment includes the HAV, HBV, and pneumococcal vaccines and a yearly influenza vaccine (Papadakis & McPhee, 2019). Liver transplantation in suitable candidates is curative.

Alcoholic fatty liver disease and non-alcoholic liver disease are two common illnesses that lead to cirrhosis. Although both diseases have similar pathological spectra, their epidemiological and clinical characteristics are different. The main cause of alcoholic liver disease is the excessive intake of alcohol, whereas the principal causes of nonalcoholic liver disease are obesity, diabetes mellitus, and hypertriglyceridemia (Papadakis & McPhee, 2019). In general, the information about the alcohol consumption of a patient can help to differentiate nonalcoholic fatty disease from alcoholic liver disease. Exceptions are the cases when a patient has strong risk factors for NAFLD while consuming alcohol excessively at the same time.

References

Muriel, P. (Ed.). (2017). Liver pathophysiology: Therapies and antioxidants. New York, NY: Academic Press.

Papadakis, M.A., & McPhee, S.J. (2019). Current medical diagnosis and treatment (58th ed.). New York, NY: McGraw-Hill Education.

Disease process

Alcoholic cirrhosis is a permanent liver damage resulting from prolonged inflammatory and noxious effects of alcohol (Hauser, 2005). In this condition, normal liver cells are substituted with scar tissues hence fibrosis and subsequent nodulation. Occurrence of fibrous tissues in the liver may lead to portal hypertension and consequent liver failure. The onset of alcoholic cirrhosis is proportional to the amount and period of ethanol intake (Fairbanks, 2010). Other risk factors may include an individual’s genetic constitution, environmental factors such as availability of alcohol and an individual’s gender (females are more vulnerable than males). Furthermore, the disease affects ten to fifteen percent of individuals who abuse alcohol for a period of about ten years and above. Alcoholic cirrhosis is viewed as a terminal phase of alcohol liver destruction.

Alcohol breakdown in the body occurs in the liver and partly in the alimentary canal. In the liver, there are 2 mechanisms of ethanol biosynthesis and they include “alcohol dehydrogenase and cytochrome P-450 (CYP) 2E1” pathways (Fairbanks, 2010). Alcohol dehydrogenase pathway involves ‘hepatocyte cytosolic enzyme’ which participates in transformation of ethanol to acetaldehyde. Acetaldehyde is then synthesized to acetate by ‘acetaldehyde dehydrogenase enzyme’ found in the mitochondria (Fairbanks, 2010). In addition, cytochrome P-450 2E1pathway participates in synthesis of ethanol to acetaldehyde.

Liver destruction is attributed to a combination of various pathways. Two enzymes are involved in reduction of Nicotinamide Adenine Dinucleotide (NAD) to form NADH (Lueckenotte, 2006). As such, the equilibrium between NAD and NADH is interrupted and this restricts gluconeogenesis process and also stops the oxidation of fatty acids. Cytochrome P-450 2E1 gets up-regulated in prolonged ethanol intake and it promotes the production of gratis hydrogen radicals via oxidation of hydrogenated ‘Nicotinamide Adenine Dinucleotide Phosphate’ (NADPH) to NADP (Fairbanks, 2010). Moreover, persistent intake of ethanol excites ‘hepatic macrophages’ which lead to formation of “tumor necrosis factor α (TNF-α)” (Fairbanks, 2010). This factor causes the mitochondria to generate more unstable oxygen radicals which enhance oxidative tension. Oxygen tension created leads to apoptosis and formation of fibrous tissues. This condition is severe in individuals who lack enough antioxidants like vitamin E. Gratis radicals start peroxidation of lipids and this as well leads to irritation and fibrosis. In addition, irritation is induced by acetaldehyde linked to cell proteins leading to creation of adducts that act as antigens (Fairbanks, 2010).

The clinical manifestation of alcoholic cirrhosis includes nausea and vomiting, exhaustion, weight loss and loss of appetite (Filbin, 2004). Besides, the disease may have symptoms like jaundice and pruritus as well as unusual diagnostic findings such as “thrombocytopenia, hypoalbuminemia, coagulopathy” (Fairbanks, 2010). In addition, the condition may be manifested by development of portal hypertension indicated by “variceal bleeding, ascites, edema and hepatic encephalopathy” (Fairbank, 2010). Furthermore, the condition may result to malnutrition and intestinal bleeding.

Pharmacologic management of the disease process

The condition is irreversible and treatment is aimed at checking further disease progression and also to control complications (Lehne, 2010). Stopping to take alcohol is an important step in treatment of alcoholic cirrhosis. However, disease victims may fail to recover completely and medical assistance and hospitalization is of great importance. Hospitalization is aimed at helping individuals with signs such as jaundice, encephalopathy and bleeding in the stomach (Wolf, 2010). Moreover, individuals who present to the clinic with renal failure, signs of dehydration as well as decreased liver activity may require hospitalization.

Blood pressure drugs such as beta-blockers assist in reduction of portal hypertension (Lippincott & Wilkins, 2005). Beta-blockers are drugs like nadolol and propranol. Propranol can also be used to control bleeding of the esophagus. The drug has generic names such as AstraZeneca, propranol hydrochloride and Wyeth. It has various trade names and some of them include Inderal, Deralin, Bedranol and Inderal LA among others (Wolf, 2010). The drug is readily absorbed in the body and its co-administration with meals seems to enhance its bioavailability. Propranol works by blocking the activity of neropinephrine as well as epinephrine at beta sites one and two of adrenergic receptors. Appropriate plasma concentrations of the drug are between 10-100ng/ml. Concentrations of above 200ng/ml may be toxic. The drug may have adverse effects in individuals suffering from shortness of breath, high blood pressure and distress as well as bradycardia. In addition, it should be used sparingly in patients having diabetes mellitus, phaeochromocytoma and in individuals taking other medications which can cause bradycardic effects.

Hemorrhage in the alimentary canal, vomiting and agony as well as nausea may be treated with drugs like sandostatin (Wolf, 2010). It is preferred as a first line drug and it is initially administered three times a day with a dosage of 100-500 µg. The drug has no known contraindications and it is appropriate to take it with meals rich in protein. It works by controlling the activities of “endocrine and exocrine glands” (Wolf, 2010). Diuretics, also known as water pills, are used to check the levels of fluid in legs and stomach (abdomen). These drugs include Spironolactone, also known as Aldactone, and Lasix, also known as Furosemide. These drugs are considered as second line chemotherapeutics. According to Wolf (2010), aldactone works by “blocking aldosterone receptors at the distal tubule”. Three hundred two five hundred milligrams should be administered on daily basis. The drug may lead to complications like “hyperkalemia, gynecomastia, and lactation” (Wolf, 2010). In such conditions, drugs like ‘amiloride and triamterene’ can act as alternative in individuals experiencing gynecomastia. The other drug, Furosemide, is either administered individually or together with spironolactone. The drug dosage is 40 to 240 mg/day and it is partitioned into one or two doses. The drug works by barring the re-absorption of sodium ions in the ‘loop of henle’. When the two drugs are used at the same time, patients rarely require potassium repletion (Fairbanks, 2010).

In addition, a patient may be treated with Lactulose, a drug that manages “hepatic encephalopathy, brain and nervous system” as a result of ammonia accumulation in blood (Wolf, 2010). This drug is a synthetic sugar (disaccharide) that enhances absorption of ammonia from tissues to the alimentary canal and prohibits the intestines from producing ammonia since the liver function on its elimination is compromised. At first, a patient is treated with 30ml two times a day and the amount is increased until the disease victim gets wet stool. However, increment of dosage may lead to “diarrhea, abdominal cramping, or bloating” (Wolf, 2010). As such, high dosage may be given using cathartics techniques. Besides, ammonia bacteria in the alimentary canal can be checked by use of antibiotic such as neomycin, metronidazole, oral vancomycin and quinolones as well as paromomycin (Rosdahl & Kowalski, 2007). However, neomycin may lead to problems of “nephrotoxicity and ototoxicity” (Wolf, 2010). An alternative to this drug may be Rifaximin, also known as Xifaxan. Other antibiotics, such as norfloxacin may be used to manage bacterial infection in case of gastrointestinal bleeding.

Proper nutrition should be given to individuals who mainly complain of anorexia and those with ascites (Wolf, 2010). They should be given sufficient amounts of proteins as well as calories. In addition, nutritional supplements and liquids may be given. Excessive fear of proteins may lead to exaggerated muscle wasting. Zinc sulphate (220mg) on daily basis may be used to increase appetite in addition to its effects on muscle cramps and hepatic encephalopathy (Wolf, 2010). Additionally, a physician may recommend upper endoscopy if the patient is experiencing internal bleeding like in the esophagus and verices. In a situation where the liver is highly damaged, transplant may be the only remedy. This is a risky operation and it requires administration of drugs that suppress the immune system so that it does not reject the new organ. The complications of this remedy are usually fatal.

Nursing implications in the use of these medications

The medication for alcoholic cirrhosis requires nurses to continually assess the patient’s fluid volume (Lueckenotte, 2006). One major function of the liver is generation of proteins that bar water leakage from blood vessels. However, in alcoholic cirrhosis, this function is compromised and water is allowed to accumulate in body cavities (Wolf, 2010). This leads to conditions like edema and ascites as well as unnecessary weight gain. Thus, appropriate fluid intake is necessary to avoid excessive water in body cavities. Individuals suffering from alcoholic cirrhosis should be limited to taking between 500ml to 1000ml per day (Wolf, 2010). Furthermore, individuals should be given a balanced diet rich in calories and containing sufficient proteins. Patients suffering from alcoholic cirrhosis may have signs of malnutrition (less than body requirement) as a result of disease process. Appropriate diet helps to control muscle wasting and provides the body with necessary energy. In addition, the patient may be put on constant vitamin K injection so as to enhance blood clotting and therefore minimize bleeding (Lueckenotte, 2006). Besides, the nurse may advise the patient to cease drinking since it leads to aggravation of the condition.

Furthermore, nurses should assess the patient’s rate of gaseous exchange. Normally, individuals suffering from alcoholic cirrhosis may have difficulties in breathing due to excessive pressure exerted on the diaphragm by ascites fluid (Wolf, 2010). Therefore, the patient should be given appropriate amounts of water and allowed to rest between activities. This helps to eliminate the problem of excessive fluids and increased demand for oxygen respectively.

Alcoholic cirrhosis is a condition affecting a big percentage of individuals who drink. It leads to fibrosis and nodulation as well as liver failure if not treated early enough. The main way of dealing with the condition is stopping to consume alcohol. This may be complimented with various drugs which are aimed at treating the disease process and its complications. Such medications require appropriate nursing interventions so as to work well.

References

Fairbanks, K. D. (2010). Alcoholic Liver Disease. Web.

Filbin, M. R. (2004).Blueprints Notes & Cases – Pathophysiology: Pulmonary, Gastrointestinal and Rheumatology. Massachusetts: Blackwell Publishing.

Hauser, C. (2005). Mayo Clinic Gastroenterology and Hepatology Board Review. United States: CRC Press.

Lehne, R. A. (2010). Pharmacology for Nursing Care (7th Ed.). St. Louis, MO: Saunders Elsevier.

Lippincott, W., & Wilkins. (2005). Pathophysiology: a 2-in-1 reference for nurses. United States of America: Library of Congress.

Lueckenotte, Annette G. (2006). Gerontologic nursing. Philadelphia: Elsevier Health Sciences.

Rosdahl, B. C., & Kowalski, M. T. (2007). Textbook of basic nursing. United States of America: Lippincott Williams & Wilkins.

Wolf, D. C. (2010). Cirrhosis. Web.

An Alcoholics Anonymous (AA) group is a group of people who are recovering or are willing to recover from alcoholism. It is a type of group therapy for alcoholics. In most cases, it is combined with other methods in the treatment of alcoholism but can also be applied alone (Mueser, 2003). One of the reasons why various people attend AA group meetings is for support. AA groups are known to provide psychosocial support to alcoholics. When they meet in the groups, they get to know that they are not alone and that someone understands their predicament.

Another reason for attending an AA group meeting is to avoid instances of relapsing. Many people think of AA groups as a means of overpowering any temptations to go back to drinking alcohol. Others attend to boost their self-esteem. Alcoholism is known to lower the self-esteem of the victims and thus being in a group of people with similar problems helps in regaining one’s self-esteem.

AA groups are also known to provide a safe environment for alcoholics to share their experiences with each other. The belief is that a problem shared is the same as a problem that is partly solved. Since AA groups are attended on a volunteer basis, the participants are always ready to talk about their experiences as alcoholics.

The primary objective of an AA group is to help alcoholics recover from alcoholism. This is achieved through therapy sessions under the guidance of a counselor. Another primary objective of AA groups is for the members to provide support to each other in the process of healing from alcoholism. The secondary objective of AA groups in the provision of psychosocial support to the group members and for them to help each other get integrated back into society. Those members who have fully recovered are the ones who help the recovering alcoholics by re-orienting them to a sober life. They do this through follow-up meetings and visits to the recovering alcoholics so as to ensure full recovery from the problem of alcoholism.

The role of individual members in an AA group is to share their experiences, stories, perceptions, and views about alcoholism. They do this voluntarily with a view of enlightening each other. Through sharing stories and experiences, they are able to acknowledge the fact that alcoholism is a life-threatening problem that must be solved. The members also have the role of participating in the discussions by asking questions or giving some insights about how best to avoid alcoholism.

The general topics of an AA group include the twelve steps of AA, the problems of alcoholism, diseases related to alcoholism, how to avoid alcoholism, and the benefits of living a sober life (Mueser, 2003). AA groups are primarily organized and moderated by recovering alcoholics who have passed through an AA group in their way to recovery from alcoholism. Recovered alcoholics are best placed to guide other alcoholics because they are beneficiaries of the AA groups. AA groups are usually disaggregated by sex or age. There may be groups of elderly women and men. There are also groups of young people as well as groups of old people (Makela, 1996).

The members of AA groups as mentioned earlier join the groups on a voluntary basis. This means that each member is free to choose which AA group to join. Members can also belong to more than one AA group. During the meetings, members share their experiences and any changes or improvement in their process of recovery. They are also empowered with life skills that enable them to stay busy at all times.

During the meetings, the members are also exposed to the word of God so as to provide spiritual nourishment. Other AA groups organize sports activities in which the members play various games such as football or netball. The games help the members realize that they can spend their free time in constructive activities instead of taking alcohol. When the members join the groups, they are requested to set their own goals and targets in the healing process. The counselors usually keep an eye on the progress of individual alcoholics through monitoring and evaluating their progress based on the goals and targets which they set. Those who show improvements are assigned some activities such as moderation, organization, and facilitation of the AA group meetings.

One of Yalom’s curative factors noted in AA groups is direct advice. This is because, during AA meetings, the members are advised on various issues like the dangers of alcoholism, how to avoid it, and the benefits of doing so. Another factor is that of altruism. This is because many AA groups are moderated by recovered alcoholics. They do this as a way of giving back to society.

The other factor is the development of socialization skills. This is because, during AA meetings, the members are trained on how to socialize with others. The reasoning behind this is that many people take alcohol so as to gain the courage to speak with other people. Socialization skills also enable alcoholics to avoid boredom which leads to loneliness and consequently to alcoholism.

References

Makela, K. (1996). Alcoholics anonymous as a mutual help movement: a study in eight societies. Madison: University of Wisconsin Press.

Mueser, K.T. (2003). Integrated treatment for dual disorders: a guide to effective practice. New York: Guilford Press.

Alcoholics Anonymous, Narcotics Anonymous, or Gamblers Anonymous meetings are a means to help people resist and fight addictions. Some people volunteer to attend such gatherings to find support and mentoring; however, some people are forced to attend a 12-step meeting by court order. I participated in a meeting of Alcoholics Anonymous and determined that 12-step programs play a significant role in treatment of a substance-related or addictive disorder.

I attended an open 12-step meeting with Alcoholics Anonymous to understand its impact on participants. It was difficult for me to determine all the members’ demographic characteristics, since I could only observe, but I have identified some of them from the discussion. First, the number of women and men was nearly equal, but there were slightly more White than Non-White people. Most of the participants looked over 40 years old, although there were a couple of young people in their 20s and 30s.

From the members’ stories and their wedding rings, I can guess that approximately 20% of them are divorced, and 40% are in a couple. In addition, some participants are unemployed, but in general, most of them have average or below-average income. Some of these details were confirmed to me by the organizer of the meeting, without disclosing details.

I find the meeting’s content and organization pleasant, friendly, and helpful despite the topics discussed by the participants. Many of the members knew each other, and they began with an informal greeting and communication. The mentor and organizer started the meeting with a short introduction, greeting and thanking the participants for their persistence to inspire the conversation that followed. After this speech, each participant talked about their successes, failures, and feelings, and the mentor provided comments or encouraged the narrator.

All participants had to introduce themselves and say the period that they abstain from alcohol before starting the story. At the same time, everyone present had to say at least a few words, even if they did not show interest or desire to participate. This small formality seems appropriate to me, since new members can be immediately involved in the process.

In addition, the members could express their opinions and approval politely. At the end of the meeting, the mentor gave instructions and recommendations for the program’s next step and also answered questions. In this way, all participants were given the opportunity to speak, get advice, or new information.

I experienced various emotions during the meeting, but I left it with a sense of hope and sadness. I felt pity and sorrow when participants talked about their failures, struggles, and the pain that their addictions caused. However, I also felt joy when I saw that the narrator felt relief and support. Many times I laughed at the jokes of the participants and wondered at their strength of will. In some cases, I felt sympathy and anger simultaneously for people who did not want to participate in the discussion.

I also respect the mentor who skillfully guides and encourages the participants and helps them in their struggle. At the same time, my main thought throughout the meeting was that most people faced difficult circumstances that made them abuse alcohol. For this reason, I left the meeting with sadness out of sympathy for people suffering from addiction, but I felt hope that the sessions would help them get rid of it.

After attending the Alcoholics Anonymous meeting, I saw that this type of treatment plays a significant role for the participants. Galanter (2016) notes that the question of the meetings’ effectiveness is controversial as studies give different results due to the difficulty of obtaining data from anonymous participants.

For this reason, many scientists question whether meetings play a role in addiction treatment. However, my experience shows that they are essential for many people who need support, compassion, and guidance in their struggle. I have seen that many participants find their strength and motivation to resist addiction in other people.

These meetings can be ineffective for those people whose beliefs do not align with the group. For example, some participants found support in God; however, some people can deny such beliefs. Consequently, if a new member does not find similarities with the group, he or she may not complete the program and continue to abuse. However, this meeting showed me that this type of treatment plays a significant role in overcoming addiction for many people, even if it is not central.

In conclusion, the experience of attending the Alcoholics Anonymous meeting has had a significant impact on my understanding of addiction treatment methods. I cannot claim that this method is 100% effective for all participants, but I can be sure that it helps many people. The central component of these meetings is the support and members’ ability to share their experiences and feelings. In addition, skillful mentoring is a crucial element for the success of such kind of treatment, since it allows members to get experienced advice. Consequently, Alcoholics Anonymous meetings play a significant role in treating alcohol abuse and should be used along with rehab and medications.

Reference

Galanter, M. (2016). What is Alcoholics Anonymous? A path from addiction to recovery. Oxford University Press.

Introduction

Demand and supply are the foundations of economic analysis in the interaction of the two market forms. The law of demand and supply works in divergent ways in the sense that, when prices of commodities change, demand and supply will change in opposite direction holding other factors constant. This depends on the nature of goods as forces of demand and supply are dictated by the type of goods in question.

For instance, demand or supply for some goods will respond more than a change in price as compared to others. Thus, the corrective role played by good-elasticity curves in the market. In addition, besides price effects on demand and supply of goods, changes in technology, climatic conditions, and government regulations such as taxes are also relevant. Companies operate in different market structures such as perfect competition, monopoly, and oligopoly.

This paper will analyze how the consumption of alcoholic drinks behaves in different scenarios. First, it discusses the changes in supply and demand when the government imposes taxes on the alcoholic drink. Secondly, it analyzes the impact of taxes on consumers’ and producers’ welfare. Also, it will discuss how taxes impact on consumption of alcohol in a monopoly and perfectly competitive market. Finally, it will discuss other alternative ways the government of Australia can use to discourage the consumption of alcoholic drinks.

Demand & supply of alcoholic drinks and the impact of taxes on the welfare of consumers and suppliers

Demand and supply of alcoholic drinks

Market equilibrium for alcoholic drinks is attained at the point of intersection of demand and supply curve. Generally, the equilibrium position maximizes the total benefits received by buyers and sellers. Equilibrium condition is not static as any factor which affects demand and supply. For instance, the imposition of taxes will cause an increase in the price of alcoholic drinks (Tewar, 1996, p. 12). This increase causes a movement along the demand and supply curve as illustrated in the figure below.

From the above graph, DD1 is the demand curve for an alcoholic drink while SS1 is the supply curve. Q1 and P1 are the equilibrium price and quantity respectively at ceteris paribus. The imposition of taxes on alcoholic drinks causes an increase in price to a new level P2.

This is captured by movement in the supply and demand price as shown by the arrows. With the increase in prices, suppliers would be willing to sell more quantity of alcoholic at Qs while the consumers will cut their consumption of alcohol to a lower level say Qd. This creates disequilibrium in the market as quantity supplied exceeds demand. In this state, both the suppliers and consumers do not benefit. However, the impact of price on the consumers and suppliers will depend on the responsiveness of alcohol drinks to changes in price (Boyes and Michael, 2008, p. 135).

Impact of taxes on the welfare of consumers and suppliers

The changes in demand and supply can affect both suppliers’ and consumers’ welfare. Mankiw (2009) defines welfare economics as the study of how the allocation of resources affects economic well-being. Welfare economics examines the benefits that buyers and sellers receive from taking part in a market. Welfare analysis focuses on the consumer and producer surplus. Consumer surplus is the difference between the quantity of a good a buyer is willing to pay and the actual amount he pays, while producer surplus is the fiscal value a seller receives for a good less the cost the seller incurs on it (Roger, 2008, p.32).

Consumer surplus captures the price a consumer is willing to pay over and above the equilibrium price (also known as the market-clearing price). Producer surplus is the price a producer receives over and above the cost of production. The demand and supply curve for the initially unregulated firm for alcoholic drinks is shown in figure1.1 below.

From the figure above, the original demand curve for the firm is shown by line DD1 and the original supply curve is shown by SS1. Equilibrium price and quantity for alcoholic drinks are P1 and Q1 respectively, holding other factors constant. Before the imposition of taxes, consumer surplus is shown by area A+B+C while the producers surplus is shown by area D+E+F. Since there are no taxes, government revenues are zero.

The total surplus is the area between the supply and demand curves unto the equilibrium quantity and it is area A+B+C+ D+E+F (Mankiw, 2009, p.156; Tewar, 1996, p. 67). The imposition of taxes affects the prices of alcoholic drinks. The price paid by the buyer increases from P1 to Pd. This reduces the consumer surplus to area A only. The price received by the supplier declines from P1 to Ps. This reduces the producer surplus to area F only. The quantity sold falls from Q1 to Q2. The total government revenue is captured by area B+D. The total surplus in the market is now shown by area A+B+D+F (Boyes and Michael, 2008, p. 168).

The imposition of taxes causes a change in welfare. Consumer and producer surplus declines while government revenue increases. The total surplus declines by area C+E. This implies that the loss from the consumers and suppliers exceed the total revenue received by the government. This loss is known as a deadweight loss. Mankiw (2009) defines it as the reduction in overall surplus due to market distortions.

Taxes results in deadweight losses since it prevents sellers and buyers from achieving gains from business (Mankiw, 2009, p.157). Therefore, the net effect of an increase in tax by the government of Australia is a reduction of the welfare of the society (producers, consumers, and the government).

Elasticity of demand of alcoholic drinks and disequilibrium in the market of alcohol

Elasticity of demand of alcoholic drinks

Elasticity is a measure of responsiveness of demand or supply to changes in market condition. Price elasticity of demand is a measure of responsiveness of quantity demanded of a good to changes in own price (Rittenberg and Tregarthen, 2009, p.28). Consumption of alcoholic drinks will change in different ways depending on the elasticity of alcohol. Assume that the demand of alcohol is perfectly price inelastic. An increase in price of alcohol will not affect the quantity consumed as shown in the figure below.

From the above graph, the equilibrium price and quantity are P1 and Q1 respectively, holding other factor constant. Since alcohol is perfectly inelastic, the demand curve takes a vertical line as shown by DD1. Supply curve is upward sloping as shown by SS1. An increase in price resulting from imposition of taxes causes an increase in price to P2. The quantity demanded will not change while the quantity supplied will increase creating disequilibrium (Bernanke and Frank, 2003, p. 122). Therefore, imposing taxes on a perfectly inelastic demand will not change consumption of alcohol.

Quantity If the demand curve of alcoholic drinks is inelastic, an increase in price would lead to a less than decline in quantity demanded. That is the quantity demanded changes by a smaller ratio than price. On the other hand, if demand is perfectly elastic, change in price will lead to a more than change in the consumption of alcohol. Demand is more than responsive to change in price (Bernanke and. Frank, 2003, p. 122; Rittenberg and Tregarthen, 2009, p.29). Changes in demand and supply are shown in the figure below.

In the graph above, the demand curve is DD1 while the supply curve is SS1. The equilibrium quantity is Q1 while the equilibrium price is P1 ceteris paribus. An increase in price say to P2 leads to an increase in quantity supplied. The change in consumption cannot be quantified as quantity consumed changes infinitely. Imposing tax on such a product may adversely affect the government revenue. However, if the alcoholic drink is elastic then an increase in price will cause a more than change in consumption. That is a unit change in price of alcohol will lead to a more than one unit decline in quantity demanded (Rittenberg and Tregarthen, 2009, p.29).

Disequilibrium in the market for alcohol

Equilibrium position in the market is vital as it is the point where both suppliers and consumers benefit. Increase in price of alcohol causes distortion in the equilibrium as the quantity supplied exceeds the quantity demanded as consumers will be forced to cut their intake of alcoholic drinks. This creates a situation of excess supply or a surplus in the market (Mankiw, 2009, p. 77). In this situation, the suppliers will be the most affected as they cannot sell all they want at the going market price. Imposition of taxes on alcoholic drinks will affect suppliers more than the consumers. However, this would also depend on the ability of the supplier to shift the tax burden on to the consumer.

Purpose of imposition of taxes

From the article, the government of Australia imposes taxes with an aim of discouraging consumption alcoholic drinks especially, those that are harmful to the health of the citizens. The exercise will greatly boost the bottom line of the budget by as much as $2.9 billion over four years (Gordon, 2010, p.1). From above analysis, it is clear that imposition of taxes will adversely affect suppliers and not the consumers as it is intended. Also it will lead to a loss in welfare. This implies inefficiency in the economy. Ultimately, it does not achieve the objectives of discouraging consumption. From the article, “the Preventive Health Taskforce recommended a rationalized tax and excise regime for alcohol that discourages harmful consumption and promotes safer consumption” (Gordon, 2010, p.3).

In the view of World Medical Association (2011), the government of Australia can

“advocate for comprehensive national policies that incorporate measures to educate the public about the dangers of hazardous and unhealthy use of alcohol, including, but not limited to, education programs targeted specifically at youth, create legal interventions that focus primarily on treating or provide evidence-based legal sanctions that deter those who place themselves or others at risk, and put in place regulatory and other environmental supports that promote the health of the population as a whole” (World Medical Association, 2011, p.1).

The government can also consider,

“promoting national and sub-national policies that may include setting of a minimum legal purchase age, restricted sales policies, restricting hours or days of sale and the number of sales outlets, increasing alcohol taxes, and implementing effective countermeasures for alcohol impaired driving (such as lowered blood alcohol concentration limits for driving, active enforcement of traffic safety measures, random breath testing, and legal and medical interventions for repeat intoxicated drivers).

Restrict the promotion, advertising and provision of alcohol so that there are fewer social pressures to consume alcohol. Support the creation of an independent monitoring capability that assures that alcohol advertising conforms to the content and exposure guidelines described in alcohol industry self-regulation codes” (World Medical Association, 2011, 1).

The government can also work collaboratively with national and local medical societies, specialty medical organizations, concerned social, religious and economic groups (including governmental, scientific, professional, nongovernmental and voluntary bodies, the private sector, and civil society) to reduce harmful use of alcohol and increase the likelihood that everyone will be free of pressures to consume alcohol and free from the harmful and unhealthy effects of drinking by others; and promote evidence-based prevention strategies in schools.

Finally, in order to protect current and future alcohol control measures, they can advocate for consideration of alcohol as an extra-ordinary commodity and that measures affecting the supply, distribution, sale, advertising, promotion or investment in alcoholic beverages should be excluded from international trade agreements (World Medical Association, 2011, p.1).

Perfectively competitive market

Mankiw (2009) defines a perfectly competitive market as a market with many buyers and sellers trading identical products so that each buyer and seller is a price taker. This market structure is characterized by free entry and exit, sellers and buyers are well informed about the prices and both established and new firms have same costs (Mankiw, 2009, p. 303). The graph of a single firm operating in perfectively competitive market is shown below.

The figure shows short run Marginal cost curve (MC), Average total cost (ATC), short run average variable costs (SAVC), average variable cost (AFC) and revenue curves for a firm in a perfectly competitive market. The price is equal to the average cost and marginal revenue. This is due to perfect information about prices in the market. Equilibrium point is attained at the point where marginal revenue intersects the marginal costs curve. The equilibrium quantity is Qeq while the equilibrium price is P (Roger, 2008, p.78).

Imposition of taxes on perfectively competitive market

Assume that a lump sum tax is imposed on a firm selling alcoholic drinks. This will increase the fixed cost since lump sum tax is like a fixed cost to the firm. The increase causes an upward shift in the short run average total costs (SATC) and the average fixed cost (AFC). The average variable cost (SAVC) and the marginal cost (SMC) will not be affected given that the SMC curve is the supply curve of the firm.

From the graph, when taxes are imposed, the average fixed costs shifts outwards from AFC1 to AFC2. Similarly the average total costs also shifts from ATC1 to ATC2. The marginal cost, marginal revenue cost and short run average variable cost curves do not change. Equilibrium is the point of intersection of marginal cost and marginal revenue curve. From the graph, there is no change in the equilibrium position of the firm in the short run (Prusty, 2010, p.170).

Assume that the firm was operating in the long run before imposition of taxes and it was in equilibrium just earning normal profits. It will not be able to cover its higher (shifted) average total costs (SATC1) may be forced to go out of business in the long run. Consequently, in the long run, market supply curve will shift outwards (Dwived, 2006, p.247). The movement in the long run curve is shown in the graph below.

In the long run both the supply and demand curves are straight lines. They are obtained by summation of all short run curves. The initial supply curve is S while the demand curve is D. The equilibrium point is at point E with output at Q1 and price at P1. Imposition of taxes increases the cost of production of the alcoholic drinks, this causes the supply curve to shift outwards say from S to S1. The shift leads to a new equilibrium point E1 with increased prices to P2 and reduction in quantity produced to Q2. We can deduce that,

“In the short run, the lump sum tax will not affect the SMC curve and the firm will continue to produce the same output as before the imposition of tax. However in the long run, the industry will produce less output if there is imposition of lump sum tax. This is because of higher average total costs and some firms will go out of business if they cannot recover the increased average costs by selling the product at a higher price” (Prusty, 2010, p.172).

In the long run, the firm may be forced to shut down.

Taxes on a monopoly firm

Monopoly is a firm that is a sole seller of a product without close substitutes (Mankiw, 2009, p. 300). A monopoly remains the only seller in its market because other firms cannot enter the market and compete with it. Barriers to entry are from three main sources, first, “if a key resource required for production is owned by a single firm, also government can give a single firm exclusive rights to produce some goods or services and if a single firm can produce output at a lower costs than can a larger number of producers” (Mankiw, 2009, p.301). Monopoly firms always make supernormal profits.

This can be attributed to the fact that they have a declining average costs. Also, monopoly has the ability to influence price of its output. The demand curve of a monopoly is downward sloping. This indicates that if a monopolist raises the price of its good, consumers buy less of it. This provides a constraint on a monopoly’s ability to profit from its market power.

Government can also impose taxes on a monopoly as a way of regulating such firms (Dwived, 2006, p.246). Assuming that the alcoholic drinks were being sold in a monopolist market, the graphs will be as shown below.

Unregulated monopoly would produce Q1 units and charge a price of P3. This price is more than the equilibrium price enabling it to make excess profits. The excess profit is represented by the area MT per unit. “If the government intends to regulate monopoly price allowing some super normal profit, then one reasonable price is P2 where LMC=AR. If the price is fixed at P1, the monopolist would be left with normal profits only while output is maximum at Q3 under the given costs and revenue conditions. If price is fixed at P2, the monopolist gets some excess profit but the output is less than that at P1 by Q3-Q2” (Dwived, 2006, p.247). In both cases, if tax is imposed on the alcoholic drink, the monopolist would produce more output.

Reference List

Bernanke, B. and Frank, H. (2003) Principles of Microeconomics, 2nd ed., New York: McGraw Hill.

Boyes, W. and Michael, M. (2008) Microeconomics, 8th ed., New York: Joe Sabatino.

Dwived, D. N. (2006) Microeconomics: Theory and Applications, 1st ed., New Delhi: Dorling Kindersley (India) Pvt. Ltd.

Gordon, J. (2010) Tax Shake-up to Hit Beer, Wine Prices. Web.

Mankiw, G. N. (2009) Principles of Microeconomics, 6th ed., New York: Joe Sabatino.

Prusty, S. (2010) Managerial Economics. New Delhi: Asoke K. Ghosh, PHI Learning Private Limited.

Rittenberg, L. and Tregarthen, T. (2009) Principles of Microeconomics. 2^nd ed., USA: Flat World Knowledge, Inc.

Roger, A. A. (2008) Economics. New York: Joe Sabatino.

Tewar, D. (1996) Principles of Microeconomics, New Delhi: New age international (P) Limited, publishers.

World Medical Association (2011) “WMA Statement on Reducing the Global Impact of Alcohol on Health and Society”. Web.