Case Study One
A 28-year-old man presented for treatment of severe binge-alcohol use and related criminal justice issues.
John had a history since his late teens of heavy bouts of drinking with his peer group.
His parents attended the assessment with him and gave a collateral history which described their son as a “Jekyll and Hyde character” when he was drinking. He became physically and verbally abusive. This led to numerous breaches of the law including public disturbances,
malicious damage, assault and drunk driving offences. At the time of the assessment he was on probation. He also used cannabis from time to time but no other illicit
drugs. He engaged in an outpatient treatment programme and is currently abstinent for the past month. There have been a number of major studies examining the role of alcohol and crime in young drinkers. In the UK in 2003 the Home Office carried out a study entitled Alcohol, crime and disorder: a study of young adults. There were a number of important findings:
• The frequency of intoxication was strongly associated with offending or disorderly behaviour.
• Binge drinkers were twice as likely to have engaged
in arguments during or after drinking, four times more. Likely to admin to have taken part in a fight, five times.
As likely to admit to criminal damage and eight times
more likely to admit to a theft than regular drinkers .
• When other confounders were controlled for, offending
and disorderly behaviour during or after drinking
remained strongly associated with frequency of intoxication
• An individual had over four times the odds of committing
a disorderly act during or after drinking if they got
very drunk at least once a week.
In 2010 it was estimated that almost 70,000 in Ireland
were directly related to alcohol with public disorder,
assault and drunkenness offences making up most of the numbers.
This equates to 130 drunken disorderly offences and 40 assaults a day.
In the same period there were nearly 11,000 drink driving offences.
Case Study Two
A 28-year-old female fashion designer presented with a long history of binge drinking and loss of jobs due to absenteeism
Mary was referred by her GP to an outpatient addiction treatment programme. This patient consumed 45 units of alcohol a week usually over consecutive days. The types of drinks varied and included spirits, wine and beer. The periods of binge drinking usually commenced after work and would often finish late into the following morning.
She would encounter periods of amnesia. Loss of days in work was a frequent occurrence and this led to her being fired from her job. She engaged in an outpatient addiction programme and significantly reduced her alcohol intake. She is now drinking within safe limits and has reduced the number of days she drinks to once a week. She is determined to maintain a sensible relationship with alcohol.
Case Study Three
A 30-year-old woman with a history of opiate dependence, severe depression and alcohol misuse was referred to hospital for inpatient treatment.
Julie had numerous admissions to hospital for bouts of depression and heavy drinking. She went through periods of abstinence but these rarely lasted long.She usually drank wine throughout the day (15-20 units) and said she used alcohol to help her mood.
She had been addicted to heroin in the past but stopped using the drug many years ago and was stable on a low dose of methadone.
She was prescribed 5mg diazepam three times daily and did not abuse the drug. She continued to struggle with symptoms of depression and her drinking steadily worsened. She committed suicide by hanging herself.
The link between heavy alcohol use, depression and suicide is well established. People who complete suicide often have positive blood alcohol levels. People who are intoxicated often use more lethal methods and suicides involving alcohol often occur in individuals with no known psychiatric history.