Case Study 10 Alcohol use disorder and Marital Distress:

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

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

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

3. Give examples of tolerance and sensitization in Kirk’scase.

Case Study:

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

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

Kirk Drinking on the Rise:

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

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

Soon after graduation, he obtained a good job in a prestigioustelecommunications corporation. His new job afforded him anopportunity to drink almost every day, both at lunches and atparties with colleagues and clients. In addition, the young manwould “reward” himself after each workday by pouring himselfexpensive scotch and rum at home. Within a few months of joiningthe work world, he was averaging 12 drinks daily. This patterncontinued for the next 17 years.

In spite of his high level of drinking, Kirk received positivework evaluations and promotions throughout the 17 years. Nor did hehave any legal problems due to drinking. Although he regularlydrove with a blood alcohol level over the legal limit, he had nothad any accidents or arrests.

Michelle Awareness on the Rise:

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

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

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

Alcoholism and Marriage Don’t Mix:

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

At the same time, Kirk was continuing his long-term pattern ofhaving 12 drinks a day, mostly scotch or rum, along with a fewbeers. He usually took his first drink of the day at lunch, when hewent out to eat with colleagues or clients. To start off, thebusinessman would have a couple of scotches while waiting for hismeal. When his food arrived, he would order a couple of beers to gowith the meal. Kirk was under the impression that he was drinkingno more than his lunch companions. However, he was actuallydoubling their consumption—not that they took special notice of hisdrinking. Although outgoing and gregarious at these lunches, Kirk’sgeneral behavior didn’t differ much from that of the others. Hisheavy drinking over the years had caused him to develop a toleranceto alcohol, so his four drinks affected him no more than one or twodrinks might affect someone else.

At least 2 days a week, Kirk had another work-related drinkingopportunity. This was at a private club where his companyentertained important clients. The club had an open bar, withwaiters who took drink orders and automatically brought refills assoon as an empty glass was detected. It would be hard not to drinkin such a place, Kirk once reflected. And of course he had nointention of making any such effort.

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

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

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

Feeling he had done his duty, Kirk poured himself a drink andretired to the den to watch television. He sat there watchingsports for the next hour and a half, pouring himself another coupleof scotches along the way.

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

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

Arguments such as these left Michelle feeling increasinglyunhappy with their life together. Indeed, she and Kirk now barelyhad any life together. In the evenings, they went their separateways. On weekends, they—mainly Michelle—did household errands. Forrecreation, she would attend activities tied to her volunteer work;he would watch sports on television while drinking himself intoisolation. The children would either tag along on Michelle’serrands or hang around the house, receiving only limitedsupervision from Kirk. Over time, Michelle began to considerleaving him.

The Incident:

Kirk and Michelle sat down one evening to do some paperwork fortheir taxes. As usual, Kirk had been drinking throughout theevening, but he was still quite alert and had no problem in sortingreceipts, organizing records, and carrying out calculations. It wasa 2-hour project, and the couple actually worked effectivelytogether, chatting and even joking throughout the task. It was oneof their rare periods of togetherness; how ironic, Michellethought, that it should come over an activity like taxes. They gotthe whole job done that night and both went to bed in goodhumor.

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

Truly upset, Kirk decided that from then on he would have nomore than a couple of beers in the evening. However, after a fewdays, his determination broke down and he returned to his usualpattern of drinking.

After the incident with the taxes, Michelle took to quizzingKirk routinely about events from the day before, and it soon becameclear that the tax affair was not an isolated event. There weremany mornings when he could not recall details from the nightbefore. Michelle finally persuaded her husband to seek professionalhelp with his drinking problem. She had seen an advertisementdescribing a community clinic that specialized in treating alcoholuse disorder and related marital problems through the use ofmarital therapy. Michelle called for information and then, withKirk’s agreement, arranged an appointment for them.