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Monday, May 25, 2009

Treatment Tuesday - Alcohol Dependence

Photo by Sheep"R"Us'

Today’s character therapy assessment comes courtesy of Eric. He’s writing in about his character Roberta*. Roberta is a homeless woman living out of her car on the streets of Denver with her two children. She’s a 24-year-old Hispanic who has been an alcoholic for the past six years or so. Her drink of choice is tequila, which she pretty much drinks every night until she passes out. She feels she is worthless, has a severe confidence problem, loves her children more than anything, but has just about lost all hope.

* Names have been changed to protect the fictional.

In the mental health field, there is quite a difference between substance abuse and substance dependence. Alcohol abuse would be drinking in situations where is it physically hazardous (i.e., driving), having recurrent legal problems for drinking (DUIs), and drinking so much that you fail to fulfill major role obligations at work, school or home. The person would also continue to use despite social/interpersonal problems that are exacerbated by the drinking.

Alcohol dependence is marked by much stronger characteristics, such as tolerance (needing increased amounts of alcohol to achieve the desired intoxication effect), withdrawal symptoms (i.e., sweating, increased heart rate, hand tremors, insomnia, nausea/vomiting, anxiety, fleeting hallucinations or illusions that can be visual, auditory or tactile, and physical motor agitation (i.e., restless, jittery legs).

It’ll be important to add these elements into your characterization of Roberta to make her a believable alcoholic. In addition, people with a substance dependence also take in larger amounts than intended, have a persistent desire and make unsuccessful efforts to cut back. A great deal of her time would be spent in activities necessary to obtain, use, or recover from the effects of the alcohol. Social, occupational or recreational activities would be given up or reduced because of her drinking, and the she would continue drinking despite knowledge that a physical or psychological problem is caused or exacerbated by the substance.

As far as alcohol treatment would go (since you mentioned she would need to go to a facility for detoxifcation and treatment), I would definitely Google this. When I worked at a private psychiatric hospital, I’m pretty sure I remember the Registered Nurse on duty in the Alcohol and Drug unit telling me that alcohol is one substance where you need to be medically monitored while you detox. Something about how the body gets so adjusted to having the substance that without medical intervention, the body could go into shock and the person might die. (Since I’m not a medical professional…you might want to check with a doctor.)

Okay. On to Roberta’s emotional state. You mentioned that she feels worthless and has a severe confidence problem. Feelings of worthlessness usually originate from the family of origin. This is why I asked questions about Roberta’s dad and mother. (Thanks for filling in the blanks I asked in my additional email of questions!)

There are four classic attachment styles identified by John Bowlby. Roberta exemplifies the Ambivalent Attachment style. I recommend you (and anyone else) get the book, Attachments: Why You Love, Feel and Act the Way You Do by Dr. Tim Clinton and Dr. Gary Sibcy. This is a book written from the Christian perspective about attachments. Fascinating for character development. The following is from that book.

Roberta would likely believe/think the following:

1) She is not worthy of love.
2) She is not capable of getting the love she needs without being angry and clingy (although you didn’t specifically mention anger or clinginess…you might want to think about writing these in)
3) Others are capable of meeting her needs but might not do so because of her flaws. (which shows the confidence issue)
4) Others are trustworthy and reliable but might abandon her because of her worthlessness (which speaks directly to the heart of Roberta’s internal dialogue…her mom left, her dad ultimately left by drinking and driving, and her first husband left, as well).

Now we’re stepping into more generalizations, but people with this type of attachment style, therapists have seem some commonalities, such as:

• fear of making decisions,
• rarely expressing disagreement with others
• obsessed with the fear of being left alone (could apply with her children…scared they might get taken away from her, maybe?)
• feelings helpless when alone
• desperately seeking new relationships when others end (which could initially be a needy relationship with Frank when she meets him?)
• perpetually seeking advice
• frequently subordinating themselves to others
• often working below their ability level
• accepting unpleasant tasks to please others
• having a tendency to express distress through medically “unexplainable” physical symptoms rather than admitting to an emotional pain (i.e., headaches while doing something stressful rather than just owning up to the fact that the activity is stressful)
The one fact that might be problematic in this list is the subordinating quality. Hispanic women are not known for this. Even Hollywood portrays Hispanic women as strong and reliable (Jennifer Lopez, Gloria Estefan, Salma Hayek, Eva Longoria Parker, etc.). So consider how you might make this element more culturally acceptable if you decide to include it.

Alright! That’ll do it for today. If you’ve kept with me this long, you’re to be commended. Eric, I hope this helps!

This service is for fictional characters only, so any resemblance to real life examples is entirely coincidental. Any other fictional character assessment questions can be directed to

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Jessica said...

Very interesting post!
It's actually helpful to me, because I think one of my heroine's may have this. How would the character go about recovering from ambivalent attachment? Is therapy necessary or could they recognize their own problems and overcome them? Would becoming a Christian help? Just wondering for my own character. :-)

Jeannie Campbell said...

well, i think anyone who recognizes their problems can achieve some success, but overcoming them completely might be difficult. in my experience, it often takes a third party (therapist or someone else) to HELP the person in realizing this kind of thing.

Katie said...

Your post makes me want to do two things:

1. Write about an alcoholic
2. buy that book!

Great stuff Jeannie!

Marie said...

I just found your blog. What a BRILLIANT idea!

There are many women writing great blogs, but very few with just a completely unique perspective. Cool! :)

I am so happy I stopped by.

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Both comments and questions are welcome. I hope you enjoyed your time on the couch today.