The Cases: March 2021
(Remember you only have to choose and write an answer for one case)
Case 1: Alcohol
Alexa is 24 years old and has been going out drinking with her friends at the weekends since
she was 13. It started with drinking with her older brother and his friends at people’s houses
or in local parks, then from around 15 she was going to pubs and clubs on Fridays and
Saturdays and binge drinking; this has recently extended to include Sundays. Alexa regularly
turns up to work on Monday with a hangover and often has to leave early as she is unable to
focus her energy and concentration; she reports also drinking sometimes in the mornings at
weekends and on Mondays, to help with the hangovers. On a drinking night she can easily
consume 30-40 units of alcohol (mainly wine and ‘shots’), and often forgets details of what
has occurred when drinking. On more than one occasion she has been admitted to hospital
for alcohol-related accidents or through being unconscious. Alexa drinks less frequently from
Monday to Thursday but says alcohol can help her deal with the stress of work. Alexa has
been encouraged to considerably reduce her drinking by her mother and friends, and has
received information about relevant supportive organisations (e.g. Alcohol Change). Despite
this, Alexa continues to drink on a regular basis and consistently drinks more than single
occasion alcohol consumption thresholds would recommend. When asked why she drinks, in
addition to managing hangover and work stress, Alexa says that she always feels awkward in
social situations and could never meet anyone romantically without a few drinks; she finds
this point very upsetting.
Case 2: Stimulants
Bixby has been brought to a Rehab Centre by his parents, who are seeking treatment for his
addiction to stimulants. He is 22 years of age and, in private, reports that he first started using
amphetamine when he was just 15, quickly moving on to use cocaine, crack and most recently
crystal meth. He has also experimented with ‘legal’ stimulants and smokes 20-30 cigarettes a
day, when he can afford to. His parents are both financially secure and give him a generous
allowance every month, as well as giving him extra money whenever he asks. They divorced
when he was 13, which Bixby says “led to a downward spiral of anxiety and aggressive
behaviour”. Bixby has never worked and performed very poorly at school. His parents want to
help him to break his addiction so that he can get a job, make some friends (he seems to have
none) and ‘be normal’; they are particularly worried about his weight and seemingly endless
minor health problems (viral infections, poor teeth, itchy and broken skin). They also worry
about his mental health, as he often seems distant; although he can be very expressive and
animated when talking about conspiracy theories. Bixby seems less concerned about
such problems but is a little worried that he has recently started to develop problems with his
ability to concentrate and to think. He has noticed this through a recent fall in his performance
in video games; which he increasingly spends most of his day playing.
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Case 3: Gambling
Siri recalls early childhood memories of spending hours in penny arcades and her first visit to a
dog-racing track with her father when she was 12. At the age of 16 she started to take up
other forms of gambling; mainly the lottery and scratch cards (sometimes spending over £400
per week on the latter by the time she was 20). Siri feels her problem significantly escalated
when she turned to gambling online: firstly, simple puzzle games for prizes, then bingo and
now mainly “faster win” roulette/casino style games. She plays daily, and often several
sessions in one day. Three years ago, at age 29, she married her long-term boyfriend and they
were soon expecting a baby. Although she was earning good money, her gambling was costing
her more and more. Finally, her wages weren’t enough and she obtained a bank loan and
credit card. Although she planned to stop gambling after the baby was born, Siri has found
that thinking about her child’s future often leads her back to gambling; each time she enters
the online casino she thinks that just one big win would fix her problems and she’d stop
gambling after that. Recently, she was declared bankrupt after building up over £80,000 in
debt and her partner has left her, having previously been unaware of the debts and gambling,
and is seeking full custody of their child (who is currently living with him). Siri was evicted
from her flat and forced to move back in with her parents at the age of 32. Her parents are
supportive of Siri and willing to do whatever they can to help.
Case 4: Sex
Mika is a 48-year-old professional who has been referred for assessment and treatment,
following a conviction for viewing and storing illegal images taken from the internet at work.
The details from his place of work, and from the police case files, show that Mika was
spending 4 or more hours of every working day viewing sexual images. This profile shows a
pattern of escalation of the time spent online in non-work-related activities, over a period of 3
years. In addition, the nature of sites visited has changed from soft- to hardcore pornography,
and towards a range of paraphilias: for example, the record on his seized work computer
shows that whilst early searches including phrases such as ‘nudity’ and ‘sex’, more recent
searches include more ‘specialised’ phrases and combinations relating to bondage, violent
sexual behaviour and to images of underage females; the latter being the reason for his
conviction. There are also very recent searches for links to sites designed to help users to find
sex workers. At the initial assessment Mika is clearly very distressed, feels his behaviour is
‘beyond his control’ and reports often feeling suicidal. He is married but leads a completely
separate life from his wife; and his children, who he also has very little contact with, have left
home. Subsequent meetings confirm a long history of affective problems, for which Mika has
been taking antidepressants (for over 8 years). He believes his use of pornography began as a
way to forget about his problems but has since become ‘all consuming’.
- Explain the individual’s addictive behaviour with reference to relevant addiction theories and research
and then, - Critically discuss at least TWO appropriate treatments/interventions, with reference to relevant evidence to justify the
appropriateness of your choice treatments/interventions for that particular addiction.
Sample Solution
