SOCIAL RESEARCH REPORTS

ISSN: 2066-6861 (print), ISSN: 2067-5941 (electronic)

LONELINESS AND ALCOHOL ADDICTION: CASE STUDY

Alexandra Mihaela FERLAI

Social Research Reports, 2019, Vol. 11, Issue 3, pp. 140-152

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https://doi.org/10.33788/srr11.3.10

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 LONELINESS AND ALCOHOL ADDICTION:
CASE STUDY
Alexandra Mihaela FERLAI1

Abstract
The theme of loneliness is one with a very long history, in ancient times being
debated by philosophers and usually regarded from a positive point of view. The
present work does not highlight the positive aspects of loneliness, but aproaches
loneliness as a negative experience that accompanies the use of alcohol. Thus, we
discuss about loneliness as the way in which individuals perceive, experience and
evaluate the lack of communication with others. Then, we examine the relationship
between loneliness and alcohol use, either as a cause, effect or maintenance factor.
The paper highlights the interplay between loneliness and alcohol use and its
importance in specialised treatment of the alcoholics. Also, the purpose of this
paper is to illustrate the imperative need for the specialists to adress the problems
that our clients deal with, from more that just a biological perspective. The case
study illustrates a female’s three attempts to escape alcohol dependence, each of
the three attempts, enriching the intervention in order to compose a multi-faceted
intervention, that we hope it will, ultimately, prove to be complete.

Keywords: loneliness, alcohol addiction, case study, social isolation, emotional

loneliness

Introduction
The theme of loneliness is one with a history that goes back a long time,
to Antiquity, when it was a topic debated by philosophers. They referred to
positive loneliness, a concept used in German literature until 1945 and defined
as the voluntary withdrawal from the daily agitation of life and oriented toward
higher goals, such as reflection, meditation and communication with God. The
present work does not, however, take into account the positive loneliness, but
the loneliness as the way in which individuals perceive, experience and evaluate
the lack of communication with others. The conceptualization and definitions of
1 Medical Center „Laura Catana”, Pianu de Jos, ROMANIA. E-mail: mihaelaferlai@
yahoo.com

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loneliness will be discussed below. Freud never spoke specifically about loneliness,
but talks about the fear of being alone in his chapters on anxiety . He illustrates
this with an anecdote about a child who fears the darkness unless his aunt talks to
him. The child says: “If someone speaks, it becomes brighter” (p. 407).

Developmental perspective
An important factor in developing loneliness in children is the relationship
with their peers. A study conducted on neglected children (neither liked nor
disliked by others) and rejected children (actively disliked by others) showed that
neglected but not rejected children had higher loneliness status than other children
(Asher & Wheeler, 1985; Parker & Asher. 1987. 1993; Parkhurst & Asher. 1992).
Moreover, among those who were rejected, those who were rejected because they
were submissive felt lonelier than those who were rejected because they were
aggressive (Parkhurst & Asher. 1992) and not all rejected children felt alone. The
loneliness of those rejected by the group was depreciated if the rejected child
maintained one friendship (Parker & Asher, 1993). Not all children with poor
interpersonal relationships (not even all neglected children) or those with poor
parental attachment feel alone. One possible answer to the question which of the
children at risk of loneliness actually feel alone can be found in the work of Fox et
al. (Fox.1989a; Fox et al., 1994; Fox, Schmidt, Calkins, Rubin & Coplan, 1996).
They showed that children with negative affectivity who face peer rejection are
more inclined to experience loneliness than children rejected by other children
but who have no negative affectivity as a trait.

Cognitivist approaches to loneliness

The cognitive discrepancy theory, defines loneliness as a consequence of
distorted social perceptions and attributions. Specifically, loneliness is defined as
the distress that occurs when an individual’s social relationships are perceived as
less satisfying than what is desired (Peplau & Perlman, 1982). From a cognitive
discrepancy perspective, it is clear that loneliness is not synonymous with being
alone, nor does the presence of others guarantee protection against feelings of
loneliness (Peplau & Perlman, 1982). Rather, discrepancies between ideal and
perceived interpersonal relationships produce and maintain a feeling of loneliness.
Loneliness is an unpleasant experience that occurs when a person’s social relations
network is significantly deficient, either qualitatively or quantitatively. This
definition has three points of view in common with how most researchers describe
loneliness. First, loneliness results from a deficiency in a person’s social relations.
Loneliness occurs when there is a mismatch between a person’s actual social
relations and the person’s needs or desires for social contact. Secondly, loneliness
is a subjective experience, not synonymous with objective social isolation. People
can feel alone without being alone, or feel alone in a crowd. Third, the experience
of loneliness is aversive. Although loneliness can be an incentive for personal
development, the experience itself is unpleasant and painful.

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 De Jong Gierveld takes into account the values, norms and standards of a
person’s life and those of in the society in which lives. From this perspective,
loneliness is defined as an unpleasant or inadmissible lack in relationships or
in the quality of the relationships. This includes the situation where the number
of existing relationships is smaller than is considered desirable or admissible,
as well as the situation where the intimacy desired by the individual is not
achieved. Thus, loneliness involves the way in which a person perceives, lives
and evaluates one’s own isolation or lack of communication with others. This
definition considers loneliness a multidimensional phenomenon, differentiating
three dimensions: feelings associated with the absence of an intimate attachment
relationship, feelings of inner emptiness and abandonment. The central concept
is the so-called “deprivation” component. The second component refers to the
temporal perspective, the way people see the future evolution of their loneliness.
The third component involves different types of emotional aspects, such as pain,
sadness and feelings of shame, guilt, frustration and despair.

Social skills deficits

Another conceptual approach to loneliness focuses on the deficit of social
skills and personality traits, which impedes the formation and maintenance of
social relationships. Research in the field of social skills has shown that loneliness
is associated with increased focus on one’s own person, lower skills in terms of
attention to partners, a lack of self-disclosure with friends, especially among
women, and reduced participation in organized groups, especially among men
(reviewed in Marangoni & Ickes, 1989). Personality research has shown that
loneliness is associated with depressive symptoms, shyness, neuroticism, low self-
esteem, optimism, low awareness and low levels of agreeableness (Marangoni &
Ickes, 1989). Early studies have suggested that correlates of loneliness regarding
behavior and personality tend to apply only to individuals with chronic loneliness,
not to those with state loneliness, circumstantial (“state-lonely” individuals) whose
loneliness is adequately explained by situational factors (for example, widowhood,
geographical relocation) (Marangoni & Ickes, 1989). More recently, however, it
has been observed that loneliness behaves as a personality trait even when induced
in an acute manner. John Cacioppo conducted a study in 2006 in wich, under
hypnosis, young adults were made to feel alone and then socially connected (or
vice versa, in a counterbalanced order), recalling a time when they felt rejected
and lacked the feelings of belonging, or a time when they were accepted and they
felt like they belonged. Compared to their basic levels of loneliness, people made
to feel lonely through hypnotic suggestions reported significantly more negative
disposition and lower self-esteem, low levels of optimism, social skills, social
support, sociability, extraversion, and agreeableness, and higher levels of shyness,
anxiety, anger, fear of cognitive assessments and neurosis (Cacioppo, Hawkley, et
al., 2006).These results place loneliness as a potential causal factor of self-esteem,
depressive symptoms, shyness, etc.
From a social needs perspective, Robert S. Weiss (1973) outlines a theory of
attachment in which loneliness is determinated by deficiencies in social relationships
that serve specific functions (for example, attachment, social integration, care) .

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Weiss described loneliness as “a chronic distress without redeeming features”
(Weiss, 1973: 15) and distinguished between social loneliness (for example, lack
of social integration), and emotional loneliness (e.g., lack of attachment persons).

Evolutionary approach
The evolutionary analysis, wich emphasizes inclusive fitness, questions the
conceptualization of loneliness as an aversive condition without compensatory
characteristics and instead defines loneliness as an aversive condition that promotes
inclusive fitness by signaling the breakdowns of social connections. The aim of
this signal is to motivate the repair or replacement of these connections (Cacioppo,
Hawkley, et al., 2006). For many species, cubs need little or no parenting to
survive and breed. In contrast, Homo sapiens, is born with the longest period of
extreme dependence compared to any other species. Mere reproduction, therefore,
is not sufficient to ensure that one’s genes will reach the genetic background. In
order for the genes to reach the genetic background, the cubs have to survive
to breed. Moreover, the social connections and the behaviors in which they
engage (cooperation, altruism, alliance) increase the survival and reproduction of
those involved, increasing inclusive fitness. People have populated the Earth as
hunter-gatherers for tens of thousands of years, often in conditions with numerous
shortcomings. The hunter-gatherers, who would have chosen not to return to share
their food and to provide protection for the mother and child (for example, who
felt no loss in breaking social / family ties), would probably have managed to
survive. They reproduce again, but their descendants and, with them, their genes,
would have had much lower chances of surviving and reproducing. In contrast,
hunter-gatherers whose genetic predisposition was inclined to share food with
their family, although it would have reduced their chances of survival, would
have increased their offspring’s chances of survival, and thus the spread of their
genes. Of course, a hunter-gatherer, who survives a hunger, can live long enough
to start another family, suggesting that no single strategy is necessarily the best.
Such an evolutionary scenario suggests that people may have inherited different
tendencies to experience loneliness. Adoption and twin studies in children and
adults have confirmed that loneliness has a considerable hereditary component
(Boomsma, et al., 2005).

Loneliness and alcohol use/abuse and addiction

In 1956, Bell conducted a pioneer study of loneliness and alcohol but this
pioneer work was only a collection of clinical observation. Nerviano & Gross
conducted in 1976 the first empirical study, specifically on loneliness and alcohol
abuse. They started the study based on the common clinical observations that
showed that many chronic alcoholics have high levels of loneliness. They saw the
loneliness of alcoholics either as a part of the specific social deterioration, resulted
from disffunctional use of alcohol, either as a part of the affective problems that
contribute or perpetuate the alcohol consumption. Also, they pointed out that
despite the serious implications that loneliness might have in the recovery process,
there were few instruments to objectively measure the loneliness.

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 Subsequent studies confirm this link between loneliness and alcohol consumption
showing that loneliness is a factor of vulnerabilit for alcohol consumption. Thus,
the first reason would be the use of alcohol as a social lubricant for the purpose
of facilitating interaction (Segal, 1987, Darkes & Goldman, 1993; Monahan &
Lannutti, 2000, Hull & Slone, 2004 ). The second reason would be the use of
alcohol as a self-medication method, in this case, the loneliness motivating the
alcohol abuse through its associated psychological suffering (Carrigan & Randall,
2003).

Alcohol as a social facilitator

Alcohol has uniquely characteristics in order to be used as a tool of socialisation,
particularly in facilitating connection, because of its effects on the subjective
experience of those who consume it. First, alcohol is used as a facilitator in
socialization because it induces higher levels of euphoria, well-being, when
consumed in a group (Darkes & Goldman, 1993; Hull & Slone, 2004 ). More than
just that, alcohol builds the unique experiential interaction, not only because of its
direct effects in alterating the emotional and cognitive state of the user, but also by
offering the occasion for the drinkers to share the experince with others around.
In other words, alcohol may prove especially tempting to the emotionaly lonely
individuals by providing the means to achieve the same state of consciousness
as another (intoxicated) person. So, drinking is “one of the means of coping with
feelings of isolation, creating an illusion of friendship and togheterness” (Segal,
1987).

Alcohol as self medication

Feelings of loneliness may also predict alcohol use to the extent that those
feelings stem from the pain of being with others but feeling excluded. These
feelings of beeing alone, when surrounded by others, is a uniquely painful
experience and loneliness correlates positively with mental health problems like
depression and anxiety (Herttua et al., 2011, Richard et al. , 2017, Caccioppo et
al., 2017). Individuals suffering from this psychological pain, may use alcohol
as a means of numbing psychological sufference or as a means to cope with the
discomfort associated with the unmet need for social connection. This hypothesis
emerges from the work showing that people use alcohol as a buffer against negative
experiences generally ( Mohr, Armeli, Tennen, Temple, Todd, Clark, & Carney,
2005), and alcohol use is highly prevalent in individuals with depression and/or
anxiety (Burns & Teesson, 2002, Butler et al., 2016).
However, these are not mutually exclusive mechanisms. It is not unsual for
an individ to be motivated to use alcohol in order to numb the pain of loneliness
or isolation and, at the same time, to be motivated use alcohol in order to seek
out connection. Either way, regardless of the way loneliness influences the use of
alcohol, it is clear that there is a positive correlation between alcohol consumption
and loneliness (Hornquist, 1984). Also, loneliness is a source of differential
vulnerability to alcohol problems among relatively heavy drinkers due to a lack of
social supports and different perceptions of social pressures. (Sadava & Thompson,

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1986). Thus, loneliness is significant at all stages of alcoholism, as a contributing
or maintaining factor in the growth of abuse or an obstacle in attempts to give up
(Akerlind & Hornquist, 1992 ).

Case study

General information
For confidentiality reasons, we will refer to the subject of the case study, as
PIF. PIF is a 45 year-old woman, graduate of the Faculty of Chemistry; she has
not practiced for about 4 years, currently dealing with the family business, taking
care of the house and family. She is married for 20 years, with two children aged
11 and 13. She lives with her two children in a city, and her husband lives in a
town, 60 km away, where they developed their own business. In weekends, the
family reunites in one of the two places. The reason for the family’s separation is
the because of the greater opportunities for education for the children in a bigger
city, compared to the small town where the family has a local business.

First admission to the rehabilitation centre

The client shows up for hospitalization accusing excessive fatigue, sadness
most of the time, agitation, insomnia, increased appetite, panic states, anxiety in
social evaluation situations, the feeling of personal loss, feelings of worthless,
states that she manages through alcohol consumption, which generates feelings
of guilt and shame.

History of the disorder, psychological evaluation and clinical diagnosis

The client was also admitted to a psychiatric hospital for alcohol dependence,
3 years before the first admission in our care; There she benefited from psychiatric
evaluation and received psychiatric treatment for the withdrawal syndrome and for
alcohol dependence and the evolution was favorable. For 2 years the consumption
stopped and the subjective state was good. Subsequently, in a stressful context
(significant deterioration of her father’s health), alcohol consumption began again.
Two months before the time of hospitalization in our center, the client was admitted
to a psychiatric hospital for the increased alcohol consumption. Again, she was
evaluated by a psychiatrist and received psychiatric treatment but the evolution was
not favorable, the intervention being strictly focused on the ethanol dependence,
only from a medical, biological point of view, so she requested admission to the
our clinic.
Since December 2014 (during Christmas holiday), the client has started abusive
alcohol consumption which she claims she could no longer control. She consumes
alcohol in the evening, after the children fall asleep, saying that she „cannot rest
and sleep unless she drinks”. However, the client claims that she does not consume
alcohol daily, but only in those days when she “can not resist any longer”; thus,
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since the beginning of the current problem, the client claims that she used alcohol
during the holidays, then stopped. After that, the consumption started again in the
context of a health problem of her father. Following this relapse she decides to seek
again specialized help, and considers it would be better to include psychological
care, not only medical care, so she is admitted to our center.
The psychological evaluation was carried out through 3 sessions and we
used for this purpose psychological interviews, observation and standardized
psychological tests : Psychiatric Screening and Diagnostic Questionnaire (PDSQ),
EMAS Anxiety Multiaxial Assessment Scales.
We used the Psychiatric Screening and Diagnostic Questionnaire (PDSQ) in
order to focus the initial interview and to determine the potential areas of symptoms.
Responses to PDSQ items and the discussion of the items and lead scores that
meet the criteria for the folowing diagnosis: Alcohol abuse / dependence (score
6, section point 1), Social phobia (score 11, section point 5), Major depressive
disorder (score 11, section point 9), Generalized anxiety disorder (score 10,
section point 8). Consistent with the symptomatological picture suggested by the
first contacts with the client and by the observations of the clients, she meets the
criteria for Major Depressive Disorder, diagnosis confirmed by the subsequent
interview and by the anamnesis performed by the psychiatrist of the center. PIF
did not respond affirmatively to the critical items referring to the suicidal tendency
present in the major depressive disorder subscale and did not declare during
the subsequent interview the presence of thoughts / behaviors that suggest the
existence of the suicidal tendencies as a priority.
Her father’s repeated hospitalizations since December 2014, as well as his
poor state of health, are major stressors, the client considering her parent entirely
dependent on her, forcing her to be permanently next to him in hospital, depriving
her of sleep and proper nutrition. These hings accentuated the symptoms, and the
client used alcohol as self-medication in times of major stress.
PIF meets the diagnostic criteria for Social Phobia, a fact confirmed by the
subsequent interview, the client declaring that no one observes what is happening
to her, but for her any social contact represents a major stress, even if she manages
to carry out most of the social activities, it does so with an enormous emotional
and energetic cost and avoiding a series of activities, such as eating and writing in
public, using public toilets, going to parties or other meetings. She was participating
only in those social events from which she could only avoid with great difficulty.
The client answered “yes” to all the items of the subscale for Generalized
Anxiety Disorder, confirming also in the interview the specific symptomatology.
Following the application of the Psychiatric Screening and Diagnostic
Questionnaire and the follow-up interview, we observed the presence of the
symptoms specific to several anxiety disorders, which is why we decided to
investigate this aspect in detail, applying the Multiaxial Assessment Scales of
Anxiety.
The first scale applied was EMAS-S to evaluate the client’s anxiety at the
time of evaluation. Based on the total score obtained by the respondent, it can be
observed that the level of anxiety as a condition is well above average (EMAS-S
total score = 65, T = 77). Analyzing the EMAS-S subscales, we found that both
the level of symptoms related to the cognitive component and the level of the
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physiological emotional symptoms are well above average (EMAS-C score = 36,
T = 79; EMAS-S-EF score = 29, T = 73).
Next, to evaluate anxiety as a trait, we applied EMAS-T. According to the
answers given on the EMAS-T scale, we find that PIF tends to feel a slightly
above average level of stress in social evaluation situations (EMAS-T-ES score
= 51, T = 60). She states that she feels much above average levels of anxiety in
situations thats he perceives as daily routines (EMAS-T-RZ score = 48, T = 68)
and average levels of anxiety in physical danger situations (EMAS -T-PF, score
= 51, T = 49) and in situations of ambiguity (EMAS-T-AM, score = 43, T = 51).
As the T-levels of the EMAS-T-RZ subscale exceed 65, it is very likely that PIF
will exhibit high levels of anxiety as a feature in daily routine situations.

Case conceptualisation and intervention

After discussing the results of the psychological evaluation with the clinet, we
interpret the use of alcohol as a bad strategy of managing stressful situations and
as a self treatment for the other comorbidities : Social phobia, Major depressive
disorder, Generalized anxiety and then we build the psychotherapy goals list.
So, we concluded that the negative feelings she has are numbed by the alcohol
consumption, which then generated other negative feelings (guilt, shame, fear)
that are numbed again by the alcohol consumption and so on, generating a spiral
of negative emotions and behaviors.
The general goals for the psychotherapeutically intervention at the first admission
were to (1) Improve the overall symptomatology, not only to stop alcohol abuse,
(2) Develop adaptive coping strategies to replace relying on alcohol, (3) Self
valuing, regardless of others opinion (4) Achieving a flexible way of thinking. In
order to achieve those goals, we defined more specific objectives: (a) Overcoming
all or nothing thinking, and demandingness, (b) Increase tolerance to frustration,
(c ) Decrease decision based on negative future-guessing, (d) Stop mind-reading,
(e) Learning to evaluate in terms of behavior, not of general value, (f) Socializing
without alcohol use, (g) Reasonably planning of activities.
PIF received psychiatric treatment for all the comorbidities identified and 14
CBT sessions (including those for assessment). PIF had a general good evolution;
she only had a few days of withdrawal syndrome symptoms that were efficiently
controlled by psychiatric medication. She begun sleeping and eating regularly,
the depressive and anxiety symptoms slowly ameliorated, she learned new skills
for emotional regulation and she proved to be able to master them quickly. At
reassessment she registered no clinical levels of depression or anxiety and, also, no
craving for alcohol. Given the good evolution, she is discharged with the following
scores on PDSQ : Depression = 2, section point 9, Generalized anxiety = 3, section
point 8, Social phobia = 4, section point 5, Alcohol abuse = 0, section point 1.

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 Results
After discharge, she goes back home, nothing changes in her environment and
she continues to take the medical treatment and begins to implement the coping
skills she learned during psychotherapy. She returned to the clinic for medical
and psychological reassessment once/month, all of the following assessments
revealing a general good evolution. After three months, the psychiatrist begun to
reduce the treatment every month, until complete elimination and the results of
the intervention are maintained even after the medication stop.

Relapse and second admission to the clinic

History of the current disorder. On 27 December 2018, she requests the second
admission to our clinic. Her main complaints this time are: restlessness, insomnia,
irritability, emotional instability, impulsivity, aggressive behavior, hostility,
feelings of loneliness, emotional isolation. In July 2018 she starts drinking again,
then she becomes more and more isolated, angry and hostile but the family didn’t
know that she has begun drinking again. On December 2018 she decided she has
to seek specialized treatment again and on 27 December 2018 she is admitted for
the second time to our center.
Psychologal assessment, diagnosis and case conceptualisation. The
psychological assessment reveals on PDSQ high scores for Alcohol addiction
syndrome (score = 6, section point 1) , depressive symptoms (score = 4, section
point = 9), social anxiety symptoms (score = 3, section point = 5), generalized
anxiety symptoms (score= 5, section point = 8). After the clinical interview and
the in-depth discussion of the items of the screening scale, we concluded that it
does not meet the criteria for any other mental disorder. PIF declarea that she
continued to use the strategies learned at the previous hospitalization and that she
no longer faced the emotional problems for which she used alcohol in the past.
She claims that the significant problems she faced at this second admission to the
center, were feelings of emotional isolation. Although she was actively involved
in social interactions at school where the children studied and in their business
relationships, she was feeling a lack of sense of belonging. For these reasons, we
have interpreted alcohol consumption as a strategy to ameliorate these extremely
distressing emotions (“When I drink, I am completely anesthetized and I do not
think about big things anymore, I no longer approach existentialist themes, but I
take things as they are, small. In fact, after drinking, I can’t even think coherently
about the difficulties of my emotional life, so no difficult thought is too much
analyzed.”). Thus, at this second admission to our center ( the third intervention
for her), we conceptualised the case as if she was spending too much time with
too much people and she had little time for meaningfull interactions. Also, the
interactions were usually superficial, so she felt lonely in a crowd, most of the
time. Thinking that no one will ever be able to emotionally connect with her, she
started drinking again, in order numb the emotional pain.

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 social interaction (3) Filtering social interaction and
reducing the superficial ones, while increasing the meaningful ones. After psychiatric
evaluation, she received psychiatric treatment for withdrawal syndrome, and a light
treatment for depressive symptoms. We conducted 8 CBT sessions on deepening
the interactions and reducing unnecessary and emotionally demanding social
interactions. The discharge assesment indicates very low depressive symptoms,
no need for alcohol and an improved general well beeing. Folowing discharge, she
came for psychiatric and psychologycal assesment once a month and after 3 visits,
the psychiatric treatment was significantly reduced and the general wellbeing is
maintained. The monthly evaluation show significant improvement in physical,
psychological and social condition. In april 2019, they closed the bussiness in
the other town, where the husband lived and in may 2019, the husband moved
back home, the family is reunited and they started a new bussiness. The last
psychological assesment (6 June 2019) shows no significant depressive symptoms,
no anxiety, no alcohol use, improvement of social interactions and no feeling of
loneliness.

Conclusions and discussions

The social connections and the behaviors in which people engage (cooperation,
altruism, alliance) increase the survival and reproduction of those involved,
increasing inclusive fitness. The aim of the sufference associated to loneliness is
to signal and motivate the repair or replacement of these connections (Cacioppo,
Hawkley, et al., 2006). Man is a social creature and often, the disfunctional
dependence on substance is an actual substitute for the functional dependence on
others (Akerlind & Hornquist, 1992).
This case study reconstructs a major episode in PIF’s life by identifying a
particular set of problematic events and relationships in the context of her strive
to stop the alcohol use. It can be studied or understood only in this precise context
because of the difficulties to draw precise boundaries. PIF had 3 specialized
interventions for its problem related to alcohol consumption. The first intervention
focused strictly on the physical dependence on alcohol and on the (physical!)
problems associated with it. Although the intervention was conducted only from
a biological perspective, purely medical, it worked for a period of time. This is
why, when she had a relapse, she asked for the same type of treatment. This time,
however, she found that it was not enough in order to recover in the long run, so
she seeked another kind of intervention. This second intervention was medical
and psychological, combining psychiatric medication and cognitive behavioral
psychotherapy, with very good results on some of the patient’s problems. The
second intervention, although was found efficient for some of the problems, it didn’t
prove to be efficient in the long run for the alcohol problem. So, the previously
diagnosed emotional problems did not reappear, however, the problem related to
alcohol consumption reappeared over a period of time. The third intervention,
besides standard psychiatric and psychological treatment, also addressed problems

149
related to psycho-social aspects. It was still a psychological approach, from a
cognitive-behavioral perspective but with a focus on the social life of the patient.
The purpose of this paper is to illustrate the imperative need for the specialists
to adress the problems that our clients deal, from more that just a biological
perspective. The biological aspects seem to be well studied and addressed long ago.
Also, in the last decades, we managed to introduce scientifically validated protocols
in psychological and social intervention. However, these interventions are often
so insularly conducted that we often deal only with one part of the problems our
clients are confronting. The analysis and interpretation of the illustrated case is
meant to lead to a better understanding of interventions on alcohol dependence
and to underline the need for a holistic approach. This integrative approach
supports not only the formation of a team of specialists, but also the education of
the team’s specialists to use its specialty and the specific techniques from such a
holistic perspective.

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