Present Complaints

Dianne (52 years old, married, no children) increasingly called her husband Mick at work, sometimes several times a day, complaining of being lonely and craving for a drink. Sometimes Mick would stop work and go to his wife to support her. When together with her husband, Dianne had been able to control her drinking but she now also started drinking during the times Mick was at home.

Dianne had been drinking excessively for the past four years, between 12 and 24 units a day (mostly beer and wine), for several days in a row. After a number of days she then would collapse (too sick to drink) for two days after which she would resume drinking. Besides drinking, Dianne complained about feeling depressed, not being able to structure her day, having difficulty sleeping and eating, having sore muscles, being lonely, feeling guilty and worthless, being on edge all the time, not being able to control her worrying, and having occasional panic attacks. Until 1994 Dianne worked as a community nurse and did not drink much. Due to some reorganization the workload increased, which led to severe burnout. Dianne stopped working and the frequency and the quantity of her drinking increased. She started drinking at home on a daily basis and took tranquilizers (Oxazepam).

During 1998, Dianne was admitted for detoxification (one-week hospitalization) and subsequently treated in a day-care programme at an addiction treatment facility. She kept on drinking; however, her depressive and anxiety symptoms only increased and her relationship with Mick deteriorated.

When we first saw Dianne and Mick in 2000, Dianne had just started using Acamprosate (an anti-craving drug) prescribed by her general practitioner. Dianne was also suffering from depressive symptoms, uncontrollable worrying and situational panic attacks. Dianne had a score of 31 on the Beck Depression Inventory (BDI) (Beck et al., 1961), which is considered rather severe. In view of the fact of a possible substance-related artefact we postponed diagnosing major depression and generalized anxiety disorder. Dianne did not meet the criteria for panic disorder.

Dianne had partly started drinking because of feeling anxious and depressed but her drinking had also made her more anxious and depressed. Using the International Personality Disorder Examination (IPDE) (Loranger, 1999), a semi-structured diagnostic interview, Dianne was diagnosed as having an avoidant and obsessive-compulsive personality disorder.

Mick and Dianne each had their own apartment during the week; during the weekends and holidays Mick stayed at Dianne's place. Preparing for his upcoming retirement, Mick was now going to move in with Dianne.

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