A Tricky Problem-Alcohol Abuse

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About This Module

Topics: Human health, epidemiology, drug abuse, alcohol abuse, driving under the influence, addiction, withdrawal, genetic vs environmental factors of substance abuse, social and emotional consequences to drug addiction

Grade levels: 9-12

Teacher Note: There are three scenarios included in the  “A Tricky Situation” PBL modules. Each involves a different drug type (alcohol, cocaine, and opioids) and a slightly different scenario, but all have the same tasks. If you divide your class into multiple student teams each having a different type of drug abuse, your class will learn about issues and health effects of different drugs, but will have the same tasks. Work is equitable throughout the class teams and can be assessed with the same rubric.

You may want to assign the specific type of drug based on what type is more prevalent in your community.

Overview

Students plan a school informational presentation after a good friend abuses alcohol and hits another car, critically injuring people while driving under the influence. They investigate the physical, social, emotional, and mental health effects of alcohol abuse as well as the genetic and environmental factors that influence substance abuse.

Learning Objectives

To better understand the complex problems of alcohol abuse, students should be able to:

  • Describe the health effects of alcohol abuse on organs of the body.
  • Explain behavior indications that could point to substance abuse.
  • Compare and contrast genetic and environmental factors affecting drug abuse.
  • Describe issues surrounding the difficulties of talking with someone about his drug abuse.
  • Explain treatment options for substance abuse addictions.
  • Describe the social, emotional and mental health effects of alcohol abuse on the user and his family and friends.
Standards

Next Generation Science Standards

Standards Aligned to PBL Modules

Scenario (with possible answers)

The Situation

“Deesha, What am I going to do?” said Meara to her best friend.   “I know I said I wouldn’t tell Mom and Dad about seeing Chris drinking, but I’m getting really worried about him. I don’t even know him anymore! He gets so mad sometimes, but other times he just sits and stares! He says he doesn’t drink that much, but I know when he stays in his room or goes to Joe’s house most of the weekend, he’s wasted.”

“Meara, you promised him! You can’t tell now or he’ll never forgive you! Your mom and dad will freak out and you’ll cause so much trouble.  If you think Chris will ever speak to you again, you’re wrong.  My brother would never speak to me if I did something like that!”

“Deesha, he’s gotten really bad, though. His grades are bad and they used to be so important to him.  He wanted to get into Delmare University with a good scholarship and his grades are so low now that he probably can’t get in, let alone get a scholarship.  My family can’t afford to pay for it all if he doesn’t qualify for a scholarship and he doesn’t have a chance now.”

stressed male teen sits on park bench“You can probably help him more if you don’t cause all that trouble. I’m telling you—don’t rat on him!” whispers Deesha as Meara’s mom comes into the room.

“I’m sorry, Deesha, but you have to go home now,” said Meara’s mom.

What’s wrong, Mom?  You look awful!”

“Meara, your brother just called—from the police station. He has been arrested for driving under the influence and has caused a bad accident.  They’re not sure if the people in the other car will make it or not. We have to go down to the police station and see about getting him bailed out and find out about those poor people.  I just can’t believe this.  I can’t believe this has happened! “

Later…

The news of Chris’s arrest and the possible deaths of the three people in the other car hit your school community hard. In your state, Chris could get up to 20 years in prison for vehicular homicide. Students have a lot of questions and are not getting a lot of correct information.

Guidance and health classes review alcohol abuse and the school had planned a presentation even before this tragedy. Now that it is a real-life situation in their world and not just another chapter in a health book, you think that your classmates will take it more seriously.

You and Chris’s friends volunteer to work on a presentation the school is having on alcohol abuse. You want to be a part of the presentation so you can help other students who may be in the same situation. You want to help students who may be abusing alcohol and also family members like Meara who didn’t know what to do with her brother’s alcohol addiction. You don’t want to pass up this opportunity to help. Just maybe some of them will relate more to this sad case than they did when they discussed alcohol use in health class.

School organizers want students to take an active role in the presentation and they enthusiastically agree to your group’s participation. Now, you and your friends have to plan your program.

What will you tell students about alcohol abuse? Make an outline for the topics and information that you want them to know. You know you won’t talk about Meara and her family directly, but you’ll feel comfortable talking about the issues surrounding alcohol abuse if you can find out a lot about them.

Your Tasks—Part I. Alcohol Abuse Effects

  • Decide on a plan that you would use to talk to someone you suspect of having a problem with alcohol abuse. Be specific with your ideas.
  • Make a presentation for your school assembly that will provide information about the effects of alcohol abuse on the body.
  • To be able to explain the health issues that surround alcohol abuse as well as the social and emotional consequences to an addict’s life.
  • Research alcoholism and alcohol abuse to prepare for your presentation. You can use any kind of presentation aid available to you, including PowerPoint. (Your teacher may have other requirements.)
  • Be prepared with statistics to back up your presentation. Epidemiologists track trends, use, increases and decreases, locations, persons, age, and many other factors as they study the incidence of drug abuse. These statistics may be a powerful tool to help students and adults understand the scope of the problem.
  • Be prepared to answer the questions presented in this module.
  • Be prepared to answer the questions from your classmates or teacher as they play the roles of other students or teachers at the school who will be interested in finding out about alcohol abuse and how to cope with it.
  • Based on the results of your classroom presentation, evaluate how effective your plan was in helping students understand the challenges of helping someone who abuses alcohol. What could you have done differently? What else could you do that may help?

 Guiding Questions:

  1. What are the effects of alcohol abuse? Explain the effects of alcohol on the various body systems. Be sure to list short-term and long-term effects.

People under the influence of alcohol have difficulty walking, blurred vision, slurred speech, slow reaction time, and impaired memory and judgement, shorter attention spans, and lack of fine motor skills. They are more likely to engage in risky behavior, including drinking and driving or aggressive behavior because their judgement is impaired.

Effects of alcohol consumption become more pronounced as the drinker consumes more alcohol. At higher Blood Alcohol Concentrations (BAC), the drinker experiences more loss of memory, delayed motor reaction, and balance problems. At even higher levels of BAC, a person may become unconscious, have no memory of events that occurred while they were intoxicated, may vomit, have a slowed heart rate, and may have no control over urination or defecation. At BACs higher than 0.35, the person may become comatose and die.

Long-term Effects

Brain: Alcohol interferes with neurons in the brain that allow you to think clearly. It can change your mood and behavior and make it difficult to move with coordination. Over time, continued alcohol abuse leads to brain deterioration and permanent ability loss.

Heart: Drinking either for a long time or just too much on a single occasion can lead to heart damage. Damage leads to cardiomyopathy (disease of heart muscle).  Heart muscle that is stretched cannot pump effectively. Alcohol abuse can also lead to arrhythmia (irregular heart beat), stroke, and high blood pressure.

Liver: Alcohol abuse damages the liver and can lead to alcoholic hepatitis, fibrosis, and cirrhosis.

Pancreas: Alcohol abuse causes the pancreas to produce toxic substances with can lead to pancreatitis, inflammation of the pancreas. This is a potential dangerous health condition.

Cancer: Over time, a pattern of alcohol use can lead to certain types of cancers, including head and neck cancer, esophageal cancer, liver cancer, breast cancer, and colorectal cancer.

Immune system: Alcohol consumption lowers your body’s ability to fight disease and makes it easier for drinkers to get diseases such as pneumonia and tuberculosis.

 2. Meara saw her brother drinking, but what are some other signs that pointed to her brother being in some kind of trouble? What are other signs to look for?

Signs of alcohol abuse in Jason’s life:

Denial: Jason denies he has a problem.   “He says he doesn’t drink that much, but I know when he stays in his room or goes to Joe’s house most of the weekend, he’s wasted.”

Hiding drinking: Jason attempts to hide his drinking and when his sister “catches” him drinking he makes her promise not to tell their mom and dad.

Changes in temperament and isolated from activities: Jason “gets so mad” sometimes and other times he just “sits and stares”. Meara says “I don’t even know him anymore!”

Family members concerned about your drinking: Meara was worried about what she saw.  “I know I said I wouldn’t tell Mom and Dad about seeing Chris drinking, but I’m getting really worried about him.”

Choosing drinking over responsibilities that were important before alcohol: “His grades have fallen and he doesn’t care about them anymore   His grades are so bad and they used to be so important to him. He wanted to get …a good scholarship…but he doesn’t have a chance now.”

Other signs to look for:

  • Experiencing short-term memory loss
  • Making excuses for drinking (relax, social situations, to deal with stress)
  • Drinking alone
  • Feeling hungover when not drinking
  • Changes in friend group
  • Changes in appearance

 3. How could Meara have approached the problem of her brother’s drug use?

What could she have said or done? Draft a list of actions that Meara could have done or discussions Meara could have had with Chris, her parents, and other people that could have approached the problem.  Be specific. List the person and the approach and content you would use if you were in this situation.

Include your approach as part of your presentation to the class. Other students may have questions or comments about your presentation.  Be prepared to talk about why you think your approach will work and back up your conclusions about Chris’s possible future with specific examples.

Teacher Note: Be sure that your students know that it is always better to have a parent/guardian or other adult with them if they are going to talk to someone about a possible drug abuse problem. The person may not react well and it could be a potentially harmful situation.

Your students will have different approaches. As long as they are reasonable, accept them. The student teams should listen to others’ approaches and provide feedback. Students may bring personal experience to the scenario and responses; this is a good activity for students to share their ideas.

Experts list the following tips for discussing alcohol (or any drug) abuse with a person abusing alcohol. You may want to discuss these points with your students.

  • It is very difficult to approach a person and talk to him/her about his/her problem with alcohol. Give this some thought; the person may not react the way you think he might.
  • It is important that you plan what you want to say to him when you have that talk. Pick a time when you know he is sober. Let close friends and family members know about the problem and that you are going to try to talk to him.
  • Be specific about what you think the problem is and what led you to your conclusion. Try not to use language that will make the person feel defensive. Calling him an alcoholic may not help him accept his problem.
  • Listen to his response. Be fair, compassionate, and ready to help.
  • Find out in advance what options are available to help him. Have resources (local programs on addiction, support groups) on hand to give to him.
  • Let him know that you will be supportive of his efforts to quit alcohol abuse, but you will not keep his secret or otherwise make it easier for him to keep drinking. You won’t promise not to tell anyone, you won’t buy him alcohol, you won’t drink with him.4. What kinds of treatments are available to help someone overcome an alcohol addiction?

There is no one answer for the rehabilitation plan used by experts to treat alcohol addiction. Addiction specialists consider many factors for each patient before they create a plan for treatment. These factors include how strong the addiction is, how much alcohol they have been using, and how long they have been alcoholics.

Alcohol addiction is a complex problem and therefore, its treatment is complex and has to address every facet of an addict’s life. Some of the components of treatment focus directly on the addict’s drug use and other components must focus on rehabilitating the individual’s personal, social, and employment life.

Treatment plans include in-patient and out-patient programs. Both include individual counseling and group therapy.

  • Average stays for inpatient alcohol rehab is from 28-30 days. Treatment includes individual counseling and group therapy. It may also include family counseling.

Some individuals may need a longer inpatient stay lasting 60-90 days.

  • Long-term alcohol rehabilitation can take from 3 months to a year or more. It is usually recommended for people with a severe alcohol addiction. These programs can last from three months to a year.

Life is very structured in long-term rehab programs. Individual and group therapy occurs every day. There are often vocational training programs, education sessions, 12 step meetings, and psychotherapy. Free time is very limited.

  • Detoxification—a time in which the body physically and psychologically adjusts to absence of alcohol—can be difficult. Withdrawal symptoms can be severe and involve seizures, hallucinations, anxiety, tremors, depression, problems sleeping, shakiness, and changes in heart rates and blood pressure. Most treatment programs begin with detoxification and managed withdrawal from alcohol. Symptoms are managed with medications to monitor and reduce potential health problems.
  • Detoxification alone does not address the many social, personal, psychological and behavioral problems that accompany alcoholism. These must also be addressed in any treatment plan so that the individual can rebuild a healthy, productive life.
  • Outpatient alcohol rehabilitation is a longer procedure, but can be more convenient for the patient because they do not have to reside in a facility. The patient has a variety of therapies several times per week for 10-16 weeks. Some patients require longer periods of treatment.

Several organizations have a well-known reputation for effective treatment for alcoholism. You can locate one of these organizations in your area by searching online for the local website. The site will have contact information for the help center.

Many treatment plans are covered by insurance plans and recent legislation has more fully ensures that mental health and substance abuse problems are covered more fairly.

 5. Be prepared with statistics to back up your presentation. Epidemiologists track trends, use, increases and decreases, locations, persons, age, and many other factors as they study the incidence of drug abuse. These statistics may be a powerful tool to help students and adults understand the scope of the problem.

There are many statistics that describe trends and facts concerning alcohol use. There are links to alcohol facts and statistics in the resource materials for this module. Students may use a wide variety of facts when they use these links. A few examples of statistics are listed below.

From the National Survey on Drug Use and Health-NSDUH, 2015

  • 1 million adults ages 18 and older had AUD (alcohol use disorder). This includes 9.8 million men and 5.3 million women.
  • An estimated 623,000 adolescents ages 12–17 had AUD. This number includes 298,000 males and 325,000 females. (NSDUH, 2015).
  • An estimated 88,000 people die from alcohol-related causes annually, making alcohol the third leading preventable cause of death in the United States. The first is tobacco, and the second is poor diet and physical inactivity.
  • In 2014, alcohol-impaired driving fatalities accounted for 9,967 deaths.
  1. Is Chris an alcoholic? Defend your opinion.

Answers will vary, but should consider the information students found when they researched alcohol abuse for this scenario.

Teacher Note: You may want to discuss:

How do you think his sister and the friend feel now that they did not speak up when they had the chance and tragedy occurred?

Part II—Genetics vs the Environment  

A model of DNA's double helix structure
A model of DNA’s double helix structure

Meara finally recognizes that Chris was just not drinking alcohol a lot. He was addicted.

When she talked to another friend about this, the friend comments that Chris probably wasn’t going to take the conversation well, considering the mood he’s been in lately. She also worries that Chris is really asking for trouble. She tells you that she knows that Joe, Chris’s friend smokes and drinks a lot and he’s wasted every weekend!

You just heard a report about a study being done to find out if addiction is inherited or if it is more of an environmental issue—if you’re around an addict maybe there’s a greater risk of picking up addictive habits.  If you knew more about this, you might be able to help your friends even more.

Guiding Questions:

  1. Investigate the genetic and environmental links to addiction. What conclusions do you draw from your research?

Scientific studies have suggested that children who have family members who have drug addictions are more likely to try drugs and may develop a drug addiction.

But, having family members who have had an addiction problem is not a guarantee the children with either use drugs or become addicted. Studies have shown that most children of parents who abuse drugs do not develop alcoholism or addiction themselves.

  1. In this case, do you think Chris’s alcohol abuse is inherited or has it been influenced by his environment? Why do you think that?

Answers will vary, but should incorporate information students found during their research for this module.

You may want to discuss the following information with your students:

Scientific research has concluded that addictions are complex diseases that have links to both genetic and environmental factors, especially in the initial use of drugs. Family history studies, adoption statistics, and twin studies have shown that an individual’s risk is related to heredity.

The heritability differs with the type of drug abuse. It also differs with age. In early adolescence, the initial use of tobacco, alcohol, and marijuana are more related to family or social factors; genetic factors become a greater influence in young and middle adulthood.

Of course, incidence of addictive behaviors and drug abuse are dependent on the availability of the drug. Availability is great affected by culture, social policies, religion, and economic status.

Stress to your students that having a family member with an addiction problem does not mean that they will develop an addiction problem.

Part III—Risky behaviors  

Chris and his family hear about the people in the car that Chris hit while driving under the influence of alcohol. They are all still in critical condition. Thankfully, they have all survived so far.

As grateful as Chris and his family are for that news, Chris is not out of trouble. A DUI (driving under the influence) with injuries can result in an Aggravated DUI Assault charge which is a second-degree felony with prison time and heavy fines.  If a DUI results in the death of someone, it will be a vehicular homicide charge that carries a longer prison term and fines.

Driving under the influence is just one of the risky behaviors that people do when their judgement is impaired.

Guiding Questions:

  1. Drug use is also tied to a lot of other risky behaviors. Cite some of these behaviors and explain how other risks are associated with drug use.

Most risky behaviors are associated with the impaired judgement that results from alcohol (or any drug) use. These include:

  • social problems
  • morbidity
  • mortality
  • injuries
  • pregnancy
  • contracting HIV/AIDS and other infectious diseases
  • other drug use
  • violence
  • suicide
  • car accidents
  • homicides
  • cancer
  1. What will be the some of the consequences of Chris’s alcohol abuse? How will this tragedy affect his life? What are the long term effects? Describe the consequences to all aspects of his life now and in his future.

Obviously, Chris and his family will have immediate legal issues to address. The driving under the influence (DUI) and other charges stemming from the accident will be on his record. Driving under the influence is a serious criminal offense.

He may have to serve time in prison and pay a heavy fine for this offense. He will certainly lose his license for a period of time and may also have his license revoked, depending on the severity of an accident caused by his drunk driving. Revocation means that his driving privileges are never restored. The conviction of his legal charges could stay on his driving record (should he at some time get his license restored) for the rest of his life.

Chris could also expect to have a civil lawsuit filed against him. He is responsible for damages he caused in the DUI accident and may have to pay for medical bills, property damage, loss of income, and emotional distress.

Chris will also have the emotional trauma of causing injuring to the people in the other car. Those people face traumatic injuries and will no doubt have a lengthy recovery, if they survive.

Chris will be required to attend rehabilitation counseling for a lengthy period of time. There is no one answer for everyone for length of time for rehabilitation. Addiction specialists consider many factors for each patient before they create a plan for treatment. These factors include how strong the addiction is, how much alcohol they have been using, and how long they have been alcoholics.

  • Average stays for inpatient alcohol rehab is from 28-30 days. Treatment includes individual counseling and group therapy. It may also include family counseling.

Some individuals may need a longer inpatient stay lasting 60-90 days.

  • Long-term alcohol rehabilitation can take from 3 months to a year or more. It is usually recommended for people with a severe alcohol addiction. These programs can last from three months to a year.

Life is very structured in long-term rehab programs. Individual and group therapy occurs every day. There are often vocational training programs, education sessions, 12 step meetings, and psychotherapy. Free time is very limited.

Detoxification—a time in which the body physically and psychologically adjusts to absence of alcohol—can be difficult. Withdrawal symptoms can be severe and involve seizures, hallucinations, anxiety, tremors, depression, problems sleeping, shakiness, and changes in heart rates and blood pressure.

  • Outpatient alcohol rehabilitation is a longer procedure, but can be more convenient for the patient because they do not have to reside in a facility. The patient has a variety of therapies several times per week for 10-16 weeks. Some patients require longer periods of treatment.

Chris will also have to be diligent in attending periodic counseling sessions for a long time after he manages to stop using alcohol.

Chris may have long-lasting health effects from damage done to his body during his alcohol abuse.

Even if he manages to control his drug addiction in the future, a history of alcoholism may put him at a disadvantage socially and professionally.

He will have to be careful to avoid associations with people who may lead him back to alcohol use. He may have to give up friendships with people who cannot keep off alcohol.

His past drug use may prevent him from getting jobs in the future. A record of drug abuse, or worse, a criminal record related to drug abuse, could make finding a job more difficult. The Americans with Disabilities ACT (ADA) protects individuals in recovery from being discriminated in the workplace, but some employers may be hesitant to hire someone who is at risk for drug abuse.

However, it is much better for Chris to seek treatment and show that he is in recovery than to continue to put himself and others at risk. He will do better in all aspects of his life if he can recover and stay off alcohol.

Sample Rubric

Information about constructing and implementing rubrics for problem-based learning strategies can be found in Developing Rubrics in the Teacher Professional Development section.

Extensions

Call local treatment centers and support groups and ask a counselor to talk to your class about drug addiction issues.

If you cannot find a local treatment center or support group, the U.S. Department of Health & Human Services (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA) has a national helpline that provides a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish). They provide information about local treatment facilities, support groups, and community-based organizations and you can then call the local groups to contact an addiction specialist that may talk to your class.

► Invite your county or district public health officer or an epidemiologist from a local university (or both) to talk to your classes about how public health concerning drug addiction is monitored in your area.

► If you haven’t used all the scenarios for different drug types included in the A Tricky Situation module, assign student teams a different drug type. They will probably be able to move more quickly through the Tasks and Guiding Questions since they have worked through one drug type, so you will not have to use as much class time for the second scenario.

►Watch the PBS NOVA documentary “Addiction” with your class:  https://www.pbs.org/wgbh/nova/video/addiction

The documentary delves into the complex issue of drug addiction by profiling several people who became addicted to drugs. Although it deals with opioid abuse, some of the issues surrounding the abuse apply to any drug addiction.

The patients are diverse: a coal miner who was in a traumatic mine accident, a young student active in sports and school, a teen from a successful, caring family, and a young mother who loses her children due to her drug abuse.

Through the stories of these people, the documentary explains the mechanism of addiction, how drugs change the brain, and how those changes make continued recovery difficult. It also explains how the epidemic of drug abuse continues to grow in the United States. How did it begin? Why is it so difficult to contain? What can be done to reduce the ever-increasing trend?

A student study guide for this documentary is included in the module. A complete teacher guide with answers to questions in the student guide is in the Teachers Pages section on the PDC site.

If possible, display your students’ work on their drug awareness project around the school.  If you had them make a poster, do a survey, or create a fact sheet, they could be displayed in the halls, the media library, or the school cafeteria.

► Local newspapers and TV stations are always looking for community news. Contact your local newspaper and TV stations about your students’ work on drug awareness and the health effects of drug abuse. Students can be interviewed about their projects and more people will become aware of community resources and important efforts to educate students about the dangers of drug use.

► Organize a school program or parent/community night that delivers the drug awareness program in the scenario in this module. Student groups could present their research on the type of drug abuse covered in their module. Each scenario in the A Tricky Problem package covers a different type of drug abuse along with the resources, effects and consequences of drug abuse, and the approach they developed to talk to their friend or family member.

Additional Resources

Additional resources about different drugs and drug abuse issues can be found:

at the alcohol abuse scenario page at:
http://www.pandemsim.com/pdc/a-tricky-problem-alcohol-abuse/

at the direct link to Internet Resources—Alcohol Abuse:
http://www.pandemsim.com/pdc/internet-resources-alcohol-abuse/

at the direct link to Internet Resources—Drug Abuse
http://www.pandemsim.com/pdc/internet-resources-drug-abuse/