Case Study on Barriers to Identifying Alcohol and Drug Problems

Mrs. Smith is 79 years old. She is a former schoolteacher who worked until age 70. She lives alone in an efficiency apartment, a place that “used to be nice, but now is a dump.” She spends her days reading and listening to the radio, has few friends, and maintains contact with relatives only by mail.

Her medical problems include unexplained dizziness and occasional bronchitis due to smoking. She has lost interest in things over the past 2 to 3 years, has low energy levels, and admits to being depressed.

Mrs. Smith complains of a failing memory and is worried that she is getting Alzheimer’s disease. She admits to drinking one or two bourbon and waters at night. She has done so for years, never drinks in bars, and denies having an alcohol problem.

She refuses to see a mental health professional, so her physician has started her on increasing doses of an antidepressant, which has helped a bit. But after a few months, she is found wandering around with extensive bruises on her right side, which appear to be from a fall. She has no idea how the bruises got there. She adamantly denies that she might have fallen or had a blackout.

What are some of the factors that make diagnosing Mrs. Smith’s problem so complex?