Comparison of ego strength between aggressive and non-aggressive alcoholics: a cross-sectional study

Abstract

AimTo determine the differences between aggressive and non-aggressive alcoholics in sociodemographic and clinical characteristics and ego strength.MethodsThis cross-sectional study included 111 aggressive and 123 non-aggressive male alcoholics aged between 25 and 60 years who were admitted to the Department for Alcoholism, University Psychiatric Hospital Vrapče, Zagreb, Croatia, from January to December 2016. All participants met the diagnostic criteria for alcohol dependence according to the Croatian Mini International Neuropsychiatric Interview (MINI), 4th revised edition of Diagnostic and Statistical Manual of Mental Disorders, and the International Classification of Diseases. Participants were clinically assessed by an experienced psychiatrist using a clinical interview, MINI, Questionnaire from the Brown-Goodwin Lifetime History of Aggression, and Ego Identity Scale (EIS) according to Erikson. A clinical psychologist performed cognitive function measurements. EIS scores were analyzed using one-way analysis of variance.ResultsIn comparison with non-aggressive alcoholics, aggressive alcoholics were more often divorced, unemployed, hospitalized, and first treated for alcoholism at an earlier age (P < 0.05 for all). They more frequently experienced depression (42.4% vs 19.4%, P = 0.013) and attempted suicide (34.7% vs 6.2%, P = 0.003), achieved a lower level of maturity at the second stage of psychosocial development related to shame and doubt (14.0 ± 4.1 vs 17.4 ± 3.7, P = 0.013) and at the fourth stage related to inferiority (13.1 ± 6.8 vs 18.1 ± 9.3, P = 0.011), and had lower total EIS score (75.8 ± 20.4 vs 85.2 ± 21.5, P < 0.012) than non-aggressive alcoholics.ConclusionAggressive alcoholics had weaker ego-strength than non-aggressive alcoholics, experienced more depressive reactions and suicide attempts, and showed poorer psychosocial functioning.Oxford Centre for Evidence-based Medicine level of evidence: 3**

Dynamics of Shame in Psychotherapy of Alcoholics

“…Liječenje osobe ovisne o alkoholu nije uvjetovano isključivo potrebom da se ublaže simptomi sustezanja, a da se pritom zanemaruje važnost stjecanja uvida u kompleksnost liječenja. Rezultati najnovijeg istraživanja pokazuju da su nasilni alkoholičari vrlo često imali puno slabiji ego od alkoholičara koji nisu bili skloni agresiji, te da su bili depresivniji i skloniji suicidalnim nakanama te da su istodobno iskazivali nižu razinu psihosocijalnog funkcioniranja (96). Potrebno je više istraživanja koja će se usmjeriti na otkrivanje većeg broja odgovora vezanih za glavne točke zastoja u razvoju koji bi nam bili korisni u psihoterapiji povezanoj s liječenjem osoba ovisnih o alkoholu.…”

“…The treatment of an addicted alcoholic is not focused solely on the need to alleviate withdrawal symptoms and simultaneously ignore the importance of the insight into the complexity of treatment of such persons. The findings of the most recent studies show that aggressive alcoholics most probably have a weaker ego-strength than non-aggressive alcoholics, that they have a stronger inclination to depression and suicidal ideation, and that they have poorer psychosocial functioning (96). Further research is required to provide more answers about the main developmental "stuck points", which may be useful in the psychotherapy of alcoholics.…”

“…To je još evidentnije među osobama ovisnim o alkoholu jer je intenzitet srama koji osjećaju puno snažniji, ali je i često prikriven agresijom i izraženom anksioznošću (4,22,27,37,96). Samim time bi se u grupnoj psihoterapiji osoba ovisnih o alkoholu trebala primjenjivati "kultura predstavljanja", a važan dio svake sesije trebao bi biti posvećen uvodnom predstavljanju ili "kratkom razgovoru" između članova.…”

“…Shamed individuals unconsciously wish for the other to take responsibility for repairing the rupture (100), and shamed persons in a group are likely to use strategies to defend against vulnerability and contact. This is even more evident among alcoholics because their level of shame is higher and often disguised by aggression and strong anxiety (4,22,27,37,96). Therefore, in a group psychotherapy of alcoholics, a "culture of introduction" should be fostered and a substantial part of each session should be dedicated to long introductions or "check-ins" with brief dialogues between members.…”

“…For persons with a reasonably intact sense of self who are psychologically rather sophisticated, the supportive-expressive, open group approach is effective. Alcoholics have a weak ego, they are vulnerable, and their self-concept is very fragmented, so the emphasis should be on autonomy (4,27,96). A dialogue in the group can worsen the self-concept of fragmented individuals who see openness as a threat to their vulnerability rather than an opportunity for growth.…”