Analyzing Alcoholism in Low Socioeconomic White Men: A Case Study

This case study delves into the pervasive issue of alcoholism among low socioeconomic white men, utilizing William Kennedy's novel 'Ironweed' as a focal point to examine vulnerability and health disparities. The study highlights the significant burden of alcohol consumption on global populations, emphasizing its direct impact on financial stability and socioeconomic well-being. It explores the correlation between lower socioeconomic status and increased alcohol dependence, referencing epidemiological data and research findings. The case study examines the impact of binge drinking, the role of social and environmental factors, and the influence of family history on alcohol abuse. Furthermore, it discusses the health consequences of alcoholism, including various cancers, stroke, and liver disease, while also considering the role of nursing interventions, such as brief interventions and the FRAMES guideline, in addressing this critical issue.

Running head: ALCOHOLISM IN LOW SOCIOECONOMIC WHITE MEN
ALCOHOLISM IN LOW SOCIOECONOMIC WHITE MEN
Name of the Student:
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Author Note:

1ALCOHOLISM IN LOW SOCIOECONOMIC WHITE MEN
Alcohol consumption has become a massive burden across global population, directly
influencing financial disturbance in millions of families and massively affecting
socioeconomic stability. 9-23% of healthcare costs in high earning countries are followed by
alcohol abuse and more than 60 diseases arise from binge drinking (WHO, 2014). It has been
observed in a meta-analysis conducted globally, that people with lower educational
opportunities have higher dependence on alcohol, and the rate of consumption could not be
defined by drinking patterns in these cases (Jones et al., 2015). Weekly consumption of <100
grams is associated with lowest possible mortality factors caused by drinking (Wood et al.,
2018). Consumption of alcoholic beverages have contributed heavy drinking patterns among
deprived SES (socioeconomic status) groups, in comparison to wealthy groups which have
higher frequency of drinking tendencies ( Huckle, You & Casswell, 2010). Binge drinking
actively effects mortality along with morbidity of an individual and therefore hampers social
behaviors and triggers domestic violence.
Recent reports on socioeconomic variability have implicated that excess alcohol abuse
initiates an onset of alcohol dependence affecting younger individuals who started drinking in
an early age of 14 or less (Gordis, 2013). Alcoholism has inflated as a primary concern
globally and is the fifth singular reason related to accidental and untimely death, clinical
depression and deterioration of psychological health. Uncontrolled drinking and dependency
over alcohol consumption is one of the major malpractices that have proliferated, effecting
population and communities all around the world. Impact derived from direct and
consequential use of alcohol has perplexed lives of countless families, contributing
psychological and financial instability. Individuals with low socioeconomic background are
on the verge of economic disruption, leading to frequent verbal abuse and physical assault.
Escalation of health related complexities have also destroyed lives in most of the cases. In
this study, severe addiction towards alcohol and its side effects have been reflected in

2ALCOHOLISM IN LOW SOCIOECONOMIC WHITE MEN
context with ‘Ironweed’, a novel by William Kennedy, taking vulnerable white male adults,
as subjects of interest. Although, the novel depicts events related to the Great Depression era
of 1930’s, social stringency and income insufficiency have similar kind of consequences
equally true for present time.
A randomized control trial involving 759 American adults with 66 years of age or more, has
anticipated that neighborhood induction certainly reflects alcohol consumption and
proliferates drinking capacity of the population, especially in white men, compared to women
who were unaffected by neighborhood influence (Assari & Lankarani, 2016). Men of 25-34
years of age showed highest level of binge drinking, while 34-68 years aged men liberated a
significantly steep increase in binge drinking connected with increased rate of neighborhood
deprivation (Fone et al., 2013). Partial effect of social media and economic strength induce
indirect consequences on binge drinking patterns on lower socioeconomic society correlating
with lower income status in white men (Tucker et al., 2015). Civilians living in a location of
lower alcohol price and higher number of alcohol outlets have depicted increased allosteric
association with drinking behavior in communities with low SES (Pollack et al., 2005;
Huckle et al., 2008). Inter-community acceptance and social trust also plays a crucial role in
regulating drinking patterns, as men devaluated by neighboring community confessed to
consume excessive amount of alcohol on a regular basis. Perception of society in heavy
drinkers has worsened further by decreased participation in normal social activities and by
overwhelming feeling of exclusion (Murphy et al., 2014).
Epidemiological understanding has provided an insight to alcohol abuse correlating
proportionally with familial factors, implying, individuals with positive family history have
greater chance to develop an onset of alcohol abuse especially in younger people of 14 years
or less, while those with negative family history tend to have lower accountability of drug
abuse at an early age (Gordis, 2013). Although, a recent sociodemographic study by

3ALCOHOLISM IN LOW SOCIOECONOMIC WHITE MEN
Haberstick et al. (2014) have found that US white males of 20-23 years of age, are more
susceptible to alcohol use disorders (AUD) and are likely to develop lifetime alcohol
dependence. In addition, older individuals with a steady history of drinking presented
environmental factors and cheap availability (Richardson et al., 2015), as modulators of
drinking patterns and a decrease in social capital status is directly linked with excessive
drinking behavior (Iparraguirre, 2015).
Three possible mechanisms have been postulated to increase risk factors regarding alcohol
consumption. Firstly, exchange and practice of social behavior in a community greatly
influence the use of alcohol among non-drinkers and occasional drinkers (Boardman et al.,
2001). Secondly, people with low socioeconomic status (SES) are much more vulnerable to
alcohol due to mental stress and absenteeism utilizing alcohol as a mediator of coping
mechanism (Hill, Ross & Angel., 2005). Thirdly, sub-cultural footprint of a society greatly
enhances individual overview of a substance, be it alcohol or any other drug, and provides a
sense of assertion even it has harmful effects on a broader perspective (Morland et al., 2002).
The story ‘Ironweed’ by William Kennedy also deciphers the direct and subsequent effects of
binge drinking in a white American male and his family staged in the time of economic
recession of 1930’s, also known as ‘Great Depression Era’. Francis Phelan, the protagonist of
this story, who used to a basketball star, has turned into an alcoholic, and left his home after
killing his own son indulged in alcohol, deserting his only wife. Afterwards, he wanders
around like a vagabond and get involved with another drinker friend of his. Influenced by his
friend he falls into the trap of addiction, as he thought it would help him forget his crime
against his own child. The story explores the unhealthy and disgusted lifestyle of an addicted
person, and the amount of ill-treatment he experiences daily. However, the novelist provided
a way out of this sordid life, illuminating possibility to return to his family and belongings
and embrace the normal way of life.

4ALCOHOLISM IN LOW SOCIOECONOMIC WHITE MEN
Alcohol abuse is linked with a wide range of cancer progression. Data from a number of
studies found alcohol dependence and low SES have significantly contributed in throat cancer
development. People who have lower education and are involved in vigorous physical labor
are more likely to develop head and neck cancer, additive with the fact that lower income
status often deteriorates the conditions of the victim and recognition of the symptoms at
appropriate time. National Alcohol Survey (2009-2010) in US reported 53% to 71% cancer
deaths in men, were causative of esophageal carcinoma or cancer in upper respiratory tract
(Nelson et al., 2013). Smoking habits further enhances the outcome of these cancers. A linear
relationship between various cancer and alcohol consumption has long been overlooked.
SES, health condition and alcohol consumption have an overlapping relationship, which is
also known as alcohol harm paradox (Bellis et al., 2016) suggested mortality in lower
socioeconomic areas are higher than in average SES communities, despite of having similar
levels of alcohol consumption in both cases. Ignorance about personal health and
unavailability of cash jointly exacerbate the multiplicity of the disease, also putting lives of
the family members in grave danger.
Alcohol consumption is significantly associated with risk of stroke in men with lower
economic status. A study by Brown et al., (2005) consisted of sample population from New
Zealand, attributed that lower socio-economic background increases the risk of stroke in
communities, including obesity and excessive alcohol consumption, leading to higher
frequency of ischemic stroke. Another study focused on northern Italy found that lower
socioeconomic status is prevalent for occurrence of stroke, adjoining with diabetes and an
increase in body mass (Veronesi et al., 2010). This study also anticipated that lower
socioeconomic status and drinking behavior are intricately related with lower education in
men, but not in women.

5ALCOHOLISM IN LOW SOCIOECONOMIC WHITE MEN
Meta-analysis on epidemiological studies elucidated that almost 20% to 25% of liver
cirrhosis and hepatitis C virus infection in men who have been drinking 50g/day for at least 5
years, are due to excessive alcohol consumption in United States (Singal & Anand, 2013).
Hepatocellular carcinoma and chronic liver disease is also associated with socioeconomic
disparity among non-Hispanic white male, having at least 3 drinks or more per day, are likely
to be the sole victim of chronic liver disease resulted in death. 29% of population had
suffered from liver cancer due to economic recession contributing to disintegration of
individual lifestyle (Major et al., 2014). Daily consumption of one drink or 12g/day enhances
risk of liver cancer by 1.1 times. Even after reassessing the data with the variable factors of
lifestyle and medical awareness, cohesively working with social support and lesser
socioeconomic difference, derived results were almost same (Myint et al., 2015).
Excess reliance over alcohol promotes vulnerability in normal lifestyle, especially in white
male, who are unemployed or cannot acquire sufficient income for betterment of their
livelihood. People who feel excluded from their neighboring community are highly depressed
and among those with a previous exposure of alcoholic beverages at an early age, have higher
chances of developing binge-drinking behavior. Binge drinking, as proposed by National
Institute of Alcohol Abuse and Alcoholism (NIAAA), in United States, is an individual
having a blood alcohol concentration of 0.08 grams/dL or consuming five consequent drinks
in just 2 hours are marked as binge drinkers. Individuals of 21 years of age or younger are
most prone to develop binge drinking (Esser et al., 2017), as reported to U.S. department of
Health and Human Services. Drinking patterns correlating with these standards have implied
that such massive consumption at a regular basis are connected with oral, esophageal,
hepatocellular and colorectal cancer in male candidates (WHO, 2018). Drinkers are
frequently involved in car accidents, alcohol poisoning and several other health hazards,
which passively influence the number of mortality cases per year (Stahre et al., 2014).

6ALCOHOLISM IN LOW SOCIOECONOMIC WHITE MEN
Evidence-based practices like, brief intervention, could be started in the form of nurse-patient
interaction, which effectively observes the causes of alcohol addiction of that particular
person. A nurse can follow the FRAMES guideline of brief intervention (Kaner et al. 2013)
to study the case more efficiently. Communicating with the patient the nurse could propose a
‘Feedback’, explaining the patient about the harmful outcome of the current alcohol
consumption possess on his health. Thereafter, the nurse can reassure the patient if his
decisions changes or if not, explain further, in a calm and composed manner, providing
information about the ‘Responsibility’ of his decision. Nurses can also ‘Advice’ the patient
about the critical aspects of his drinking behavior based on factual analysis done in respective
fields and can influence him to alter his standpoint. Assisting the patient with various
behavioral changes, that can improve his health, supplying a list or ‘Menu’ for the candidate.
Understand the psychological and social perspective of the victim from a neutral and non-
judgmental point of view through ‘Empathic interview’, to focus on the real issues that might
have acted as triggers. Encouraging the patient to get rid of addiction and elaborating the
positive possibilities that he can achieve by augmenting his ‘Self-efficacy’.
A nurse can initiate practice of minimal intervention for alcoholics to reduce dependency,
suggesting him the widely used DRAMS Scheme or ‘drinking reasonably and moderately
with self control’ (Heather, 2016). However, in cases of binge drinking minimal intervention
could bear a little to no effect, as the patient who belongs from lower socioeconomic status, is
less likely to discontinue his daily habit due to coping mechanism, as stated earlier. Again,
neighbors of that community might have a higher influence over that person, if he is given
the liberty to drink and less likely to remain in limits.

7ALCOHOLISM IN LOW SOCIOECONOMIC WHITE MEN
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