Alexander: The Great Addiction

Alexander: The Great

Addiction
Waleed Sami
Wake Forest

Alexander: The Great Addiction

Alexander The Great

Addictions
Waleed Sami
8/14/16
Alexander the Great
My client that I chose to conceptualize for treatment was Alexander the Great. Alexander
the Great was one of the greatest military commanders this world has ever known, with an
empire stretching from Macedonia and Greece to the west, all the way to the Punjab in modern
day Pakistani to the East, (History.com Staff, 2009). His military prowess was second to none,
rising from the early ranks as a cavalry captain under his father, Philip II. He would soon usurp
his own father and become the commander of the Macedonian and Greek forces and conquer the
Persian Empire, along with Egypt- a feat not accomplished by anyone to date. My personal
interest in Alexander the Great comes from a cultural connection to him. My roots are PunjabiPakistani, and name Alexander is still well known and recognized in that part of the world. The
name Sikander, is the Persian pronunciation of his name, and is common name all over Central
and South Asia. I have several Sikanders in my family! The story goes is that Alexander met his
match in King Raja Porus, the Punjabi King who resisted Alexanders invasion. Though he was
defeated on the field of battle, Alexander was nonetheless impressed with the fighting prowess
displayed by King Porus and his army, and the stiff challenge he faced is what led to his officers
and soldiers to mutiny, and resist any further attempts of invading the heartland of India (Sunday
Tribune, 2009). On his journey back from India, he died in Babylon, which is modern day Iraq.
Numerous accounts differ on the exact cause of his death, with the common cause given by

Alexander: The Great Addiction

historians being poisoning. It is natural to assume that someone who conquered a portion of the
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world as large as Alexander did would make an enemy or two. However, there is compelling
evidence to suggest that Alexander died through alcohol poisoning (Denison, 1992). Alexander
was a notorious drunkard, and his bouts with alcohol and excessive drinking were well
chronicled by all of his historians. After his victory in Punjab, it was well known he was
depressed and unhappy, and was drinking excessively as his army marched back towards Greece
and Macedonia. There were a number of external stresses during that part of the of his life, as his
army was resisting integrating new soldiers from Asia, his officers were mutinying, and his
general style described as cruel (Denison, 1992), was rubbing everyone around him thin.
It is quite clear that Alexander the Great needs to come to counseling for his alcohol
abuse. Alexander recently killed his best friend, Cleitus in a drunken rage, (Beard, 2011) Alcohol
addiction and abuse can be very difficult to overcome and fatal. Alcohol is classified as a
depressant, and works as a central-nervous system suppressant. It produces sedative-hypnotic
like effects, and slows down your general function. Alcohol also produces slurred speech, lack of
inhibition, and questionable judgement. Withdrawal from sustained alcohol use can be very
difficult, as it can cause anxiety, convulsions, tremors, insomnia, and even death. It is imperative
that he seek counseling for it.
In my opinion, the psychological model would be the best model to describe Alexanders
relationship with alcohol. Alexander the Greats insecurities and struggles are surprisingly well
documented. Alexander was notoriously insecure and thirsted for power as a way of getting
back at his father, Phillip II, (Thomas, 1995). His father engaged in political gamesmanship,
creating an environment of distrust and sarcasm. There was very little father and son
relationship, which lead to Alexander overthrowing his own father and improving his army.

Alexander: The Great Addiction

Furthermore, his mother Olympias was also overbearing, and used him as a vehicle for her own
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ambition, filling his head with the idea that he was a god himself, destined to rule the world.
Within this complicated family dynamic along with the pressures of military warfare, it is
reasonable to conclude that Alexander turned to alcohol as a coping mechanism to numb his
psychological stress and his constant insecurity. One of the assumptions of the psychological
model is that addiction is used as a coping mechanism. The insecurity that his father caused him
and the resentment it created within Alexander is often cited as a pretext for Alexanders bloody
conquests, as a bid to prove himself greater than his father. While this drive did sustain his
conquests, we know that it can take a psychological toll, as the human being cannot subsist on
rage and insecurity without self-destructing eventually. Using alcohol to numb his feelings
around his father and mother, the therapist should look to create interventions that deal with
these underlying anxieties and anger.
There are several criteria met for Alexander the Great on the DSM V criteria for Alcohol
Use Disorder. The historical record is unclear on the all the details of Alexanders drinking, we
only know that he consumed a lot of alcohol, as did his entire party. Towards his later part of his
life, Alexander was frequently drunk throughout the week, and even asked for alcohol on his
death bed when he was thirsty, (Beard, 2011). We will have to take a creative view in order to
assess him properly within our modern context. For alcohol use disorder, at least 2 criteria (over
the course of at least 12 months) must be consistently met. The first criteria that Alexander meets
is A1, which is Alcohol is taken in larger amounts or over a longer period than was intended,
(American Psychiatric Association, 2013). This is a natural precursor to drunkenness, which
Alexander the Great is noted to have displayed often times over the course of his life. Another
criterion that Alexander the Great would meet would be A4: Craving or strong desire or urge to

Alexander: The Great Addiction

use alcohol, (American Psychiatric Association, 2013). Alexander, we know craved wine even
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when he was dying, requesting it on his death bed. Alexander also meets A6, continued alcohol
use despite having persistent or recurring social or interpersonal problems caused or exacerbated
by the effects of alcohol, (American Psychiatric Association, 2013). Alexander was under great
pressure from his own expectations and his mothers. Furthermore, he had the monumental task
of leading his army and administering the regions he was conquering at a rapid rate. Exorbitant
alcohol use would have undermined his duties and responsibilities, but he continued to do so.
Criteria A9 would also be met with Alexander the Great: Alcohol use is continued despite
knowledge of having a persistent or recurrent physical or psychological problem that is likely to
have been caused or exacerbated by alcohol, (American Psychiatric Association, 2013).
Alexander the Great was known to have been filled with remorse after bouts of drunkenness, one
of his most extreme resulted in the killing of his own best friend, Clietus. Alexander knew he
was full of paranoia and anger, but continued to drink in spite of it, as a coping mechanism. A10
is also met: Tolerance, as defined by either of the following: A. A markedly increased need for
increased amounts of alcohol to achieve the desired effect. B. A markedly diminished effect with
continued use of the same amount of alcohol, (American Psychiatric Association, 2013).
Alexander needed more alcohol as he grew older, and his drunkenness increased, providing us
with evidence that Alexander was growing more tolerant to the drug. Putting the evidence of the
criteria together, we can specific the criteria and assign Alexander the Great with an Alcohol Use
Disorder, severe with the code: 303.90 (F10.20), (American Psychiatric Association, 2013)
Some of other factor, including co-occurring disorders need to be discussed when
conceptualizing Alexanders diagnoses. Perhaps the largest clue to a co-occurring disorder is his
trauma history and PTSD. Alexander has fought in numerous wars thus far in his short life, and

Alexander: The Great Addiction

seen some of the greatest battles of the ancient world. He has likely seen friends die, killed his
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opponents, and seen death and destruction on a scale few of us can imagine. He is likely
experiencing PTSD and trauma from his ongoing conflicts. I would screen and assess for trauma
history, more than likely he would be diagnosed with PTSD too and alcohol use can be used a
coping mechanism for those who have undergone trauma. Furthermore, it is helpful to look at the
stages of addiction in order to assess where Alexander may fall on the spectrum. It is of my
opinion, that Alexander falls on stage IV, the excessive stage. Towards the end of his life,
Alexander was in constant pain and struggled emotionally, even though his campaigns were
successful. Furthermore, he has high chemical tolerance for the drug, and he has lost several
friends due to his addiction. Alexander needs a large intervention for him to be saved.
There can be several clinical strategies used to treat Alexander the Greats addiction
before it becomes too late. There exist evidence based interventions, such as CBT and
Motivational Interviewing that have proven to help individuals struggling with addiction. I
would start with counseling Alexander using motivational interviewing in order to assess his
intrinsic motivation to change, along with any ambivalence he might have towards the process. I
would express motivational interviewing skills such as empathy, affirmation, and evocation. I
believe Alexander has a lot of personal wisdom into his own motivations and psychological hang
ups. More than likely, he would speak about his culture (Macedonian) promotes drinking, his
need to drink to cope, and the fact that when he drinks-his complex feelings of family and
warfare seem to be numbed. There remains ample clinical possibility to help Alexander around
his thoughts and feelings related to these facts. Motivational Interviewing includes focusing on a
topic and keeping the conversation hovering around change talk and the various motivations
behind it. It is important that we not push and confront Alexander, already an angry warrior.

Alexander: The Great Addiction

Rather, we must artfully go with him and employ double-sided reflections in order to show the
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clients disrpenacy behind addiction and his stated goals. For example, the therapist could bring
up how much he adored his best friend Clietus, but that drinking seems to have pushed him into
a rage against him.
Relapse prevention is important for Alexander. The entire military encampment drinks,
and it is within the Macedonian culture to drink heavily and celebrate occasions. Thus,
strategizing goals for proper relapse prevention will be important in order to Alexander to be
successful. In order to identify the best ways to prevent relapse prevention, we must first identify
his triggers, emotional, psychological, and physical. It would stand to reason that Alexander the
Great has many different types of emotional triggers, as he was said to be paranoid and hostile
for much of the latter part of his life, (Denison, 1992). Some of these feelings, such as anger,
anxiety, remorse, and mood swings might enable him to relapse and create another cycle. It is
important that we address Relapse Prevention from a CBT perspective, and organize his thoughts
and behaviors around it.
It is normal to expect that there will be lapses. Alexander the Great faces a number of
pressures in his life. He has historical anxieties that stem from his relationship with his father.
His mother is overbearing and manipulative, and he has an empire to command. He is culturally
reinforced to drink and it is no doubt there will be lapses from time to time. It is important that
we turn these lapses into teaching moments and make them therapeutic. These are called
prolapses, and they involve reframing Alexanders lapses into positive learning experiences
instead of punitively reprimanding him. For example, at a celebratory feast on the occasion of
defeating a rival army, Alexander might take a sip or two with his fellow soldiers to
commemorate the occasion. A positive prolapse could be telling Alexander that he is keeping

Alexander: The Great Addiction

custom and not offending his soldiers, but at the same time preventing him from getting drunk
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and harming himself. Setting goals for Alexander the Great would be important, and making
them small and achievable would greatly increase our chance of success. This is where the
concept of Harm Reduction comes into place, looking to reduce the harm of addiction rather than
constantly shooting for absistience. Our goals can start small, with perhaps drinking every day,
but not getting to the point of losing ones senses, or avoiding triggers that would make one
relapse (stressful conversations with his mother). Our goals can increase more towards abistence
and healthier living as Alexander gains confidence and develops his own internal skills, while we
develop alternative coping mechanisms.
In terms of modes of treatment, I believe it will have to follow several different
levels of treatment, as Alexander is quite severely addicted to alcohol. He will need to start off
with some individual therapy in order to develop some of the personal and internal skills needed
to understand change. Individual counseling needs to happen first in order to assess motivation
for change and any ambivalence he has towards motivation. Later, if individual counseling
proves successful, I believe therapy with his mother is important. Family therapy can hopefully
solidify roles within the family system, and remove any inappropriate boundaries that are around
his mother and him. I strongly believe that Alexander the Great needs to enter a co-occurring
disorder intensive in-patient treatment center in order for him to gain the help he needs through
therapy, pharmaceutical medication, and psychoeducational resources that will address his
addiction and his other diagnoses. I would recommend the inpatient intensive care be around 2-3
months, (he can afford to do that in between his campaigns). Alexander the Greats aftercare plan
should involve him meeting with monthly AA groups around Mesoptomia and attending them in
order to keep social support and a community around him. Lastly, he should see his addictions

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counselor weekly in the beginning, and then gradually reduce services as needed, in order to
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reframe relapses.

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Reference

American Psychiatric Association. (2013). Diagnostic and

statistical manual of mental disorders (5th ed.). Washington, DC:
Author.
Beard, M. (2011). Alexander: How Great? Retrieved August 14, 2016, from
http://www.nybooks.com/articles/2011/10/27/alexander-how-great/
Denison, S. (n.d.). Was Alexander a great alcoholic? Retrieved August 14, 2016, from
http://www.independent.co.uk/news/uk/was-alexander-a-great-alcoholic-1537664.html
History.com Staff. (2009). Alexander the Great. Retrieved August 14, 2016, from
http://www.history.com/topics/ancient-history/alexander-the-great
The Sunday Tribune - Spectrum. (n.d.). Retrieved August 14, 2016, from
http://www.tribuneindia.com/2009/20090329/spectrum/main5.htm
Thomas, K. (1995). A psychoanalytic study of Alexander the Great. Retrieved August 14, 2016,
from http://www.ncbi.nlm.nih.gov/pubmed/8657823