____________________________________ Substance Use Disorders: Assessment and Treatment, 2nd Edition
Client : Well, we always had enough to eat and clothes to wear and a roof over our heads, but my father wasn’t much of a dad to any of us. I remember spending most of the day at school feeling scared about what was going to happen that night. It was hard to learn anything when you’re always scared, and I guess my grades showed it. I never flunked any classes or anything, but I don’t think that I ever did as well as I might have. Therapist : I wonder, do you think that your feeling worried and scared had anything to do with your drinking when you were young? Client : Yeah, when I drank, I didn’t worry so much and I wasn’t scared. I guess drinking was one of the best things in my life growing up. Therapist : What happened with your drinking after your father found out you were taking his alcohol? Client : I always worked. I had a paper route, and in the summer, I would cut lawns and in the winter shovel snow, so I always had some money coming in. Pot was easy to get, so for a while I just smoked that. It was almost as good as the drinking. For a while, in high school, I got into selling pot. It was easy money, but I never got heavy into the drug scene. I did meet some older guys who were into drugs, and they would always get me alcohol if I paid them to do it. After high school, I joined the Army. I stayed in for 8 years and got to be a corporal. That’s where I learned to be a machinist. Man, talk about drinking. I spent the whole time stateside at one military reservation or another. Everywhere I went, there was a lot of drinking. Therapist : What happened then? Client : I left the Army and thought about going to college, but I got a real good job as a machinist right off, so I never went back to school. Pretty soon I met my wife, and we were married. She liked to party a lot, but once she got pregnant and we started having kids, she decided the party life wasn’t for her. Therapist : Then what happened? Client : We had three kids: The oldest, a boy, David, he’s 12; next a girl, Alice, she’s 9; and the youngest is another girl, Francine, she’s 5.
Client : Yeah, I guess you’re right about that. Therapist : If I could just come back to the reason you came to see me. What kinds of concerns did your doctor have about your drinking? Client : He said that the blood tests showed that there was something wrong with my liver. Something was off in the lab tests. And he said that my red blood cells were larger than they should be, and my blood pressure is high. He said all of that was because of my drinking. Therapist : Since your doctor has told you that you have some medical problems that are probably caused by your drinking, have you done anything about your drinking? Client : No, I haven’t. I just don’t think I’m an alcoholic or anything. Therapist : I can understand you not wanting to be labeled an “alcoholic.” I want you to know how much I admire your willingness to talk about your drinking so frankly; it takes real courage. I want to take a moment to summarize what you’ve told me about your
drinking, if that’s OK? Client : Yes, that’s fine.
Therapist : You let me know that your drinking makes you miss out on some activities with your children and that your doctor thinks that you have some developing medical problems related to your drinking. How do you reconcile the thought that you are not an alcoholic with this information you are telling me? Client : Yeah, whether I like it or not, I’d be an idiot not to do something about my drinking. But I’ve been drinking so long I’m not sure I want to stop. Therapist : Are you willing to talk about it a little more with me? Client : Sure. DETOXIFICATION There are many situations in which individuals require detoxification prior to treatment. This can be an important first step for clients who are addicted to opioids; alcohol, bar- biturates, or other sedatives/hypnotics; and amphetamines. Detoxification is typically not recommended for individuals who use cocaine/crack or cannabis. A medical professional can determine if detoxification—which can occur on an inpatient medical unit or sometimes can be completed in an outpatient setting—is required. Detoxification is required only for individuals who have physi- cal dependence that results in dangerous withdrawal symp- toms that require the supervision of a medical professional. Withdrawal symptoms differ based on the substance and can range from severe depression (as in the case of withdrawal from stimulants such as amphetamine) to risk of death (as in the case of withdrawal from sedatives/hypnotics such as alcohol). Alcohol withdrawal, which can be life-threatening and occurs 6 to 48 hours after alcohol cessation, often requires careful medical management. Detoxification strategies are based on the client’s history of past withdrawal and the current clinical status. Laboratory studies that include blood alcohol level are
All of them are really good kids. I guess I’m really lucky. Therapist : You seem to be proud of your children.
Client : I am. They’re the best thing that ever happened to me. I try to make sure that they have everything they need, and I would never do anything to harm them. Therapist : I wonder, has your drinking had any impact on your relationship with your children? Client : I don’t think so. I mean, my wife doesn’t want me going to any Little League games or school stuff with beer on my breath. Beer is all I drink. I swore off the hard stuff a long time ago. So, I guess I have missed a few games and some school functions. Therapist : Let me make sure I understand. On the one hand, you don’t think that your drinking has affected your relationship to your children, and on the other you are aware that sometimes you miss some important activities in their lives because you are drinking. Do I understand correctly?
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