Chapter 6. Jorge’s Case: “Can I Get a Refund if I Don’t Need to Be Here?”
6.1 Screen 1
1. Individual stops or reduces drinking after excessive alcohol use.
2. Presence of at least 2 of the following symptoms within days after stopping alcohol consumption:
• Sweating or heart racing
• Hand shaking
• Difficulty sleeping
• Nausea or vomiting
• Short-term hallucinations or illusions
• Nervous movements
• Anxiety
• Seizures.
3. Significant distress or impairment.
(Information from: APA, 2013)
1. Individual has drunk alcohol recently.
2. Individual experiences marked changes in behaviors or psychological functioning while or shortly after drinking.
3. Presence of at least one of the following symptoms starting while or shortly after drinking:
• Slurred speech
• Poor coordination
• Walking difficulties
• Fast, involuntary movements of the eyes
• Poor attention or memory
• Stupor or coma.
(Information from: APA, 2013)
1. Individual displays a maladaptive pattern of alcohol use leading to significant impairment or distress.
2. Presence of at least 2 of the following symptoms within a 1-year period:
a) Alcohol is often consumed in larger amounts or over a longer period than intended
b) Unsuccessful efforts or persistent desire or to reduce or control alcohol use
c) Much time spent trying to obtain, use, or recover from the effects of alcohol
d) Failure to fulfill major role obligations at work, school, or home as a result of repeated alcohol use
e) Continued use of alcohol despite persistent social or interpersonal problems caused by it
f) Cessation or reduction of important social, occupational, or recreational activities because of alcohol use
g) Continuing to use alcohol in situations where use poses physical risks
h) Continuing to use alcohol despite awareness that it is causing or worsening a physical or psychological problem
i) Craving for alcohol
j) Tolerance effects
k) Withdrawal reactions.
(Information from: APA, 2013)
1. Individual displays a maladaptive pattern of stimulant use leading to significant distress or impairment.
2. Presence of at least two of the following symptoms within a 1-year period:
a) Stimulant is often taken in larger amounts or over a longer period than intended
b) Unsuccessful efforts or persistent desire to reduce or control stimulant use
c) Much time spent trying to obtain, use, or recover from the effects of stimulant
d) Craving for stimulant
e) Failure to fulfill major role obligations at work, school, or home as a result of repeated stimulant use
f) Continued use of stimulant despite persistent social or interpersonal problems caused by it
g) Cessation or reduction of important social, occupational, or recreational activities because of stimulant use
h) Continuing to use stimulant in situations where use poses physical hazards
i) Continuing to use stimulant despite awareness that it is causing or worsening a physical or psychological problem
j) Tolerance effects
k) Withdrawal reactions.
(Information from: APA, 2013)
The adjustment that the brain and the body make to the regular use of certain drugs so that even larger doses are needed to achieve earlier effects.
What brought you in?
Jorge
- Son, Tomas, brought him in because of his drinking
- He believes he doesn’t have a drinking or drug problem
- Says he engages in social drinking → not a “problem drinker”
Tomas
- Trying to get his dad to come for treatment for years
- Jorge passed out and hit head on coffee table
• Mother called to tell him about Jorge ‘s accident → Parents have been divorced for years
• Jorge doesn’t remember how he got there
Alcohol/substance use
Jorge
- Doesn’t use drugs
- Doesn’t smoke → he stopped cold turkey after having a heart attack 6 months ago
- 2 drinks per day → doesn’t drink every night
Tomas
- Spent time with Dad 2 weeks ago
- On leave from Air Force → Tomas is training to be a pilot like his father
- Jorge drinks in afternoon into the night – every day:
• one or more bottles of wine
• several glasses of Jack Daniels after dinner
• Never seems drunk
• Doesn’t suffer from hangover
Drinking habits
Jorge
- Claims what Tomas is saying is not true
- Only thing he agrees with is that he does not get hangovers
Tomas
- Reports that Jorge often doesn’t remember what he did the night before
• Jorge thinks it’s Alzheimer’s
• Tomas thinks it’s drinking
How has drinking affected his life?
Jorge
- States Tomas is worried about him, but that he doesn’t need to be here
- Denies any problems
Tomas
- Alcohol caused Jorge’s fall
- Jorge’s FAA medical files → doctor thinks Jorge’s health problems are related to drinking
- Observes that Jorge is not losing weight, despite healthier lifestyle since heart attack
Why is Jorge at the clinic?
Jorge
- Woke up on floor after passing out
• Couldn’t get up
• Didn’t know how he got there
• Worried he had another heart attack
• Paramedics say he passed out from drinking
• Feeling depressed, nothing on TV
• Drank more than a bottle of wine
- Called 911 for ambulance
- ER doctor asked about his drinking
- Regular doctor also bugging him about drinking
- Jorge says he is only at clinic to make others happy
Tomas
- Worried because he cares about his dad
- Wishes Jorge were going into 14-day treatment plan instead of 7-day stay
When did Jorge first start drinking?
- Did not drink at all growing up due to parents’ religion
- Graduated high school → felt need to look for biological dad
• Visited his dad and much younger stepmother
• Introduced to alcohol; they drank wine and hard alcohol
• Jorge loosened up, felt less awkward, enjoyed drinking
College experience
- Went to college
- Corresponded by letter with dad until dad died a year later
- Joined a fraternity → drank a lot
• Drank more than he studied
• Was able to drink others under the table
Military service
Jorge
- Served after college
- Air Force → pilot training
• Train all day during the week
• Drink all night on the weekend
• Served 8 years
- Afterwards, got a job as commercial airline pilot
Tomas
- Doubts Jorge can get off medical leave unless he stops drinking
Relationship with family
Jorge
- Don’t need them hovering around
- Jokes that “Jack” (Daniels) is best friend
- Met his wife during military service
• She didn’t like his drinking
• Divorced a few years after he retired from Air Force and became commercial pilot
- Dated flight attendants on and off, never remarried
Tomas
- Parents fought a lot growing up, so felt relief when they divorced
- Missed Jorge after he left and stated he loves him
- Wants to fly cross-country with dad
- Can only do if dad stops drinking and gets off medical leave
Unpleasant, sometimes dangerous reactions that may occur when people who use a drug regularly stop taking or reduce their dosage of the drug.
A persistent thought, idea, impulse or image that is experienced repeatedly, feels intrusive ans causes anxiety.
Damage to the liver due to many possible causes, in this case, excessive drinking.
The medical term for bad breath.
A substance that increases the activity of the central nervous system.
A substance that slows the activity of the central nervous system and in sufficient dosages causes a reduction of tension and inhibitions.
A highly addictive substance made from the sap of the opium poppy seed.
A substance that causes powerful changes primarily in sensory perception, including strengthening perceptions and producing illusions and hallucinations.
The behavioral model argues that our actions are determined largely by our experiences in life. Behavioral theorists focus on principles of learning, in particular how abnormal behavior might be learned by observing others or reinforced by contingencies in our lives such as avoiding discomfort. Behavioral theorists and therapists are more interested in observable behaviors and environmental factors than the inner workings of the mind. This model argues that operant conditioning plays a role in substance use disorders. When taking a substance reduces stress or raises spirits temporarily, it produces rewarding effects and makes it more likely that the user will continue to use the substance and consume higher dosages.
The biological model adopts a medical disease perspective on psychological disorders. The main focus of this model is that psychological abnormality is an illness brought about by malfunctioning parts of the organism. Typically, the biological model focuses on genetic predispositions for disorders and abnormalities in brain anatomy or chemistry. This model argues that there may be a genetic predisposition for alcohol use disorder if parents or other relatives also have the disorder. In addition, alcohol (indirectly) stimulates the brain’s reward centers to produce pleasurable sensations, thus increasing the likelihood that it will be used repeatedly.
The psychodynamic model argues that abnormality is largely determined by early childhood experiences navigating stages of development focused around erogenous zones. This model argues that substance use disorders can be tied to dependency needs that go back to early childhood, when parents fail to satisfy a child’s needs. Therefore, the child grows up to seek satisfaction and support elsewhere, which may lead to a dependent relationship with a substance.
The sociocultural model argues that stressful conditions, especially situations such as unemployment or poverty, are linked to higher levels of substance use disorders. The model also argues that these disorders are more likely to occur in situations where people are exposed to other types of stress such as intense discrimination or if they are part of an environment in which substance use is accepted or even valued.
A residential treatment center is a drug- and alcohol-free environment where people who are trying to recover from addiction live, work, and socialize. The residential treatment program would take place in such a center. In Jorge’s case, he would live at the clinic for anywhere from seven to 28 days. He would attend group and individual therapy sessions daily and be involved in responsibilities around the center, such as cooking and cleaning. Psychological and medical staff members would monitor Jorge’s detox from alcohol, and give him guidance for managing his sobriety after leaving the program.
A conversational treatment used by psychodynamic therapists that includes techniques such as free association, or letting the client talk about whatever comes to mind, and therapist interpretation, which involves giving insight and offering an opinion on patterns noticed in the client’s free association and other things such as dreams. A psychoanalyst would treat Jorge by seeing him 3-5 times per week for several years. Psychoanalysis is costly and it requires a large time commitment.
CBT involves challenging distorted thoughts and helping patients change maladaptive behaviors. Cognitive-behavioral therapists work with patients to address their maladaptive thoughts in each phase of the disorder. In Jorge’s case, treatment for his substance abuse would entail logging his drinking behaviors to determine what might trigger his drinking episodes and challenging the unhelpful thoughts he might have about drinking.
Medication involves taking a chemical agent prescribed by a medical doctor to alter brain chemistry, which subsequently alleviates symptoms. A psychiatrist, who has a medical degree (MD) would be able to prescribe patients medication to treat their symptoms. In Jorge’s case, a psychiatrist might prescribe antagonist drugs to help block or change the effects of alcohol to help him resist the temptation of drinking. However, antagonist drugs produce intensely unpleasant reactions, such as nausea, vomiting and dizziness, when alcohol is consumed and Jorge may not be motivated to take the medication.
Author: Taryn A. Myers, Ph.D., Virginia Wesleyan College
6.2 Screen 2
Please note: Clinical Choices allows you to enhance and test your understanding of the disorders and treatments covered in your textbook, in a simulated case study environment. It is not intended to replicate an actual intake interview or therapy session or provide training on therapeutic techniques. Clinical Choices is for educational purposes only and is not intended as a substitute for clinical training.
6.3 Screen 3
You are a clinician working at a residential treatment center treating people with substance use and addictive disorders. The receptionist hands you intake paperwork prior to your interview with your new client, Jorge, and mentions that his son, Tomas, has brought him in. Tomas is very concerned about his father. Click the button below to review the paperwork before you begin the interview.
New Client
Jorge: Case #10112
Residential Treatment Center
Intake Paperwork
Client Name: Jorge
Age: 55 years old
Gender: Male
Ethnicity: Latino
Occupation: Commercial pilot on medical leave
Current living situation: Live alone
Why are you seeking services at our clinic?
My sons asked me to come because they’re worried about me and my health. I don’t have a problem but I want to get them to stop bothering me so I’m here.
6.4 Screen 4
You will now ask Jorge and his son, Tomas, a number of questions you would typically ask during the intake interview. As you conduct the interview with Jorge, begin to think about his symptoms, what his diagnosis might be, and later, what type of treatment might be most helpful to him. Click the “play” button below the illustration to hear Jorge’s and his son’s responses to your questions. To read the transcript for these answers, click the “transcript” button. Take notes in the box provided as you listen to Jorge’s responses.
6.5 Screen 5
“Hi Jorge. It’s good to meet you. Tomas, thank you for coming in with your father today. What we are doing today is called an intake interview. I’m going to have you tell me what brought you here today, and ask you some questions that I ask everyone who comes to the clinic. This information will tell me how best to help you. This may mean continuing treatment at this facility, or it may involve referring you to another mental health professional or facility. Let’s start. Tell me about what brought you to the center today.”
Transcript
Jorge: [defensively] My son, Tomas, made me come. I don’t know why. I don’t have a drinking or a drug problem. Tomas and his brother Alex just need to get it into their heads that I’m a social drinker. I’m not a problem drinker, an alcoholic… or a drunk or any of the other things they say I am.
Tomas: I’ve been trying to get my dad to get treatment for years. He finally agreed this time because he passed out and hit his head on his coffee table. After he came to, he called an ambulance! [incredulously] He didn’t even call me to tell me about it! Mom had to fill me in, and they’ve been divorced for years. [to his father] She said you didn’t even remember how you got on the floor, dad. That’s really scary.
Question 6.1
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What brought you in?
Jorge
- Son, Tomas, brought him in because of his drinking
- He believes he doesn’t have a drinking or drug problem
- Says he engages in social drinking → not a “problem drinker”
Tomas
- Trying to get his dad to come for treatment for years
- Jorge passed out and hit head on coffee table
- Mother called to tell him about Jorge ‘s accident → Parents have been divorced for years
- Jorge doesn’t remember how he got there
6.6 Screen 6
“Jorge, is what Tomas is saying true? Do you drink alcohol or use any substances? If so, how much and how often?”
Transcript
Jorge: [indignantly] I certainly don’t use any drugs! I don’t even smoke cigarettes – I used to, but after my heart attack six months ago… my doctors asked me to give it up, so I quit cold turkey – no problem! I don’t have a drinking problem. I limit myself to 2 drinks a day – and I don’t drink every night.
Tomas: [sadly] Dad, that’s not true. [explaining to clinician] About two weeks ago, I spent a week with Dad when I was on leave from the Air Force – I’m in pilot training because my dad used to be a pilot in the Air Force, too. He was my hero growing up. [sadly] Dad, you would start to drink in the middle of the afternoon, and by dinner, you would have finished off one bottle of wine on your own and started on another. [to clinician] I’m up for a drink as much as the next guy, but I could never hold my liquor like Dad. He drinks all that and never even seems drunk! After dinner, he would open up the Jack Daniels and drink it over ice. Every night, he would have at least 3 tumblers full of Jack before he fell asleep on the couch. I would be drunk and have a hangover the next day, not even drinking half of what he did, but Dad never seemed to get a hangover.
Question 6.2
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Alcohol/substance use
Jorge
- Doesn’t use drugs
- Doesn’t smoke → he stopped cold turkey after having a heart attack 6 months ago
- 2 drinks per day → doesn’t drink every night
Tomas
- Spent time with Dad 2 weeks ago
- On leave from Air Force → Tomas is training to be a pilot like his father
- Jorge drinks in afternoon into the night – every day:
- one or more bottles of wine
- several glasses of Jack Daniels after dinner
- Never seems drunk
- Doesn’t suffer from hangover
Question 6.3
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Think about the amount Jorge is consuming compared to what an average adult might consume in an evening.
6.7 Screen 7
“Jorge, what do you make of what Tomas is saying? What do you really think about your drinking habits?”
Transcript
Jorge: [irritated] I don’t know what he’s talking about, other than me never having a hangover – that’s true! To me, that says I don’t have a problem.
Tomas: [clearly upset] Don’t have a problem! Dad! You don’t even remember what you did the night before – [to clinician] he would tell me he didn’t remember what we had for dinner or what movie we watched. [to Jorge] When I told you, you got all upset and wondered if you had “early onset Alzheimer’s or something.” That to me says something is wrong. I think it’s because of your drinking.
Question 6.4
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Drinking habits
Jorge
- Claims what Tomas is saying is not true
- Only thing he agrees with is that he does not get hangovers
Tomas
- Reports that Jorge often doesn’t remember what he did the night before
- Jorge thinks it’s Alzheimer’s
- Tomas thinks it’s drinking
6.8 Screen 8
“Jorge, do you feel like your drinking is affecting your life in any way?”
Transcript
Jorge: [exasperated, speaking slowly as if to explain to a child] I’ve been trying to explain to you that it’s not. The only reason I’m here is because Tomas is worried because I fell. He says he’s afraid of losing me … [more quickly] Not going to happen, son.
Tomas: Dad, this is about more than that! Not only did the alcohol cause your fall, it’s been messing up your life for a while now. When I was visiting, I was playing solitaire on the computer after you passed out one night. I stumbled upon your FAA medical files … [hastily, defensively] before you get mad, I wasn’t snooping … you left the folder out on the desk… I saw the notes from your last physical, and the doctor said that you lied to him about how much you drink. Even though you told him you only have two drinks a night – a lie you’re trying to tell this doctor right now, too – the FAA doctor wrote “Alcohol related” with a question mark next to your complaints about memory loss. [louder] Your drinking is keeping you from flying again. But more than that, it’s affecting your health. You’ve done all these great things since your heart attack – you’re taking cholesterol medication, you go to the gym, eat more salads and fish – but you’re not losing weight. Think about it: you’re probably drinking like, 1500 calories a day in alcohol! I’m worried about you. Alex is worried about you. We lost you once before when you and mom got a divorce. We don’t want to lose you again.
Question 6.5
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How has drinking affected his life?
Jorge
- States Tomas is worried about him, but that he doesn’t need to be here
- Denies any problems
Tomas
- Alcohol caused Jorge’s fall
- Jorge’s FAA medical files → doctor thinks Jorge’s health problems are related to drinking
- Observes that Jorge is not losing weight, despite healthier lifestyle since heart attack
6.9 Screen 9
“Jorge, what do you think about what Tomas is saying? What happened that made you come here to the clinic?”
Transcript
Jorge: I don’t know why Tomas is so worried. I’m fine [pauses] … except for what happened the other week. I woke up on the floor and didn’t know how I got there. I couldn’t get up… I was worried that I’d had another heart attack. Luckily, my phone was in reach, so I called 911. The paramedics said I had passed out from drinking – they had no idea, didn’t know what they were talking about. Still, I didn’t drink for two days after Tomas left to go back to the Air Force. [triumphant] See…I can stop if I want to! [hesitates, slightly embarrassed] But then … there was nothing on TV and I was feeling a little down, so I drank some wine. [defensive] I only had one bottle! Well … maybe part of another one, too. [sounding annoyed again] The ER doc asked me all these questions about my drinking, implying that I had a problem. And my regular doctor won’t get off my back about my drinking, either. So I came here to appease them … well … mostly to appease Tomas and his brother. One of my buddies came here and said this place is a piece of cake if I tell you what you want to hear – [pleasantly] no offense, doctor. He said it was nice, and for 10 grand a week, it better be! Here’s what I really want to know, doctor – if you tell me I don’t need to be here, can I get a refund? Because I really don’t think I need to be here. And if the FAA found out, well – let’s just say I’m doing this on my own dime because I love my boys.
Tomas: [to his father] I’m worried because I care. I’m glad you’re here. I just wish you would have signed up for the standard 14 days instead of only agreeing to a week, Dad!
Question 6.6
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Why is Jorge at the clinic?
Jorge
- Woke up on floor after passing out
- Couldn’t get up
- Didn’t know how he got there
- Worried he had another heart attack
- Paramedics say he passed out from drinking
- Feeling depressed, nothing on TV
- Drank more than a bottle of wine
- Called 911 for ambulance
- ER doctor asked about his drinking
- Regular doctor also bugging him about drinking
- Jorge says he is only at clinic to make others happy
Tomas
- Worried because he cares about his dad
- Wishes Jorge were going into 14-day treatment plan instead of 7-day stay
6.10 Screen 10
“Well, before we talk about the length of your stay, Jorge, let’s explore the issue a little more first. When did you first start drinking?”
Transcript
Jorge: [trying to remember] Hmm… Well, I didn’t drink at all growing up. My mom and step-dad raised me, and they were Seventh Day Adventists, so they didn’t drink or even allow alcohol in the house. I think it must have been the summer after I graduated from high school, before I started college. My biological dad left before I was born … and I really wanted to find him before I started college. I got it in my head I needed to. I tracked him down in Texas. He’d remarried a much younger woman, very pretty. [ashamed and sad] My dad never amounted to much – my mom always said that would be the case. But he and his wife were happy to have me visit. I ended up staying three weeks with them, and we had wine and long talks every night over dinner. I realized I liked the taste of wine, and I also got to try the “hard stuff” with my Dad. It loosened me up, made me feel less awkward. [reminiscing] We had a great time that summer, and I really started to enjoy drinking.
Question 6.7
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When did Jorge first start drinking?
- Did not drink at all growing up due to parents’ religion
- Graduated high school → felt need to look for biological dad
- Visited his dad and much younger stepmother
- Introduced to alcohol; they drank wine and hard alcohol
- Jorge loosened up, felt less awkward, enjoyed drinking
6.11 Screen 11
“What happened after that, Jorge?”
Transcript
Jorge: I went off to college, and my dad and I kept up by writing letters for a while …[laughs] this was before all this email, texting stuff. We wrote real letters! But I guess we both got busy and I didn’t get the chance to visit him again before… he – he passed away of a heart attack about a year later. [slight pause] I went to a state university, pledged a fraternity, made the football team. You know how it is in a fraternity house – we drank as much as we slept and ate, and probably more than studying! I could drink a lot, and that made me popular. [with pride] I could drink anyone under the table and still be standing while they were passed out or throwing up.
Question 6.8
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College experience
- Went to college
- Corresponded by letter with dad until dad died a year later
- Joined a fraternity → drank a lot
- Drank more than he studied
- Was able to drink others under the table
6.12 Screen 12
“Tomas mentioned earlier that you were in the military at some point. Thank you for your service to our country. When did you serve, Jorge? Was it after college?”
Transcript
Jorge: I always wanted to be a fighter pilot. After I graduated from college, I applied for the Air Force and was accepted to pilot training. I made some really good friends -- those were the days! Hard work all week, then gathering at the local watering hole on Friday and Saturday nights. We would all start drinking around 5pm, have some sandwiches at the bar, flirt with some ladies who came looking for guys in uniform, and close down the bar with cognac and black coffee. Just like college, I could still drink anyone under the table and be fine Saturday or Sunday morning. I served 8 years, and then got a job with a commercial airline when I got out. Same airline that I’ll get back to flying for soon if I can get my health back in shape!
Tomas: [under his breath] No way you’re going to be able to go back to flying if you can’t get your drinking under control.
Question 6.9
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Military service
Jorge
- Served after college
- Air Force → pilot training
- Train all day during the week
- Drink all night on the weekend
- Served 8 years
- Afterwards, got a job as commercial airline pilot
Tomas
- Doubts Jorge can get off medical leave unless he stops drinking
Question 6.10
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Think about what might help Jorge on his journey to recovery.
6.13 Screen 13
“What’s your relationship like with your family, Jorge?”
Transcript
Jorge: Eh. Don’t really need them hovering around all the time when I have the best friend a man can have – Jack. [laughs]… [adds]…as in Daniels… Am I right? But Tomas and his brother Alex are good kids, they look out for me. I met their mom when I was in pilot training. We didn’t see much of each other after we got married because I was deployed so often in the Air Force and she wanted to stay near her parents. When I was a commercial pilot, I only flew 10 or 12 days a month, so I had plenty of time to relax at home. [a little angrily] She didn’t like that though. She used to complain I drank too much and nag me all the time. Funny thing was I only had a few drinks a night to keep her from getting on my nerves. We got divorced after a few years of that… Found myself a nice condo. Hung out with pilot buddies, had some fun – if you know what I mean – with some flight attendants. Never did get married again. Never saw the need. I just enjoyed myself, until Tomas here got all worried about it. That doctor thinks my drinking caused my heart attack – ridiculous!
Tomas: [sadly] I remember hearing my mom and dad fight all the time when I was growing up. It was really tough. It was almost a relief when they got divorced and you moved out, Dad. But then I missed you… [choking up a little] I love you, Dad. I want you to get better. I want you to be able to go off medical leave and get cleared for flying so that we can fly cross-country together. But I don’t see how we can do that if you don’t commit yourself to getting help for your drinking.
Question 6.11
Aw4Neimql6WiMoYbuJRsIoWYmUI0RI7zrHbz76SzMIbhWEDqh6ekegUlrs1Emw4+XZkUEXqAzYeD9ge9pFWce/4cOT0=Check Your Notes
Relationship with family
Jorge
- Don’t need them hovering around
- Jokes that “Jack” (Daniels) is best friend
- Met his wife during military service
- She didn’t like his drinking
- Divorced a few years after he retired from Air Force and became commercial pilot
- Dated flight attendants on and off, never remarried
Tomas
- Parents fought a lot growing up, so felt relief when they divorced
- Missed Jorge after he left and stated he loves him
- Wants to fly cross-country with dad
- Can only do if dad stops drinking and gets off medical leave
6.14 Screen 14
Question 6.12
Which of the following symptoms is Jorge currently experiencing? Check all that apply. Use your interview notes to help you remember!
| bI0LPa9lfHQ+dYqk | Alcohol is taken in larger amounts than was intended |
| wCfH0QtRgXJ8o+c+ | Sweating or pulse rate greater than 100 bpm |
| bI0LPa9lfHQ+dYqk | A great deal of time is spent using alcohol |
| wCfH0QtRgXJ8o+c+ | Nausea or vomiting |
| bI0LPa9lfHQ+dYqk | A strong desire to use alcohol |
| wCfH0QtRgXJ8o+c+ | Sleeping less than usual |
| bI0LPa9lfHQ+dYqk | Continued alcohol use despite persistent interpersonal problems caused by alcohol |
| bI0LPa9lfHQ+dYqk | Important social or occupational activities are given up because of alcohol use |
| bI0LPa9lfHQ+dYqk | Alcohol use is continued despite knowledge of a physical problem that is likely to have been caused or exacerbated by alcohol |
| wCfH0QtRgXJ8o+c+ | Transient visual, tactical, or auditory hallucinations or illusions |
| bI0LPa9lfHQ+dYqk | Need for more alcohol to achieve desired effect |
| wCfH0QtRgXJ8o+c+ | Unsteady gait and incoordination |
| wCfH0QtRgXJ8o+c+ | Drinking more alcohol to relieve withdrawal symptoms |
| wCfH0QtRgXJ8o+c+ | Stupor or coma |
Hint
Think carefully about Jorge’s drinking and related behaviors, especially as described by his son during the interview.
6.15 Screen 15
From the File. You remember a former patient who shared symptoms similar to Jorge’s. You review this case to help you diagnose Jorge.
Question 6.13
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Question 6.14
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Think about the following symptoms Jorge exhibits in making your choice: Spending a lot of time drinking; continuing to drink despite consequences to his health; and continuing to drink despite not being able to return to work.
6.17 Screen 17
Question 6.15
I0hwcuM9J66yqwD5Pi37jBCt/kCHxi5KM1hw+Nu3HuPK15VvEvGiOKFZs34mPlNJrFCZGFl+rkfe/fN3k+NT3oREqZipQl5+TJDXocY6zlg99iGSc4hTtxcvBVyktFrdQuestion 6.16
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Question 6.17
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
This is a symptom of alcohol use disorder.
Question 6.18
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This type of drug slows down the nervous system.
6.19 Screen 19
Question 6.19
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In making your choice, think about which model talks about rewards and punishments being important explanations for whether a behavior will continue.
6.20 Screen 20
Question 6.20
QsTOYn0io6R+Hf2piLcE2ay5bi4GmSPxxcvjXERTZYEDV+6iFCbDx+1Mww5aw4L7G25dBqqZNK2su39CESreKbNxNCzwjFeV0Rr8WNHGKPxST4CH8adiob0UHQMGWfY6zNekU/Yn2/G5eFLuScOMQRFSbTfUo5LHDs1OhsL8c0ildqvWTwflpSmck+q1qCOhXW8UhI0ev/Q7rZHRejjsF5u8nLkriQygJ6AaUOYrg/mpnIXROeR7HlL5zMa8z46FHDQ/lJJn2nfwUWVZt36UkmWja6GSbuVWV3v1047PL+G3h0h/fNXE0dm4BbGBPg/rMq14RRuxJ+I+zcpRcDl+YgK3fYkjDJ/WME1AidJGnxfFGfqZibQfL0XP9wau8qV2lgrVPuh83o6Ne6l/AKNYQp7Fs+9gyX6e+DiOqUXZ1l9xrkF6fBrlWsU1xaVOjcqrf+0RuvN3EISsxvPsgHeZiywKSi9pLIUyABXE7DEVf/O5Flr9MqaXCXGoyt3fzDXocDN0F5xA9gOLr2bfL3PB8Ielhdbpl8CdEKE4Hu/9fXBOpK750+RZI3HOjPZKMT4xlABnRDcbl10nmmwIFBMjwJNA6PloBs7L5373kdvIoNhHAyNdB56krXghhrK5LH+7UrEhPzRtwuSEvYUWoi6UsxPnyPz8QsPTI+dHHjCDDoL2/mC9ZP5HPTFfiXrlYRFx0qfdua9MyJIE/0mI6XxNbaqXbfvqVqsdiI2p6SwHrVQ927nbG3hSsyaqJM9IrbGIOm+Mw6YItwTmM0u93sgIsfbVQBCQOwZ7gVjx+RadfEuNWRiDv4jkaq7XtmGM2wXxO/58ehIyi9yKASHD16HoDBgyMK6ar34EWjnN6u3+9IQvWKl/u3i4lVH0kbCAT5TI4Q2Qo9r/FHfjrL15/JTviRy2F//zgo2Yz15e4bZfhqPJypmqpmh4URpwaPuwPzvK4Y+zAtntCrnW/l7pOylAK9kyisiPb2NV1b3vnn9cEn4wCtga90/Iw2MHpx5YZwKCvFkKFucH1+uNn9GbUC8SUxTFCArzRIOXZs0Y98voBuxc+ngZSuQx+ws5j3lGQWPfnUgZ9cRTAM6gpUiD91NMZIzKqVo/nEWk3uXsgJ9KL1lFQ9x4k/3Q00CLTIvcOCFdOE0RnNXq8qOmmqImdK7+VB3aqpOb7GRRkfbdfPlekWJtnnmmQvgcbn7d32yI27w2kvewQM0McssbP67VCM5whdawp/J7GaEVgbGwK+Cba1Rq8Y6KvHrnYatPqk1PpzDxkTzEvGENCdpmzPVu/hYTgqXOEK+HFp3HxkBMIb+cnM4L8COGx9tNLtdjgXJ0MghDx+73YUBNizUk++IuwN5+UG7CVJ/vlEVSiWPS171tcX0y9kiSr66H4my3/Wkc5D11rWg/CguNBskJE/o63MTFNQWJePwPi+N6F8EbZqdXRutlqNrN+qMHPudVyNx8tDPDD/C8wfQ3XNue1qFaBBpobu0R9fkggolESe0thYhVUP2NxrGpEB4IjEQhdw/aSYw3gMkkilEtWtjDqX0tUN0r9mtwCvhrro7JLiSipEyHZbuLRQiMuZNBCkpvIUHRL+irz2aMpDqWzNwLy4PVixH9vZyDFWWnLZlPNQna0qF/t+Sf55evMyYwyZ1mzQr5/CAPwrMxSRYZ1vUIFzx3Kx622x8YIqfbri0Nqptk3X2x0Y2srC2uQFFQBt6MVzaW2Q4OW0WQB3v2egNKlxqoejOXrDs6AyDWv92xFH7OoEBdBwKkAu2USrc8thL52tYHO+YkGgssQQK6LxqcRcUs28tUX4g0wr+UTpO48iOhFXe2rzhlGOxwH+j0WFuiZI/rMXDFqImMvQlmGsd+9XimI1C+mivE2UO0VeC+CtsxcJy05tfu+FN1lPS+j6DN40SNzvhQGHdc+ipKLg4ZJy+qezCQE66o/pZMhiImze+Uuzx2rMvPz3MAMHetQALKJI54TXaIlK8iSjvkma3e7vAWJ3MaLJXh9w2hlqzkCQZQYUeazLPyMsbx6fIXYIkN/Qoc7sdtK5iIGUykckMz6qR/B75XqJG182cYdoaw0U2wyNECqEkGpIuGrTP9g7sUzjn/KXrBm26RqLqRj9nsGcYKXDeFknYAfVQlxPpeMSJOK8mw0wYNIqLhg6Ks3/UtnDej6Uvu3+JsoScGu5QGY9J4gn5SIS3PambF9a9KnIrqF9YGahsFdUpUPQ5wL/dNTQTEtBEcheB9YtyBPwpPUqYewxzKfRms8zeoi91/uXNFsKpETVBvXHTmmj1KSY4RuAIAyZSuM5LYrB96ZxXlHAWr0P9Jt7eYINf4lJBaJ+yYs41NpykgJbTEkh0n+pyupci9Hhxk63nCYXRicVkVphy7cz809U9eTT9ZRR4RJir8XK79JjOISKDAilaC3DE12alTmPaVnbJEFX33d+xO19EkCQqp0FvQuPOrmuUxsnTdrisvhnjSR0CbfQ6sbguqZiYFVBH0wUz5aHXAilTOen5yafK0fjhT6Darg9aFAG9S9GbnHKEz5xAy7acU3pTKl4z1ZmyqKTvPrV9MB0D42uFTm8AbpPeQJQs0wgSAvOXxCw7/h2ekvGMJ+amvyybQHhrgAw86MTBqQNECQ9oy+BqYPakwnvwFnwP24idn5kcyUJmH1b4gcOl5cw4ghuljnuDhg1btvIoZJ97ql2ZCGvwIay8bXmcZpSQ17Gw5YE6iz5JGfG4RrhcTvrTGdikUyJGeQROM1E46treCZH0fVGTouQgTMCwy6SVb4lvj2GO4TgwzHrC78Swub36/qJy7XIA0VrPjGJcdkG9cNmD9cAvl5bXKcA==Hint
In making your choice, think about how serious Jorge’s drinking is and the possible physical consequences of withdrawal.
6.21 Screen 21
EPILOGUE
After meeting with you, Jorge still only agreed to try the clinic for 7 days. He said he just wanted to get it over with, commenting that he couldn’t see how the treatment facility that “look[ed] like an upscale hotel” could help him. You explained to Jorge that a week’s stay likely would not be enough to help him and he’d be wasting his money. You left the decision up to him.
Jorge was surprised by the rules of the residential treatment center, including sharing a room with a roommate, having to clean his room daily, help cook and serve one meal a day, not being allowed to read anything except books provided by the center, no access to TV or the Internet, having to participate in group and individual therapy every day, and not being allowed to use the phone or have visitors for the seven-day duration of his stay. He claimed that he was being treated like a cross between a child and a prisoner and that he felt like he was back in basic training, but he stayed on at his sons’ insistence. He told you, however, that he was skeptical of group therapy because “I won’t have anything to say, since I’m not a drunk.” You encouraged him to participate in order to gain a better perspective on the very real consequences alcohol was having on his physical and mental health.
Jorge grumbled quite a bit the first few days at the clinic, but on the fifth day of treatment he had a breakthrough, in part because as his therapist you had persisted in encouraging him to see why he needed to change and make the decision to get better on his own. The clinic’s adherence to the 12-step model of Alcoholics Anonymous seemed to resonate with him. He ended up staying a full 14 days and attended AA meetings daily after he left the clinic. Even so, Jorge struggled with recovery, and he did have a lapse and drink again when he had been about 30 days sober. However, Jorge was honest with himself, returned to AA and, with the help of his sponsor, picked right up where he left off. He often struggled with wanting to drink, especially when he got bored or lonely, but he was able to call his sponsor, who was also former military, and talk through the situations where he was tempted to drink. When he was very tempted, his sponsor would make Jorge call him every day.
Once he quit drinking, Jorge began to lose weight quickly. He increased his time at the gym, improved his physical fitness level, and about 6 months later, his physician cleared him to begin procedures to get off medical leave. He and Tomas have plans to buy a small plane, refurbish it, and fly it across the country together next summer.
6.22 Screen 22
Real World Application
Watch the following video, then answer the questions.