Chapter 6. Jorge’s Case: “Can I get a refund if I don’t need to be here?”
6.1 Screen 1
Unpleasant, sometimes dangerous reactions that may occur when people who use a drug regularly stop taking or cut back on the substance.
Presence of at least two of the following symptoms within days after the individual stops alcohol consumption:
Sweating or heart racing
Hand shaking
Difficulty sleeping
Nausea or vomiting
Short-term hallucinations or illusions
Nervous movements
Anxiety
Seizures
Significant distress or impairment
(Information from: APA, 2013)
Individual experiences marked changes in behavior or psychological functioning while drinking or shortly after drinking.
Presence of at least one of the following symptoms starting while the individual is drinking or shortly after the individual has been drinking:
Slurred speech
Poor coordination
Walking difficulties
Fast, involuntary movements of the eyes
Poor attention or memory
Stupor or coma (Information from: APA, 2013)
Individual displays a maladaptive pattern of alcohol use, leading to significant impairment or distress.
Presence of at least two of the following symptoms within a 1-year period:
Alcohol often consumed in larger amounts or over a longer period than intended
Unsuccessful efforts or persistent desire to reduce or control alcohol use
Much time spent trying to obtain, use, or recover from the effects of alcohol use
Failure to fulfill major role obligations at work, school, or home as a result of repeated alcohol use
Continued use of alcohol despite persistent social or interpersonal problems caused by it
Cessation or reduction of important social, occupational, or recreational activities because of alcohol use
Continued use of alcohol in situations where use poses physical risks
Continued use of alcohol despite awareness that it is causing or worsening a physical or psychological problem
Craving for alcohol
Tolerance effects
Withdrawal reactions (Information from: APA, 2013)
Presence of at least two of the following symptoms within a 1-year period:
Stimulant often taken in larger amounts or over a longer period than intended
Unsuccessful efforts or persistent desire to reduce or control stimulant use
Much time spent trying to obtain, use, or recover from the effects of stimulant use
Craving for stimulant
Failure to fulfill major role obligations at work, school, or home as a result of repeated stimulant use
Continued use of stimulant despite persistent social or interpersonal problems caused by it
Cessation or reduction of important social, occupational, or recreational activities because of stimulant use
Continued use of stimulant in situations where use poses physical hazards
Continued use of stimulant despite awareness that it is causing or worsening a physical or psychological problem
Tolerance effects
Withdrawal reactions (Information from: APA, 2013)
The adjustment that the brain and the body make to the regular use of certain drugs so that increasing doses of the substance are needed to produce the desired effect.
Individual has consumed stimulants recently. Individual experiences marked changes in behavior or psychological functioning while or shortly after consuming stimulants. Presence of at least one of the following symptoms starting while or shortly after the individual is consuming stimulants: Slurred speech Poor coordination Walking difficulties Fast, involuntary movements of the eyes Poor attention or memory Stupor or coma (Information from: APA, 2013)
A persistent thought, idea, impulse or image that is experienced repeatedly, feels intrusive ans causes anxiety.
A persistent thought, idea, impulse or image that is experienced repeatedly, feels intrusive ans causes anxiety.
The cognitive-behavioral model argues that our actions are determined largely by our experiences in life and how we interpret those experiences. Cognitive-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. Cognitive-behavioral theorists and therapists are more interested in observable behaviors and environmental factors than in 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.
Damage to the liver due to many possible causes, in this case, excessive drinking.
Drinking large amounts of alcohol in a short amount of time.
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-free 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 7 to 28 days. He would attend group and individual therapy sessions daily, and he would 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 they would give him guidance for managing his sobriety after he leaves 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 indicators 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.
Cognitive-behavioral therapy 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), could prescribe clients medication to treat their symptoms. In Jorge’s case, a psychiatrist might prescribe antagonist drugs to help block or change the effects of alcohol in order to help him resist the temptation to drink. 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, PhD, Virginia Wesleyan University
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 the 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. Select the button 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. Select the “play” button to hear Jorge’s and his son’s responses to your questions. To read the transcript for these answers, select the “transcript” button.
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 having you continue 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.
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 6.1
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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.
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 your 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 6.2
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Hint
Think about the behaviors Tomas says Jorge is engaging in that could be hazardous to his health.
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 6.3
Based on what Jorge and Tomas have told you already, which of the following could be what Jorge is experiencing? Select all that apply. To review the definition for each term, select the term.
Alcohol Use Disorder
wCfH0QtRgXJ8o+c+Stimulant Use Disorder
bI0LPa9lfHQ+dYqkBinge Drinking
wCfH0QtRgXJ8o+c+Alcohol Withdrawal
bI0LPa9lfHQ+dYqkAlcohol Intoxication
wCfH0QtRgXJ8o+c+Stimulant Intoxication
Hint
Think carefully about Jorge’s drinking behaviors, especially as described so far during the interview.
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 6.4
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Hint
Think about Jorge’s experiences with alcohol.
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.
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 5 pm, 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 6.5
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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 6.6
Which of the following symptoms is Jorge currently experiencing? Select all that apply.
Alcohol is taken in larger amounts than was intended
wCfH0QtRgXJ8o+c+Sweating or pulse rate greater than 100 bpm
bI0LPa9lfHQ+dYqkA great deal of time is spent using alcohol
wCfH0QtRgXJ8o+c+Nausea or vomiting
bI0LPa9lfHQ+dYqkA strong desire to use alcohol
wCfH0QtRgXJ8o+c+Sleeping less than usual
bI0LPa9lfHQ+dYqkContinued alcohol use despite persistent interpersonal problems caused by alcohol
bI0LPa9lfHQ+dYqkImportant social or occupational activities are given up because of alcohol use
bI0LPa9lfHQ+dYqkAlcohol 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+dYqkNeed 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.
6.14 Screen 14
From the File. You remember a former patient who experienced symptoms similar to Jorge’s. You review this case to help you diagnose Jorge.
Transcript
MAN: I just used to do it excessively. I'd spend Saturday afternoon in the pub, then come home and drink a bottle of vodka, fall asleep, and wake up start on vodka again, Excessively. I didn't feel like I was going to die or anything, but yeah, apparently that's the point I was at. I was knocking on death's door.
INTERVIEWER: Did you used to have a drink on the train coming home?
MAN: That's where it started. Go to the old P, get a half bottle of vodka, get on the train. 45 minute journey. And I'd just sit there on the train, swigging it on the way home. Then by the time I got back, I'd finished that and I'd want another one. Go to bed and get up for work the next day again.
DOCTOR: He's generally a little bit tender.
MAN: I just did it over and over again.
DOCTOR: He is normal and his chest is clearing.
MAN: See, Sunday would have been this is your last drink, so let's make it count. So he would. And then Monday, he'd feel so bad because of Sunday, he's have to go and get another drink to make himself feel better. And just began round and round and round like that. No, it's not a little ride that you can't get off.
Question 6.7
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Question 6.8
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Hint
In making your choice, think about the following symptoms Jorge exhibits: 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.
6.16 Screen 16
Question 6.9
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dLZGPp2KPbf5f8cvWcVrxt2vugktDniuzzwcZwoncC8QLD4yl3U2EkdYk2fKuIxLky38bbBiyixRXCl6N094R+oDwLSZD82gGfbAVr9F8I0D4Umc5LSDRvk6J7hEL/w5+Fe77C5SAoUpiFQHPCuPtXR3HPnlY74pyJVxJ5tPi0yUvWnq8fXTo0Fn7yGhPqGYzMXrFs8BzC1njeqXWExOF7FfyvlP98WgX0OOnxaXxZ9pyO3j9idRuyECFrXZpwqW4vabGNKDhqQqxbURZ4LoUvFYSrj1u+SKlU8NrptZdxPRmS4kozVtmBiSsd5yCkHfr72RIEPBdgrXeIeOnTuapxxaJyEG+0FaRqlRZjEZRz6ftaEtQ+TNOfL+RRntmvYorMysasukN7qfkrn0wA1fEqPnODKhLgaXv+KNpFdlEPB2qRcsWRHmg3BzPc3o4v1t0T01kGXDnylHksqeMxZ6N9vBEgj9qSIFYQSoOMf1cvdKutgjJOKY0t41WnCNpRBH7gHB/MmY8i5ibyMMnN+CSy8gkId0sSpH6ZvQ4nrtpKhMwQs8J8TzAibWVb9llHeHQ1vU/xnZQ8pINbyYUuD0+JZtGmgkCuW8c0X7IfU5x756mLsCiGNNOE3kBlduiPRWOWPj8riGV4FyM/we7YSuKyM8AEJSt30fgPz9nzF0kCsoXzjjkGZ2OZdwEUynRGQrbIZMb/dRH7a67u3NR94mzMs1sYMq1kWKQW0UIJtSV04STVvD5cfnStgrpJtu0FxuwXeoDDyOqa5ofW1ijJ0g+Xl7XkH06oyV3sV45fDfC1NKDDCgEQlGm3+kL1okPzLi8UenlLfODFdTJdJxW/u28FtKtnoWZbek58BLPldtGeo9NdiILJlXBiKD6n3M34uBD1CHNHK0VfrH2gPPqyasK2/3uKsFJeFtPG210KV+MxKMdWdi0NHzP+ctJB3rSPrU84joD6GzWIeYeVzNy3FMpPpy70zpbyYhHLRo24LcAWng+Pv7qdbRwYe7Kzl/7hbXrUY2XPIL846w2C7MbKj9CGRxe4O6K9E3SF1AuQXDVXYFM95+uAWL/RwXVzzIXjL8zdBQZRjtC/Z840BjoDfH2lou0XWtfvt00UuSX+C0J2gH21gmbX4m1uHhrQzv/HNSgQimtJGtgyprebPPNZzNBSA3gIYu4QGrEO3FQvmI8IsGqgVY/8auKEAffZIVq8fy7nBLcITMKfY57hAOdHiZHdp4Yza/0jRI3quMtcmTvVw8zqOL+uwYglRKWCjx+s84kDMog900X85yyakBe+WJeqTg8uEoEXjJhTbwNfAQTC4VBteQPUP4K3J9jgHJJ1EgOfjNYaOWeprOH9tmCb/Txc4J+QPnRoBdZ6y7tx6WjOH8y6Tj5FryyDb8fu4YeHyxT0njvZBxqxBpmZQnnJJXVuMX+p8gjjCndqEtlDzmeD+Aqqcng5NLmsT9aS1WluCxeYY0rjRoYQ29uZiruuCs+dBfoIg=Hint
This is a symptom of alcohol use disorder.
6.17 Screen 17
Question 6.11
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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.
Question 6.12
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In making your choice, think about how serious Jorge’s drinking is and what the possible physical consequences of withdrawal are.
6.18 Screen 18
EPILOGUE
After meeting with you, Jorge agreed to try the clinic for only 7 days. You had recommended a 28-day stay and explained that staying only a week would not be enough to help him and that he’d be wasting his money. But you left the decision up to him.
Jorge was surprised by the rules of the residential treatment center, including sharing a room with another patient, having to clean his room daily, helping cook and serve one meal a day, not having 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. He claimed that he was being treated like a cross between a child and a prisoner, 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 to gain a better perspective on the very real consequences alcohol was having on his physical and mental health.
Jorge grumbled quite a bit during his first few days at the clinic, but on the fifth day of treatment he had a breakthrough, in part because you had persisted in encouraging him to see why he needed to change and make the decision to get better on his own. The 12-step model of Alcoholics Anonymous resonated with him. He ended up staying the full 28 days, and he 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 sober about 30 days. However, Jorge was honest with himself, returned to AA, and, with the help of his sponsor, resumed his work toward sobriety. He often struggled with wanting to drink, especially when he got bored or lonely, but he was able to call his sponsor and talk through the situations where he was tempted to drink. When Jorge felt 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.
6.19 Screen 19
Real World Application
Watch this video, then answer the questions that follow.
Transcript
JAMES COOK: For some drinkers, too many nights end like this. And too many people in Scotland drink too much. It's thought nearly 200,000 Scots dependent on alcohol are not getting help. So will a pill which lessens the buzz in the brain from booze help wean them off?
SPEAKER 1: They could still enjoy some alcohol. They tend to be drinking less and less as months go by. They actually use the nalmefene less and less as the months go by, as the craving for alcohol diminishes and the whole scenario that they used to be in is no longer so important.
JAMES COOK: So from today, drinkers in Scotland can take a pill before heading to the pub. It costs just 3 pounds, but it's only available on prescription, along with counseling.
SPEAKER 2: I think for people that have drink problems, it will be good. So maybe solve a few problems like that.
SPEAKER 3: It's your usual, let's find a quick solution. But at the same time, if you're a willing participant and you're wanting something to help you, obviously, it's a good idea.
SPEAKER 4: Doctors and politicians have tried many ways of reducing Scotland's alcohol problems. And this latest drug is aimed at a particular group of drinkers, those who perhaps are having three or four pints a day and who may be on the road to more serious health problems unless something is done.
JAMES COOK: So nalmefene is no magic bullet, but it may just help dent Scotland's love affair with booze.
James Cook, BBC News, Glasgow.