Transcript Can My Client Keep Drinking?

Can My Client Keep Drinking?
How You Can Help Them Decide
When Enough is Enough
Cyndi Turner, LCSW, LSATP
Craig James, LCSW
Four Types of Drinkers
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WATER: 35% do not drink at all
DONUTS: 37% drink within normal limits
CUCUMBERS: 22% drinkers experiencing
problems
PICKLES: 6% alcoholics
Who is Drinking in the US?
Who is Drinking in the US?
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2014 Census Bureau recoded 323 million people
in US
17 million people are alcoholics - state of FL
90 million people are drinkers experiencing
problems - Central Time Zone
28% of population drink at levels that put them at
risk for alcohol related problems
Only 6% are alcoholics
DSM-5 Diagnosis
Problematic Pattern of alcohol use leading
to impairment within a 12-month period:
1. Taken in larger amounts than intended
2. Desire or unsuccessful efforts to cut down
or control
3. Time spent in activities to obtain, use,
recover from
4. Recurrent use resulting in role failure
5. Continued use despite consequences
DSM Continued
7. Recurrent use in physically hazardous
situations
8. Continued use despite problem exasperated
by use
9. Tolerance – more needed to get effect or
diminished effect with same amount
10. Withdrawals
DSM Continued
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Diagnosis on a spectrum
Substance Use Disorder
Mild: 2-3 symptoms
Moderate: 4-5 symptoms
Severe: 6 or more (unlikely to be able to
moderate)
Withdrawals
Occur 24-72 hours after last drink
 Can be life threatening. Seek medical help:
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1. Sweating/high pulse
2. Hand tremors
3. Insomnia
4. Nausea or vomiting
5. Hallucinations
6. Psychomotor agitation
7. Anxiety
8. Seizures
DSM-IV TR
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Abuse: if it causes a problem, it is a problem
Dependence: alcoholic
Encourage self-assessment
Spectrum of Alcohol Use
Why the 22% Avoids Getting Help
Moderation Management found 90% of drinkers
experiencing problems will avoid getting help:
 Afraid of being labeled alcoholic
 Made to go to rehab
 Forced to go to 12-Step meetings
 Have to give up drinking forever
 Life will be boring/miserable
Need A Different Kind of Help
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4Xs as many people who misuse alcohol than
alcoholics
Most treatment geared for the 6% who are severe
alcohol use disorder
Need treatment options for the 22% who meet
DSM criteria for mild or moderate alcohol use
disorder
Call for Change
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Estimated that 75-93% of treatment facilities
require total abstinence
Insight Into Action Therapy does something
different
By removing abstinence as the main goal, people
become more open to education and information
Focus on “why” not “don’t”
Client Example: Sarah
How We Got Involved in Moderation
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Worked in place where we had to follow recovery
“rules”
Clients did not get better
Became more open…clients more receptive…open
to feedback and tools…got better
Moderation Management: www.moderation.org
HAMS: www.hamsnetwork.org
Moderation Defined
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One drink a day for women < 7 a week
Two drinks a day for men < 14 per week
Older adults no more than one a day due to
percentage of body fat decreasing with age
And not all at once!
Why Do Men Get to Drink More?
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Alcohol is dispersed through body in water…
Women have less water in their body…
Women usually weigh less than men…
Women have higher concentration of alcohol in
their bodies…
Women become intoxicated faster than men
Men have stomach enzyme that breaks down
alcohol 4 times faster
Moderate Drinking Research
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Moderation training reduced consumption by 5070%
Those with severe problems tried moderation but
ultimately decided upon abstinence
Most successful moderators had less severe
problems at start
1/3 of people who tried moderation stopped
permanently
Easier to do all or nothing
Harm Reduction
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Alcohol use seen as psychosocial problem—looks
at whole person
Explores ways to reduce consequences of drinking
Views small changes as Success
Client Example: Kate, Mike, Jackie
Stages of Change
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Use Motivational Interviewing Techniques
Way to get people in the door
Starts a conversation
Stages of Change Model
Moderation Work Begins
You want me to do… What?!
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Recommend 4 months abstinence before
moderation
Deal with life on life’s terms
Make it through holidays, events, celebrations
Develop support system
Practice change
Learn to manage risky situations
Manage cravings
Identify new coping skills
How Do I Know If I Can Keep Drinking Quiz?
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Gives predictions for ability to moderate
Should be reviewed with someone trained in dual
diagnosis and familiar with moderation/harm
reduction
Full quiz:
www.insightactiontherapy.com
or
www.canIkeepdrinking.com
Interpretations
Drinking how long:
 Prior to 15 – 45% chance of developing SUD
 After age 18 - drops to 10% 
Tolerance 
Daily use 
 How many drinks a day and why
 Check patterns and associations
Has medical issues or taking medication 
Interpretations
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Consequences: if it causes a problem, it is a
problem
Blackout 
 Beyond binge drinking in college, most cannot blackout
 Brain damage: experiences unable to be encoded
 Most pass out or throw up
Interpretations
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Why Do You Drink?
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To deal with life or emotion 
Drinking alone 
As part of celebration, social gathering, taste 
What is your goal?
 To be altered 
 Part of something- not main event 
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What are family’s goals?
 Trust
 Trauma
Interpretations
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Co-occurring Mental Health Issues? 
Abuse other drugs? 
Legal, probationary, employment: address these
first
Most Negative Predictor
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Withdrawals
 Usually signifies severe alcohol use disorder
 Physiology has changed
 Can’t go back from a pickle to a cucumber
Most Positive Predictors 
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Willing to establish a period of abstinence
Willing to monitor use
Has a support system who gives perspective,
accountability, and motivation
Before Implementing Plan
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Understand biological, psychological, and social
consequences of drinking
Have not developed physical dependence on
alcohol
Can commit to not engaging in unsafe behavior
after consuming
Do not abuse other drugs
Do not act destructive after drinking
Before Implementing Plan
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Have had period of abstinence and addressed
issues that arose
Identified triggers and have plan to deal with them
Have experienced range of positive and negative
emotions and dealt successfully with them
Satisfied any legal, probationary, work, family, and
friend obligations
Before Implementing Plan
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Understand why you drink and determine that it is
safe to continue
Identified a support person to review plan and
keep you accountable
Moderate Drinking Plan
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Why I want to keep drinking
Where/when I will not drink
Not drink until…
Not drink after…
Will not drive after consuming
Alternate alcoholic beverages with X
No more than X drinks per X
Review my plan with
If I/we notice X, I/we will…
Tools for Moderation
Play it through- if/then
Drink only in social situations
Offer to be DD
Use tangible reminders
Eat something
Have a mocktail
Use technology
Put $ saved on drinking towards fun event
Levels of Risk
Preparing to Drink Again
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Impact of losing clean date
Prepare friends and family
Pick person, place, and drink
Practice one liner
Have exit plan
Gut Check
Donuts
“Drinking alcohol is like eating donuts. Having one
or two occasionally is not going to hurt you but
having several a day is eventually going to lead to
serious problems.”
CanIKeepDrinking.com
@CanIDrinkBook