Question

Jed Smith is a 38-year-old welder who came into the treatment center after being arrested for drinking and driving (DUI/DWI). His attorney has suggested that he quit drinking and enter treatment, at least until his trial, which is scheduled to occur in 2 months. Jed does not anticipate serving jail time, but he believes that treatment could strengthen his legal case. After his first arrest for DUI 2 years ago, he simply paid a fine and attended a special driver's education program for 6 weeks. Jed found the program to be a “waste of time.”

Jed has been married for 8 years and has two daughters, aged 8 and 6. He has had numerous arguments with his wife, Emily, concerning his drinking. He gets very angry and defensive when she confronts him about his heavy drinking and he asserts that he is not an alcoholic. He knows this is true because his father was an alcoholic and Jed says that he is not like his father. His father died as the result of a fight that occurred in traffic when he was drunk. Jed says that his father used to “beat the tar” out of him and his brother when he was drunk and that his father always belittled, taunted, and threatened their mother, whether he was drunk or sober. Jed references that his family is Irish and that it was cultural normal to drink and enjoy alcohol and that all of his family and relatives drink in excess.

Jed's work history is very good; he misses less than one day per year. He works the day shift on weekdays, putting in time-and-a-half on most Saturdays. He is well regarded by his supervisors and peers at work. He is fearful that his employer will find out about his treatment (it is being covered by his HMO), and that people at work will learn about the second DUI arrest.

Jed drinks with his buddies from the plant, and does not think that his drinking is any more than what they do. He was just “unlucky” and was caught doing what everyone else seems to get away with. Jed's drinking is very predictable: he drinks 8-9 beers on a weeknight. Several of these are consumed at the bar with friends, the remainder at home over the course of the evening. He usually falls asleep in front of the television. When he is not working on Saturdays, he often drinks several 12-packs between Friday and Sunday. A typical Saturday involves getting up at 10:00 a.m., playing soccer with friends, and going to the bar for the rest of the day and night. This pattern leads to arguments with Emily, who calls him a “lousy father.” At times, Jed has had unsettling episodes of being unable to recall what happened while drinking. He has commented to friends that “maybe I overdo it a bit.” Several times, he has attempted to cut down on his drinking, especially after the last DUI. He once attended a few AA meetings, but did not feel that AA was helpful: "It was listening to a lot of guys whining…" and he especially did not care for the prayers.

Despite these attempts, Jed has experienced increased consumption levels over the past 2 years. He admits that, as a result of the drinking, he has become increasingly estranged from his wife and daughters. Jed feels that his marriage has been basically good, but that he would not blame Emily for leaving him, the way things have been going lately. She will no longer sleep with him while he is intoxicated, which occurs regularly. She complains that the house is falling apart because Jed does not keep up with his chores. He believes that his marriage would become solid again, if he stopped overdoing the drinking, but he complains about her hassling him about the alcohol.

Jed is not close to his remaining family members. His mother is very religious and wishes Jed would see religion as a way out of his problems. His siblings live in other communities and they rarely get together. His wife and daughters regularly attend his mother's church, but Jed only attends on Christmas Eve and Easter Sunday.

Jed is distraught about having to remain abstinent in preparation for the trial. He has trouble getting to sleep without alcohol. He also “gets jumpy” when he tries to stay away from drinking, feeling “closed in or like he is suffocating.” Jed reports that he is not used to socializing without alcohol and alcohol helps him relax and be more social with people.

Jed is willing to go to AA meetings only because he knows they may be court ordered and it may be better for his legal case. He does struggle with the philosophy of AA. He does not like the spirituality part of the program and does not like when people talk about God.

He does believe that he can go to the bars with his friends and not drink. He does think that he can increase his sports activities to help him not drink although many of his friends who play also drink.

Part 1: Harmful/Destructive Behaviors Chart

Complete the chart below by including a minimum of three behaviors as well as associated rewards and consequences related to relapse and abstinence behaviors.

Harmful/destructive behaviors that the client will need to avoid to prevent a relapse	Possible rewards the client experiences when they choose to use drugs/engage in relapse activities.	Possible costs for returning to use and the associated consequences

Part 2: Current Risks of Relapse

In this section, you will identify the steps to reduce the risk of relapse. Describe how you might assist Jed to identify high-risk situations, and specific triggers leading to relapse.

1. What steps has the client already taken to reduce the risk of relapse? What is the client’s agreement to abstain from substance use/misuse?

2. What are some high-risk situations that may trigger a relapse for the client? List three specific situations that may lead to relapse.

3. What are some examples of irrational thinking that may create the urge to return to previous harmful behavior leading to relapse?

Part 3: Relapse Response Plan

In this section, you will create a response plan to use when the client is faced with triggers and urges to lapse into using behavior. Complete the chart below and include coping strategies, client’s skills to redirect thoughts, and immediate actions to take before using substances.

List three people that the client identifies for a supportive network	List three new activities the client can use as they shift their focus away from the destructive activities involved in their addiction	List three actions or coping responses the client will utilize when a potentially negative pattern of behavior or high-risk situation emerges.

Part 4: Continued Health and Well-Being

1. Describe three community and support resources that are available to the client. Identify how often and the amount of support group meetings the client will participate in (any type of recovery support meeting) to improve health and sobriety. What resources might Jed find for himself and how will we know if they are effective resources?

2. Identify at least two strategies the client can do to improve his family relationships and describe how this is important to the success of the relapse prevention plan?

3. Describe how the ethnic and cultural aspects of the client may impact the relapse prevention plan?

4. Develop with the client an emergency contact sheet that the client may carry with them. Create a contact card with the client to list the people and resources to have available to use prior to a lapse or relapse to use substances. Go to Insert > Tables > and Select Table Size to begin creating the Contact Card.

Jed Smith
Client Signature	Date
Counselor Signature

Answer 1

Part 1: Harmful/Destructive Behaviors Chart

Complete the chart below by including a minimum of three behaviors as well as associated rewards and consequences related to relapse and abstinence behaviors:

Harmful/destructive behaviors that the client will need to avoid to prevent a relapse	Possible rewards the client experiences when they choose to use drugs/engage in relapse activities.	Possible costs for returning to use and the associated consequences
1. Decrease in alcohol consumption	Good Sleep	1. Broken Marriage
1. Anger fits	1. Pleasure of drinking	1. No contact with family
1. Broken Family	1. Rest

Part 2: Current Risks of Relapse

In this section, you will identify the steps to reduce the risk of relapse. Describe how you might assist Jed to identify high-risk situations, and specific triggers leading to relapse.

1. What steps has the client already taken to reduce the risk of relapse? What is the client’s agreement to abstain from substance use/misuse?

The client has agreed to abstain from alcohol till his court hearing.

2. What are some high-risk situations that may trigger a relapse for the client? List three specific situations that may lead to relapse.

1. The client majorly drinks with his colleagues after work.

2. On weekends when he is free.

3. Also because he is unable to sleep at night.

3. What are some examples of irrational thinking that may create the urge to return to previous harmful behavior leading to relapse?

1. Court hearing has ended.

2. Nothing to do after work.

3. Constant nagging from wife that the client feels.

Part 3: Relapse Response Plan

In this section, you will create a response plan to use when the client is faced with triggers and urges to lapse into using behavior. Complete the chart below and include coping strategies, client’s skills to redirect thoughts, and immediate actions to take before using substances.

List three people that the client identifies for a supportive network	List three new activities the client can use as they shift their focus away from the destructive activities involved in their addiction	List three actions or coping responses the client will utilize when a potentially negative pattern of behavior or high-risk situation emerges.
1. His Wife	1. Spending time with family.	Getting away from the situation.
1. Daughters	1. Going to Church with family.	1. Resisting the Urge.
1. Mother	1. Joining new hobby.	1. Thinking of the consequences.

Part 4: Continued Health and Well-Being

1. Describe three community and support resources that are available to the client. Identify how often and the amount of support group meetings the client will participate in (any type of recovery support meeting) to improve health and sobriety. What resources might Jed find for himself and how will we know if they are effective resources?

A. Support Groups

B. Church meetings

C. Family Therapy

2. Identify at least two strategies the client can do to improve his family relationships and describe how this is important to the success of the relapse prevention plan?

A. Spending quality time with his family so that they may not feel left out or neglected from the client.

B. Planning on going on vacation with the family.

3. Describe how the ethnic and cultural aspects of the client may impact the relapse prevention plan?

The client has mentioned that his Irish culture influence him to drink more and at family gathering, whole family drinks to the excess to celebrate.

4. Develop with the client an emergency contact sheet that the client may carry with them. Create a contact card with the client to list the people and resources to have available to use prior to a lapse or relapse to use substances.

Name- Jed Smith Wife- Emily Smith
Address-
Contact No.-
Family Contact No.-
Other Contact Details-
Identity Proof-
Signature-

Jed Smith	Emily Smith (wife)
Client Signature	Date
Counselor Signature