Question

Case Study

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.

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

1) Three major sources of community and support resources available to Jed would be:

a) His immediate family, including his wife Emily, and his two daughters. Although Jed has a complaint about Emily harassing him over his drinking, maybe this aspect can be worked upon in therapy. With a calmer Emily, his family can prove to be an important source of support to him.

b) Since Jed has continued to be competent at work, this can be another support for him. Working more vigorously may help curtain his drinking to at least some extent, and the fear of losing the confidence of his colleagues in case his drinking problem comes to light may also result in greater motivation to seek help.

c) It appears that Jed is uncomfortable with ideas of God and religion. However, he invests in sports. Aligning with his non-drinking sporting buddies can prove to be an important community support.

As stated above, Jed is uncomfortable talking about God and other such issues, and does not like the AA primarily for this reason. Hence, recovery programs with him will have to involve personal and group therapy focusing on other principles, such as cognitive behavior therapy (CBT) and motivational interviewing. The latter can help him come to a firmer decision regarding seeking help, after which CBT and aspects of family therapy can be employed twice week for 6-8 weeks in the beginning. The frequency for later sessions can be decided upon progress achieved.

2) Social support is of immense importance when recovering from substance abuse. People lacking social support are more likely to seek the help of the substance again to either overcome their loneliness or seek comfort from their drinking buddies. Two ways in which Jed can improve his relationship with his family is by changing his Saturday schedule and spending it with his wife and daughters; and by making planned efforts to organize bi-weekly or monthly get-togethers with his mother and his siblings.

3) The client is Irish, and claims (and has a strong belief) that all the Irish drink excessively, and that this is completely acceptable in the culture. Clinging on to this belief can result in adverse outcomes during recovery as it can serve as an excuse for the client to convince himself into drinking in moments of craving. To counter this potentially dangerous belief, examples may need to be discovered with the client in therapy of Irish people who either abstain from alcohol, or have kicked their habit of excessive drinking. This will provide alternative role models to the client, which will them modify his belief. Specifically, an Irish sportsperson would be a very good alternative role model to counter this belief.

4) This emergency contact sheet should have the following contacts:

His wife, the therapist, a trusted friend, a doctor, a local community de-addiction centre, and a sponsor (in case the client agrees to having one).