Healthcare Training Institute - Quality Education since 1979
Psychologist, Social Worker, Counselor, & MFT!!

Section 1
Track #1 - Introduction

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Welcome to the Home Study Course sponsored by the Healthcare Training Institute, homestudycredit.com.  This course is entitled, Addiction Volume 5:  Tools for Controlled Drinking.

Our primary intent for this home study course is to provide quality education to foster your professional growth.  The Institute has provided quality education since 1979.

We appreciate that you have chosen us as a vehicle for you to earn your Continuing Education Credit.

The purpose of the course is to assist you in increasing your knowledge regarding how to treat patients, clients, etc. dealing with excessive drinking.  As each case study is given, if the concepts seem to be applicable to your situation, I encourage you to turn your CD player off and make a few notes regarding the application of the principle to your setting.  However, these notes are for your purposes only and are not to be sent to the Institute.  Also each track is very content dense.  So feel free to replay the track to review the content either for your own purposes, or if you feel appropriate play the track in an individual or group session for client education.  Also permission is granted to reproduce this CD.  We encourage you to duplicate and give copies of this CD to colleagues, clients, etc. as you deem appropriate. We feel the information on our CD's is valuable.  Thus, we have an interest in distributing CD's in as many ways as possible, to benefit the greatest number of people, who have a need and are receptive to this practical information.

The questions in your Answer Booklet are sequential and deal with the section of content that preceded it.  For this reason, to facilitate the answering of each question, you might read the question from the Answer Booklet prior to listening to that CD track.  By knowing what the question is ahead of time, you will then know the content to listen for that contains the answer.  So just a hint, after you write down the answer to a question in your Answer Booklet, read on to the next question in order to give you a “heads up” to listen for the content that contains the answer to the next question.

Merely write the correct letter on the corresponding blank line in your answer booklet. Each answer is only used once. Keep in mind there is nothing tricky or hard about these questions.  They are merely intended to verify the playing of this CD.

For the purpose of brevity, most generally, I will use the term “therapists” or “mental health professional.”  However, don’t let these terms deter you from applying the concepts to your situations.  When you hear the word “therapists,” if your job title is social worker, psychologist, marriage and family therapist, mental health counselor, professional counselor, resident director, program assistant, etc. merely substitute the appropriate term that is the most meaningful to you. In short, don’t let my use of the term “therapists” cognitively set you off track from hearing the content because your job title is school counselor, for example.  I will also use the term “client” for the purposes of brevity.  However, if you deal with patients, residents, students, consumers, etc., transpose “client” for the term that is the most meaningful to you in your work setting. 

On this CD set we will discuss such topics as:  self monitoring, slowing down, affirming progress, identifying triggers, managing emotions, preserving positive self concepts, and relating to others.

So  let’s get started

You may, of course, have clients whom you feel perhaps needs to go to a twelve step program and stop drinking altogether.  However, what is your strategy when your client states to you, “I am not an alcoholic.  I don’t feel I need to stop drinking, but I would like to control my drinking.”  So the stance I take is what I term in my mind, “step zero”, which is the step before admitting that he or she may be powerless over alcohol.  When my client is at ‘step zero’, they are not interested in stopping and only interested in cutting down the amount that they drink.  I have found, like you, that after many clients unsuccessfully tried controlling their drinking, they hit bottom and perhaps decided to go to a 12 step program.  This course is geared towards your “step zero’ clients that come into your office requesting help to control their drinking.  According to author William R. Miller, author of "Controlling Your Drinking" he has had a 63% success rate with his clients that want to try controlled drinking.  Miller reports the other 37% ended up deciding they were alcoholics and that controlled drinking did not work for them.

For your client who is at ‘step zero’ and does not feel they are an alcoholic and is not motivated to stop drinking totally, consider providing them with tools for moderation and control, which is the purpose of this course.  As you listen to how Greg used the techniques on this track for his self monitoring, consider how your client can implement similar strategies.  Could playing this track for your client at your next session help initiate a productive use of tools for moderation?  Greg, age 32, had recently gotten married.  He and his wife planned to start a family.  Greg felt that the frequency with which he consumed alcohol would not be appropriate for his role as a father.  Greg stated, “Now that I’m married, I guess I need to settle down some.  I’ll have to do things differently, but I don’t want to give up the good times.”  The first tool for moderation that Greg used was self monitoring.  There were three general steps that Greg used to implement a self monitoring technique.  The three steps to Greg’s successful self monitoring were to focus on ounces and percentage of alcohol, when and where alcohol is consumed, and self monitoring around others. 

#1  Ounces and Percentage of Alcohol
First, let’s discuss focusing on ounces and percentage of alcohol.  I explained to Greg that to use self monitoring effectively, he could begin to keep good records of his alcohol use.  Greg monitored two aspects of his drinks to begin this self monitoring technique.  The first aspect was the ounces of alcohol in each of his drinks.  I stated, “When you are drinking from a commercial can or bottle, the number of ounces is usually indicated on the label.  However, it becomes a little trickier when alcohol is poured into a glass.”  Greg replied, “I like mixers and cocktails, so how do I keep track of the ounces in those drinks?”  I explained that Greg could fill his usual drinking glasses, minus the ice, and pour the contents into a measuring cup.  Greg mentioned that he sometimes enjoys drinking at a bar.  I stated, “Your bartender will know how much alcohol your drink contains.”  Greg then expressed concern that he might feel self-conscious asking the bartender to measure each of his drinks.  Greg asked, “What’s everyone else going to think if I’m sitting there asking, ‘How much alcohol is in this or that?’”  I explained to Greg some low key ways he could ask the bartender about the measurement of his drinks.  For example, Greg could say, “I’m driving- could you tell me how much alcohol is in this margarita?”  As you probably know, most bartenders are concerned with the safety of their customers and will be glad to provide accurate information.

The second aspect of Greg’s self monitoring technique was to become aware and keep track of the percentage of alcohol each drink contained.  Greg used the same techniques for gathering information regarding alcohol percentage as he did for tracking the ounces of his beverages.  Greg stated, “Tracking alcohol percentage is pretty easy.  It’s usually on the label.  If it’s not, wine is about 9 to 14%.  Beer is between 4 and 6%.  The hard stuff is usually 40 to 50%.” 

After Greg and I reviewed the self monitoring technique of tracking ounces and percentage of alcohol, Greg implemented the technique.  At our next session, I found that Greg’s records indicated that he had consumed a six-pack of beer, a pint of vodka, five whiskey sours, and a liter of wine in one evening.  I as Greg if he felt he was drinking too much.  Greg stated, “I know.  I probably am And I’m writing it all down the next morning. So I probably did not remember everything.”  Since Greg was confident this method would work.  I stated, “Consider breaking it up into one drink units, and remember to write it down just before you start each drink.  Also, remember to be specific about each drink in ounces and alcohol percentage.”

#2  When and Where Alcohol is Consumed
The second step Greg used to implement the self monitoring technique was to track when and where he consumed alcohol.  Clearly, tracking when and where alcohol is consumed included the date, time and location.  However Greg found it challenging to keep track of this information while drinking.  I explained to Greg that each step in the self monitoring technique was important to getting a handle on his drinking.  I shared with Greg the following motivating reminders that other clients had found useful.  As you listen to these reminders that other clients found useful to maintain good self monitoring habits, consider your client.  Could one of these work for your Greg?

1. Make it a rule never to take a drink before recording it, and think of your first sip as a reward for writing it down.
2. Figure out a good reminder for yourself, something you will see just before you drink that will remind you to keep records.  Greg kept a small stone in his pocket because, he said, it reminded him that he needed to be as solid as a rock for his new family.
3. Each time you write down a drink, before starting it, congratulate yourself for keeping track.  Greg thought to himself, ‘Way to go!  I’m really sticking to the program.’
4. Involve other people in your record keeping.  Greg usually drank in the company of his wife.  She helped him remember to write down his drinks and encouraged him along the way.

#3  Self Monitoring Around Others
In addition to ounces and percentage of alcohol and when and where alcohol is consumed, the third step Greg used to self monitor was self monitoring around others.  Greg expressed concern regarding how those around him might react to his record keeping.  I explained to Greg, clients generally find self monitoring is even less noticeable if records are kept in a small notebook, a check book or a personal digital assistant like a Palm Pilot.  After hearing this, Greg still had his doubts.  Greg stated, “Ok, whatever.  But what do I say if somebody does notice and asks me what I’m doing?”  Clearly, there are no answers that work for all clients, but I shared with Greg some replies that he might find useful, such as

• “I’m trying to cut down, so I’m keeping track of my drinks.”
• “I’m on a diet, so I’m keeping track of calories.”
• “I’m keeping track of expenses.”
• “It’s something I’m doing for myself.”
• “It’s for a class I’m taking.”
• “I’m taking notes for the FBI.”

Consider your client.  Would he or she feel more comfortable fielding questions regarding self monitoring if he or she had some creative responses?

Another alternative I explained to Greg was to be subtle.  I stated, “Excuse yourself to the rest room, or make a call to keep your records in private.  Leave the table and go to the bar to make notes.  Or make notes on your bill, bar tab, or charge slip.”

Which method for effectively self monitoring around others might benefit your client?  Would playing this track be a helpful therapeutic introduction to self monitoring?

On this track we have discussed self monitoring.  The three steps to self monitoring are to focus on ounces and percentage of alcohol, when and where alcohol is consumed, and self monitoring around others. 

On the next track we will discuss the moderation tool of slowing down.  Three aspects of slowing down are types of drinks, making it last, and spacing drinks.

QUESTION 1
What are three steps to the self monitoring technique? To select and enter your answer go to Answer Booklet