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Cognitive-Behavioral Therapy for Alcohol Use Disorders
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In the last section, we discussed the moderation tool of slowing down. Three aspects of slowing down were types of drinks, making it last, and spacing drinks. We also summarized slowing down in five concise steps.
After beginning self monitoring and trying to slow down their drinking, many of my clients report that they feel they have worked on moderation. For these "controlled drinking" clients, do you agree that it can be productive to help them gain awareness of their progress and encourage themselves?
In this section, we will discuss the Cogntiive Behavior Therapy technique of affirming progress.
Colin, age 24, stated, " I am drinking too much." Colin’s drinking had started in college, but he expected that he would ‘grow out of it.’ After Colin began using tools for moderation, he approached me with concern that he did not feel that he was overcoming the urge to overdrink. I explained to Colin that his progress would be gradual.
To help Colin remind himself of his progress, we examined affirming progress through rewards, self agreements, and his progress partner. As you listen to the rest of this section, consider how affirming progress can help your ‘controlled drinking" client more efficiently utilize tools for moderation and control.
♦ #1 Rewards
First, let’s discuss rewards. Colin congratulated himself with two kinds of rewards. The two kinds of rewards that Colin congratulated himself with throughout his progress in learning moderation were tangible rewards and mental rewards. Regarding tangible rewards, I stated to Colin, "When choosing a reward, keep in mind that what may work for someone else may not work for you. Watch out for specific details that could cause a reward to backfire. Clearly, drinking is not an appropriate reward for not drinking. Though some of your clients may want to use alcohol as a reward.
Some guidelines for choosing an appropriate reward may include:
Another criteria of Colin’s tangible rewards was that they should be readily available as soon as possible following success in moderation. Also, Colin made sure that his rewards were above and beyond the types of things he normally experienced. Colin stated, "I always wanted to paint. I think I’ll use that as my reward." Colin set a plan to purchase painting supplies with respect to his moderation goals.
In addition, Colin planned to enroll in an art class at a nearby community college after six weeks of controlled drinking. Colin stated, "I’ll use the money I’ll save from not buying so much booze to pay for my class!"
Regarding Colin’s mental rewards, I stated, "Try to mentally focus on congratulating your behavior, as well as personal characteristics that you are proud of. Also, when you are successfully managing your drinking, picture yourself waking up without a hangover, living a healthier life, or doing well at work.
♦ #2 Self Agreements
After Colin identified the rewards he had decided to use, we began discussing self agreements. Colin’s self agreement became a definitive plan for affirming progress and regulating rewards. I helped Colin devise a self agreement for affirming progress using a three step CBT technique.
a. First, Colin decided what would be a reasonable amount of progress for him. Colin had previously identified his moderation goal when he stated, "I’m having about 30 drinks each week right now. I’d like to have no more than two a day and spend at least one day each week without alcohol." Colin had decided to start by cutting his drinking down by three drinks each week over a six week period to achieve this goal. Thus, Colin had defined what he felt was a reasonable amount of progress for him.
b. Second, Colin chose his reward. Colin’s reward was chosen as learning to paint. Colin stated, "After the first week, I want to buy some brushes. The week after that, I’ll get some watercolors." Colin chose to begin purchasing art supplies each week after successfully completing his three drink decrease.
c. In addition to deciding on reasonable progress and choosing a reward, the third step for Colin in making a self agreement was to make a commitment to himself. Colin agreed to make a commitment to himself that only if he achieved his goal of moderation would he allow himself his reward of painting.
Think of your Colin. Could using self monitoring from the first section be a good tool for deciding reasonable progress? How can your client best affirm progress through a self agreement?
♦ #3 Progress Partners
In addition to rewards and self agreements, a commitment to himself a fourth way to help clients affirm progress is through encouraging them to choose progress partners. When Colin mentioned in one of our sessions that he had a friend who agreed with him that moderation could benefit them both, I encouraged Colin to work with his friend as progress partners.
I stated, "There are two ways in which having a progress partner can benefit you.
a. First, a partner can be interested in and encourage your progress. The two of you can discuss your progress at regular intervals.
b. A second way your progress partner can benefit you is by sharing in rewards with you."
Colin’s friend did not hold the same interest as Colin regarding painting. However, if your client has a potential progress partner, perhaps your client’s rewards can be something the client can share together with a progress partner.
In addition to ways Colin’s progress partner could benefit Colin, I gave Colin some tips on how not to use a progress partner. Consider informing your ‘Controlled Drinking" client regarding these nonproductive progress partner applications. I stated, "Don’t turn your progress partner into a police officer. Also don’t have your partner penalize you if you fail to reach a goal."
As you listen to four additional guidelines I gave to Colin for progress partners were as follows:
Choose someone whom you trust and who cares about you. This should be someone who isn’t too emotionally tied up with your drinking and who isn’t an alcoholic.
Tell your progress partner about your goals and share your treatment plans.
Explain that you’re not asking your potential progress partner to be responsible for your progress, but rather to only take an active interest in it.
Explain how the person can clearly help. Colin specifically told his partner what he needed.
Can your controlled drinking client think of ways to keep his or her partner aware of progress made? Would it be helpful to play this section for your client?
In this section, we have discussed affirming progress through rewards, self agreements, and his progress partner.
In the next section, we will discuss identifying triggers that can lead to overdrinking. This section intends to provide practical information and techniques for dealing with four common triggers . The four triggers that can lead to excessive alcohol use that we will look at in this track are places, people, time, and feelings.
Peer-Reviewed Journal Article References:
Berking, M., Margraf, M., Ebert, D., Wupperman, P., Hofmann, S. G., & Junghanns, K. (2011). Deficits in emotion-regulation skills predict alcohol use during and after cognitive–behavioral therapy for alcohol dependence. Journal of Consulting and Clinical Psychology, 79(3), 307–318.
Foy, D. W., Nunn, L. B., & Rychtarik, R. G. (1984). Broad-spectrum behavioral treatment for chronic alcoholics: Effects of training controlled drinking skills. Journal of Consulting and Clinical Psychology, 52(2), 218–230.
Rose, G. L., Skelly, J. M., Badger, G. J., Naylor, M. R., & Helzer, J. E. (2012). Interactive voice response for relapse prevention following cognitive-behavioral therapy for alcohol use disorders: A pilot study. Psychological Services, 9(2), 174–184.
What are three ways for controlled drinking clients to affirm progress? To select and enter your answer go to .