April 4, 2025 • 18 mins
We explore Alcohol Use Disorder (AUD), covering diagnosis criteria, progression, causes, and effective treatment approaches according to the DSM.
• AUD falls under substance-related disorders in the DSM with 11 specific criteria
• Severity is classified as mild (2-3 criteria), moderate (4-5), or severe (6+ criteria)
• Criteria include drinking more than intended, inability to quit, cravings, and withdrawal symptoms
• People often drink to self-medicate stress, trauma, or negative emotions
• Effective treatment requires individualized approaches rather than one-size-fits-all solutions
• The trans-theoretical model (stages of change) recognizes recovery as a cyclical journey
• Motivational interviewing helps clients explore ambivalence and move toward healthier choices
• Family therapy helps relatives understand AUD and provide appropriate support
• Other effective approaches include contingency management, DBT, and relapse prevention
• Key assessment tools include AUDIT-C, CAGE, TWEAK, T-ACE, CRAFFT, and ASSIST
• Recovery should be viewed as a journey with potential relapses, not a one-time fix
Remember, it's in there!
If you need to study for your national licensing exam, try the free samplers at: LicensureExams
This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
Hi, there you lightworkers.
I'm Dr Linton Hutchinson, andwith me today is Eric Twatman.
Speaker 2 (00:09):
Hi you pillars of society.
Today, the disorder of the dayis AUD or alcohol use disorder,
and we're going to include whatyou're going to look for in the
DSM how it progresses, where itcomes from and what the best
treatments are Lucky for you.
Speaker 1 (00:26):
you inherited an allergy to alcohol.
Speaker 2 (00:29):
Yes, well, at least mom said she broke out whenever
she took a sip, but I think Inoticed a few sips happening
regardless.
Speaker 1 (00:38):
Right, and every time that you take a sip, I know you
break out in handcuffs.
Speaker 2 (00:42):
Well, yes, that's a good reason to quit.
That last bender was.
You know they had to write itup in the paper.
Speaker 1 (00:49):
Okay, so Ez, what do we need to know about AUD?
Speaker 2 (00:53):
Well, it's a substance-related disorder in
the DSM which you know if youthink about.
It makes sense, and it'sdiagnosed when someone's
relationship with alcohol startsresembling a toxic waste dump,
draining their quality of lifeas they refuse to quit drinking.
Speaker 1 (01:09):
Hmm, so are there other disorders in the DSM that
address alcohol use?
Or is AUD the Taylor Swift ofthis category?
Speaker 2 (01:20):
Well, well, yeah, I listen to all its albums.
Yes, there are differentials orother conditions to rule out,
but we're going to be talkingabout AUD A because of its
prevalence and because when it'scomorbid with another disorder,
it's usually obvious thatthat's part of the deal.
Speaker 1 (01:44):
Well, luckily Stacy isn't here she would ask you
about specifiers.
That's her favorite thing totalk about.
Speaker 2 (01:53):
Well, and it's well that you have her around,
because there are threespecifiers mild, moderate and
severe.
And you can tell because thosespecifiers there are 11 criteria
in the DSM Mild is 2 to 3,moderate is 4 to 5, and severe
is 6 or all the way up to 11.
Speaker 1 (02:12):
So give me an example of what those criteria might be
.
Speaker 2 (02:17):
Well, drinking more or longer than intended, not
being able to quit, even ifyou're trying, drinking larger
amounts over a longer periodthan you intended to cravings
that won to quit, even if you'retrying, drinking larger amounts
over a longer period than youintended to Cravings that won't
quit.
Symptoms when you do quit,basically when alcohol becomes
your clungy BFF and won't takethe hint.
Speaker 1 (02:37):
Or another one would be when you skip social events
because you can't bring your ownbottle right.
Yes, exactly.
Speaker 2 (02:44):
Or you know that friend that comes to your house
and immediately starts askingwhere the alcohol is right, yeah
, so there's withdrawal symptomsthat people have, like
trembling or sweating, when theystop drinking.
Speaker 1 (02:58):
So what's that called ?
Speaker 2 (03:00):
That's called the DTs delirium tremens and yes,
that's a definite sign thatsomething's happening, and they
all have to happen within a12-month period.
So you know, you had a cravingback in 1975 and you haven't had
it since.
You're not a candidate.
Speaker 1 (03:18):
Uh-huh.
So why do you think peopledrink anyway?
Speaker 2 (03:22):
Well, often stress, trauma, negative emotions, which
in that case we think of it asself-medication, but basically
covering up the problems in life.
And of course there's a geneticcomponent, but mainly the, you
know, we think of it as theself-medication as a starting
point.
Speaker 1 (03:42):
So, basically, people drink to cover up the dumpster
fires that they have of theirlives, instead of trying to put
them out.
Speaker 2 (03:49):
Yes, because we know alcohol is flammable.
It's really the worst thing toput out the dumpster fire with.
Speaker 1 (03:55):
Yeah, that's right.
Well, sometimes I self-medicatewith sushi and extra wasabi.
Speaker 2 (04:00):
Yes, as a matter of fact, I've seen you laying in
the gutter asking passersby formore wasabi and it's a sad sight
and we're going to do anintervention soon for you.
Speaker 1 (04:11):
Okay, well, you know it does give me some temporary
relief and, as you know that,once you start doing it, it
leads to the vicious cycle wheresushi becomes your primary
method for coping with anyproblems that people have.
Speaker 2 (04:26):
Well, yes, when you've got to have wasabi, it's
not that bad a self-medicationthing, whereas alcohol can
certainly ruin your life, andwhat's important to know is
whether it's stress or traumasor physiological.
It is a complex web of issuesthat can start a person down the
path and it's important to dealwith, regardless of which
(04:48):
thread is coming to make it theproblem in the person's life, or
whether or not you understandwhat's driving the engine Once
it's out of control.
The point is to stop it.
So you want to help the clientfind the root causes and also
deal with the problems Right.
Speaker 1 (05:05):
So you, as a therapist, try to help the
client find the root causes andalso deal with the problems
Right.
So you, as a therapist, try tohelp the client by not blaming
them.
And another thing you need todo is try to identify the causes
.
Speaker 2 (05:14):
You're right.
Once you start blaming, you'rereally just heaping on what
they've felt from everybody else, and now you're part of the
problem.
Speaker 1 (05:22):
So once they understand why they drink, then
that's it right.
Speaker 2 (05:29):
But once they understand why they're drinking
where it's coming from, that's,like you know, seeing where you
started on the road.
But no, the problem is thatthey need to find a better
coping strategy, like you havewith celery juice.
Speaker 1 (05:46):
Except my celery juice.
When I do it, it's a healthykind of a thing, so I'm really
not addicted to it.
Speaker 2 (05:52):
I only drink one glass a day every day yeah, it
sounds like the definition of anaddiction.
Every day you got to have thatgreen monkey on your shoulder
there.
Well, the bottom line is, whenyou're treating AUD, you should
operate under the assumptionthat your client or your celery
juice addict can recover.
(06:13):
But it takes a lot of work frommultiple directions, and it's
not just understand how youdrink and stop.
It's all of the threads thatare going to help.
Speaker 1 (06:23):
Okay.
So the one thing you've got toremember is you have to have an
individualized treatment planwith the client, because one
size fits all just doesn't workExactly Right.
So how do we help clients withAUD?
I assume it's more than justsaying, just say no, and
handling them.
A celery juice recipe.
Speaker 2 (06:46):
The recipe you mean grinding up a bunch of celery.
That is a toughie.
Yes, as a matter of fact, thereare multiple ways of dealing
with it and one of them is yourfavorite.
Speaker 1 (06:59):
Yes, stages of change .
Model right the transtheoretical model yes,
absolutely the.
The words are like music to myears okay, we I know we just did
a podcast on that, but that'sright, let's go ahead and talk
about the stages of change, or Icall it the PCP-AMT.
Speaker 2 (07:19):
Yes, you do.
You love to call it that Right,or?
Speaker 1 (07:23):
what are they?
Pre-contemplation, precontemplation, contemplation,
preparation.
Speaker 2 (07:28):
Preparation.
Speaker 1 (07:29):
Action.
Speaker 2 (07:30):
Maintenance.
Maintenance and termination,yes.
And in pre-contemplation youdon't think you have a problem,
I I don't know why people aretalking about it.
I can quit anytime I want.
It's not a deal.
And so it's like their friendthat having 12 cats is totally
manageable.
And then you know, all itsmells like is the inside of a
(07:50):
litter box.
Then comes a contemplationstage where the client starts
weighing the pros and cons.
But they're still weighing itbecause they don't realize that
it's a deal in their life.
Sort of me like when I'm at anall-you-can-eat buffet.
Speaker 1 (08:05):
Right, okay.
So what about motivationalinterviewing?
Speaker 2 (08:10):
Well, that's where you take a more active role.
Right, because in the stages ofchange, you're helping the
client realize what stagethey're in.
Right, in the motivationalinterviewing, you're doing just
what it says.
You're helping to motivate themto make those changes.
So you know, go ahead and putdown that bottle right, Right.
Speaker 1 (08:33):
So basically you're helping them explore their
ambivalence about change andnudging in towards the healthier
choices.
Speaker 2 (08:42):
Yes, and it's the nudging that makes it the more
active part.
You're not just sitting on thesideline anymore, you're
actually intervening to a biggerextent.
Speaker 1 (08:52):
Right, so you do that , and a lot of things are going
to come up to the surface.
So when it bubbles up, thenwhat?
Speaker 2 (09:01):
Well, right, and now they're looking at the.
Well, back to thetrans-theoretical model, they're
looking at the contemplationstage they're actually looking
at do I really need to drinkthat fifth of Jack Daniels every
day?
Or do I need to do somethingabout fifth?
Speaker 1 (09:16):
of Jack Daniels every day, or do I need to do
something about it?
I thought you liked rum andcoke.
Well, how about family therapy?
That sounds important too,unless, of course, part of your
family is part of the problem.
Speaker 2 (09:25):
Not, unless you assume the family is part of the
problem and that they need helpin figuring out what to do with
their problematic sibling, son,father, whatever it is, because
often the family is just asclueless as what to do as the
client themselves.
So family therapy is importantto help ground them in A what to
(09:47):
look for and, b how they canactually be of help, rather than
what they've probably beendoing, which is just heaping on
the guilt.
Speaker 1 (09:55):
Right, judgment and blame.
They have a tendency to do that.
Speaker 2 (09:59):
Well, right and you can see where it comes from and,
by the same token, you can seewhy it's so unhelpful.
Speaker 1 (10:05):
Yeah, one of the problems with the family therapy
is the fact someone's doingreally well and let's say they
were in the maintenance phase.
Then they relapse and the wifeor the husband or the
grandparents starts blaming themand shaming them.
Speaker 2 (10:21):
Yes, If only you had stayed off the bottle, then we
wouldn't be in this problem,which that's part of the genius
of the trans-theoretical modelis noticing the cyclical nature,
like we mentioned in thepodcast, of the fact that you
expect it.
It's baked into the theory thatthere are going to be problems,
there are going to be relapses,and that you just expect it and
(10:43):
that you figure out what to do,not if it happens.
Speaker 1 (10:47):
but when it happens.
So I guess you'd have to spenda lot of time educating the
family about what they canexpect in terms of someone
dealing with their addiction.
Speaker 2 (10:58):
Well, yes, and as a matter of fact, that's such a
big part of it that we haven'ttalked about it yet.
But you know about the 12-stepprograms, like in Alcoholics
Anonymous.
There's another group calledAl-Anon that's specifically for
families of alcoholics.
It deals with the you know,their own 12-step journey in how
to deal with the alcoholicmember of their family.
(11:21):
So, yeah, it's that big a thingthat it's not just some little
niche where you talk aboutfamily therapy.
It's like part of what you needto deal with.
Speaker 1 (11:30):
It's a good point.
It's a good point.
You know, there's anothertechnique contingency management
.
Speaker 2 (11:36):
Yes, I figured you'd love that one because you like
the Premack principle, don't you?
I do like the Premack and itsounds just like it.
Yes, tell us what it involves.
Speaker 1 (11:46):
Basically, you're going to be getting some type of
tangible rewards for whateverpositive behaviors you have
regarding not drinking.
Speaker 2 (11:55):
Right.
So you didn't drink today, sohere's a nickel.
Good job.
Speaker 1 (11:58):
No, it's got to be more than that is.
Speaker 2 (12:01):
Oh, you didn't drink, so here's a 10 spot.
There you go.
Yes, so basically classicbehaviorist therapy where you're
giving a positive reward forpositive behavior, exactly, and
not really talking about thenegative behaviors, but
basically just the positive sideof things.
(12:22):
How about DBT?
Oh, yes, dialectical behavioraltherapy.
That actually has proven to beeffective in a lot of the
research studies that manypeople have used DBT
successfully and it's proved tobe a viable thing.
Speaker 1 (12:41):
Yeah, I'll tell you when I think about this.
To answer any questions on AUD,on a licensing exam, it looks
like I have to have a wholerange of knowledge base from DBT
to CBT to family therapy, totrans-theoretical models.
Speaker 2 (12:58):
So there's a lot involved in this problem in our
society, that people haverealized that, as you said at
the beginning, you need theindividualized approach to the
person, which means that somepeople won't respond to the
behavioral side, some peoplewon't respond to the
motivational interviewing side,so you've got to have a pretty
(13:21):
broad spectrum, which makes itcomplicated if you're trying to
take a test and they're askingabout it.
You're absolutely right.
Speaker 1 (13:32):
Yeah Well, one of the things that you need to know is
the vocabulary.
If you don't know thevocabulary, you may miss some
questions.
So let's go ahead and do aquick lightning round.
Speaker 2 (13:39):
Lightning round.
I love it, I'll start.
Craving is when you can't stopthinking about drinking, like me
with pizza, when I'm reallyhungry at night.
Speaker 1 (13:48):
Okay.
Tolerance means that you needmore alcohol to feel high, like
needing extra espresso shots atyour age.
Speaker 2 (13:57):
Yes, exactly, detoxification, the process of
allowing the body to eliminatealcohol.
Speaker 1 (14:04):
Relapse is returning to drinking after you haven't
done it for some period of time.
Speaker 2 (14:10):
Yes, Harm reduction is a set of strategies that aim
to reduce the negativeconsequences of drinking Tools
that a person can use toameliorate their problems until
they quit drinking.
Speaker 1 (14:24):
for good Enabling.
Enabling is behavior thatunintentionally supports a
client's substance use.
Speaker 2 (14:33):
So let's summarize what we covered.
Obviously, it's a complex thing.
Like we mentioned, a lot ofmoving parts biological,
psychological, physiological,social and the SM has clear
criteria and it should be anindividualized technique that's
going to be most effective forthat person.
And there are differenttechniques motivational
(14:56):
interviewing, cbt, relapseprevention and your favorite
trans-theoretical model.
Speaker 1 (15:02):
Right, which is also known as Stages of change?
Speaker 2 (15:06):
Exactly, which is also known as stages of change?
Exactly, yes, and so therapistsand family members need to
understand it as a journey, nota one-time thing.
Not that I went to detox andnow I'm finished.
And, as we mentioned, ttm, thetrans-theoretical model, has it
baked in that there are going tobe relapses, that there are
going to be problems, thatyou're going to need to
(15:27):
recognize the fact and not feelguilt over that fact, that there
were problems in resurfacingafter having problems with
alcohol.
Speaker 1 (15:37):
Thanks for joining us today.
Speaker 2 (15:39):
Yes, thank you so much.
We hope the podcast has givensome valuable information that
you might see in your licensingexam and some practical insights
to help support your client'srecovery.
And remember it's in there,it's in there.
Speaker 1 (15:54):
Did we miss anything?
No, this is starting to remindme of a Marvel movie, where they
have a trailer after thecredits.
Speaker 2 (16:03):
Oh, yes, really.
If only we had Captain America,you know, swing in here, that
would be good.
But I'm glad people stuckaround, because what we didn't
talk about were assessmentinstruments.
Speaker 1 (16:13):
Okay, this one's pretty easy.
If an assessment instrument hasthe word alcohol in it, you
know what it's for.
So let me give you some of thenot obvious assessments that
might show up on your licensureexam.
One is called Audit C.
You wouldn't think that hasanything to do with alcohol, but
it's a shortened version ofAudit, consisting of three
(16:37):
questions related to thefrequency of alcohol use, the
typical amount consumed andoccasions when you end up having
heavy drinking.
How about the cage?
Speaker 2 (16:48):
as the cage is another assessment instrument
and once again, you see the cage.
You'd never guess it was foralcohol until you see the
question, and it's four yes orno questions.
Have you ever felt you shouldcut down the C?
Have people been annoyed byyour or criticized your drinking
the A?
Have you ever felt guilty aboutyour drinking the G and the eye
(17:11):
opener have you ever had tohave a drink first thing in the
morning to steady your nervesafter a bender last night?
And that's the E, c-a-g-e.
Speaker 1 (17:20):
Okay, there's a couple more.
One's called Tweak and T-Aceand T-ACE.
Tweek and T-ACE are assessmentinstruments specifically
designed to work with pregnantwomen.
Oh.
Speaker 2 (17:36):
All right.
So Tweek and T-ACE are both forthat.
Speaker 1 (17:40):
Yeah, both of them are Okay, all right.
Speaker 2 (17:42):
And then the CRAFT C-R-A-F-F-T is used to identify
risky substance use, includingalcohol, among adolescents and
basically for anyone under 21.
Speaker 1 (17:55):
Right, and another one, or the last one we're going
to talk about is called ASIST.
You would never think that hadanything to do with alcohol, but
the ASIST is for Alcohol,Smoking and Substance Involve
and substance involvementscreening tests is what it's
called.
It's a comprehensive assessmentinstrument developed by the
(18:16):
World Health Organization.
It screens all levels ofproblems of risky substance use.
Well, that's it for this partof the universe, Ez.
How about you?
Speaker 2 (18:26):
Well, that sounds good, and I'm glad we had a
little tag at the end, becausethe assessments, I think, are
things that would show part ofthe universe.
Ez, how about you?
Well, that sounds good, and I'mglad we had a little tag at the
end, because the assessments, Ithink, are things that would
show up on the test as well.
So I'm good now and I'm feelinglike we could use a little
reward of sushi from Publix.
Speaker 1 (18:40):
Well, how about some celery juice?
Speaker 2 (18:43):
Okay, I'll go out to the sushi.
You have the celery juice andjust crank down Either way.
To reiterate to our listenersremember it's in there, it's in
there.
Hi, there you lightworkers.
I'm Dr Linton Hutchinson, andwith me today is Eric Twatman.
Speaker 2 (00:09):
Hi you pillars of society.
Today, the disorder of the dayis AUD or alcohol use disorder,
and we're going to include whatyou're going to look for in the
DSM how it progresses, where itcomes from and what the best
treatments are Lucky for you.
Speaker 1 (00:26):
you inherited an allergy to alcohol.
Speaker 2 (00:29):
Yes, well, at least mom said she broke out whenever
she took a sip, but I think Inoticed a few sips happening
regardless.
Speaker 1 (00:38):
Right, and every time that you take a sip, I know you
break out in handcuffs.
Speaker 2 (00:42):
Well, yes, that's a good reason to quit.
That last bender was.
You know they had to write itup in the paper.
Speaker 1 (00:49):
Okay, so Ez, what do we need to know about AUD?
Speaker 2 (00:53):
Well, it's a substance-related disorder in
the DSM which you know if youthink about.
It makes sense, and it'sdiagnosed when someone's
relationship with alcohol startsresembling a toxic waste dump,
draining their quality of lifeas they refuse to quit drinking.
Speaker 1 (01:09):
Hmm, so are there other disorders in the DSM that
address alcohol use?
Or is AUD the Taylor Swift ofthis category?
Speaker 2 (01:20):
Well, well, yeah, I listen to all its albums.
Yes, there are differentials orother conditions to rule out,
but we're going to be talkingabout AUD A because of its
prevalence and because when it'scomorbid with another disorder,
it's usually obvious thatthat's part of the deal.
Speaker 1 (01:44):
Well, luckily Stacy isn't here she would ask you
about specifiers.
That's her favorite thing totalk about.
Speaker 2 (01:53):
Well, and it's well that you have her around,
because there are threespecifiers mild, moderate and
severe.
And you can tell because thosespecifiers there are 11 criteria
in the DSM Mild is 2 to 3,moderate is 4 to 5, and severe
is 6 or all the way up to 11.
Speaker 1 (02:12):
So give me an example of what those criteria might be
.
Speaker 2 (02:17):
Well, drinking more or longer than intended, not
being able to quit, even ifyou're trying, drinking larger
amounts over a longer periodthan you intended to cravings
that won to quit, even if you'retrying, drinking larger amounts
over a longer period than youintended to Cravings that won't
quit.
Symptoms when you do quit,basically when alcohol becomes
your clungy BFF and won't takethe hint.
Speaker 1 (02:37):
Or another one would be when you skip social events
because you can't bring your ownbottle right.
Yes, exactly.
Speaker 2 (02:44):
Or you know that friend that comes to your house
and immediately starts askingwhere the alcohol is right, yeah
, so there's withdrawal symptomsthat people have, like
trembling or sweating, when theystop drinking.
Speaker 1 (02:58):
So what's that called ?
Speaker 2 (03:00):
That's called the DTs delirium tremens and yes,
that's a definite sign thatsomething's happening, and they
all have to happen within a12-month period.
So you know, you had a cravingback in 1975 and you haven't had
it since.
You're not a candidate.
Speaker 1 (03:18):
Uh-huh.
So why do you think peopledrink anyway?
Speaker 2 (03:22):
Well, often stress, trauma, negative emotions, which
in that case we think of it asself-medication, but basically
covering up the problems in life.
And of course there's a geneticcomponent, but mainly the, you
know, we think of it as theself-medication as a starting
point.
Speaker 1 (03:42):
So, basically, people drink to cover up the dumpster
fires that they have of theirlives, instead of trying to put
them out.
Speaker 2 (03:49):
Yes, because we know alcohol is flammable.
It's really the worst thing toput out the dumpster fire with.
Speaker 1 (03:55):
Yeah, that's right.
Well, sometimes I self-medicatewith sushi and extra wasabi.
Speaker 2 (04:00):
Yes, as a matter of fact, I've seen you laying in
the gutter asking passersby formore wasabi and it's a sad sight
and we're going to do anintervention soon for you.
Speaker 1 (04:11):
Okay, well, you know it does give me some temporary
relief and, as you know that,once you start doing it, it
leads to the vicious cycle wheresushi becomes your primary
method for coping with anyproblems that people have.
Speaker 2 (04:26):
Well, yes, when you've got to have wasabi, it's
not that bad a self-medicationthing, whereas alcohol can
certainly ruin your life, andwhat's important to know is
whether it's stress or traumasor physiological.
It is a complex web of issuesthat can start a person down the
path and it's important to dealwith, regardless of which
(04:48):
thread is coming to make it theproblem in the person's life, or
whether or not you understandwhat's driving the engine Once
it's out of control.
The point is to stop it.
So you want to help the clientfind the root causes and also
deal with the problems Right.
Speaker 1 (05:05):
So you, as a therapist, try to help the
client find the root causes andalso deal with the problems
Right.
So you, as a therapist, try tohelp the client by not blaming
them.
And another thing you need todo is try to identify the causes
.
Speaker 2 (05:14):
You're right.
Once you start blaming, you'rereally just heaping on what
they've felt from everybody else, and now you're part of the
problem.
Speaker 1 (05:22):
So once they understand why they drink, then
that's it right.
Speaker 2 (05:29):
But once they understand why they're drinking
where it's coming from, that's,like you know, seeing where you
started on the road.
But no, the problem is thatthey need to find a better
coping strategy, like you havewith celery juice.
Speaker 1 (05:46):
Except my celery juice.
When I do it, it's a healthykind of a thing, so I'm really
not addicted to it.
Speaker 2 (05:52):
I only drink one glass a day every day yeah, it
sounds like the definition of anaddiction.
Every day you got to have thatgreen monkey on your shoulder
there.
Well, the bottom line is, whenyou're treating AUD, you should
operate under the assumptionthat your client or your celery
juice addict can recover.
(06:13):
But it takes a lot of work frommultiple directions, and it's
not just understand how youdrink and stop.
It's all of the threads thatare going to help.
Speaker 1 (06:23):
Okay.
So the one thing you've got toremember is you have to have an
individualized treatment planwith the client, because one
size fits all just doesn't workExactly Right.
So how do we help clients withAUD?
I assume it's more than justsaying, just say no, and
handling them.
A celery juice recipe.
Speaker 2 (06:46):
The recipe you mean grinding up a bunch of celery.
That is a toughie.
Yes, as a matter of fact, thereare multiple ways of dealing
with it and one of them is yourfavorite.
Speaker 1 (06:59):
Yes, stages of change .
Model right the transtheoretical model yes,
absolutely the.
The words are like music to myears okay, we I know we just did
a podcast on that, but that'sright, let's go ahead and talk
about the stages of change, or Icall it the PCP-AMT.
Speaker 2 (07:19):
Yes, you do.
You love to call it that Right,or?
Speaker 1 (07:23):
what are they?
Pre-contemplation, precontemplation, contemplation,
preparation.
Speaker 2 (07:28):
Preparation.
Speaker 1 (07:29):
Action.
Speaker 2 (07:30):
Maintenance.
Maintenance and termination,yes.
And in pre-contemplation youdon't think you have a problem,
I I don't know why people aretalking about it.
I can quit anytime I want.
It's not a deal.
And so it's like their friendthat having 12 cats is totally
manageable.
And then you know, all itsmells like is the inside of a
(07:50):
litter box.
Then comes a contemplationstage where the client starts
weighing the pros and cons.
But they're still weighing itbecause they don't realize that
it's a deal in their life.
Sort of me like when I'm at anall-you-can-eat buffet.
Speaker 1 (08:05):
Right, okay.
So what about motivationalinterviewing?
Speaker 2 (08:10):
Well, that's where you take a more active role.
Right, because in the stages ofchange, you're helping the
client realize what stagethey're in.
Right, in the motivationalinterviewing, you're doing just
what it says.
You're helping to motivate themto make those changes.
So you know, go ahead and putdown that bottle right, Right.
Speaker 1 (08:33):
So basically you're helping them explore their
ambivalence about change andnudging in towards the healthier
choices.
Speaker 2 (08:42):
Yes, and it's the nudging that makes it the more
active part.
You're not just sitting on thesideline anymore, you're
actually intervening to a biggerextent.
Speaker 1 (08:52):
Right, so you do that , and a lot of things are going
to come up to the surface.
So when it bubbles up, thenwhat?
Speaker 2 (09:01):
Well, right, and now they're looking at the.
Well, back to thetrans-theoretical model, they're
looking at the contemplationstage they're actually looking
at do I really need to drinkthat fifth of Jack Daniels every
day?
Or do I need to do somethingabout fifth?
Speaker 1 (09:16):
of Jack Daniels every day, or do I need to do
something about it?
I thought you liked rum andcoke.
Well, how about family therapy?
That sounds important too,unless, of course, part of your
family is part of the problem.
Speaker 2 (09:25):
Not, unless you assume the family is part of the
problem and that they need helpin figuring out what to do with
their problematic sibling, son,father, whatever it is, because
often the family is just asclueless as what to do as the
client themselves.
So family therapy is importantto help ground them in A what to
(09:47):
look for and, b how they canactually be of help, rather than
what they've probably beendoing, which is just heaping on
the guilt.
Speaker 1 (09:55):
Right, judgment and blame.
They have a tendency to do that.
Speaker 2 (09:59):
Well, right and you can see where it comes from and,
by the same token, you can seewhy it's so unhelpful.
Speaker 1 (10:05):
Yeah, one of the problems with the family therapy
is the fact someone's doingreally well and let's say they
were in the maintenance phase.
Then they relapse and the wifeor the husband or the
grandparents starts blaming themand shaming them.
Speaker 2 (10:21):
Yes, If only you had stayed off the bottle, then we
wouldn't be in this problem,which that's part of the genius
of the trans-theoretical modelis noticing the cyclical nature,
like we mentioned in thepodcast, of the fact that you
expect it.
It's baked into the theory thatthere are going to be problems,
there are going to be relapses,and that you just expect it and
(10:43):
that you figure out what to do,not if it happens.
Speaker 1 (10:47):
but when it happens.
So I guess you'd have to spenda lot of time educating the
family about what they canexpect in terms of someone
dealing with their addiction.
Speaker 2 (10:58):
Well, yes, and as a matter of fact, that's such a
big part of it that we haven'ttalked about it yet.
But you know about the 12-stepprograms, like in Alcoholics
Anonymous.
There's another group calledAl-Anon that's specifically for
families of alcoholics.
It deals with the you know,their own 12-step journey in how
to deal with the alcoholicmember of their family.
(11:21):
So, yeah, it's that big a thingthat it's not just some little
niche where you talk aboutfamily therapy.
It's like part of what you needto deal with.
Speaker 1 (11:30):
It's a good point.
It's a good point.
You know, there's anothertechnique contingency management
.
Speaker 2 (11:36):
Yes, I figured you'd love that one because you like
the Premack principle, don't you?
I do like the Premack and itsounds just like it.
Yes, tell us what it involves.
Speaker 1 (11:46):
Basically, you're going to be getting some type of
tangible rewards for whateverpositive behaviors you have
regarding not drinking.
Speaker 2 (11:55):
Right.
So you didn't drink today, sohere's a nickel.
Good job.
Speaker 1 (11:58):
No, it's got to be more than that is.
Speaker 2 (12:01):
Oh, you didn't drink, so here's a 10 spot.
There you go.
Yes, so basically classicbehaviorist therapy where you're
giving a positive reward forpositive behavior, exactly, and
not really talking about thenegative behaviors, but
basically just the positive sideof things.
(12:22):
How about DBT?
Oh, yes, dialectical behavioraltherapy.
That actually has proven to beeffective in a lot of the
research studies that manypeople have used DBT
successfully and it's proved tobe a viable thing.
Speaker 1 (12:41):
Yeah, I'll tell you when I think about this.
To answer any questions on AUD,on a licensing exam, it looks
like I have to have a wholerange of knowledge base from DBT
to CBT to family therapy, totrans-theoretical models.
Speaker 2 (12:58):
So there's a lot involved in this problem in our
society, that people haverealized that, as you said at
the beginning, you need theindividualized approach to the
person, which means that somepeople won't respond to the
behavioral side, some peoplewon't respond to the
motivational interviewing side,so you've got to have a pretty
(13:21):
broad spectrum, which makes itcomplicated if you're trying to
take a test and they're askingabout it.
You're absolutely right.
Speaker 1 (13:32):
Yeah Well, one of the things that you need to know is
the vocabulary.
If you don't know thevocabulary, you may miss some
questions.
So let's go ahead and do aquick lightning round.
Speaker 2 (13:39):
Lightning round.
I love it, I'll start.
Craving is when you can't stopthinking about drinking, like me
with pizza, when I'm reallyhungry at night.
Speaker 1 (13:48):
Okay.
Tolerance means that you needmore alcohol to feel high, like
needing extra espresso shots atyour age.
Speaker 2 (13:57):
Yes, exactly, detoxification, the process of
allowing the body to eliminatealcohol.
Speaker 1 (14:04):
Relapse is returning to drinking after you haven't
done it for some period of time.
Speaker 2 (14:10):
Yes, Harm reduction is a set of strategies that aim
to reduce the negativeconsequences of drinking Tools
that a person can use toameliorate their problems until
they quit drinking.
Speaker 1 (14:24):
for good Enabling.
Enabling is behavior thatunintentionally supports a
client's substance use.
Speaker 2 (14:33):
So let's summarize what we covered.
Obviously, it's a complex thing.
Like we mentioned, a lot ofmoving parts biological,
psychological, physiological,social and the SM has clear
criteria and it should be anindividualized technique that's
going to be most effective forthat person.
And there are differenttechniques motivational
(14:56):
interviewing, cbt, relapseprevention and your favorite
trans-theoretical model.
Speaker 1 (15:02):
Right, which is also known as Stages of change?
Speaker 2 (15:06):
Exactly, which is also known as stages of change?
Exactly, yes, and so therapistsand family members need to
understand it as a journey, nota one-time thing.
Not that I went to detox andnow I'm finished.
And, as we mentioned, ttm, thetrans-theoretical model, has it
baked in that there are going tobe relapses, that there are
going to be problems, thatyou're going to need to
(15:27):
recognize the fact and not feelguilt over that fact, that there
were problems in resurfacingafter having problems with
alcohol.
Speaker 1 (15:37):
Thanks for joining us today.
Speaker 2 (15:39):
Yes, thank you so much.
We hope the podcast has givensome valuable information that
you might see in your licensingexam and some practical insights
to help support your client'srecovery.
And remember it's in there,it's in there.
Speaker 1 (15:54):
Did we miss anything?
No, this is starting to remindme of a Marvel movie, where they
have a trailer after thecredits.
Speaker 2 (16:03):
Oh, yes, really.
If only we had Captain America,you know, swing in here, that
would be good.
But I'm glad people stuckaround, because what we didn't
talk about were assessmentinstruments.
Speaker 1 (16:13):
Okay, this one's pretty easy.
If an assessment instrument hasthe word alcohol in it, you
know what it's for.
So let me give you some of thenot obvious assessments that
might show up on your licensureexam.
One is called Audit C.
You wouldn't think that hasanything to do with alcohol, but
it's a shortened version ofAudit, consisting of three
(16:37):
questions related to thefrequency of alcohol use, the
typical amount consumed andoccasions when you end up having
heavy drinking.
How about the cage?
Speaker 2 (16:48):
as the cage is another assessment instrument
and once again, you see the cage.
You'd never guess it was foralcohol until you see the
question, and it's four yes orno questions.
Have you ever felt you shouldcut down the C?
Have people been annoyed byyour or criticized your drinking
the A?
Have you ever felt guilty aboutyour drinking the G and the eye
(17:11):
opener have you ever had tohave a drink first thing in the
morning to steady your nervesafter a bender last night?
And that's the E, c-a-g-e.
Speaker 1 (17:20):
Okay, there's a couple more.
One's called Tweak and T-Aceand T-ACE.
Tweek and T-ACE are assessmentinstruments specifically
designed to work with pregnantwomen.
Oh.
Speaker 2 (17:36):
All right.
So Tweek and T-ACE are both forthat.
Speaker 1 (17:40):
Yeah, both of them are Okay, all right.
Speaker 2 (17:42):
And then the CRAFT C-R-A-F-F-T is used to identify
risky substance use, includingalcohol, among adolescents and
basically for anyone under 21.
Speaker 1 (17:55):
Right, and another one, or the last one we're going
to talk about is called ASIST.
You would never think that hadanything to do with alcohol, but
the ASIST is for Alcohol,Smoking and Substance Involve
and substance involvementscreening tests is what it's
called.
It's a comprehensive assessmentinstrument developed by the
(18:16):
World Health Organization.
It screens all levels ofproblems of risky substance use.
Well, that's it for this partof the universe, Ez.
How about you?
Speaker 2 (18:26):
Well, that sounds good, and I'm glad we had a
little tag at the end, becausethe assessments, I think, are
things that would show part ofthe universe.
Ez, how about you?
Well, that sounds good, and I'mglad we had a little tag at the
end, because the assessments, Ithink, are things that would
show up on the test as well.
So I'm good now and I'm feelinglike we could use a little
reward of sushi from Publix.
Speaker 1 (18:40):
Well, how about some celery juice?
Speaker 2 (18:43):
Okay, I'll go out to the sushi.
You have the celery juice andjust crank down Either way.
To reiterate to our listenersremember it's in there, it's in
there.
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