Stefan is a 33-year-old man experiencing a difficult period: his own business does not improve, he has little time to relax, receives no support from his wife, and struggles to find a connection with his toddler son. He deals with this pressure by having at least one beer daily and sometimes getting out of control by drinking until he passes out. Indeed, Waddell et al. (2021) state that people develop such mechanisms because of the “beliefs about alcohol’s ability to reduce tension, and explicit motivations to drink to cope with negative mood states” (p. 48). Alcohol has always been a part of life, and both his and his wife’s families perceive it as a cultural and socialization attribute. Stefan describes himself as an anxious person who cannot think clearly under stressful circumstances, sweats a lot, and has headaches. Drinking helps him remain calm; however, the habit has become severe, making the client feel that his life is out of control.
Assessment tools to identify if the substance abuse or addiction is appropriate for the given case revealed that alcohol is not the cause of the client’s problems but the outcome of current life difficulties. Stefan scored two out of ten in his impression of the issue, meaning that he knows that changes beyond the drinking habit are necessary. He experiences problems in his work regardless of the long hours he devotes to it, and getting new customers forces him into uncomfortable situations where drinks help him socialize. Furthermore, he receives little support from his wife, whose expectations regarding living and wealth are hard to achieve now, putting an additional burden on man’s mental health.
Stefan’s family history of alcohol use also demonstrates that drinking is a central attribute of every gathering and a normal part of everyday life. The assessment tool included an analysis of the patient’s current situation: he is satisfied with the accommodation, has no legal issues, and his educational background allowed him to start his own business as a structural engineer. However, Stefan reported health concerns such as inability to relax, financial anxiety, feeling lonely and depressed, difficulty developing meaningful connections, and fears about the future. Assessment displayed no signs of crisis, violent tendencies in the client’s behavior, and no history of mental health treatment.
Assessment scores selected for Stefan’s issue analysis were Michigan Alcohol Screening Test (MAST) and Alcohol Use Disorders Identification Test (AUDIT) because of their reliability in identifying early signs of addictive behaviors. In MAST, the client scored six points because of the positive responses to several signs of addictive behavior in alcohol consumption; this result indicates a moderate probability of substance abuse (Pavkovic et al., 2018). Indeed, Stefan reported occasions of not remembering what happened during the night of drinking, engaging in drunk fights, severe hangovers, and experiencing difficulty stopping after a couple of beverages. The AUDIT score displayed that the client is at the risk of developing severe alcohol dependence. The test’s responses revealed the abnormal frequency of drinking and the increasing number of cases when patients failed to deliver their responsibilities because of being drunk or having a severe hangover. The results recommended Stefan seek medical or mental health advice and address the issue while it is in the preventable stage.
Stefan demonstrated several strengths and positive characteristics helpful for further treatment. Firstly, Stefan admits his behavior is abnormal and is willing to make positive changes. The self-motivational factor is crucial for dealing with habitual activities, modifying which is commonly difficult, especially for adults (Stevenson et al., 2019). Secondly, Stefan demonstrated well-developed self-reflection as he can recognize anxiety symptoms and identify how his actions influence his relationship with his wife. Lastly, the client’s strength is awareness of the consequences of drinking and understanding that it will not help improve life.
Treatment Plan
Treatment strategy and recommendations for Stefan should be based on changing his coping mechanisms in stressful situations and helping him deal with anxiety. Norm referencing, such as re-taking MAST and AUDIT assessments, should be performed each month throughout the therapy to check the progress and adjust the initial plan. Considering the latest AUDIT results, Stefan is recommended to get medical counseling and treatment to prevent worsening conditions (Pavkovic et al., 2018). The pharmacological approach is excluded from options to avoid physical health harm or switching addictive behavior from alcohol to medication. Thus, two main treatment recommendations and related SMART goals were developed: cognitive-behavioral therapy and social skills training. The initial duration of the program is 12 weeks, as this period is optimal to measure progress and adjust the strategy effectively.
Treatment Recommendation: Cognitive-Behavioral Therapy
Cognitive-behavioral treatment is appropriate for Stefan because it is based on developing actionable tactics to deal with anxiety without involving alcohol. Furthermore, counseling as a part of therapy will enable the patient to re-evaluate their current approaches to address stress and select practical alternatives (Magill et al., 2019). Cognitive-behavioral treatment recommendations include weekly sessions with a specialist, implementation of self-assessment frameworks, and logging the cases when drinking goes out of control to identify the negative triggers. A SMART goal would be to have at least two weekly situations when Stefan managed to locate and reduce anxiety without alcohol. The patient is encouraged to try various techniques, such as breathing, meditation, or journaling, and select the most effective based on self-assessment. If they fail to achieve the goal for three weeks, their treatment should be modified, and objectives should become more concrete. Cognitive-behavioral therapy is beneficial for Stefan because it aims to work with the causes of alcohol abuse rather than simply forcing the patient to change their drinking habits.
Treatment Recommendation: Social Skills Training
Another treatment recommendation effective for Stefan is social skills training because assessment and conversations revealed that communication with others or performing in uncomfortable conditions trigger them to engage in uncontrolled drinking. Helping the patient to become more confident at socializing is necessary to reduce the risk of difficult situations and increase the odds of successful behavioral changes. A SMART goal for this treatment recommendation is to initiate at least three new conversations with unknown individuals every week without involving alcohol. Therapy will include group workshops to help Stefan develop better social skills and apply them in practice at work and daily life. While learning to socialize comfortably is necessary for dealing with alcohol abuse, emotional intelligence and the ability to communicate feelings are also essential for a patient’s success (Le Berre, 2019). Family sessions would be helpful to train interconnection, integrity, and trust to be workable for the client’s confidence improvement. Furthermore, Stefan’s wife may be involved in the treatment as the closest person who can actively listen and help decrease the anxiety and pressure her husband experiences due to the current uncertainty.
References
Le Berre, A. P. (2019). Emotional processing and social cognition in alcohol use disorder. Neuropsychology, 33(6), 808.
Magill, M., Ray, L., Kiluk, B., Hoadley, A., Bernstein, M., Tonigan, J. S., & Carroll, K. (2019). A meta-analysis of cognitive-behavioral therapy for alcohol or other drug use disorders: Treatment efficacy by contrast condition. Journal of Consulting and Clinical Psychology, 87(12), 1093.
Pavkovic, B., Zaric, M., Markovic, M., Klacar, M., Huljic, A., & Caricic, A. (2018). Double screening for dual disorder, alcoholism and depression. Psychiatry Research, 270, 483-489.
Stevenson, B. L., Dvorak, R. D., Kramer, M. P., Peterson, R. S., Dunn, M. E., Leary, A. V., & Pinto, D. (2019). Within-and between-person associations from mood to alcohol consequences: The mediating role of enhancement and coping drinking motives. Journal of Abnormal Psychology, 128(8), 813.
Waddell, J. T., Corbin, W. R., & Marohnic, S. D. (2021). Putting things in context: Longitudinal relations between drinking contexts, drinking motives, and negative alcohol consequences. Psychology of Addictive Behaviors, 35(2), 148.