This week you will apply your understanding of cognitive-behavioral therapy to respond to a case study of Dave.
Read the following case study:
Dave is a 38-year-old small-parts factory worker 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 in two months. Dave does not anticipate serving jail time, but he believes that treatment could strengthen his legal case. After his first arrest for DUI two years ago, he simply paid a fine and attended a special driver’s education program for six weeks. Dave found the program to be “a waste of time.”
Dave has been married for 10 years and has two sons aged 8 and 6 years. He has had numerous arguments with his wife, Melanie, concerning his drinking. He gets very angry and defensive when she confronts him about his heavy drinking, and asserts that he is not an alcoholic. He knows this is true because his father was an alcoholic and Dave 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. Dave 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.
Dave’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 overtime 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.
Dave 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 got caught doing what everyone else seems to get away with. Dave’s drinking is very predictable: he drinks 8 or 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. On weekends, he often drinks 3-4 twelve 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 Melanie, who calls him a “lousy father.” At times, Dave 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 it was helpful: “It was listening to a lot of guys whining” and he especially did not care for the prayers.
Despite these attempts, Dave has experienced increased consumption levels over the past two years. He admits that, as a result of the drinking, he has become increasingly estranged from his wife and sons. Dave feels that his marriage has been basically good, but that he would not blame Melanie 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 Dave 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.
Dave is not close to his remaining family members. His mother is very religious and wishes Dave would see religion as a way out of his problems. His siblings live in other communities and they rarely get together. His wife and sons regularly attend his mother’s church, but Dave only attends on Christmas Eve and Easter Sunday.
Dave 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.” He also cannot imagine how to explain to his buddies why he is not joining them in the bars.
Reflecting on this case study, complete the following:
Pick three cognitive techniques and illustrate how you might use these in this situation.
Pick three behavior therapy techniques and illustrate how you might use these to help Dave address his substance abuse issues.