Bill came to see me because his drinking was scaring him. He said the last thing he remembered was going to the liquor store, picking up a six pack, and getting into his truck. He had no memory of driving home and this scared him. Even though his wife had been begging him for years to get help, it took an alcoholic blackout while driving to scare him into therapy.
After a very thorough history and a review of previous attempts to quit drinking, Bill and I began to identify situations that caused him problems. Bill worked in construction, so co-workers were constantly offering him alcohol. Also problematic was going out with friends. It turned out that many of Bill's problem situations were social. Everyone wanted him to drink with them. At first, Bill avoided situations that he knew would lead to drinking. He was exercising what in learning theory is called, "stimulus control" (Thombs, 2006).
Next, we talked about and role played ways he could change his behavior in the problem situations. Instead of accepting the drink, he learned to say, "no, thank you," and request a coke. As many of you know, this is referred to as reinforcing an incompatible behavior. At the next session, Bill came in delighted with himself. After driving two hours to Santa Barbara, he arrived at his friend's front door, thirsty and exhausted. But, when his friends were waiting with a "cool one" again, he said, "no thank you, how about a coke?" For a few weeks, Bill completely abstained from drinking.
Bill really took off in therapy and continued to surprise me. About 2 to 3 months into therapy, he came in saying, he had gone to dinner with friends and ordered everyone a round of drinks. He had one drink during the first round. Then, he ordered a second round for everyone else and substituted a coke for himself. I was dumbfounded. My therapeutic plan for Bill was complete abstinence. But entirely on his own, he started a program of controlled drinking.
Six months after the completion of therapy, I called Bill's wife to follow-up. She reported that Bill had completely stopped drinking and was doing fun things with the family like he used to years ago. She was thrilled to have her husband back!
Now, in Bill's case, learning theory, stimulus control, role playing, contingency management, and controlled drinking seemed to work. But, why? Still, this case study generates more questions than it answers...1.Is controlled drinking possible? 2. Why was Bill's case successful? Was it the behavioral intervention or was he highly motivated? Or both? 3. Will Bill return to drinking? 4. Will this intervention be successful with others? As always, I learn from the readers and welcome your input. What do you think?
Thombs, D. (2006). Introduction to Addictive Behaviors. New York: the Guilford Press.
