This is the transcript of a conversation with a 22 year old man who promised his brother he would see someone about “getting his alcohol problem under control” and who “only had 20 minutes because I have a dentist appointment”. Paul’s first concern, apart from his obvious desire to get out of the session as quickly as possible was how much he would be expected to talk about his life and “triggers”. He didn’t have “triggers” he maintained but he had seen a programme about alcoholics and they talked about triggers. Paul lives with his older brother and is taking a year out before returning to training in the emergency services. I have changed names, ages, professions. “Paul” has given permission for me to include our work together on the case studies page including updates from subsequent sessions.
EM: Paul,tell me how much you think I need to know in order to be able to help you today.
P: How do you mean?
EM: Well, I’m very aware that you are the expert of how you live your life and what works for you…..and what doesn’t. So I’m just reminding you that you are best placed to know how much of that life is necessary to share with me in order to work on the alcohol issues that you want to discuss.
P: Yeh, okay. I just don’t want to trace over stuff, I don’t mean any offence.
EM: Absolutely no offence taken Paul. I totally agree with whatever point you decide to start.
P: Its just difficult. I actually don’t have an alcohol problem – its my brother that said I do.
EM: Okay – so if this meeting was to be helpful to you – what would be the result?
P: I would know that my drinking is not out of control and that its normal really.
EM: What level of drinking would you say is normal?
P: A couple of drinks when I’m out and a red with dinner
EM: Okay – and is that what your level of drinking is?
P: Kind of, sometimes I have a couple more than I should I suppose, you know you get carried away but its not a problem, I dont drive so what’s the fuss. And I haven’t drunk wine with dinner since my girlfriend left me anyway.
EM: So is your aim to reduce the level of drinking you do now? and do you want to discuss anything about how it was for you since your girlfriend left?
P: No – it just petered out, no problem really to me. If the drinking is a problem, I suppose, yeah I should reduce it, like if its too much, like over the recommended limit stuff they go on about..
EM: Okay – let’s see on the computer what the medical people recommend as “ok” – would that help?
P: Yeah – but that’s a bit strict that is isn’t it. According to them you would only have a unit once a week and I can’t get my head around the Unit stuff. Why can’t they say x amount of pints, then you’d know where you stand.
EM: Okay – according to the patient.co.uk website: “men should drink no more than 21 units of alcohol per week (and no more than four units in any one day).
One unit of alcohol is about equal to: half a pint of ordinary strength beer, lager or cider or a small pub measure (25 ml) of spirits”. Is that helpful to know?
P: Yeh, see what I mean about the Units? its hard to keep in your head when you’re out – so they are saying about 11 pints a week is max?.
EM: I think so yes, what does that sound like?
P: Yeh – its okay. I do more than that now I suppose but at least I know.
EM: Can I ask Paul what will different when you are happy with your level of drinking?
P: I feel bad sometimes now, bloated, unhealthy – I know my brother is right really.
EM: And when you are healthier, happier about the level? what small things will be different for you?
P: Just feel better and do more I suppose.
EM: I’m just trying to get a picture of that Paul – say in one week’s time, you came back for another appointment and you tell me you are doing well and feeling better about your levels of drinking and I asked you what small things were better for you – could you tell me what you would be telling me then?
EM: Shall I rephrase that question Paul?
P: No – i’m just thinking…………………………I would know how much I was going to drink and not go above it. I would talk more and drink less and I would feel better.
EM: What is that “better” Paul? physically? or emotionally? how do you mean?
P: Bit of both I suppose.
EM: What would your brother notice first about you that would tell him you are doing something different when it comes to your drinking level?
P: I would be up earlier in the morning – that’s when he nags me most.
EM: and then what?
P: I wouldn’t be groggy till lunchtime
EM: So how would you be instead?
P: Sharp, on the ball, like I used to be.
EM: Okay – and in the evenings? what would he say he noticed that was different?
P: I would be in or at golf – not in the pub.
EM: This description of how you will be Paul – is it fitting with you comfortably?
P: Yeh, its me, it’s what I always did before
EM: And these things worked for you?
P: Yeh – I’m a bit lazy apart from the golf
EM: I think you are very wise, if I may say so, to check out your alcohol intake at this point and amend it as you see fit. I think its a very intelligent approach.
P: So – its good timing then?
EM: Well yes, change can happen at any time in a person’s life but especially with you at this early stage – its a great idea to check out stuff and change things to help you live a healthier life. Have you ever done the same about anything else in your life? any other habit or pattern?
P: I gave up smoking years ago. I started at 16 and stopped at 18.
EM: And your motivation for doing that?
P: Health and money I suppose.
EM: Is that what your motivation will be this time, on this issue?
P: Yeh. It will – I spend too much and always have to borrow off my brother half way through the week.
EM: So that’s another benefit then to you – more money left at the end of the week?
P: Hopefully, yes.
EM: So – what’s your plans from today then? What are you taking away with you from what you have discussed here?
P: Just slow down with the drinking I suppose, do something else – I don’t really enjoy drinking so much, its just boredom sometimes.
EM: What was useful for you to discover in this session about yourself Paul?
P: Nothing about myself I don’t think. The drinking level explanation was good – that was useful. I couldn’t get me head around it.
EM: I hope I have translated it properly Paul. Let’s just check again to make sure I have.
Paul went home with some observation tasks about what was different for him when he wasn’t drinking so much. It did seem clear that this was an early intervention at a time when he was beginning to drink more than was good for him. A different approach would have taken place, with much more use of “exceptions” and “visualation” had his alcohol issue been more long-standing or indeed more chronic. Paul slso suggested that he ask his brother to rate him everyday on his “healthy attitude since the alcohol cut-down”. Paul has one more session in 6 days (from 10/11/10) and I will update on the What’s Better session afterwards.
Second Session: Due to a bout of flu, Paul missed his next appointment and we met 13 days later:
EM: Nice to see you again Paul….so, how are you doing and what’s better since we last met?
Paul: mmm, i think i was doing ok really but the flu kept me off the drink anyway.
EM: So – how have things been?
Paul: I can’t remember all the stuff I was supposed to remember now but I remember the stuff I did.
EM: Okay – great.
Paul: When I left here last time, I know I didn’t go to the pub that night
EM: Okay – what did you do instead?
Paul: I went home and arranged a game, X Box live with this bloke in South Africa
EM: I wish I could ask a question about that Paul but I know I won’t understand a word you say…… I am still coming to terms with the wireless radio
Paul: No – don’t worry, I won’t go on about it but I won anyway!
EM: And when you finished the game?
Paul: I just listened to music and watched a DVD and went to bed
EM: Okay – can I ask on a scale of 1-10 now Paul with 1 being you are not happy with your progress and 10 being you feel you are making progress in your own goals?
Paul: I think I’m doing okay really, I would say about 6 or even 7 before I got the flu, lately I would even say a 10 for this week.
EM: Let’s go with the latest number then Paul, the 10: what is it you are doing that brings you to the 10?
Paul: I do lots of stuff I suppose, I don’t slob around anymore
EM: What do you do instead?
Paul: Different things every day. I still go to the pub sometimes though – I haven’t got a problem with that or anything.
EM: No, of course, not – sounds like you have organised a varied social life and keeping yourself healthy. Is that what you are saying?
Paul: Yes, still more to do – I can’t go to golf yet, I need new clubs really but I am saving up for that.
EM: Can I ask what difference this new behaviour makes for you physically Paul?
Paul: I don’t feel so sluggish I suppose
EM: Okay – so what do you feel instead? stay small for me if you could please.
Paul: Right………I get up earlier, I sleep better, I move about a bit let’s put it like that.
EM: And your brother? what would he say he notices about you?
Paul: He doesn’t say much but he doesn’t nag me anymore. I told him about the Units of alcohol thing but apart from that – nothing really, he’s just pleased that I’m back on my feet and doing stuff.
EM: Okay – this is all good stuff Paul isn’t it?
Paul: Yep, doing good.
EM: I am curious now about what your personal strategies are for staying healthy and drinking moderately that you will take forward with you?
Paul: Doing lots of things that are interesting and treating myself now and then to a couple of pints. I did want to ask something though on that.
EM: Yes, please do
Paul: I don’t think I had a problem, just a rutt I got in. Do you think so?
EM: I totally agree with you – you started a new behaviour by cutting down and doing other things too. I guess when you start golf again that that will be another healthy behaviour that you will get into. Yes – I think you are absolutely right, you got into a rut and then you got out of it again.
Paul: Great – thanks for everything.
EM: Well, I enjoyed hearing about your new health progress.
Paul: Shall I make another appointment?
EM: Well, I certainly don’t think that’s necessary but how about you take a task with you and then if you want to come back at some point in the future to assess your strategies and goals etc, no problem.
Paul: Okay – what task?
EM: Just to continue to observe really: observe how healthier you feel and what works for you and to keep doing more of what works – nothing drastic really.
Paul: Okay, will do.