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michelleyunun

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reducing alcohol consumption

therapist

Thanks for filling it out. We give this form to everyone once a year regardless of why they come in. It helps us provide better care. Is it okay if I take a look at what you put down?

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reducing alcohol consumption

client

Sure.

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neutral

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reducing alcohol consumption

therapist

So, let's see. It looks that you put-- You drink alcohol at least four times a week on average-

therapist_input

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reducing alcohol consumption

client

Mm-hmm.

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reducing alcohol consumption

therapist

-and you usually have three to four drinks when you do drink.

therapist_input

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reducing alcohol consumption

client

Usually three drinks and glasses of wine.

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reducing alcohol consumption

therapist

Okay. That's at least 12 drinks a week.

therapist_input

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reducing alcohol consumption

client

Something like that.

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reducing alcohol consumption

therapist

Okay. Just so you know, my role, um, when we talk about alcohol use, is just to share information about risk and to help patients who want help. This is different than telling them what I think they should do. I don't do that.

therapist_input

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reducing alcohol consumption

client

Okay.

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neutral

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reducing alcohol consumption

therapist

Uh, what else can you tell me about your drinking.

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reducing alcohol consumption

client

Well, I usually drink when I'm at home trying to unwind and I drink while I'm watching a movie. And sometimes, um, I take a bath but I also drink when I take a bath sometimes.

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reducing alcohol consumption

therapist

Okay. So, can I share with you some information on alcohol use?

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reducing alcohol consumption

client

Okay.

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reducing alcohol consumption

therapist

Okay. So, there has been a lot of research on alcohol use and the guidelines we use in this country says that having seven or more drinks per week can raise the risk of health problems for women.

therapist_input

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reducing alcohol consumption

client

Hmm. Seven?

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reducing alcohol consumption

therapist

Seven.

therapist_input

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reducing alcohol consumption

client

Wow. I knew my doctor didn't like me drinking the amount that I did but I didn't know that seven was the limit.

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reducing alcohol consumption

therapist

Yeah, you're surprised to hear that?

question

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reducing alcohol consumption

client

Yes. What-what kind of health problems?

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reducing alcohol consumption

therapist

Well things like heart disease, cancer, liver problems, uh, stomach pains, insomnia. Unfortunately, uh, people who drink at a risky level are more likely to be diagnosed with depression and alcohol can make depression worse or harder to treat.

therapist_input

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reducing alcohol consumption

client

Hmm. Well, that's not good news.

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reducing alcohol consumption

therapist

Well, how do you think your drinking relates to the depression you've experienced?

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reducing alcohol consumption

client

Well, to be honest, I drink sometimes when I'm feeling down and I find it more interesting and not so blur.

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reducing alcohol consumption

therapist

Okay. And how do you feel after you drink?

question

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reducing alcohol consumption

client

Well, then I feel blur again.

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reducing alcohol consumption

therapist

So, there are some answers on this form here. Uh, less than monthly you drank more than you intended to.

therapist_input

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reducing alcohol consumption

client

Yes on occasion.

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reducing alcohol consumption

therapist

And sometimes you feel guilty after you drink.

therapist_input

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reducing alcohol consumption

client

Sometimes I just don't like how much I drink. I sometimes finish a bottle in one night.

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reducing alcohol consumption

therapist

So you're not proud of finishing a bottle?

question

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reducing alcohol consumption

client

No, it's not like I get crazy or anything but I just don't like the amount that I'm drinking.

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reducing alcohol consumption

therapist

Right. By the way, binge drinking is defined for women as having more than, uh, three drinks and there are about five drinks in a bottle. So, you enjoy drinking wine because it helps make things, uh, a little bit more interesting when you're feeling down but at the same time you don't like drinking when you have more than you want it to and then the depression returns after you drink.

reflection

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reducing alcohol consumption

client

Mm-hmm. Yes, sometimes I feel worse after drinking.

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reducing alcohol consumption

therapist

Where do you wanna go from here? What do you wanna change about your drinking habits?

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reducing alcohol consumption

client

Well, I don't think that I'm ready to cut down to seven drinks a week. That seems like a lot but I would consider cutting back to two drinks a night. I think that would be my goal.

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reducing alcohol consumption

therapist

If I gave you a scale from 0 to 10, 0 being not ready at all to cut back on drinking and 10 being very ready, what number would you be at?

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reducing alcohol consumption

client

I'd say an eight.

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reducing alcohol consumption

therapist

Okay. Why do you think it's not something less like a six?

question

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reducing alcohol consumption

client

Well, I'm more ready than a six because I'm ready to cut back on my drinking and I don't wanna make my depression any worse.

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reducing alcohol consumption

therapist

What would help you cut back to two drinks?

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reducing alcohol consumption

client

Maybe having less wine in the house.

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reducing alcohol consumption

therapist

Having less wine in the house will help?

reflection

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reducing alcohol consumption

client

Yes.

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reducing alcohol consumption

therapist

What else besides drinking helps you relax and unwind in the evenings?

question

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reducing alcohol consumption

client

Well, I like to watch movies, read a book, and take a bath but sometimes I drink when I take a bath.

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neutral

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reducing alcohol consumption

therapist

So, it's not just wine that helps you relax. Um, there's reading a book, watching a movie, and taking a hot bath too.

reflection

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reducing alcohol consumption

client

Mm-hmm. Yes.

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neutral

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reducing alcohol consumption

therapist

Okay. So, it sounds like you have some reasons to cut back on drinking and you have ways to relax besides drinking and it sounds like you're pretty ready to cut back.

therapist_input

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reducing alcohol consumption

client

Yes.

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reducing alcohol consumption

therapist

Great. I'd be interested to see how well you do on your goal in the next few weeks. Would you be willing to come back and talk to me about it?

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reducing alcohol consumption

client

Sure.

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reducing alcohol consumption

therapist

Great. So, let's see how well you're doing with these new meds.

other

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reducing alcohol consumption

client

Okay.

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reducing alcohol consumption

therapist

And before you leave, uh, is it okay if we go over this screening form that you filled out today on your alcohol use?

question

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reducing alcohol consumption

client

Sure.

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reducing alcohol consumption

therapist

Okay. Uh, thanks for filling this out. Uh, looks like you use alcohol two to three days a week?

reflection

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reducing alcohol consumption

client

Yeah, but only on the weekend.

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sustain

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reducing alcohol consumption

therapist

Okay. And then when you do drink alcohol, you typically have five or six drinks.

reflection

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reducing alcohol consumption

client

Yeah. Uh, maybe a couple more.

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neutral

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reducing alcohol consumption

therapist

Okay. Well, the reason why I like to talk to patients when they fill out this form is because sometimes, uh, alcohol use can impact our health. Um, and my role is to be helpful. I can share some information with you about alcohol use, um, but I don't tell anyone what to do. It's always up to the patient to decide what they wanna do about their drinking. Um, so is it okay if we talk a little bit more about your alcohol use?

question

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reducing alcohol consumption

client

So, uh, are you saying I drink too much?

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reducing alcohol consumption

therapist

How would you define drinking too much?

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reducing alcohol consumption

client

Well, I-- If-if I was getting fallen down drunk or if I drink every night. Um, it's not like I get sloppy drunk or anything.

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reducing alcohol consumption

therapist

Mm-hmm. Well, in this country, the guidelines are men can drink up to 14 drinks a week or up to four on one occasion and still be low risk.

therapist_input

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reducing alcohol consumption

client

So I'm already at the week limit. And then I have four beers a night. Are you sure?

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reducing alcohol consumption

therapist

So a limit of four a night doesn't feel right to you?

reflection

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reducing alcohol consumption

client

I have five or six beers when I go out with friends to a bar. It's not a problem for me.

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sustain

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reducing alcohol consumption

therapist

You're not alone in feeling that way. Uh, binge drinking can feel normal to some people.

reflection

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reducing alcohol consumption

client

Well, I don't consider my drinking binge drinking.

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reducing alcohol consumption

therapist

Why is that?

question

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reducing alcohol consumption

client

I don't chug a lot of beers in a row. I have about five or six beers throughout the entire evening.

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reducing alcohol consumption

therapist

Mm-hmm. Well, technically, we define binge drinking as having more than four drinks on one occasion.

therapist_input

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reducing alcohol consumption

client

But I'm healthy. What health problems are you talking about?

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reducing alcohol consumption

therapist

Well, uh, we know if someone binge drinks over time, there's kind of two categories of risk. There's the short-term risk where someone who binge drinks is more likely to fall down, hurt themselves through an accident, uh, they're more likely to drive while under the influence. Uh, but over the long term, binge drinking can also, uh, cause things like heart disease, uh, different kinds of cancer, liver problems obviously, and then even mental health issues like depression and anxiety are more likely to happen.

therapist_input

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reducing alcohol consumption

client

Well, I didn't know about those things.

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neutral

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reducing alcohol consumption

therapist

Can I ask you, uh, what do you like about drinking alcohol?

question

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reducing alcohol consumption

client

Well, I-I like beer. I like the way it tastes, I like the way it makes me feel. Uh, like when I'm around friends and it's not a problem for me.

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sustain

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reducing alcohol consumption

therapist

And so what about your drinking do you not like or is there anything that worries you about your drinking?

question

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reducing alcohol consumption

client

Well, that was fine until I came here, uh, but now that I know about the health risk, uh, I have something I gotta think about.

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reducing alcohol consumption

therapist

So, on one hand, you like how beer tastes, uh, it's part of your social life to some extent, um, but on the other hand, you don't like the idea of it posing risks to your health over the long term?

reflection

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reducing alcohol consumption

client

E-exactly.

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reducing alcohol consumption

therapist

So weighing those things, you know, what you like about your drinking, what you don't like about your drinking, uh, where do you wanna go from here? Uh, what would you like to change about your drinking?

question

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reducing alcohol consumption

client

Hmm, I'm not sure. Uh, something I have to think about.

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neutral

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reducing alcohol consumption

therapist

Well, how about hypothetically if I were to ask you, how would your drinking have to impact your life in order for you to be ready to change your drinking?

question

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reducing alcohol consumption

client

Uh, I don't know. Maybe if I got sick or something, uh, maybe I'd wanna change things then.

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neutral

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reducing alcohol consumption

therapist

So if you experienced a negative consequence from your drinking, uh, that would feel meaningful to you?

reflection

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reducing alcohol consumption

client

Yeah.

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neutral

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reducing alcohol consumption

therapist

Okay. Well, I like to give this handout to patients. Uh, it defines risky drinking, it talks about what the consequences are, uh, and it also lists signs of what an alcohol use disorder is. So thanks again for taking the time to fill this out and being honest with me, uh, to talk about it. I provide better care, uh, when I know about my patient's substance use. When we come back for a three-month follow-up appointment for your ADHD, I'd also like to talk to you and check in about your alcohol use too, if that's okay with you.

therapist_input

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reducing alcohol consumption

client

Sounds good.

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neutral

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reducing alcohol consumption

therapist

Okay, great. See you next time.

therapist_input

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weight loss; diet

therapist

Hi, John. Nice to see you again. So, tell me, how are things going?

question

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weight loss; diet

client

Well, doc, I know you told me that I need to lose weight. And even though the scale didn't show today, I was able to lose about 5 pounds, but then I gained it right back.

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neutral

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weight loss; diet

therapist

Well, I appreciate you bringing your weight to the forefront. Do you mind if we explore this issue further?

question

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weight loss; diet

client

No, by all means. I know we have to discuss it.

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weight loss; diet

therapist

All right. Uh, well, it sounds like you've been struggling with your weight recently. And I understand how difficult it is to lose the weight and then have it come back again. So, tell me what you did to lose that initial 5 pounds.

reflection

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weight loss; diet

client

I started watching what I ate and I ate less. I've been eating more fruits and vegetables. I've also been walking a lot. I'm walking up to 20 minutes a day now. I saw the weight come slowly off, um, and I felt better. But then when I watched it come back on again, you know, I gave up.

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change

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weight loss; diet

therapist

But you did have some success. Tell me how you felt when you lost the weight.

reflection

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weight loss; diet

client

I felt great and I felt really proud of myself. I thought that this was something that I could do.

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change

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weight loss; diet

therapist

Okay. Well, it sounds like you realized that when you lost the weight you feel better and that it's gonna affect your overall health. So, tell me what you think changed that caused you to gain the weight back.

reflection

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