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Session 3: Managing Thoughts About Alcohol and Drinking Rationale The following paragraph is inserted between the first and second elements of the Monti et al. rationale: Recovering alcoholics need to be aware of a state of mind that can predispose them to a relapse-a state of mind characterized by certain dangerous attitudes and thought processes. This state of mind is often described as "negative tapes," These thought processes and attitudes are dangerous because they induce alcoholics to relax their guard (decrease vigilance). Stinking thinking, as the saying goes, leads to drinking thinking, and then, usually, to drinking without thinking. It is not the thinking itself that creates the problem, but how people deal with it. If alcoholics can learn to dismiss this thinking from their minds whenever it appears, recognize it for what it is, or counter it with contrary thoughts, it need not lead to a relapse. The following items are added to the list of situations that may lead clients to have thoughts about resuming drinking: f. Escape. Individuals wish to avoid the discomfort aroused by unpleasant situations, conflicts, or memories. Failure, rejection, disappointment, hurt,humiliation, embarrass- ment, discontent, or sadness all tend to demand relief. People get tired of feeling hassled, lousy, -and upset. They just want to get away from it all and, more to the point, from themselves. It is not necessarily intoxication that is sought; rather it is numbness, the absence of problems, and peace. g. Relaxation. Thoughts of wanting to unwind are perfectly normal, but they go awry when they are coupled with the NOTE: The major portion of this session is based on the corresponding session in Monti et al. (pp. 79-83). A number of additions made to the original materials are derivedfrom Ludwig (1988).0 Oxford University Press. Used with permission.
Cognitive-Behavioral Coping Skills Therapy Manual expectations of this happening immediately, without the benefit of doing something relaxing. Rather than engag- ing in a wide variety of possibly enjoyable and relaxing activities, the individual may choose the more immediate route induced through alcohol. Socialization. This overlaps with relaxation but is con- fined to social situations. Many individuals, shy or uncomfortable in social settings, may feel a need for a social lubricant to feel more at ease and decrease the awkwardness and inhibitions they feel around others. Improved self-image. This situation typically involves a relatively pervasive negative and low self-esteem. When individuals start becoming unhappy with themselves, when they are feeling inferior toothers, when they regard themselves as lacking in essential qualities, when they feel unattractive or deficient, they often begin to think again of alcohol, through which they may have previously achieved immediate and temporary relief. Romance. Individuals often indulge in adolescent fanta- sies. When bored or unhappy with their lives, they yearn for excitement, romance, the joy of flirtation, and the thrill of being in love. This is usually the kind of thought that, when engaged in too seriously, requires a drug like alcohol to sustain it and make it more vivid and real. To hell with it. Some individuals seem to have lost all incentive for pursuing any worthwhile goals. Their thoughts express disillusionment; nothing really mat- ters. There is no reason to try. Why should they give a damn? Such an attitudinal set leads these individuals to be less vigilant and not care whether they remain sober. No control. This represents the other side of the coin from the "Testing Control" script. Just as believing in one's ability to handle alcohol is usually a setup for relapse, the opposite attitude of not being able to control one's cravings virtually insures it. Individuals give up the fight, conceding defeat even before they have made any effort to resist. Alcohol is seen as one of the few viable options available. This differs from the "hell with it" attitude. In that situation, individuals do not necessarily feel powerless; they just do not want to exert the effort to continue what they have been doing.
Page 1 and 2: E M U L O V 3 National Institute on
Page 3 and 4: Project MATCH is supported by grant
Page 5 and 6: Cognitive-Behavioral Coping Skills
Page 8 and 9: Rationale for Patient- Treatment Ma
Page 10 and 11: Caveats and Critical Considerations
Page 12: Preface purposes of standardization
Page 15 and 16: Cognitive-Behavioral Coping SkillsT
Page 18 and 19: Introduction The interventions to b
Page 20 and 21: Length of Treatment Supporting Data
Page 22: References Introduction Abrams, D.B
Page 29 and 30: Cognitive-Behavioral Coping SkillsT
Page 31 and 32: Cognitive-BehavioralCoping Skills T
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Page 38 and 39: Session 1: Introduction to Coping S
Page 40 and 41: Assessing High-Risk Situations (15
Page 42 and 43: Treatment Contract 1. I understand
Page 44 and 45: Session 2: Coping With Cravings and
Page 46 and 47: Session 2: Coping With Cravings and
Page 48 and 49: In-Session Exercises Session 2: Cop
Page 50: Daily Record of Urges to Drink P In
Page 58 and 59: Rationale Skill Guidelines Session
Page 60 and 61: Session 5: Drink Refusal Skills The
Page 62: Session 5: Drink Refusal Skills The
Page 65 and 66: Personal Emergency Plan: High-Risk
Page 68 and 69: Session 7: Seemingly Irrelevant Dec
Page 70: Final Core Session: Termination Thi
Page 74 and 75: Elective Session: Starting Conversa
Page 76 and 77: Elective Session: Introduction to A
Page 78 and 79: Elective Session: Receiving Critici
Page 80 and 81: Elective Session:Anger Management T
Page 82 and 83: Elective Session: Managing Negative
Page 86 and 87: Thinking Errors Elective Session: M
Page 94 and 95: In-Session Exercise Elective Sessio
Page 96 and 97: Elective Session: Enhancing Social
Page 98 and 99: Elective Session: Jobuseeking Skill
Page 100 and 101: Rehearsal of Interview Process Elec
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JobLeads Log
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Skill Guidelines a. Help you work t
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Couple@amily Involvement I bminder
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Skill Guidelines Elective Session:
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Reminder Sheet Practice Exercise Co
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Cognitive-Behavior Coping Skills Th
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Therapist Selection Appendix B: The
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Appendix B: Therapist Selection,Tra
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