Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

CHAPTER 22Cognitive TherapyJUDITH S. BECKBRUCE S. LIESELISA M. NAJAVITSKim is a 32-year-old woman with a complex history of substance abuse thatbegan when she was 13 years old. At various times, Kim has experimentedwith most illicit substances (including marijuana, heroin, LSD, Ecstasy,and cocaine) and she has been dependent on nicotine, alcohol, amphetamines,and barbiturates. She also suffers from chronic depression. She hasbeen treated intermittently for depression since age 15 and has cycled inand out of substance treatment programs since age 19. Kim has never beenmarried. She works as a night janitor at a fast-food restaurant.Currently, Kim smokes marijuana several times daily. She says, “Ismoke so much, I don’t even get high anymore.” She smokes to deal withfeelings of depression, emptiness, and loneliness. She views herself ashopeless but says she has no plans to kill herself, because she is afraid ofdying. She has gained over 50 pounds in the last few years, and she says shewants to “do nothing but sit around the house all day.”Kim meets criteria for avoidant personality disorder with dependentand borderline features. She describes constant boredom and isolation.Nonetheless, she refuses to take social or occupational risks, saying “If I putmyself out there, I’ll only get burned.” She has a history of numerous failedrelationships and jobs.Eventually Kim joins a self-help group for women with depression,where she admits to daily marijuana use. Another group member, Jenna,explains that she, too, was a heavy marijuana smoker at one time. Jennawarns Kim that she will only feel better when she quits smoking marijuana.474