Understanding Craig’s Alcohol Use- A Holistic Approach to Healthcare

Understanding Craig’s Alcohol Use- A Holistic Approach to Healthcare

Case:

Craig, a 40-year-old male, visited his primary care provider’s office to inquire about medicine for his regular insomnia. Craig completes a US-AUDIT as part of the clinic’s universal screening protocols. Craig’s score prompts his primary care physician to recommend him to me, the clinic’s care coordinator. Craig says he doesn’t understand why he needs to talk to someone about alcohol when he only came in for insomnia treatment. He drinks four beers 4-6 times a week, and they are approximately 12-16 ounces in size.

Using the US-AUDIT

Craig’s US-AUDIT score is 16, placing him in the “III – Harmful Use” category. This indicates a moderate level of risk associated with his alcohol consumption. While he doesn’t meet the criteria for severe Alcohol Use Disorder (AUD), his score suggests that his drinking patterns have the potential for negative health consequences (Moehring et al., 2019). Craig’s responses reveal a frequency of 4-6 times a week, consuming four drinks on typical drinking days. Additionally, he acknowledges experiencing guilt/remorse, and others have expressed concern about his drinking in the past year. These factors contribute to his elevated score (Moehring et al., 2019). Healthcare providers need to address Craig’s alcohol use, as continued harmful drinking may lead to more severe health issues over time.

The Purpose of Asking Craig About What He Sees As The Pros and Cons of His Alcohol Use

Asking Craig about the perceived pros and cons of his alcohol use serves several crucial purposes. Firstly, it provides insight into his subjective experience and motivations, allowing for a more comprehensive understanding of his relationship with alcohol. Identifying perceived benefits (pros) may uncover coping mechanisms, social influences, or emotional drivers behind his drinking (Corcoran & Walsh, 2009). On the other hand, recognizing perceived drawbacks (cons) can highlight potential negative consequences, health concerns, or interpersonal issues associated with alcohol consumption.

Secondly, exploring these aspects helps build rapport and foster a therapeutic alliance. It allows Craig to openly discuss his thoughts and feelings, facilitating a non-judgmental and collaborative approach to intervention. Moreover, understanding the pros and cons can inform personalized interventions and treatment plans tailored to Craig’s needs and motivations (Corcoran & Walsh, 2009). It provides a foundation for developing strategies to enhance the positive aspects of his life while addressing the challenges associated with alcohol use, ultimately supporting him in making informed decisions about his health and well-being.

Examples for each Component of OARS and how these Could be Used in Talking to Craig About His Alcohol Use

Open-ended question

“Can you tell me more about the role alcohol plays in your daily routine?” This question encourages Craig to share freely, providing insights into his alcohol use patterns, triggers, and motivations.

Affirmation

“It’s commendable that you’ve been honest about your drinking habits, acknowledging areas where you may want to make positive changes.” Affirmations reinforce Craig’s openness and readiness to address his alcohol use, fostering a supportive and non-judgmental atmosphere.

Reflection

“It sounds like you value the relaxation that comes with having a drink after a long day. Yet, you have also mentioned feeling guilty at times. It must be challenging to navigate these conflicting emotions.” Reflecting helps Craig explore the ambivalence surrounding his alcohol use, promoting self-awareness and facilitating a deeper understanding of his motivations.

Summary

“So, it seems that while alcohol helps you unwind, there are concerns about its impact on your well-being, both physically and emotionally. Let’s work together to find a balance that aligns with your health goals.” Summarizing consolidates key points, setting the stage for collaborative goal-setting and intervention planning (Corcoran & Walsh, 2009).

How to use Motivational Interviewing and the Readiness Ruler to Help Craig Explore His Ideas About Cutting Back

In Motivational Interviewing (MI), the readiness ruler is a valuable tool to assess and explore an individual’s motivation for change. In response to Craig’s readiness rating of 4 out of 10, I would use reflective listening to acknowledge his contemplation, saying, “It sounds like you’re beginning to consider the possibility of cutting back on your alcohol intake.” Then, I would ask open-ended questions to explore his thoughts further, such as, “What makes you think that cutting back might be beneficial for you?” This encourages Craig to articulate his reasons for change. Additionally, I would use affirmations to reinforce his willingness to consider change and express empathy to validate any ambivalence or concerns he may have about reducing his alcohol consumption (Golightly & Goemans, 2020). By employing these MI techniques, the conversation becomes collaborative, respecting Craig’s autonomy and allowing him to explore his readiness for change at his own pace.

Plan

In this scenario, it would be appropriate to follow up with Craig at a later appointment to review and support his plan for cutting down on alcohol. Since Craig has independently identified reasons for change and created a plan, it reflects a positive step towards self-efficacy and motivation for reducing alcohol consumption. By revisiting the plan in a subsequent appointment, healthcare providers can assess progress, address any challenges or barriers, and provide additional guidance or resources in a client-centered and collaborative environment (Golightly & Goemans, 2020). Only if Craig struggles to implement his plan or expresses a desire for more intensive support should the consideration of more intensive treatment services be explored, respecting his autonomy and self-directed efforts to change.

References

Corcoran, J., & Walsh, J. (2009). Mental health in social work: A casebook on diagnosis and strengths based assessment.

Golightly, M., & Goemans, R. (2020). Social work and mental health. Sage.

Moehring, A., Rumpf, H. J., Hapke, U., Bischof, G., John, U., & Meyer, C. (2019). Diagnostic performance of the alcohol use disorders identification test (AUDIT) in detecting DSM-5 alcohol use disorders in the general population. Drug and alcohol dependence, 204, 107530. https://doi.org/10.1016/

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Craig is a 40-year-old man who came into his primary care provider’s office to see about getting medication for his frequent insomnia. As part of the clinic’s universal screening procedures, Craig completes a US-AUDIT, which is included on the next page. Craig’s score leads the PCP to refer Craig to you, the clinic’s care coordinator. Craig states that he does not understand why he needs to talk to someone about alcohol when he comes in to be seen about insomnia, but informs you he normally drinks 4 beers 4-6 times a week and that they are probably about 12-to 16 ounces in size.

1. Using the US-AUDIT, explain what Craig’s score means and what risk category he falls into. Does Craig meet the criteria for Alcohol Use Disorder? Why or why not?
2. What would be the purpose of asking Craig about what he sees as the pros and cons of his alcohol use?
3. Give one example for each component of OARS (Open-ended questions, Affirmations,
Reflections and Summaries) and how these could be used in talking to Craig about his alcohol
use.
4. When Craig is asked about readiness, he says, “I’ve never thought about this before, but maybe I do need to cut back a little,” and picks a 4 out of 10. Describe how you would use Motivational Interviewing and the readiness ruler to help Craig explore his ideas about cutting back.
5. Craig is able to identify some reasons for change and creates a plan to cut down on his own. Would it be more appropriate to follow up with Craig at a later appointment about that plan or to suggest more intensive treatment services? Please provide a full rationale for your answer.