Dr. Elena Klaw
Psyc. 190
 Assessing
alcohol use: CAGE
 Transition Workbook for Combat Veterans
(Naval Combat Research Center)
• Facts
• Signs to look out for: stress & addiction
• What to do
 Practice
Motivational Interviewing (MI)
 1. Have
you ever felt you should cut down
on your drinking?
 2. Have people annoyed you by criticising
your drinking?
 3. Have you ever felt bad or guilty about
your drinking?
 4. Have you ever had a drink first thing in
the morning to steady your nerves or get
rid of a hangover (eye-opener)?
 Problem
drinking: alcohol use that causes
functional impairment, and/or interferes
with your responsibilities, your life &
relationships – it causes problems!
• Thought of as a bad habit
 Addiction: characterized
by increasing
tolerance and withdrawal symptoms, long
term heavy alcohol use will cause the
shakes (DT), memory loss, and liver damage
• Thought of a disease (AA: alcoholism) or disorder
(DSM: dependence)
 Study
of over 29,000 vets entering
Housing & Urban Development Veterans Affairs
Supported Housing (HUD-VASH)
 60% had a substance use disorder (SUD)
 54% of those: both drug and alcohol
disorder
 SUDs linked to more extensive
homelessness
 SUDs clients benefitted equally from
housing but needed further support for
SUDs
Women should keep regular drinking to 1
drink or fewer (12 oz. beer, 5 oz. wine, 1.5 oz. 80
proof alcohol); for men 2 or fewer drinks
 Women should not exceed 3 drinks on any day,
or a total of 7 per week
 Men should limit to 4 drinks per day and 14 per
week
 Do not drink if you are responsible for work,
care or safety of others.
 DOD standard is never drive after any drinking.

 What
are Signs of Stress?
 What
are signs of addiction?
 Diffuse
pain: muscle aches, headaches
 Upset stomach
 Fatigue
 Change in eating
 Drastic change in weight
 Irritability/short temper
 Sleeping all the time or insomnia
 Lack of follow through, poor work quality
 Anhedonia
 Frequent lateness or absence
 Excuse
 Blaming others
 Mood swings
 Changes in relationships
 Falling asleep at work
 Avoiding others
 Careless risk taking
 Financial problems
 Deteriorating self care
 Evidence of use at work
 Confront
gently “I have noticed… Is
everything OK?”
 Do not judge or diagnose, state what you
have noticed
 Refer to relevant medical and counseling
resources; include mutual help and
recovery groups:
• AA: www.alcoholics-anonymous.org,
• MM: www. Moderation.org
• SMART: http://www.smartrec-sv.org/
 Think
of a habit you each want to change.
 Ask your partner:
• What are the risks of changing?
• What are the benefits of changing?
 Restate this for your partner. Then ask:
• What is your goal?
• What are your triggers (antecedent situations for the
behavior)?
• What will you do instead?
 Sum
up the goal and the plan together.
 Change
is hard.
 We need to own a goal and have
motivation to change (“buy in”).
 Need to think about relapse prevention.
 Targeted social support is essential and
may involve a biopsychosocial model.