1. Dr. Elena Klaw Psyc. 190

2.  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)

3.  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)?

4.  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)

5.  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

6.  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.

7.  What are Signs of Stress?

8.  What are signs of addiction?

9.  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

10.  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

11.  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/http://www.smartrec-sv.org/

12.  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.

13.  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.