Disordered Drinking: Comprehensive Assessment and Treatment

Outline

The Spectrum of Disordered Drinking

Beyond Traditional Diagnostics

• The 26% gap – heavy drinkers fall through clinical cracks
• Why DSM™ changes matter
• “Alcoholic/nonalcoholic” binary
• Drivers of problematic drinking
• The role of trauma in development and maintenance
• The impact of social anxiety
• Cultural myths that perpetuate clinical blind spots
• When harm reduction helps vs. enables
• The problem of internalized bias in the client and clinician

Assessment of Disordered Drinking

Catching Problems Before Crisis

• Multi-dimensional assessment tools to reveal hidden severity
• What you need to know about detox and withdrawal
• The “Can You Moderate” quiz Alcohol timelines to detect patterns
• Track cumulative risk factors
• Physical dependency markers commonly missed in “high-functioning” clients
• Alcohol’s impacts on physical health
• Common co-occurring mental health disorders
• Effects of alcohol on important relationships and areas of functioning
• Warning signs of failed moderation attempts

Working with Resistance

When Clients Won’t Accept That They Need Help

• ACT strategies to identify choices
• Differentiate alcohol-filtered vs. traditional denial
• Cognitive defusion and the ego-syntonic nature of drinking identity
• Stages of change adapted for alcohol use
• Core MI techniques that bypass resistance
• Values work to build willingness
• The “failed moderation experiment”
• Scripts for difficult conversations that maintain rapport

Evidence-Based Interventions for Disordered Drinking

Comprehensive Tools for Lasting Change

• Teach emotion regulation without substances
• Trauma-informed approaches to window of tolerance
• Break the shame-relapse cycle with self-compassion strategies
• Help clients set and maintain boundaries
• Establish a sober support system
• Authentic self-care strategies
• Manage cravings with DBT distress tolerance skills
• Relapse prevention for the modern drinker
• When moderation isn’t working – transitioning the conversation

Additional Clinical Considerations

Move Clients from Shame to Empowerment

• Create defensible treatment plans when clients refuse appropriate care
• Level of care determinations
• Documentation strategies that protect you and your client
• “Conditional treatment” agreements that work
• When to refer out vs. maintain therapeutic relationship
• Manage liability while practicing harm reduction
• 12-step groups and alternatives
• When and how to involve family and friends
• Countertransference management
• Limitations of the research and potential risks

Objectives

1. Evaluate clients’ use of alcohol and its impact for case conceptualization.
2. Choose 3 motivational interviewing techniques to build motivation in clients who are resistant to abstinence-based treatment.
3. Determine 4 evidence-based interventions focused on improving emotion regulation and enhancing self-compassion of clients who engage in disordered drinking.
4. Differentiate successful from unsuccessful moderation to inform treatment planning.
5. Integrate harm reduction principles with appropriate level of care determinations while maintaining defensible documentation.