DR. JON CARLSON Welcome to our program on addictions. In a minute, we’re going to be inviting our guest, Joan Zweben, out to learn about self-help groups and how she integrates her therapy with these groups, groups like Narcotics Anonymous and Alcoholics Anonymous. What’s your understanding, Judy, about how this process works? 

00:00:20DR. JUDY LEWIS Well, I think this is something that’s really important for the field right now. I think there have been, there had been times historically when there was such a distance between the self-help groups on the one hand and therapy on other hand as, as though, they’re like on opposite sides of the Grand Canyon and with no possibility of a bridge. But I think we’ve gotten past that. I think that now, therapists really see the value of the self-help groups and I think people in 12 Step groups are more open- 

00:00:501-2 

00:00:50DR. JUDY LEWIS – to the possibility of therapy but we need people like Joan to help us figure out how we can make those connections. 

00:00:55DR. JON CARLSON So you actually believe that something like this can happen, that these groups can really work collaboratively? 

00:01:00DR. JUDY LEWIS Yeah, I do. I think they’re very different from each other. I think therapy and self-help groups are very different. In fact, I find it really annoying when people charge money to teach people the 12 Steps. They’re different. What you do in therapy is different from what you do in self-help. 

00:01:15DR. JON CARLSON So, this is, sort of, like oil and water and we’re gonna try to bring them together today in our program? 

00:01:20DR. JUDY LEWIS We will do it. 

00:01:20DR. JON CARLSON We will do it? 

00:01:20DR. JUDY LEWIS Yes. (crosstalk) 

00:01:20DR. JON CARLSON  Let’s bring out Joan Zweben and find out how to do this. Joan, welcome. 

00:01:25DR. JOAN ZWEBEN Thank you. 

00:01:25DR. JUDY LEWIS  Hi, Joan. 

00:01:30DR. JOAN ZWEBEN Hi. Uh hmm. 

00:01:30DR. JUDY LEWIS  Joan, we’d like to start out getting, sort of, ah, a general overview of your, ah, approach, how you work in therapy to make for some kind of integration with the 12 Step work that some of- 

00:01:501-3 

00:01:50DR. JUDY LEWIS – the clients are doing. 

00:01:50DR. JUDY LEWIS Could you begin by telling us how you conceptualize addiction? 

00:01:55Joan Zweben, Ph.D. INTEGRATION WITH 12 STEP PROGRAM 

00:01:55DR. JOAN ZWEBEN Uh hmm. Uhm, addiction is a biopsychosocial disorder. It has many different levels to it. Ah, it has to be addressed on all of those levels in order for an intervention to be effective… (crosstalk) 

00:02:10DR. JUDY LEWIS Uh hmm. 

00:02:10DR. JOAN ZWEBEN …or for whatever the person does in recovery to be effective. So, the 12 Step, uhm, participation is a key piece of the psychosocial component. 

00:02:20DR. JUDY LEWIS Uh hmm. 

00:02:20DR. JOAN ZWEBEN  But it’s, ah, the, the kinds of things you need to think about in addressing addict, addiction are very broad so that in my way of thinking about it, uhm, I try to adapt what I do as a therapist to the person’s stage in recovery. Many people come to therapy for other reasons besides dealing with their alcohol and drug use, so the task may be to help them- 

00:02:501-4 

00:02:50DR. JOAN ZWEBEN – understand the relationship of their using and drinking to the problems that they are hurting about. 

00:02:55DR. JUDY LEWIS Uh hmm. 

00:02:55DR. JOAN ZWEBEN Then to help them become able to do something about that, to change their behavior preferably to, uhm, uhm, become abstinent and then to make all of the personal and lifestyle changes it takes to lead a comfortable and satisfying life without alcohol and drugs which usually means mastering many of life’s situations, ah, in a much different way… (crosstalk) 

00:03:20DR. JUDY LEWIS Uh hmm. 

00:03:20DR. JOAN ZWEBEN …in all of the way, you know, mastering all the things they used alcohol and these drugs for, ah, developing coping mechanisms, internal mechanisms to, to deal with those. Recovery can’t be just a deprivation or it’s not gonna last. 

00:03:35DR. JUDY LEWIS Uh hmm. 

00:03:35DR. JOAN ZWEBEN People need to, ah, find ways to enrich their lives and fill in the gaps. So, that’s my big picture of addiction and what our tasks are. 

00:03:45DR. JUDY LEWIS Do you think the way you conceptualize addiction as a therapist just that, are there differences between how you would conceptualize- 

00:03:501-5 

00:03:50DR. JUDY LEWIS – addiction and how say a member of a 12 Step self-help group would conceptualize it? 

00:03:55DR. JOAN ZWEBEN  Ah, there’s overlapping. There’s, ah, many differences. Uhm, ah, ah, and also, uhm, I think professionals often tend to assume more hetero, more homogeneity in 12 Step group members than is really the case. (crosstalk) 

00:04:15DR. JUDY LEWIS Yeah. 

00:04:15DR. JOAN ZWEBEN It is enormously diverse. 

00:04:15DR. JUDY LEWIS Uh hmm. 

00:04:15DR. JOAN ZWEBEN  Very wide range in every dimension that you can imagine. So, to talk about a person involve with 12 Step, I mean, we have, in California, 12 Step groups, you could find one if you wanted for Unix-speaking computer executives. 

00:04:30DR. JUDY LEWIS Uh hmm. 

00:04:30DR. JOAN ZWEBEN  And, and that’s… (crosstalk) 

00:04:35DR. JON CARLSON You know where that is? 

00:04:35DR. JOAN ZWEBEN Yeah, in Palo Alto. (laughs) 

00:04:35DR. JON CARLSON Okay. 

00:04:35DR. JOAN ZWEBEN  So, ah, there’s a very wide range in, in people’s, ah, the way they understand it. 

00:04:45DR. JUDY LEWIS Uh hmm. 

00:04:45DR. JOAN ZWEBEN Even within, I think the 12 Step, ah, approach. 

00:04:50DR. JON CARLSON So, so this is a biopsychosocial approach? (crosstalk) 

00:04:50DR. JOAN ZWEBEN Uh hmm. 

00:04:501-6 

00:04:50DR. JON CARLSON  And your role- 

00:04:551-6 

00:04:55DR. JON CARLSON – as a psychotherapist is to match or to tailor your treatment of your client and to… (crosstalk) 

00:05:00DR. JOAN ZWEBEN  No, I, I think we have, uhm, complementary roles and with, with, quite a bit of overlap. In other words, I, uhm, have come to believe that recovery from addiction is, uhm, not as complete if it depends on the role of a psychotherapist and the client alone. 

00:05:25DR. JUDY LEWIS Uh hmm. 

00:05:251-7 

00:05:25DR. JOAN ZWEBEN  There’s an element of connecting to a sub-culture that supports recovery that’s really crucial… 

00:05:30DR. JUDY LEWIS Yeah. 

00:05:30DR. JOAN ZWEBEN  and the things people get out of meetings, ah, that I cannot provide. And, uhm, so, I think my role is partly the traditional therapist role to help them with the obstacles to their personal growth with the framework of recovery task always, ah, uppermost in my mind. But it’s also to help- 

00:05:551-7 

00:05:55DR. JOAN ZWEBEN – them use this incredible support system, ah, to their benefit. 

00:06:00DR. JON CARLSON Okay, well, what would it, your, your idea of an outcome of this approach be? I mean what is the… (crosstalk) 

00:06:05DR. JOAN ZWEBEN Uh hmm. 

00:06:05DR. JON CARLSON …outcome of your therapeutic, ah, efforts? (crosstalk) 

00:06:05DR. JOAN ZWEBEN  Well, ideally that people are abstinent from alcohol and drugs… (crosstalk) 

00:06:15DR. JUDY LEWIS Uh hmm. 

00:06:15DR. JOAN ZWEBEN …and leading a, a, what they consider to be a rich life in terms of satisfying, ah, and, ah, with confidence in their ability to master life stresses without alcohol and drugs. So ultimately, the outcome, you know, includes what, ah, therapy that’s not centered on addiction would normally include to. You know, uhm, reducing your symptoms and, and, ah, feeling more, uhm, positive about your, your life. 

00:06:45DR. JON CARLSON How does that compare with the goals or outcomes of a 12 Step program? 

00:06:501-8 

00:06:50DR. JOAN ZWEBEN  I think actually it’s pretty similar, ah, because the steps are about the personal transformation and I think that it’s, ah, sometimes overlooked by people who haven’t looked into it closely. That, uhm, that stopping alcohol and drug use is only the beginning. It’s working on all of the other things that begin to unfold once that is removed as an issue. 

00:07:25DR. JON CARLSON Hmm. 

00:07:25DR. JOAN ZWEBEN And if you look at the 12 Steps and get beyond the language, it’s basically, ah, the same as the therapeutic process in terms of what people are actually, uhm, ah, what’s actually unfolding. And interestingly for me, it’s, ah, interesting that’s, if you read the literature on, ah, spiritual transformation, ah, you see the same kinds of steps in evolution, ah, many of the same in that. (crosstalk) 

00:07:50DR. JON CARLSON Well, in, in, in psychotherapy though there are goals and we have determination… (crosstalk) 

00:07:55DR. JOAN ZWEBEN Uh hmm. 

00:07:551-9 

00:07:55DR. JON CARLSON …and then, we really turn our, our clients loose… (crosstalk) 

00:08:00DR. JOAN ZWEBEN Uh hmm. 

00:08:00DR. JON CARLSON …that people don’t ever graduate from AA, they stay in the system and they go on forever and ever and ever. 

00:08:10DR. JOAN ZWEBEN No, no, (crosstalk) 

00:08:10DR. JUDY LEWIS Uh hmm. 

00:08:10DR. JOAN ZWEBEN that people do all kinds of things. Ah, they, some stay forever and ever. Some go to meetings occasionally. Some discontinue and then return when they feel like they’ve had a snag. 

00:08:20DR. JUDY LEWIS  Uh hmm. 

00:08:25DR. JOAN ZWEBEN Ah, and remember, you can’t study AA directly. You cannot go into an AA or NA meeting and draw a sample and study. 

00:08:30DR. JUDY LEWIS Hmm. 

00:08:30DR. JOAN ZWEBEN All of our work, all of what we know is in indirect and anecdotal. We can draw a sample of people who went through our chemical dependency programs and study the ones that did and didn’t go to AA and see how they do but that’s, ah, uhm, tsk, not, not a random, I mean, that’s, ah, uhm, a specialized sample. 

00:08:50DR. JUDY LEWIS Right. 

00:08:50DR. JOAN ZWEBEN So, I, I think you see all kinds of patterns with it. And some people, uhm,- 

00:08:551-10 

00:08:55DR. JOAN ZWEBEN – continue for many, many years and many don’t. 

00:09:00DR. JUDY LEWIS So people use it in the way they need to use it? 

00:09:00DR. JOAN ZWEBEN  Yeah, and, and, it’s, ah, certainly, ah, ah, people do discontinue prematurely, uhm, some of the time for reasons that have to do with drifting towards relapse. But other people, ah, just change their focus after a period of time. 

00:09:15DR. JUDY LEWIS  Uh hmm. You know, you are talking about the goals of therapy and the goals of 12 Step groups as being complementary and maybe even similar but, of course, they’re different in practice. What are the, some of the kinds of strategies or techniques that you used in your therapy with clients dealing with addictions? 

00:09:40DR. JOAN ZWEBEN You mean more generally not related to 12 Step? 

00:09:40DR. JUDY LEWIS  Generally and then also how you, uhm, how you make that integration happen. 

00:09:50DR. JON CARLSON Yeah. 

00:09:50Joan Zweben, Ph.D. INTEGRATION WITH 12 STEP PROGRAM 

00:09:50DR. JOAN ZWEBEN Uh hmm. Uhm, well, I had a, an orthodox psychoanalytic training. (crosstalk) 

00:09:55DR. JON CARLSON Uh hmm. 

00:09:55DR. JUDY LEWIS Uh-huh. 

00:09:55DR. JOAN ZWEBEN So, my earliest training was- 

00:10:001-11 

00:10:00DR. JOAN ZWEBEN – to look at things psychodynamically. And what I had to, uhm, change was, ah, ah, ah, was, to try to make this automatic to look on all of the different levels, the biological. I mean, you can have somebody who’s, ah, expressing a lot of feelings but if their, ah, feelings that are colored by their physiological withdrawal from cocaine for example… (crosstalk) 

00:10:25DR. JUDY LEWIS Uh hmm. 

00:10:25DR. JOAN ZWEBEN …you view those differently and work with them in a, with a different focus ah, than you would, if, ah, somebody had been clean and sober a year or more, expressing the same kind of feeling. So, I have learned to integrate, ah, ah, the, the kind of behavioral, uhm, strategies that help people, well, first of all, to help them really look at their, ah, willingness to give up alcohol and drugs and the very great ambivalence that most people have about that. Nobody comes into treatment saying, “I can’t hardly wait to- 

00:11:001-12 

00:11:00DR. JOAN ZWEBEN – give up my drugs.” 

00:11:00DR. JUDY LEWIS Uh hmm. 

00:11:00DR. JOAN ZWEBEN Even if they know and they’re at some kind of bottom, there’s always some ambivalence that will ultimately show itself and you have to, to, ah, keep watch. 

00:11:10DR. JUDY LEWIS Yeah. 

00:11:10DR. JOAN ZWEBEN On that. So, to help them, ah, acknowledge that and work with that and move to a point of being ready to give up, ah, certain behaviors then, there’s the, the, early abstinent stage, both the physiological, ah, (crosstalk) 

00:11:25DR. JUDY LEWIS Uh hmm. 

00:11:25DR. JOAN ZWEBEN pieces that may need medical intervention and knowing when that’s the case as well as the behaviors to establish abstinence. And then as that unfolds, anticipating all of the things that are gonna come up for people to both sabotage, ah, being clean and sober or, ah, if they remain clean and sober, what’s some of the other issues, interpersonal and emotional, are gonna be? So, that’s how I think about it. And the, uhm, 12 Step system is such an, uhm, tsk, in most urban areas at least and in many, ah, less urban areas- 

00:12:001-13 

00:12:00DR. JOAN ZWEBEN – ah, a very rich support system to accelerate people’s learning so I try to get people connected to that as soon as possible. 

00:12:10DR. JON CARLSON How do you handle people? I think there’s a woman named Wendy Kaminer, who wrote this book, “I’m Dysfunctional” or “So Dysfunctional,” and then. (crosstalk) 

00:12:20DR. JOAN ZWEBEN “I’m Dysfunctional, You’re Dysfunctional.” 

00:12:20DR. JON CARLSON Well, right. Yeah. 

00:12:20DR. JOAN ZWEBEN Yeah. 

00:12:20DR. JON CARLSON That kind of ah, you know, I’m, it’s, it’s like I’m not okay, you’re not okay… (crosstalk) 

00:12:25DR. JOAN ZWEBEN (laughs) Yeah. 

00:12:25DR. JON CARLSON …let’s get together and, ah, that’s a liability group, this, this, this 12 Step groups. How do you, and, and, and psychotherapy tries to tap into abilities? How do you, you deal… (crosstalk) 

00:12:40DR. JOAN ZWEBEN But… (crosstalk) 

00:12:40DR. JON CARLSON …with those differences? (crosstalk) 

00:12:40DR. JOAN ZWEBEN …yeah, I, I (crosstalk) 

00:12:40DR. JON CARLSON That some people talk about? (crosstalk) 

00:12:45DR. JOAN ZWEBEN Think people are, uhm, sometimes prone to over-generalize that, that feature, in other words using the identity of a recovering person as a way of castigating oneself is something that individuals do based on who they are. Other individuals don’t do that. 

00:13:001-14 

00:13:00DR. JOAN ZWEBEN And within the 12 Step, uhm, meetings and exchanges that you hear, ah, there, there are many other ways to address those issues focusing on the solution, not on the problem. (crosstalk) 

00:13:15DR. JON CARLSON Uh hmm. 

00:13:15DR. JOAN ZWEBEN There are many more positive, ah, ways. I have met countless number of people who’ve been through 12 Step programs who don’t have that, who don’t retain that self-castigating part or at least they, they have begun to distance themselves from it. So, I don’t think it’s a feature of 12 Step programs. It’s a feature of people. 

00:13:30DR. JON CARLSON Uh hmm. 

00:13:30DR. JUDY LEWIS I wondered about this. I think that I have the impression that the aspect of the 12 Step work that, that you seem to feel as especially important is that idea of, of mutual help, that idea of people. (crosstalk) 

00:13:45DR. JOAN ZWEBEN Hmm. 

00:13:45DR. JON CARLSON  Uh hmm. 

00:13:50DR. JUDY LEWIS Not having to just be in the role of patient but to be in the role… (crosstalk) 

00:13:50DR. JOAN ZWEBEN Uh hmm. 

00:13:50DR. JUDY LEWIS …of helper to other people… (crosstalk) 

00:13:55DR. JOAN ZWEBEN Uh hmm. 

00:13:55DR. JUDY LEWIS …and to always have a support network that they can turn to. Do you think that’s the source of gain from AA or NA more so than the specific philosophy? 

00:14:10DR. JOAN ZWEBEN Tsk, ah, I really think it’s both. I think that, uhm, we are basically tribal as humans and that many of the social institutions that made people feel like they were part of a community have disintegrated. And that this is one of the most alive communities… (crosstalk) 

00:14:25DR. JUDY LEWIS Uh hmm. 

00:14:25DR. JOAN ZWEBEN …ah, ah, that we have today. And that helps people integrate a change. 

00:14:30DR. JUDY LEWIS  Uh hmm. 

00:14:35DR. JOAN ZWEBEN And I also think that, ah, the, the work of the steps really gives people, uhm, a process for personal development that does not have financial barriers. And, uhm, it’s, ah, for me, it’s a real treat to have people who are really working their steps in my recovery groups… (crosstalk) 

00:14:50DR. JUDY LEWIS Uh hmm. 

00:14:50DR. JOAN ZWEBEN …because I have people who are doing both because they’re right there with what the therapeutic task is. It’s, it’s basically very similar. 

00:15:00DR. JUDY LEWIS And that sense of community is something that treatment or therapy could never duplicate? 

00:15:051-16 

00:15:05DR. JOAN ZWEBEN Not really. I think, as professionals, we have so much emphasis on the brilliance of our services that we provide. (crosstalk) 

00:15:10DR. JUDY LEWIS Uh hmm. 

00:15:10DR. JOAN ZWEBEN That we underestimate the impact of a community in producing change. (crosstalk) 

00:15:15DR. JUDY LEWIS Yeah. 

00:15:15DR. JOAN ZWEBEN And the addiction field therapeutic communities are another arena where it’s understood that the community is a powerful change agent that transcends what an individual can do particularly with people who need a major rehabilitative effort. So, yeah I, I do tend to think in both ways and, you know, more experience makes me more accepting of our limitations. 

00:15:35DR. JUDY LEWIS  Yeah. 

00:15:40DR. JON CARLSON Yeah, the general public, ah, tends to think that AA is the best, (crosstalk) 

00:15:45DR. JOAN ZWEBEN Uh hmm. 

00:15:45DR. JON CARLSON ah, way of dealing with problems of addictions. They kind of act as if the, the data in support of this particular intervention is, ah, is, is incredible. What’s your understanding as of today about just how effective this particular- 

00:16:051-17 

00:16:05DR. JOAN ZWEBEN Uh hmm. 

00:16:05DR. JON CARLSON – their 12 Step models are? 

00:16:05DR. JOAN ZWEBEN  Well, again, it’s, uhm, a difficult question because the, the diversity of the groups in a, you can’t do research to control the variables… (crosstalk) 

00:16:20DR. JON CARLSON Uh hmm. 

00:16:20DR. JOAN ZWEBEN …and answer that question. There isn’t enough research done anyway. And there is a body of research that’s growing that suggest that people with a strong AA affiliation do, do better long-term but it’s not a huge number of studies. And you, you can’t, you know, if people are going to 20 different groups in their community, how are you gonna generalize about your data? So, I think part of the, I think the public perception is shaped by the vast numbers of people who feel strongly how much they benefited from participation… (crosstalk) 

00:16:50DR. JUDY LEWIS Yeah. 

00:16:50DR. JOAN ZWEBEN …in AA. Ah, but our ability to research it is limited and the amount of, ah, resources put into… (crosstalk) 

00:17:00DR. JON CARLSON Uh hmm. 

00:17:00DR. JOAN ZWEBEN …getting good data is less than one might suspect. Ah, the statement, “there’s no evidence- 

00:17:051-18 

00:17:05DR. JOAN ZWEBEN – to support X, Y and Z,” is often interpreted by the, by lay people to mean we’ve looked at this thoroughly and there’s no evidence… (crosstalk) 

00:17:15DR. JUDY LEWIS Yeah. 

00:17:15DR. JOAN ZWEBEN Whereas in fact, it usually means there aren’t a whole lot of studies. (crosstalk) 

00:17:15DR. JUDY LEWIS Lot(ph) of studies. 

00:17:15DR. JON CARLSON Uh hmm, uh hmm. 

00:17:15DR. JOAN ZWEBEN You know, nobody have looked very hard or very carefully. There are a few interesting studies that have come up. There’s, uhm, uhm, John Morgan is trying to, I think he’s at Cornell, uhm, has done ah, a factor analysis that even suggests that the operative active ingredients in cognitive behavioral therapy and in 12 Step programs are essentially not very different. 

00:17:35DR. JUDY LEWIS  Uh hmm. 

00:17:40DR. JOAN ZWEBEN Ah, which certainly, uhm, conforms to my feeling that the language is different and they, sort of, conceptual slant is different but we’re really talking about many of the same things. 

00:17:50DR. JUDY LEWIS What about one, one issue that I think, ah, ah, people see as problematic sometimes is when you’re working with people who have both an addiction-related problem… (crosstalk) 

00:18:00DR. JON CARLSON Uhm, Uh hmm. 

00:18:00DR. JUDY LEWIS …and also a mental health problem? 

00:18:05DR. JOAN ZWEBEN Uh hmm. 

00:18:05DR. JUDY LEWIS What do you see in your approach- 

00:18:051-19 

00:18:05DR. JUDY LEWIS – about working with people who, uhm, have dual diagnosis? 

00:18:10Joan Zweben, Ph.D. INTEGRATION WITH 12 STEP PROGRAM 

00:18:10DR. JOAN ZWEBEN Uh hmm. Well, that’s certainly the area that’s, ah, of most attention and development now, dual disorders. And, ah, because of the history that professionals have played in the addiction field, there is, uhm, ah, subgroup of recovering people who are very suspicious of psychotherapy. At the same time, there’s a growing number of people in recovery who are, are benefiting greatly from psychotherapy and talking about that in meetings. So, ah, my own approach to that is, again, it’s oriented to recovery task and what do we really need to do? (crosstalk) 

00:18:50DR. JUDY LEWIS Uh hmm. 

00:18:50DR. JOAN ZWEBEN If somebody has a co-existing mental health disorder, the task is where are we at recovery and how can I address that disorder, uhm, ah, in a way that’s consistent with moving forward on getting and staying clean and sober? Ah, in, in the past, the, the- 

00:19:051-20 

00:19:05DR. JOAN ZWEBEN – mistrust of therapists led to the conviction that you should postpone any psychotherapy for a year. 

00:19:10DR. JUDY LEWIS  Uh hmm. 

00:19:15DR. JOAN ZWEBEN That was one of those nice theories that doesn’t work very well in practice. (crosstalk) 

00:19:15DR. JUDY LEWIS Uh hmm. 

00:19:15DR. JON CARLSON Uh hmm. 

00:19:15DR. JOAN ZWEBEN You know, if you have, ah, people with a trauma history, for example, which is extremely common and extremely, ah, a very strong factor in, in, uhm, influencing treatment. How come you can’t tell them, “I don’t wanna hear about this for a year?” 

00:19:30DR. JUDY LEWIS Yeah. 

00:19:30DR. JOAN ZWEBEN What you have to do is look at it from a prospective of how can I help you express these feelings or contain them without drinking and using so you can get to the point where you can do meaningful work on this? So, you have, and so, you try to integrate them, ah, with respect to the, keeping focused on the task, ah, to move people step by step forward. Uhm, and that, ah, is, depends a lot on the complexity of the disorders that the person brings to you. So, yeah, it’s in, it’s integrated. 

00:20:05DR. JUDY LEWIS Uh hmm. 

00:20:05DR. JOAN ZWEBEN It can be integrated. 

00:20:05DR. JON CARLSON (coughing) Speaking of tasks, sort of(ph), one of the tasks of this- 

00:20:101-21 

00:20:10DR. JON CARLSON – video is to have you work, ah, with a, ah, a real client with real addictions issues. Can you talk a little bit, ah, about the interview that, ah, you conducted and kinda set it up for our viewers? 

00:20:25DR. JOAN ZWEBEN Yeah, this was, uhm, ah, a young man who is, has had periods, ah, meaningful periods of, of abstinence… (crosstalk) 

00:20:35DR. JUDY LEWIS Uh hmm. 

00:20:35DR. JOAN ZWEBEN …in his life from alcohol… (crosstalk) 

00:20:40DR. JON CARLSON Hmm. 

00:20:40DR. JOAN ZWEBEN …who, but has gone back to drinking usually between nine months to a year. (crosstalk) 

00:20:45DR. JUDY LEWIS Uh hmm. 

00:20:45DR. JOAN ZWEBEN And in this case, ah, we meet with him at the point where he knows he needs to stop drinking and he needs to return to AA. And he’s, uhm, preparing himself to do that. 

00:21:00DR. JON CARLSON Hmm. 

00:21:00DR. JUDY LEWIS So, he’s still feeling some ambivalence at this point? 

00:21:00DR. JOAN ZWEBEN Yes, so we’re having… (crosstalk) 

00:21:00DR. JON CARLSON Uh hmm. 

00:21:00DR. JOAN ZWEBEN  trouble, yes, ambivalence and, ah, finding himself, ah, with problems mobilizing… (crosstalk) 

00:21:05DR. JUDY LEWIS Uh hmm. 

00:21:05DR. JOAN ZWEBEN  to follow through on what he kind- 

00:21:101-22 

00:21:10DR. JOAN ZWEBEN – of knows he needs to do. So, that’s… (crosstalk) 

00:21:10DR. JUDY LEWIS Uh hmm. 

00:21:10DR. JON CARLSON So, he’s practicing right now? I mean he’s, he’s drinking right now. (crosstalk) 

00:21:15DR. JOAN ZWEBEN Yes, he’s drinking right now… (crosstalk) 

00:21:15DR. JON CARLSON Uh hmm. 

00:21:15DR. JOAN ZWEBEN …and having negative consequences so. 

00:21:20DR. JON CARLSON And are there particular strategies or techniques or things that our viewers should look for that might be unique the, the way that you work? 

00:21:25DR. JOAN ZWEBEN Uh hmm. Tsk, well, what I try to do is really get a clear sense of where he’s starting from and where he’s blocked. Ah, one the places addiction treatment can go awry is people assuming people are truly at the action stage… (crosstalk) 

00:21:50DR. JUDY LEWIS Yeah. 

00:21:50DR. JON CARLSON Oh, okay. 

00:21:50DR. JOAN ZWEBEN …when they aren’t or aren’t as fully, ah, where they’re really ambivalent. They have positive feelings. They’re quite sincere. I always assume that people are sincere in, in a part of themselves but I wanna go back a little bit further and see where they’re blocked and see about those obstacles ‘coz it will move more slowly if I’m not pushing prematurely for- 

00:22:101-23 

00:22:10DR. JOAN ZWEBEN – some action that they may not be ready to sustain. 

00:22:15DR. JUDY LEWIS Uh hmm. 

00:22:15DR. JOAN ZWEBEN So I think that would be a, (crosstalk) 

00:22:15DR. JON CARLSON Uh hmm. 

00:22:15DR. JOAN ZWEBEN a thing to watch for. 

00:22:15DR. JON CARLSON Well, let’s watch your interview. 

00:22:20DR. JOAN ZWEBEN Okay. (laughs) 

00:22:202-1 

00:22:20DR. JOAN ZWEBEN Hi, Mark. I’m Joan Zweben. 

00:22:25MARK Hi, Joan. 

00:22:25DR. JOAN ZWEBEN Hi. And, uhm, I was wanting to know what you hoped to get out of being here today. 

00:22:30MARK  As a session, uhm, I haven’t had many counseling sessions. I don’t exactly what to expect… (crosstalk) 

00:22:45DR. JOAN ZWEBEN Uh hmm. 

00:22:45MARK …or, or, in a, in the interview, ah, like this or of this nature. Uhm, to be honest with you, I don’t know. 

00:22:55DR. JOAN ZWEBEN Uh-huh. 

00:22:55MARK I don’t exactly know why. I know I want it here. I know I, ah, ah, I’m being interviewed but I don’t know what issues that I need to… (crosstalk) 

00:23:05DR. JOAN ZWEBEN Sure. 

00:23:05MARK …to des, describe(ph). I’m like, I’m not a doctor. I mean I’m- 

00:23:102-2 

00:23:10DR. JOAN ZWEBEN Yeah. 

00:23:10MARK – I know my problems but I don’t know what to, how to interpret them or that sometimes how to effectively work through them. 

00:23:15DR. JOAN ZWEBEN  Okay, or how to use this time? 

00:23:20MARK Exactly. 

00:23:20DR. JOAN ZWEBEN Yeah. Uhm, we have a particular interest in people, ah, and how they use 12 Step programs or, uhm, have obstacles to using 12 Step programs so we can discuss that but we can really talk about anything we get into, ah, in the, in the course of the 45 minutes that we’ll spend today. 

00:23:40MARK Okay. 

00:23:40DR. JOAN ZWEBEN Can you give me a really big picture about, uhm, how you got here, what your issues are with alcohol and drugs, and where you are in your recovery? 

00:23:50MARK Okay. Uhm, as far as I am, where I’m at in my recovery I’m not, I’m a, I guess you’d say I’m a practicing drinker. Uhm, (crosstalk) 

00:24:05DR. JOAN ZWEBEN Uh hmm. 

00:24:05MARK I know that I, I’m making some inquiries lately about getting back into the 12 Step programs, you know, in the area. But to go back- 

00:24:102-3 

00:24:10MARK  uhm, I’ve come from a big family of alcoholics. Ah, so it started when I was in high school, growing up in, in the home, it was in the home, it was in the high school where I went. I picked it up there really easy, you know, at the, the teenage parties, although, you know, the average teenager goes, you know, and has a couple and that would be it, but I’d be the one at the end they’d have to help up and take home. 

00:24:40DR. JOAN ZWEBEN Uh hmm. 

00:24:40MARK  So, uhm, it progressed and progressed to, ah, I came to a part of my life where I would have to, ah, either take care of where I was going in the future, I’d, I didn’t do very well at all in high school and so, and everybody else is going out to college. 

00:25:05DR. JOAN ZWEBEN Uh hmm. 

00:25:05MARK Ah, I’d, I’m not gonna say I felt miserably in high school but it was, there was a border there, uhm, so I chose the Marine Corps. 

00:25:102-4 

00:25:10MARK  And, ah, which is a perfect place for an alcoholic. 

00:25:15DR. JOAN ZWEBEN Uh hmm. 

00:25:15MARK Ah, nothing about the Marines but it’s a perfect atmosphere. It was accepted and it, ah, (crosstalk) 

00:25:25DR. JOAN ZWEBEN Uh hmm. 

00:25:25MARK it, it just, I was able to, to be where I wanted to be there and I guess I was a drinker. Uhm, so, uhm, after that, after I got out of the Marine Corps, after Desert Storm, I came back, uhm, as family members, friends told me, “Look, ah, aren’t you getting a little tired of this?” Oh, and, and in the Marine Corps, I had a, an incident where I got in trouble out in the town, ah, in one of the bases. And as a, ah, not as a punishment, but as a, just part of, of the process I, I had, went into rehab there, (crosstalk) 

00:26:00DR. JOAN ZWEBEN Uh hmm. 

00:26:00MARK in the Marine Corps. Uhm, so it was my first experience with 12 Step. Uhm, and I, I enjoyed it. (crosstalk) 

00:26:10DR. JOAN ZWEBEN Uh hmm. 

00:26:10MARK Uhm, but as it, ah- 

00:26:152-5 

00:26:15MARK – just a minute, it would seem to me that every time I tried I would get to about a year… (crosstalk) 

00:26:25DR. JOAN ZWEBEN Uh hmm. 

00:26:25MARK …and I don’t know exact, it’s been a while since I’ve been to a, to the meetings and everything but I, I can’t imagine at what point in the steps I am at there after a year, whatever it’s, maybe it’s psycho, psychologically where you’re supposed to move up and beyond certain issues or maybe I’m just stuck there at that year and I, I just disgruntled. Or maybe I think it’s all well I, you know, I got this licked and I can make excuses to go drink now. 

00:26:55DR. JOAN ZWEBEN Uh hmm. 

00:26:55MARK Or. (crosstalk) 

00:26:55DR. JOAN ZWEBEN When you say a year, you mean a year with no drinking? 

00:26:55MARK  Right. Right. (crosstalk) 

00:27:00DR. JOAN ZWEBEN Yeah, what about other drugs like marijuana? 

00:27:00MARK No, no. 

00:27:00DR. JOAN ZWEBEN Uh hmm. 

00:27:00MARK Uhm, in high school I experimented with marijuana but that was it. 

00:27:05DR. JOAN ZWEBEN Yeah(ph). 

00:27:05MARK Uhm, no cocaine, none of that. 

00:27:10DR. JOAN ZWEBEN Oh, uh-huh. 

00:27:10MARK Ah, just the drug, just, just the ah, alcohol use. 

00:27:15DR. JOAN ZWEBEN Oh, I see, so when you say year, that- 

00:27:152-6 

00:27:15DR. JOAN ZWEBEN – means clean of everything? 

00:27:15MARK Right. Right. 

00:27:15DR. JOAN ZWEBEN Uh hmm. 

00:27:15MARK But not necessarily a model, uhm, 12 Step or, or if there’s a. (crosstalk) 

00:27:25DR. JOAN ZWEBEN Oh, right. 

00:27:25MARK But there’s no… (crosstalk) 

00:27:25DR. JOAN ZWEBEN Yeah. 

00:27:25MARK …just maybe getting to the point where I can, I can function, it seems, you know what, ah, I could do well, so I could be on my ninth month and things are going real well. Uhm, ah, last time I’ve been through the, the program and I swear my ninth month I, I got my new job doing, the job I have now for the last five years and, uhm, things have been happening really well for me. (crosstalk) 

00:27:55DR. JOAN ZWEBEN Uh hmm. 

00:27:55MARK Uhm, but recently, uhm, the issues in my, in the house, ah, my daughters are getting older, you know, they, the, the, the pile of beer cans in the table is not acceptable anymore. And I, I wanna take care of going back to the 12 Step program. (crosstalk) 

00:28:10DR. JOAN ZWEBEN Okay(ph). 

00:28:10MARK  Ah, so basically that’s where I’m at right now. Uhm. 

00:28:152-7 

00:28:15DR. JOAN ZWEBEN  I see, wait, I’m a little unclear. So you had, uhm, nine or 10 months… (crosstalk) 

00:28:20MARK  Right. 

00:28:25DR. JOAN ZWEBEN …about five years ago when you got, when you, (crosstalk) 

00:28:25MARK  I kinda skipped over. (crosstalk) 

00:28:30DR. JOAN ZWEBEN Yeah. 

00:28:30MARK I, I’ve in the Marine clad about nine or 10 months… (crosstalk) 

00:28:30DR. JOAN ZWEBEN Uh-huh. 

00:28:30MARK I, I got stationed to Okinawa, Japan. (crosstalk) 

00:28:35DR. JOAN ZWEBEN Ah. 

00:28:35MARK So, I guess maybe a new location. I, I’ve picked up drinking there again. 

00:28:40DR. JOAN ZWEBEN I see. 

00:28:40MARK Uhm, I got lucky as far as drinking goes. I got sent to Desert Storm. 

00:28:45DR. JOAN ZWEBEN Uh-huh. 

00:28:45MARK No alcohol at all. 

00:28:45DR. JOAN ZWEBEN How was it? 

00:28:45MARK  Uhm, oh, you look at the newspapers and look at the TV and say, “Oh, my soul, you know, that was, that was an easy one.” (crosstalk) 

00:29:00DR. JOAN ZWEBEN Uh hmm. 

00:29:00MARK You know, but it’s not necessarily easy. (crosstalk) 

00:29:05DR. JOAN ZWEBEN Uh hmm. 

00:29:05MARK I was, ah, I was on a tank, uhm, one of the ground troops, you know, it was easy… (crosstalk) 

00:29:10DR. JOAN ZWEBEN Hmm. 

00:29:10MARK …for the spectator watching CNN, I suppose. But it was something I- 

00:29:152-8 

00:29:15MARK – would never wanna do again. 

00:29:20DR. JOAN ZWEBEN Uh hmm. 

00:29:20MARK Uhm, which is an experience I could never, never volunteer for again, never. (crosstalk) 

00:29:25DR. JOAN ZWEBEN Uh hmm. 

00:29:25MARK  Uhm, I made it through fine. Uhm, my tank made it through fine with some scrapes and stuff but it’s just, ah, the, visualizing it on TV is not anything like being there and in the middle of this chaos. (crosstalk) 

00:29:40DR. JOAN ZWEBEN Uh hmm. 

00:29:40MARK  I guess you can call it. (crosstalk) 

00:29:45DR. JOAN ZWEBEN Uh hmm. 

00:29:45MARK Uhm, that, ah. 

00:29:50DR. JOAN ZWEBEN So you had a really hard time, ah, in that extent. (crosstalk) 

00:29:55MARK With, with the, with the war, it wasn’t physically hard. 

00:30:00DR. JOAN ZWEBEN Uh hmm. 

00:30:00MARK Uhm, and emotionally hard, it wasn’t that bad until the very, ah, the, the war was over. They had, we are in a southern Kuwait city and we had liberated an airport and we’re resting there ‘coz it was over. (crosstalk) 

00:30:10DR. JOAN ZWEBEN Hmm. 

00:30:10MARK  And everybody is, the elation, you know, and you could hear the jubilation firing the city- 

00:30:202-9 

00:30:20MARK – ah, and you have been, we would, we were riding out and they’re all greeting us and waving and everything. But after that I’ve been there for a couple more more weeks and when it sets in and the, and the, ah, the adrenaline, adrenaline’s gone. 

00:30:35DR. JOAN ZWEBEN Uh hmm. 

00:30:35MARK You’re just sitting there and you can, thinking yourself out. You know, the things you see and, and some of the things that, that, have been going on around you for the, (crosstalk) 

00:30:45DR. JOAN ZWEBEN Uh hmm. 

00:30:45MARK the six to 10 days and, and not even to mention the air war. 

00:30:50DR. JOAN ZWEBEN Uh hmm. 

00:30:50MARK They don’t sink in until you actually have time to process them. You’re not really processing…(crosstalk) 

00:30:55DR. JOAN ZWEBEN Uh hmm, uh hmm. 

00:30:55MARK …while you’re doing them. You’re, you’re saying I gotta take care of this… (crosstalk) 

00:31:00DR. JOAN ZWEBEN Uh-huh. 

00:31:00MARK …and so you, when you process them, you, you gotta, you really, you stop to think, so, “Wow, that was, it was really horrific,” you know, it’s a, the dynamics of that. (crosstalk) 

00:31:10DR. JOAN ZWEBEN Uh hmm. So you, it sounds like you have leftovers from there now. 

00:31:15MARK Yeah, I do. I, I don’t have, ah, not like a- 

00:31:202-10 

00:31:20MARK – a shell shock or anything like that. (crosstalk) 

00:31:25DR. JOAN ZWEBEN Uh hmm, Uh hmm. 

00:31:25MARK But just a, I, I use it as a, a point sometimes in, in reference to, uhm, my, my motivations. 

00:31:35DR. JOAN ZWEBEN Uh hmm. 

00:31:35MARK Ah, the only motivations I really have nowadays are the negative ones. 

00:31:35DR. JOAN ZWEBEN Uh hmm. 

00:31:35MARK  You know, ah, like tax time, gosh, last day. 

00:31:45DR. JOAN ZWEBEN Uh hmm. 

00:31:45MARK That’s the negative motivation. 

00:31:45DR. JOAN ZWEBEN Uh hmm, Uh hmm. 

00:31:45MARK Uhm, unfortunately, but fortunately I, I got it done but this is the first year I didn’t have to rush out and get, but in my life, when I would have to take care of some important things it seems like it’s just a, I’ll wait and I’ll wait and I’ll wait until… (crosstalk) 

00:32:00DR. JOAN ZWEBEN Uh hmm. 

00:32:00MARK  something makes me do it. 

00:32:05DR. JOAN ZWEBEN Uh hmm. 

00:32:05MARK Uhm, and in my drinking in the past, ah, the incident in the Marine Corps had forced me into it. And, you know, when you’re back in your mind that you should be doing it anyways… (crosstalk) 

00:32:15DR. JOAN ZWEBEN Uh hmm. 

00:32:15MARK …and then after a while you, you take that, that seems like a year for me- 

00:32:202-11 

00:32:20DR. JOAN ZWEBEN Uh hmm. 

00:32:20MARK – nine months to a year where I say, well, this is, things are happening. I got a new job, you know? So I got on the Marine Corps, a year-and-a-half goes by. Ah, I got my car wrecked. Uhm, some serious damage, ah, to my ear… (crosstalk) 

00:32:40DR. JOAN ZWEBEN Uh hmm. 

00:32:40MARK …scars and, nothing to the other person. Uhm, but it, it’s just one of those another wake-up calls. 

00:32:50DR. JOAN ZWEBEN Uh hmm. 

00:32:50MARK Where I, gee, what am I doing now? What have I done? Time to take care of it, ah, so I went to rehab again in ’93, (crosstalk) 

00:32:55DR. JOAN ZWEBEN Hmm. 

00:32:55MARK  ’93, ’94. Uhm, and things went well for about actually, about little over a year. I got a new job and shortly after my fiancé at the time and I got our first apartment, we were scheduled to get married, I started drinking again. 

00:33:202-12 

00:33:20MARK  So it’s just a cycle, I guess, and. (crosstalk) 

00:33:25DR. JOAN ZWEBEN Uh hmm. So what do you think happened? What went into the decision to start drinking again? 

00:33:30MARK  It’s not of, it’s not one of the, it’s not a, I’m cured. (crosstalk) 

00:33:40DR. JOAN ZWEBEN Uh-huh. 

00:33:40MARK I wouldn’t be foolish enough to think that. 

00:33:45DR. JOAN ZWEBEN Uh-huh. 

00:33:45MARK It’s, at first I think, it’s maybe, uhm, I can get away with it… (crosstalk) 

00:33:55DR. JOAN ZWEBEN Uh hmm. 

00:33:55MARK …or nobody’s watching. 

00:33:55DR. JOAN ZWEBEN Uh hmm. 

00:33:55MARK  I don’t know. I mean (inaudible ). When it gets to that point I think to myself, “Well, I can handle it.” 

00:34:05DR. JOAN ZWEBEN  Uh hmm. 

00:34:10MARK But it’s, then the next day when you wake up, you say, “What are you doing?” But then there was no repercussion from yesterday, so why not today? (crosstalk) 

00:34:15DR. JOAN ZWEBEN Uh hmm, uh hmm. 

00:34:15MARK  Or you could say to, I could say to myself, “I can have so many drinks tonight and not go to work- 

00:34:202-13 

00:34:20MARK – smell like alcohol tomorrow.” 

00:34:25DR. JOAN ZWEBEN Uh hmm. 

00:34:25MARK So basically that’s where I’m at right now. 

00:34:25DR. JOAN ZWEBEN  Uh hmm. 

00:34:30MARK Uhm, I’ve been looking into some information and when I say looking into, it’s not a lie, uhm, but it’s, I could, for the last week I’ve been looking into it. If I really, truly had been looking into it, I would’ve known exactly where I know where to find it. 

00:34:45DR. JOAN ZWEBEN Uh hmm. 

00:34:45MARK  So, uhm, I’ve got, there’s just no motivation sometimes. 

00:34:55DR. JOAN ZWEBEN Uh hmm. 

00:34:55MARK To, I know what I have to do. Uhm, then physically I feel okay today so I’m thinking, “Well, I didn’t get over by a car, I didn’t get into a bar fight when I was in.” You know, nothing’s happened so… (crosstalk) 

00:35:05DR. JOAN ZWEBEN Uh hmm. 

00:35:05MARK …I’ve got some more time to drink. So I, I don’t wanna kinda want tomorrow to be that, that incident that makes me go back… (crosstalk) 

00:35:15DR. JOAN ZWEBEN Right. 

00:35:15MARK …and do that, something looming over my head or like that negative motivation. 

00:35:252-14 

00:35:25DR. JOAN ZWEBEN Uh hmm. So. (crosstalk) 

00:35:25MARK That was it. 

00:35:25DR. JOAN ZWEBEN Ah, tell me if I understand you that a lot of what mobilizes you about drinking and other things is bad consequences and you wanna make the shift to be mobilized by something more positively and not… (crosstalk) 

00:35:40MARK Exactly… (crosstalk) 

00:35:40DR. JOAN ZWEBEN …going towards rather than… (crosstalk) 

00:35:40MARK Exactly. 

00:35:40DR. JOAN ZWEBEN yeah. 

00:35:40MARK Uhm, when I was a child, it would be like a, ah, if it takes me all summer, I’m gonna go off to a high dive. 

00:35:50DR. JOAN ZWEBEN Uh hmm. Uh hmm. 

00:35:50MARK And you wouldn’t believe the, the, I don’t even have a name for it. (crosstalk) 

00:35:55DR. JOAN ZWEBEN Uh hmm. 

00:35:55MARK My daughter. (crosstalk) 

00:35:55DR. JOAN ZWEBEN Passion. 

00:35:55MARK Yeah. 

00:35:55DR. JOAN ZWEBEN Uh hmm. 

00:35:55MARK Where is that? It’s where is that at now, now, what? 

00:36:00DR. JOAN ZWEBEN Uh hmm. 

00:36:00MARK I’m 33 years old, where is it, you know? (crosstalk) 

00:36:00DR. JOAN ZWEBEN Uh hmm. 

00:36:00MARK And then you see, ah, just read books and magazines on inspirations and some 80-year-old guy is running triathlons and, and what happened to me? What, where is it at? 

00:36:15DR. JOAN ZWEBEN Well, but alcohol is a depressant drug. (crosstalk) 

00:36:15MARK It’s like(ph). 

00:36:15DR. JOAN ZWEBEN It’s kinda hard to have that if you’re drinking it all the time. 

00:36:20MARK Exactly. 

00:36:20DR. JOAN ZWEBEN Yeah, so the, it sounds like you’ve had, uhm, some sense of real vitality- 

00:36:252-15 

00:36:25DR. JOAN ZWEBEN – during the periods you were sober. 

00:36:25MARK Oh, ah, yeah. 

00:36:25DR. JOAN ZWEBEN  Yeah. 

00:36:30MARK Yeah, ah, ah, gosh, I could get things accomplished. (crosstalk) 

00:36:35DR. JOAN ZWEBEN  Uh hmm. 

00:36:40MARK I mean, to me, cleaning my bedroom. 

00:36:40DR. JOAN ZWEBEN Uh hmm. 

00:36:40MARK Uhm, I don’t wanna, well, I guess I, I go to that, ah, the week-and-a-half will go by, I won’t clean my bedroom. You know, it, it should be every other day. I straighten out the bed, dust, vacuum, what-have-you. So, the, I mean, those kind of things where you sit home and well, is it clean the house tonight or sit around and do nothing or, or drink or whatever? 

00:37:10DR. JOAN ZWEBEN Uh hmm. 

00:37:10MARK Ah, I don’t really go out except maybe to dinner with my wife every now and then. But it’s not, I don’t go out to, to the bars or with the buddies after work. It’s not social drinking. It’s basically sitting by myself or, my wife drinks- 

00:37:252-16 

00:37:25MARK – occasionally. So. 

00:37:25DR. JOAN ZWEBEN How does she feel about your drinking? 

00:37:30MARK She, tsk, she notices that I, I’m not completely, ah, motivated. Ah, especially when, uhm, we moved into a new house and there’s so many chores to get done and, (crosstalk) 

00:37:45DR. JOAN ZWEBEN Uh hmm. 

00:37:45MARK you know, there’s only so many times when she’s gonna, to ask me to, to finish the landscaping or something or just, ah, something I should have done a long time ago or she asked me to do and I said, yeah, and just hadn’t do, done half of it… (crosstalk) 

00:38:00DR. JOAN ZWEBEN Uh hmm. 

00:38:00MARK …or not done the whole thing or stuff like that. So, I don’t know. I, I don’t, ah, it’s not that I don’t have energy. I, the job I have is, I work on a dock, uhm, (crosstalk) 

00:38:20DR. JOAN ZWEBEN Uh hmm. 

00:38:20MARK unloading and loading trucks, forklift operator. I got, you know, I could lift and move boxes all day. 

00:38:25DR. JOAN ZWEBEN Uh hmm. 

00:38:252-17 

00:38:25MARK Uhm, but that’s no, if you don’t do that, you’re fired. So I have to do that. 

00:38:30DR. JOAN ZWEBEN Uh hmm. 

00:38:30MARK  But I just can’t seem to get any of the passion towards any other aspect of my life. 

00:38:40DR. JOAN ZWEBEN Uh hmm. 

00:38:40MARK Uhm, everyday it’s, it’s just, things are, you know, the, your hopes and dreams, you still have them but, you know, you just de, decide to do something one day and you just forget about it the next because you know, I would drink. 

00:38:55DR. JOAN ZWEBEN Hmm. 

00:38:55MARK  So basically, that’s where I am. (crosstalk) 

00:39:00DR. JOAN ZWEBEN Yeah. 

00:39:00MARK I’m stuck. 

00:39:00DR. JOAN ZWEBEN  Now, you said when you were involved with 12 Step programs before you liked them. 

00:39:05MARK I do. 

00:39:05DR. JOAN ZWEBEN  And what do you like? 

00:39:10MARK Socializing comes to mind, number one. 

00:39:10DR. JOAN ZWEBEN  Uh hmm. 

00:39:15MARK I like people. I like the interaction, uhm, and it beats getting in trouble. 

00:39:20DR. JOAN ZWEBEN Uh hmm. Uh hmm. 

00:39:20MARK  To me ah, it’s a- 

00:39:252-18 

00:39:25MARK – little smothering at times. 

00:39:30DR. JOAN ZWEBEN Hmm. 

00:39:30MARK Uhm, when, uhm, after meetings everyone wants to go out and, uhm, ah, for coffee and all this other stuff and, I don’t know, you, hmm, I don’t know, about the hugging stuff that I don’t really like but other than that, uhm, I enjoyed it. I enjoyed the socialing, ah, social, ah, socializing. (coughing) 

00:40:05DR. JOAN ZWEBEN  So, so the socializing was fine but the smothering was when it? 

00:40:10MARK  Well, a lot of the. (crosstalk) 

00:40:15DR. JOAN ZWEBEN Extended too far or not. (crosstalk) 

00:40:15MARK No, well sometimes, you know, you get, you get to know some, a lot of the huggy(ph)… (crosstalk) 

00:40:20DR. JOAN ZWEBEN Uh-huh. 

00:40:20MARK …touchy, feely type stuff. 

00:40:20DR. JOAN ZWEBEN  Uh-huh. 

00:40:25MARK I, you know, a lot of people are, they just wanna hug you. 

00:40:25DR. JOAN ZWEBEN Uh-huh. 

00:40:25MARK And I’m, I’ll settle for a handshake. 

00:40:302-19 

00:40:30DR. JOAN ZWEBEN Uh-huh. 

00:40:30MARK You know, stuff like that or, it doesn’t, I would never say that to somebody. 

00:40:35DR. JOAN ZWEBEN Uh hmm. 

00:40:35MARK You know, but I would just, you know. 

00:40:35DR. JOAN ZWEBEN  Uh hmm. 

00:40:40MARK I would never, I wouldn’t embarrass them. 

00:40:40DR. JOAN ZWEBEN Uh hmm. 

00:40:40MARK I wouldn’t, you know, but then sometimes it’s, it’s generally I don’t, I, I enjoy something like that or an old friend I might see or something like that. But it’s different. But, uhm, I don’t know what it is about the year. 

00:40:55DR. JOAN ZWEBEN  About the… (crosstalk) 

00:41:00MARK The, the year into it, I’ve, I’ve categorized the, I’ve looked at it each time. 

00:41:00DR. JOAN ZWEBEN  Uh-huh. 

00:41:05MARK And it’s right about a year. 

00:41:05DR. JOAN ZWEBEN Yeah. 

00:41:05MARK And I’m trying to, to think, well what I’m gonna, my intentions are this next time when I get there, uhm, is to ask why, ah, there’s usually that trip-up or, or whatever it might be, (crosstalk) 

00:41:20DR. JOAN ZWEBEN  Uh hmm. 

00:41:25MARK whether it’s me or, I don’t know. I can, I can work on it there. 

00:41:302-20 

00:41:30DR. JOAN ZWEBEN Well you’ve come up with what I think is a big piece of the answer where, when you’re doing well and it’s easier to convince yourself that you can handle it now. 

00:41:40MARK Right. 

00:41:40DR. JOAN ZWEBEN You’re feeling good. (crosstalk) 

00:41:40MARK Right(ph). 

00:41:40DR. JOAN ZWEBEN So as long as you’re motivated by negative stuff only, negative consequences only, it would be very easy to fall in the trap. 

00:41:50MARK Exactly. 

00:41:50DR. JOAN ZWEBEN So, ah, for this time we’re on a part of what you’ve expressed earlier is you wanna be motivated more positively to sustain the goodies… (crosstalk) 

00:41:55MARK Exactly. 

00:41:55DR. JOAN ZWEBEN Rather than to avoid the problems and, and that would be an important thing to… (crosstalk) 

00:42:00MARK Right. 

00:42:00DR. JOAN ZWEBEN  keep your eye on as you get more time. 

00:42:05MARK Right. It would always be nicer to think and I walked in here instead of being pushed in here. 

00:42:10DR. JOAN ZWEBEN Uh hmm. 

00:42:10MARK The first couple of times, first time, I would have been kicking and screaming… (crosstalk) 

00:42:15DR. JOAN ZWEBEN Uh hmm. 

00:42:15MARK …but I wasn’t an idiot. 

00:42:15DR. JOAN ZWEBEN Uh hmm. 

00:42:15MARK And, you know, what the, the questions the doctors asked me, I was truthful on so it’s not like, ah, “Oh, well, by the way Mr. Sally(ph), you know, you’re an alcoholic.” (crosstalk) 

00:42:30DR. JOAN ZWEBEN Uh hmm, uh hmm (crosstalk) 

00:42:30MARK “Oh gee, thanks!” You know- 

00:42:302-21 

00:42:30MARK – I’ll, I’ll go to AA right away. 

00:42:30DR. JOAN ZWEBEN Uh hmm. 

00:42:30MARK  It’s not how it generally works but I, but I knew that I had a problem. 

00:42:35DR. JOAN ZWEBEN  Uh hmm. 

00:42:40MARK Uhm, and the second time, like I said in the, the car accident and, and I don’t want a third incident… (crosstalk) 

00:42:45DR. JOAN ZWEBEN Right. 

00:42:45MARK …to make me go. 

00:42:50DR. JOAN ZWEBEN And you mentioned your kids played a role in this thing. 

00:42:50MARK Well they’re going through a dare. 

00:42:50DR. JOAN ZWEBEN  Oh, uh-huh. 

00:42:55MARK And they’re very sharp. 

00:43:00DR. JOAN ZWEBEN Yes. 

00:43:00MARK Uhm, it’s hard to be a role model for a child when you’re not doing the right things anyways. 

00:43:10DR. JOAN ZWEBEN Uh hmm. 

00:43:10MARK What kind of role model would I be if I kept up my negative behaviors or, or the, the drinking and, and, and probably negative behaviors too, besides, you know, associated with drinking just, ah, just, ah, you know, I wanna be that, that role model that, that they’ll look up to and they, they talk about instead of looking outside the home for one and… (crosstalk) 

00:43:302-22 

00:43:30DR. JOAN ZWEBEN Uh hmm. 

00:43:30MARK  find one there. (inaudible ) (crosstalk) 

00:43:37DR. JOAN ZWEBEN Uh hmm. Did they talk to you about your drinking? 

00:43:37MARK No. 

00:43:37DR. JOAN ZWEBEN I see. 

00:43:37MARK  Not in a negative, (crosstalk) 

00:43:40DR. JOAN ZWEBEN But you, you know that they’re, (crosstalk) 

00:43:40MARK Yeah, I know. I know that. Well, yeah, they could say, you know, “Dad, you know, I, you will only let me have one Pepsi but you can have your fourth beer.” 

00:43:50DR. JOAN ZWEBEN Uh-huh. 

00:43:50MARK And you can’t answer that. (crosstalk) 

00:43:50DR. JOAN ZWEBEN Uh hmm, uh hmm. (crosstalk) 

00:43:50MARK You can’t say, “Well, that’s the way it is.” I, I have a hard time with just with answering that question. (crosstalk) 

00:44:00DR. JOAN ZWEBEN Uh hmm. 

00:44:00MARK So it’s the stuff like that. It’s, uhm, you know, what happened to that paper I had you sign yesterday? Ah, you said you left it on the table and it would be under my ashtrays and under my things that I, that I left from work and I didn’t clean up after myself, you know? Uhm, just, just stuff like that. I don’t like, ah, it just seems an untidy part of my life. 

00:44:25DR. JOAN ZWEBEN Uh hmm, Uh hmm. 

00:44:25MARK And I need to, to make it cleaner with, before my daughters, uhm, well I guess- 

00:44:302-23 

00:44:30MARK  that they’re not, they’re, they’re pretty bright. They’re not, they’re not, ah, slow by any means. So I, I’m not sure that they see a problem. They haven’t confronted me on it like, I mean, like, they’re 11 and 12… (crosstalk) 

00:44:45DR. JOAN ZWEBEN Oh, I see. 

00:44:45MARK …so I don’t know if they know how to. If they’re, if they were older, I’m sure they might say something different. (crosstalk) 

00:44:50DR. JOAN ZWEBEN Sooner than you think. 

00:44:50MARK Exactly. 

00:44:50DR. JOAN ZWEBEN Uh hmm. 

00:44:50MARK Exactly. 

00:44:50DR. JOAN ZWEBEN Uh hmm. Yeah. 

00:44:50MARK Exactly. My, my friend’s parents don’t do that. 

00:44:55DR. JOAN ZWEBEN Uh-huh. 

00:44:55MARK Or, you know, my friend’s father don’t do that. So, I wanna, I, I wanna shift away from all of that. I wanna, I wanna take care of some of the things I need to. 

00:45:05DR. JOAN ZWEBEN Uh hmm. So have you looked into meetings to go to? 

00:45:10MARK Yes. 

00:45:10DR. JOAN ZWEBEN Yeah. 

00:45:10MARK Uhm, in the last, ah, it’s been about a week. I mean, I’ve, I’ve, ah, I have, I mean, it’s gonna sound like a lame excuse, uhm, I’ve gotta get this pamphlet that has all the local meetings. 

00:45:25DR. JOAN ZWEBEN  Uh hmm. 

00:45:30MARK Uhm, and there is a, a club in the area. Uhm- 

00:45:352-24 

00:45:35MARK – so I’ve got to go to the club. I wanted that, to attend one of the meetings, pick up the pamphlet and ah, just go… (crosstalk) 

00:45:40DR. JOAN ZWEBEN  Uh hmm. 

00:45:45MARK …basically. (coughing) So I’ve, and they’re, they’re at all different times of the day. (crosstalk) 

00:45:50DR. JOAN ZWEBEN Uh hmm. 

00:45:50MARK So I really don’t have an excuse and I need to, I need to go and, and take care of this as soon as possible before, like I said this, before any incidence or… (crosstalk) 

00:46:05DR. JOAN ZWEBEN Uh hmm. 

00:46:05MARK …before anything happens. 

00:46:05DR. JOAN ZWEBEN Uh hmm. So, it, it sounds like you’ve got strong poles, positive and negative, that you’re really mobilizing to tackle it. You know what you have to do. (crosstalk) 

00:46:15MARK I know what I have to do. 

00:46:15DR. JOAN ZWEBEN But there’s obstacles. 

00:46:20MARK I get home from work. I could tell myself I’m tired. 

00:46:25DR. JOAN ZWEBEN Uh hmm. 

00:46:25MARK And go to the refrigerator instead. 

00:46:25DR. JOAN ZWEBEN  Uh hmm. 

00:46:30MARK Uhm, and in the morning when I’m getting up for work, I say, my God- 

00:46:352-25 

00:46:35MARK – I have, you know, the perfect opportunity yesterday and what happened? I can think about it all day. You know, here’s what I’m gonna do, here’s what I’m gonna do, here’s what I’m gonna do. You know, the whistle blows and something different happens. 

00:46:45DR. JOAN ZWEBEN Uh hmm. 

00:46:45MARK I get home, it’s all right. I don’t even go home right away. I should just go right to where I need to go and then get the information and and start talking to some people because, uhm, I have family members that are, ah, involved but I, I just wanna, say, I, I just wanna do it myself, but then there’s not even a program about doing it yourself. (crosstalk) 

00:47:15DR. JOAN ZWEBEN Uh hmm. 

00:47:15MARK It’s, it’s about, you getting help. 

00:47:20DR. JOAN ZWEBEN Uh hmm. 

00:47:20MARK So, there’s some of the issues there where I need to, I don’t have to do it all by myself. I can ask for a ride. I can ask for help. 

00:47:25DR. JOAN ZWEBEN Uh hmm. 

00:47:25MARK You know, I can ask where they’re at in town. So, this, that’s what I’m gonna work on. Uhm. 

00:47:352-26 

00:47:35DR. JOAN ZWEBEN Well, those things are, uhm, sort of the, the nuts and bolts of getting there but I wonder if some of it isn’t, that this is a really big step for you to commit yourself to this effort again and going to meetings… (crosstalk) 

00:47:45MARK It is. 

00:47:45DR. JOAN ZWEBEN …is a symbol of that. 

00:47:50MARK It is. 

00:47:50DR. JOAN ZWEBEN Yeah. 

00:47:50MARK Uhm, except, just going to meetings was a, was just a ticket. And you can just go to meetings for the rest of your life and that would be it. You don’t have to worry about drinking anymore but that’s not it. 

00:48:00DR. JOAN ZWEBEN Uh hmm. 

00:48:00MARK Uhm, you need to go to meetings and, and work on the things I say I wanna work on right now. 

00:48:10DR. JOAN ZWEBEN Uh hmm. 

00:48:10MARK But when the closet’s open, what really happens, what, you know, when somebody asks me a, a question in a meeting or, you know, they’re gonna ask me how does that make me feel. Well, (coughing) to be honest with you, I, you know, I don’t know if I’ll be, I, I can do that. I can open up to people but I, that’s where the, the work is. 

00:48:352-27 

00:48:35DR. JOAN ZWEBEN Are you talking about in the 12 Step meeting? 

00:48:40MARK Yes. 

00:48:40DR. JOAN ZWEBEN Yeah, and do people normally around here ask questions in meetings? Or it’s just usually, you know, (crosstalk) 

00:48:45MARK No, no, no, I’m sorry. Well, if, they don’t ask questions now… (crosstalk) 

00:48:45DR. JOAN ZWEBEN Yeah. 

00:48:45MARK But if I wanted a sponsor? 

00:48:45DR. JOAN ZWEBEN  I see and your relationship… (crosstalk) 

00:48:50MARK And if he were to, and if he, yeah, if he was wondering about my sincerity or, (coughing) or lack thereof it and say, “Look, well, how, you know, what are you gonna do? What are you gonna do to,” I can say, “Well, I’ll make 90 meetings in 90 days.” Tsk, and he’d say, “Well, what if you miss a day… (crosstalk) 

00:49:05DR. JOAN ZWEBEN Uh hmm. 

00:49:05MARK …or 90 meetings in 91 days?” Well, I, I’ve never used that line but I thought to myself, well if he said that to me, well then, you know, you’d, I just, it, it’s a lot easier to, it’s a lot easier saying it, to go to meetings and having to work, like I said, work on yourself and, and doing the things you need to do inside of, of the 12 Step program. I, I can say I need it and I, I can say I want it but when I get there… 

00:49:352-28 

00:49:35MARK  Working it, you know, the two, first two steps, I can say honestly that, you know, I, I, I’m 100% uhm, but when it gets to, down the line where you’ve got to do some work. 

00:50:00DR. JOAN ZWEBEN Uh hmm. 

00:50:00MARK Uhm, some soul, soul searching, ah, then it get, you know, it gets painful there. 

00:50:10DR. JOAN ZWEBEN Uh hmm. 

00:50:10MARK And then you need to, and what’s easier, staying home or doing that? 

00:50:15DR. JOAN ZWEBEN Uh hmm. 

00:50:15MARK Uhm. 

00:50:15DR. JOAN ZWEBEN I, I’m getting a feeling you’re, you’re worried you’ll gonna open up some can of worms that you can’t handle? 

00:50:20MARK  Not that I can’t handle. Well, no, I, I don’t know. 

00:50:35DR. JOAN ZWEBEN Uh hmm. 

00:50:35MARK I can’t honestly say, no. 

00:50:35DR. JOAN ZWEBEN Uh hmm. 

00:50:352-29 

00:50:35MARK Uhm, I can’t imagine anybody with a drinking history like mine for so many years, in and out of the program, and some would just say they’re unrelated incidences that happened in my life, that, just kinda be falling or, into your lap, uhm, yeah, everybody, I mean, there are some scary things in there, yeah. 

00:51:05DR. JOAN ZWEBEN Uh hmm. 

00:51:05MARK Yeah. 

00:51:05DR. JOAN ZWEBEN  Uh hmm. Ah, the, the other thing I wondered about, you were saying that, when you were just, ah, participating in the meeting itself wasn’t that scary, but… (crosstalk) 

00:51:15MARK No. 

00:51:15DR. JOAN ZWEBEN …it was the interaction with the sponsor and the kind of questions the sponsor would put. What? (crosstalk) 

00:51:20MARK Right. 

00:51:20DR. JOAN ZWEBEN How do you feel, I’m putting a lot of questions to you here? 

00:51:25MARK Do you want an honest answer? 

00:51:25DR. JOAN ZWEBEN Sure, huh. 

00:51:25MARK  I may never see you again. 

00:51:30DR. JOAN ZWEBEN I see, so that makes it different? 

00:51:30MARK  Right. 

00:51:35DR. JOAN ZWEBEN Yeah. 

00:51:35MARK And I can’t see anybody else in here ‘coz of the lights. 

00:51:35DR. JOAN ZWEBEN I see. 

00:51:352-30 

00:51:35MARK  So, that’s easy. 

00:51:40DR. JOAN ZWEBEN  I see, but, so it’s being questioned by somebody… (crosstalk) 

00:51:45MARK That I know. 

00:51:45DR. JOAN ZWEBEN …that you’re kinda stuck… (crosstalk) 

00:51:50MARK That I will see. 

00:51:50DR. JOAN ZWEBEN Yeah. 

00:51:50MARK And, he might say, “Well, oh, my soul, you did that?” 

00:51:55DR. JOAN ZWEBEN Uh hmm. 

00:51:55MARK But I know he won’t. He might come back and say, “Yeah, well, I’ve been there too.” 

00:52:00DR. JOAN ZWEBEN Uh hmm. 

00:52:00MARK  But I’ve gotta ah, you’ve got to, and I can talk about all I want but it’s actually going and doing it, getting it over with, I guess. I don’t know. You know, I never truly got a real sponsor. 

00:52:20DR. JOAN ZWEBEN Uh hmm. 

00:52:20MARK I can always ask somebody, “Hey, can you be my temporary sponsor?” What’s that? (crosstalk) 

00:52:25DR. JOAN ZWEBEN Uh hmm. 

00:52:25MARK Is that somebody I can call? 

00:52:25DR. JOAN ZWEBEN Uh hmm. 

00:52:25MARK  Uhm, not that that’s not important. I can always talk to somebody but that’s not really, it will get to the time where you’ll need a real sponsor and I have a, just- 

00:52:402-31 

00:52:40MARK – laying the whole thing on, on the table that… (crosstalk) 

00:52:45DR. JOAN ZWEBEN Uh hmm. 

00:52:45MARK ..that’s scary. I’m. (crosstalk) 

00:52:45DR. JOAN ZWEBEN Uh hmm. 

00:52:45MARK  You know, you’re gonna tell these people some things that you haven’t even told your wife or your, other people in your family. 

00:52:55DR. JOAN ZWEBEN Uh hmm. 

00:52:55MARK Uhm, or at least that’s, the way, way I perceive things would work because I’ve never gotten a sponsor. 

00:53:05DR. JOAN ZWEBEN Uh hmm. 

00:53:05MARK A true sponsor. 

00:53:05DR. JOAN ZWEBEN Uh hmm, Uh hmm. 

00:53:10MARK And, uhm, maybe I could just, ah, get to the point where I, I don’t need a sponsor, I don’t need this, I don’t need that. I feel good, got a new job. It’s that type of pattern… (crosstalk) 

00:53:25DR. JOAN ZWEBEN Uh hmm, Uh hmm. 

00:53:25MARK …that I need to get away from. 

00:53:25DR. JOAN ZWEBEN Yeah, ‘coz a sponsor is, ah, one of the most meaningful parts of the program… 

00:53:30MARK Right. 

00:53:30DR. JOAN ZWEBEN For a lot of people. What, the sense I got as you were talking about it is being judged harshly by the sponsor was a real issue. 

00:53:35MARK Yeah, well. 

00:53:35DR. JOAN ZWEBEN  So yeah? 

00:53:40MARK Yeah. 

00:53:402-32 

00:53:40DR. JOAN ZWEBEN And we all know that can happen… 

00:53:40MARK Exactly. 

00:53:40DR. JOAN ZWEBEN  if you don’t pick them carefully. 

00:53:45MARK Exactly, but that’s just a risk I’m gonna have to take, I guess… (crosstalk) 

00:53:50DR. JOAN ZWEBEN Yeah. 

00:53:50MARK ‘Coz you can’t, ah, can’t have an omelet without breaking any eggs. 

00:53:55DR. JOAN ZWEBEN Yeah, yeah. Have you ever been in any kind of therapy? 

00:54:00MARK There was a group. I, I don’t, I’m not gonna make lie of it. There was a, a group of, I went to the Veteran’s Memorial, (crosstalk) 

00:54:05DR. JOAN ZWEBEN  Uh hmm. 

00:54:10MARK ah, for that rehab and there was a questionnaire that was handed out. 

00:54:10DR. JOAN ZWEBEN Hmm. 

00:54:10MARK  Uhm, at the end, ah, I was asked to participate because I was a, a combat veteran. 

00:54:20DR. JOAN ZWEBEN Uh hmm. 

00:54:20MARK So, you, and then there were, (inaudible ) unobtrusive questions, they weren’t, you know, they didn’t actually, you know, the loud noises scare you stuff, that wasn’t that type of… 

00:54:30DR. JOAN ZWEBEN Uh hmm, Uh hmm 

00:54:30MARK …thing. And, I, I filled it out and then they asked me if I wanted to sit down on this, uhm, post-traumatic stress. 

00:54:40DR. JOAN ZWEBEN Uh hmm. 

00:54:40MARK I’m thinking, okay, I’ll sit- 

00:54:452-33 

00:54:45MARK – here a couple of times and I was the only one from Desert Storm. Uhm, I’m not, it’s gonna sound like an excuse but the whole room is, 10, 15 guys are, to Vietnam veteran there. (crosstalk) 

00:55:00DR. JOAN ZWEBEN Uh hmm. 

00:55:05MARK Discussing a lot of the, uhm, the, the, a, a lot of the combat I mean a lot of the, the missions and stuff like that, and I, I, to me, that, that just seemed, I, I couldn’t relate to them on that level. 

00:55:25DR. JOAN ZWEBEN Uh hmm. 

00:55:25MARK You know, if it would have been a different atmosphere, maybe like a one-on-one or, or a smaller group dynamic thing of my peers, because I, my peers in Desert Storm, 90 percent of them haven’t seen the, ah- 

00:55:452-34 

00:55:45DR. JOAN ZWEBEN Uh hmm. 

00:55:45MARK – casualties up close or even hand-to-hand combat… (crosstalk) 

00:55:45DR. JOAN ZWEBEN Uh hmm. 

00:55:45MARK …like some of these other gentlemen were. So, uhm, that, that type of stuff and I don’t, I don’t know. Ah, and it seemed that I wasn’t taken seriously enough. 

00:56:05DR. JOAN ZWEBEN Uh hmm. Uh hmm. 

00:56:05MARK Ah, so that’s when I said I’d, I didn’t really care for that group. 

00:56:10DR. JOAN ZWEBEN Uh hmm. 

00:56:10MARK Uhm, Now, if it had been other people, other circumstances, uhm, like my peers, for example, (coughing) that, that would be, uhm, maybe I could, I could have benefited more from that type of thing. (crosstalk) 

00:56:25DR. JOAN ZWEBEN Uh hmm. 

00:56:25MARK But I don’t know exactly how that would tie in. I’m not, I’m not a doctor, I, but I do know that, ah, (crosstalk) 

00:56:30DR. JOAN ZWEBEN  Well, no, I, I think that you’re on the right track, that their experience was so different. 

00:56:35MARK  Right. 

00:56:40DR. JOAN ZWEBEN And yours was painful. 

00:56:40MARK Right. 

00:56:40DR. JOAN ZWEBEN And it’s important to have somebody who really understands that and doesn’t minimize- 

00:56:452-35 

00:56:45DR. JOAN ZWEBEN – what you went through because what they went through, (crosstalk) 

00:56:45MARK Right. 

00:56:45DR. JOAN ZWEBEN ah, is different. 

00:56:45MARK  Uhm, I mean the ground war only lasted six days. 

00:56:55DR. JOAN ZWEBEN Uh hmm. 

00:56:55MARK Well, that could, I would take any other six days of my life and replace those. 

00:56:55DR. JOAN ZWEBEN  Uh hmm, Uh hmm. 

00:57:00MARK So, to me, that would, ah, I don’t know, that would give you some idea of, of, uhm, people say, you know, “Hey, we got this thing going on and you’re up right now.” Ah, ” Sorry, guys, I can’t help you.” 

00:57:15DR. JOAN ZWEBEN Uh hmm. 

00:57:15MARK You know, I’m not a conscience objector. I just would not go back to the military. 

00:57:20DR. JOAN ZWEBEN Uh hmm. 

00:57:20MARK Uhm, even if there was combat or not. I just, the whole atmosphere, ah, the camaraderie is gate, great but you just, if, if I’m gonna try to work on myself, that, that’s not the type of atmosphere that I need. 

00:57:35DR. JOAN ZWEBEN Uh hmm, Uh hmm. 

00:57:35MARK  Uhm, it’s like going out with the buddies and shooting pool. (crosstalk) 

00:57:40DR. JOAN ZWEBEN Uh hmm. 

00:57:40MARK Sure, pool might be a sport but it’s where they play that it gets me in trouble. (crosstalk) 

00:57:45DR. JOAN ZWEBEN Uh hmm. 

00:57:452-36 

00:57:45MARK So, uhm, like when I’m in the military, I, I enjoyed it but, no, thanks. 

00:57:50DR. JOAN ZWEBEN Uh hmm. The reason I asked you about therapy is, ah, that I, I think psychotherapy and 12 Step programs are complementary, that there are things you get out of 12 Step that you can never get out of therapy and there are some things you can get out of psychotherapy more regularly and the key is to, to recognize when you’re not getting what you need and go for… (crosstalk) 

00:58:10MARK Right. 

00:58:10DR. JOAN ZWEBEN  where you’re likely to get it. Ah, just like you, you recognize that you need a group of Dev, Desert Storm era people who… (crosstalk) 

00:58:20MARK Exactly. 

00:58:20DR. JOAN ZWEBEN Understand what you’re talking about. 

00:58:25MARK Right. 

00:58:25DR. JOAN ZWEBEN And aren’t measuring it by the standard of what went on in Vietnam. It’s that, that… (crosstalk) 

00:58:30MARK Right. 

00:58:30DR. JOAN ZWEBEN Same kind of thing that, you, you, people do get much of what you’re wanting from, from sponsors and from these 12 Step meetings. 

00:58:35MARK Uh hmm. 

00:58:35DR. JOAN ZWEBEN But sometimes probingly the feeling states and, and being in a situation where that person’s job is to work with you on that issue and nothing else, (crosstalk) 

00:58:45MARK Uh hmm. 

00:58:45DR. JOAN ZWEBEN the psychological issue is not just the- 

00:58:452-37 

00:58:45DR. JOAN ZWEBEN – recovery issues, uhm, you can get more from a professional situation. 

00:58:50MARK Right. Well, when it comes to motivation, I guess, nobody else is gonna light the fire in your pants. 

00:59:05DR. JOAN ZWEBEN Uh hmm. 

00:59:05MARK Uhm, so, I’m just gonna have to get moving. 

00:59:10DR. JOAN ZWEBEN  Uh hmm. What would help you do that? 

00:59:15MARK Besides something negative? 

00:59:15DR. JOAN ZWEBEN  Yeah. 

00:59:20MARK Ah, uhm, a day off, no, ah, being off of work early then. 

00:59:30DR. JOAN ZWEBEN Uh hmm. 

00:59:30MARK Ah, and going over to the club and getting all the information. 

00:59:35DR. JOAN ZWEBEN Uh hmm. 

00:59:35MARK I still have all the books and some other books, uhm, dusting them off and starting to read them. 

00:59:45DR. JOAN ZWEBEN Uh hmm. 

00:59:452-38 

00:59:45MARK  Uhm, my wife knows I’ve what I’m, what I went on doing, she’s a hundred percent behind me so that’s not an issue, uhm, so just going and doing it. 

01:00:00DR. JOAN ZWEBEN  Uh hmm. 

01:00:05MARK Basically, that’s it, but. 

01:00:10DR. JOAN ZWEBEN So, asking for part of a day off is one way? 

01:00:15MARK Ah, I was kinda making light, ah, ‘coz these places are, it’s open late. The club is open late. They have late meetings but I use the excuse of, I had a long day. Uhm, I go home and relax and now I wanna get up… (crosstalk) 

01:00:30DR. JOAN ZWEBEN Uh hmm. 

01:00:30MARK …but I need to go from work right there, (crosstalk) 

01:00:30DR. JOAN ZWEBEN Uh hmm. 

01:00:30MARK  not necessarily half day or day off. (crosstalk) 

01:00:35DR. JOAN ZWEBEN Uh hmm. 

01:00:35MARK I might tell my bosses that but I, I just need to go from work, (crosstalk) 

01:00:40DR. JOAN ZWEBEN Uh hmm. 

01:00:40MARK don’t even, don’t even go home. 

01:00:45DR. JOAN ZWEBEN Uh hmm. 

01:00:45MARK Go right there, meet some people, ah- 

01:00:502-39 

01:00:50MARK – stay there long enough, uhm, have uhm, uhm, my meeting, come home, go to bed, (crosstalk) 

01:01:00DR. JOAN ZWEBEN Hmm. 

01:01:00MARK or sit around and digest but, and then the next day, uhm, I just need things to occupy my time instead of drinking. Uhm, it wouldn’t be feasible for me to go to a meeting everyday so I need, maybe a hobby, maybe. 

01:01:20DR. JOAN ZWEBEN Uh hmm. 

01:01:20MARK Doing the lawn, landscaping them. My wife’s been asking me about that. I just need to do things. I need to stay busy. Ah, ’cause if I just sit around and think, I just, boredom is, ah, a problem. 

01:01:40DR. JOAN ZWEBEN Uh hmm. Uh hmm. 

01:01:40MARK And, you know, if I get bored, I would drink, basically, and. (crosstalk) 

01:01:452-40 

01:01:45DR. JOAN ZWEBEN  What would make it hard for you to go everyday, at least for a while? 

01:01:55MARK Ah, well, my daughters, but I’ve got some pretty understanding family. I think they can cover that. 

01:02:05DR. JOAN ZWEBEN Do you understand why that’s useful? 

01:02:05MARK Well, I’ve mentioned earlier, 90 days, 90 meetings, 90 days. 

01:02:10DR. JOAN ZWEBEN Yeah. 

01:02:10MARK Uhm. 

01:02:10DR. JOAN ZWEBEN But, but do you understand why people say that? 

01:02:15MARK Not entirely, not. 

01:02:15DR. JOAN ZWEBEN Uh hmm. You get a momentum, (crosstalk) 

01:02:15MARK (coughing) Well, maybe that would… 

01:02:15DR. JOAN ZWEBEN  and a routine and I, it’s, it’s, in some ways easier once you really get into it and, at that level of intensity, then some other things can carry you. 

01:02:30MARK Right. Well, that would basically fill in the blank spots. (crosstalk) 

01:02:35DR. JOAN ZWEBEN Uh hmm, Uh hmm. (crosstalk) 

01:02:35MARK Instead of the idle spots, excuse me. 

01:02:35DR. JOAN ZWEBEN  Uh hmm. 

01:02:40MARK Yeah, ah, I do have a, a wonderful family. So I, covering for me- 

01:02:502-41 

01:02:50MARK – for a couple of hours… (crosstalk) 

01:02:50DR. JOAN ZWEBEN Uh hmm. 

01:02:50MARK …’til my wife gets home or I could just go to a later meeting but, just a, yeah, basically that was an excuse, uhm, I could feasibly do 90 in 90 days. And it wouldn’t really be a lot of work to find, babysitters and stuff like that. So, yeah, yeah. I just have to go there. I have to start. 

01:03:20DR. JOAN ZWEBEN Uh hmm. 

01:03:20MARK  Thursday. 

01:03:25DR. JOAN ZWEBEN Was coming here part of mobilizing yourself? 

01:03:25MARK Yeah. 

01:03:25DR. JOAN ZWEBEN  Yeah. 

01:03:30MARK Uhm, I mean, I didn’t drink today. 

01:03:35DR. JOAN ZWEBEN Uh hmm. 

01:03:35MARK It’s gonna be too late for me to go home and drink. So, that was easy. 

01:03:40DR. JOAN ZWEBEN Uh hmm. 

01:03:40MARK Uhm, so tomorrow, this one’s okay, Thursday. Tomorrow, I need to find out what time’s the meeting is on- 

01:03:502-42 

01:03:50MARK – in my local town and, and take care of some things. I mean, get the ball rolling and, uhm, in the next week or two, and try to find, at least, I use the word temporary sponsor but I need to find a real sponsor too. 

01:04:10DR. JOAN ZWEBEN Uh hmm. 

01:04:10MARK Uhm, but I’m not gonna rush into that, ah, at least not the first week. I wanna be comfortable with somebody. 

01:04:20DR. JOAN ZWEBEN Uh hmm. 

01:04:20MARK Uhm, I don’t wanna, you, you use the word, ah, I don’t wanna lay everything out and have somebody be rejected, ah, morally because somebody thinks I did something horrendous or, you know, how could you do that, you know, or how can you let that happen, or something like that. I don’t wanna hear that. 

01:04:50DR. JOAN ZWEBEN Uh hmm. 

01:04:502-43 

01:04:50MARK Ah, at least, from a sponsor. Now, if I need to take my medicine, then, then, that’s what I have to do but, uhm, if somebody’s telling me I’m, you know, being a jerk, then, then that’s fine, (crosstalk) 

01:05:10DR. JOAN ZWEBEN You could(ph). 

01:05:10MARK  working in the parameter of, you know, of AA, the 12 Steps. 

01:05:15DR. JOAN ZWEBEN Uh hmm. But could you picture yourself saying to somebody, “I need you to tell it like it is to me but it wouldn’t help if you were harsh with me?” Could you lay that out to some. (crosstalk) 

01:05:25MARK If I was talking to somebody… (crosstalk) 

01:05:25DR. JOAN ZWEBEN Uh hmm. 

01:05:25MARK …and I was asking them, ah, as, as a role-reversal 

01:05:30DR. JOAN ZWEBEN Uh hmm. 

01:05:30MARK I would never be judgmental. 

01:05:35DR. JOAN ZWEBEN Yeah, hmm. (crosstalk) 

01:05:35MARK That’s a lie. Ah, in my mind, (crosstalk) 

01:05:35DR. JOAN ZWEBEN Uh hmm. 

01:05:35MARK  I can’t help but, I mean, some things, you, you can’t help what you’re thinking at a given time. 

01:05:45DR. JOAN ZWEBEN Uh hmm. 

01:05:45MARK I wouldn’t tell him. Now, if, if he had said to me, “You know, I’m just cheating on my wife for the last five years- 

01:05:552-44 

01:05:55MARK – and it’s really getting the better of me.” Well, stop, (crosstalk) 

01:05:55DR. JOAN ZWEBEN Uh hmm. 

01:05:55MARK  you know, that’s, that’s not one of those, ah, okay, ah, what else? (crosstalk) 

01:06:05DR. JOAN ZWEBEN Uh hmm. 

01:06:05MARK I mean, that would, you, you know, you see that. It’s not, uhm, see maybe I’m, maybe I’m judgmental on some things and not others so… (crosstalk) 

01:06:15DR. JOAN ZWEBEN Uh hmm. 

01:06:15MARK  but something is continually doing. And, well, now, see that. 

01:06:25DR. JOAN ZWEBEN Yeah, we’re almost out of time. I just, uhm, was hoping that if you can articulate what you need from a sponsor and how you need him or her to act, him probably to act. 

01:06:35MARK Yeah. 

01:06:35DR. JOAN ZWEBEN Ah, and you’re more likely to make a connection where that’s understood from the outset. 

01:06:40MARK  Right. 

01:06:45DR. JOAN ZWEBEN And it sounds like that is very important, the right, sort of, balance. 

01:06:50MARK Uhm, see, but I, I would need somebody who I was completely comfortable with. 

01:06:552-45 

01:06:55DR. JOAN ZWEBEN Uh hmm. 

01:06:55MARK Although, uhm, if you think about it, the person you are completely comfortable with, (crosstalk) 

01:07:00DR. JOAN ZWEBEN  Uh hmm. 

01:07:05MARK well, in AA, may or may not be the best sponsor for you. (crosstalk) 

01:07:10DR. JOAN ZWEBEN Uh hmm. 

01:07:10MARK ‘Coz he, he’d probably be a really good friend. And then you could find yourself being not so truthful or, I don’t know. I would, yeah, you’re right, I would need somebody to lay it on the line. 

01:07:25DR. JOAN ZWEBEN Uh hmm. 

01:07:25MARK I would thank him. 

01:07:25DR. JOAN ZWEBEN Uh hmm. Well. I think we’re coming to the end, and I wanna thank you for coming. 

01:07:30MARK  Oh, it’s my pleasure. 

01:07:35DR. JOAN ZWEBEN Good. 

01:07:35MARK Thank you. 

01:07:35DR. JOAN ZWEBEN Good. 

01:07:35DR. JON CARLSON  Well, Joan- 

01:07:403-2 

01:07:40DR. JON CARLSON  was that a good example of your work with people? 

01:07:45DR. JOAN ZWEBEN  For that kind of situation, yes. 

01:07:50DR. JON CARLSON Uh hmm. Was it a biopsychosocial? 

01:07:55Joan Zweben, Ph.D. INTEGRATION WITH 12 STEP PROGRAM 

01:07:55DR. JOAN ZWEBEN Well, we were focusing primarily on the element of his mobilizing to get started on his recovery, uhm, and his relationship to 12 Step programs and what obstacles there might be to resuming them. 

01:08:10DR. JON CARLSON Uh hmm. 

01:08:10DR. JOAN ZWEBEN So I was focused a bit more narrowly than I might be. (crosstalk) 

01:08:15DR. JON CARLSON Hmm. 

01:08:15DR. JOAN ZWEBEN Ordinarily, I, I would wanna, ah, have some information also about any symptoms that he may have had discontinuing alcohol in the past, whether these would… (crosstalk) 

01:08:25DR. JON CARLSON Uh hmm. 

01:08:25DR. JOAN ZWEBEN …need to have some medical involvement of some kind. Uhm, yeah, I, I would be interested- 

01:08:303-2 

01:08:30DR. JOAN ZWEBEN – in other things if I were gonna work with him ongoing. 

01:08:35DR. JON CARLSON Well, where would you go if you are gonna work with him in the future? 

01:08:35DR. JOAN ZWEBEN Yeah, oh, he would be wonderful to work with, ah, (crosstalk) 

01:08:40 Uh hmm. 

01:08:40DR. JOAN ZWEBEN because I think he’s really, ah, at, at a point of, uhm, movement that, that I think if he gets in the right situation, he’ll, ah, be able to take the recovery process much further than he was when he was younger. Uhm, he did not, uhm, have a concept of how professional help might be useful, but I think it’s probably obvious to… (crosstalk) 

01:09:10DR. JON CARLSON Uh hmm. 

01:09:10DR. JOAN ZWEBEN The viewers that, ah, the issues of post-traumatic stress disorder were very real, the family issues, whatever, went on in his family of origin, ah, and the role that the alcohol played there would be also very real. So, those would be nice things to be in a position to explore with him, plus I think it’s, ah- 

01:09:303-3 

01:09:30DR. JOAN ZWEBEN – ah, would be important for him if he could func, connect with the group of Desert Storm vets through the VA that that would be a very meaningful kind of experience. 

01:09:40DR. JUDY LEWIS Uh hmm. 

01:09:40DR. JOAN ZWEBEN Ah, in AA, I think that when people are going to meetings and that you’re available to talk with them about what their experiences are there, ah, you can help them connect with the whole process of going to meetings and, and when they get working on the steps in, in a different way, so that, I think that dovetails very nicely with most… (crosstalk) 

01:10:05DR. JON CARLSON Uh hmm. 

01:10:05DR. JOAN ZWEBEN …therapy processes. So, ah, if you got started on that, that would be something useful. 

01:10:10DR. JUDY LEWIS I got a sense as you are working with him what you’re really focusing on is helping him figure out how to get mobilized as you said… (crosstalk) 

01:10:20DR. JOAN ZWEBEN Uh hmm. 

01:10:20DR. JUDY LEWIS …to take this action. (crosstalk) 

01:10:20DR. JOAN ZWEBEN Uh hmm. 

01:10:20DR. JUDY LEWIS But I wondered would it have been just the same if he hadn’t been talking about entering a 12 Step group? If he had been talking about, well, I really need to get involved in going back to school or I- 

01:10:303-4 

01:10:30DR. JUDY LEWIS  really need to get involved in a program of regular exercise? Would it have looked the same or would you have tried to re-focus to get him… (crosstalk) 

01:10:40DR. JOAN ZWEBEN Hmm. 

01:10:40DR. JUDY LEWIS …involved in, uhm, AA in that case also? 

01:10:45DR. JOAN ZWEBEN Well, in his case, I think that, that a becoming absent in his foundation for doing many other things, so… (crosstalk) 

01:10:55DR. JUDY LEWIS Uh hmm. 

01:10:55DR. JOAN ZWEBEN …I would have kept that as the priority. But the motivational enhancement approach can be applied to any of the other things you’re talking about, ah, the process by which people decide to make a change in their behavior and then actually do that. (crosstalk) 

01:11:10DR. JUDY LEWIS So, it would’ve looked the same. 

01:11:10DR. JOAN ZWEBEN Oh, it could look very similar, yes, but in, in my focus, getting clean, getting sober was first, ah, for a whole host of reasons. Because you can’t even evaluate, ah, some… (crosstalk) 

01:11:20DR. JUDY LEWIS Hmm. 

01:11:20DR. JOAN ZWEBEN …of the other problems accurately until he has some time without… 

01:11:25DR. JON CARLOS Uh hmm. 

01:11:25DR. JOAN ZWEBEN …drinking. 

01:11:25DR. JUDY LEWIS Uh hmm. 

01:11:25DR. JON CARLSON You said that going to, to meetings for him, you looked at it, as a symbol of his wanting to take action. 

01:11:353-5 

01:11:35DR. JON CARLSON Ah, are attending meetings, or not attending meetings, is, is that, ah, important in therapy, in terms like maybe even a projective technique of some sort? 

01:11:40DR. JOAN ZWEBEN Absolutely, yeah. I, I, I, thought of it as a, a symbol of his commitment to the entire recovery effort. It’s a shorthand way… (crosstalk) 

01:11:55DR. JUDY LEWIS Uh hmm. 

01:11:55DR. JOAN ZWEBEN …of talking… (crosstalk) 

01:11:55DR. JUDY LEWIS Uh hmm. 

01:11:55DR. JOAN ZWEBEN …about it ah, for people. So, yes I always, ah, explore the decision to go or not to go as, uhm, likely representing lots of other feelings and thoughts and positions people have. When people, ah, stop going to meetings, its often, uhm, not a decision made with any awareness, but reflects a, a shift into what we call the relapse state of mind, that relapses… (crosstalk) 

01:12:25DR. JON CARLSON Oh. 

01:12:25DR. JOAN ZWEBEN …is a state of mind, that precedes… (crosstalk) 

01:12:25DR. JON CARLSON Uh hmm. 

01:12:25DR. JOAN ZWEBEN …actual relapse behavior. So, when people just stop going, they maybe often having, ah, feelings of, or belief, beliefs more than the usual that this is the problem they used to have… (crosstalk) 

01:12:35DR. JUDY LEWIS  Uh hmm. 

01:12:40DR. JOAN ZWEBEN And they don’t need to put all this effort into it anymore. 

01:12:40DR. JUDY LEWIS And that’s what happened with him? 

01:12:40DR. JOAN ZWEBEN  Yeah, and other things I suspect as well. If you work with people in, ah, over a period of time, once you pose that kind of question to them, they frequently can come back a week or two weeks later saying, “Oh, you know, what I remembered what else was going on during that period.” 

01:13:00DR. JON CARLSON Uh hmm. 

01:13:00DR. JOAN ZWEBEN So, you’re launching a process that really unfolds and it’s very valuable, in my mind, to look at periods of sobriety that people had and get into the nitty-gritty details of what happened to end it. 

01:13:15DR. JUDY LEWIS I wondered about what you, what you were talking about before about the research. You mentioned that people who stay with AA longer do better in their recovery. 

01:13:25DR. JOAN ZWEBEN There are some research, I wouldn’t say we have a voluminous, volumes and volumes of that. (laughs) 

01:13:30DR. JUDY LEWIS Yeah, but there also is another way to look at that, and that is that people who were doing better in their recovery stay with their meetings… (crosstalk) 

01:13:35DR. JOAN ZWEBEN Stay with their meetings, uh hmm. 

01:13:35DR. JUDY LEWIS More. 

01:13:353-7 

01:13:35DR. JOAN ZWEBEN  It’s hard to know. 

01:13:40DR. JUDY LEWIS Yeah. 

01:13:40DR. JOAN ZWEBEN The, ah, the retention issue is consistent in the treatment outcome literature and drug abuse, (crosstalk) 

01:13:45DR. JUDY LEWIS Uh hmm(ph). 

01:13:45DR. JOAN ZWEBEN …that the longer people stay in treatment… (crosstalk) 

01:13:50DR. JON CARLSON Hmm. 

01:13:50DR. JUDY LEWIS Yeah. 

01:13:50DR. JOAN ZWEBEN …the better they do, (crosstalk) 

01:13:50DR. JON CARLSON Yeah. 

01:13:50DR. JOAN ZWEBEN which is not good news for managed care. (crosstalk) 

01:13:50DR. JUDY LEWIS Yeah. (laughs) 

01:13:50DR. JOAN ZWEBEN But if you want to improve outcome, you seek to improve retention and I think what we see in 12 Step, ah, Programs is exactly the same thing, that the people who kind of keep going back do well… 

01:14:05DR. JUDY LEWIS Uh hmm. 

01:14:05DR. JOAN ZWEBEN …but we can’t really get systematic evidence. We have no idea what the true dropout rate is in AA, for example, and that’s a very important thing to know. 

01:14:10DR. JUDY LEWIS Hmm. 

01:14:10DR. JON CARLSON  Well, you know our audience has been patiently waiting. (crosstalk) 

01:14:15DR. JOAN ZWEBEN Hmm. 

01:14:15DR. JON CARLSON Why don’t we, ah, (crosstalk) 

01:14:15 Give them a chance. 

01:14:15DR. JON CARLSON you know get some questions from them? Why don’t we begin specifically with questions about the interview and then, generally, a little later about, ah, Dr. Zweben’s approach? 

01:14:25  You said that, before we watched the interview, that you’d like to get an idea about where the client is starting from- 

01:14:353-8 

01:14:35 – and where the blocks are. 

01:14:40DR. JOAN ZWEBEN Uh hmm. 

01:14:40 And I am wondering if you were able to identify the blocks, what you think they are and whether you think that there has been any movement toward breaking them down? 

01:14:50DR. JOAN ZWEBEN Uh hmm. 

01:14:50DR. JOAN ZWEBEN Well, one of the first things I want to know is, do they have an antipathy, ah, towards 12 Step Programs, or AA, or whatever. And he had a positive experience in the past although it didn’t quite take, at least, he didn’t have that sort of digging your heels in, I won’t do this kind of thing. Uhm, I think a part of the block is the ah, depression it comes with drinking, and for that structure, somebody is simply asking, “What is the, what are the mundane things that would help you get going?” ah, can be useful ‘coz it’s hard for people to get beyond that when they’re in that sort of, uhm, state. So, I, I would like to think there was some movement in helping him just see some practical ways to get himself- 

01:15:403-9 

01:15:40DR. JOAN ZWEBEN – to make those steps. 

01:15:40 One of the things that I noticed was that he said that he had a feeling of a sense of being judged… (crosstalk) 

01:15:45DR. JOAN ZWEBEN Uh hmm. 

01:15:45 …while he was in there. Do you think that that is also something that might be blocking him toward getting more involved in those programs? 

01:15:55DR. JOAN ZWEBEN Oh, yeah. Now, I think he’s ah, uhm, ah, hard on himself and, ah, expects people to be hard on him once they see who he really is. And I was trying to, ah, at least make a foray into neutralizing some of that… (crosstalk) 

01:16:15 Uh hmm. 

01:16:15DR. JOAN ZWEBEN …or at least bringing it to his attention. 

01:16:15 Ah, Joan, one of the things that I kept hearing those was the recurring thing from him that he felt successful nine months to a year in the program… (crosstalk) 

01:16:25DR. JOAN ZWEBEN Uh hmm, Uh hmm. 

01:16:25 …and then he would relapse, and that he didn’t know why, and it actually speaks to what is that block there. Uhm, I guess my, I’d like to know what your thoughts are. One of the things- 

01:16:403-10 

01:16:40 – that, ah, I had also heard with that was, he did okay working the first and second step… (crosstalk) 

01:16:45DR. JOAN ZWEBEN Uh hmm. 

01:16:45 …and when he would come to the fourth and fifth, (crosstalk) 

01:16:50DR. JOAN ZWEBEN Uh hmm. 

01:16:50 which is more intimate and it’s a really looking at yourself and being able to express it, and, I know that people work the program at different lengths of time, and, you know, they may be on the first two steps forever, but I’m wondering if, perhaps that cycle for him is when he has to become more intimate with reviewing and looking, and then being able to put it out there. And I just like, would like to know perhaps your thoughts on that. 

01:17:20DR. JOAN ZWEBEN Yeah, I, I think it would be very useful for him once he had some sobriety to be in that kind of individual therapy situation that felt comfortable for him. Ah, because, I think that some of those issues are the family of origin issues, and some of the Desert, Desert Storm, ah, issues that, that, that he- 

01:17:403-11 

01:17:40DR. JOAN ZWEBEN – is very apprehensive about beginning to look at. And usually, people have, are quite correct in, uhm, in the sense that the, there’s, they have a good reason to be, even though they can’t articulate it to you in a moment like the moment, ah, of that interview. Uhm, what was your first question? I, are, are they(ph). (crosstalk) 

01:18:00 Well, well actually, it seems like and so that’s where the actual therapy and the 12 Step go hand in hand? When a client would bring that to you, and you would be able to, help him work through something like that? 

01:18:15Joan Zweben, Ph.D. INTEGRATION WITH 12 STEP PROGRAM 3-11 

01:18:15DR. JOAN ZWEBEN Well, I think some of it he might get out of the 12-Step Program, but it’s more chancy and also because people like him do tend to have an unerring eye for somebody who’s gonna be a little too harsh. So, to the extent that he duplicates that, ah, he’s gonna be more defensive in the 12 Step context. Remember, it’s a self-help group, it, it, there’s so much variability that, ah, you have to- 

01:18:403-12 

01:18:40DR. JOAN ZWEBEN – I think encourage people to go for the best that’s in it, but be realistic about some of the places that it can go wrong. You’re more likely to have that… (crosstalk) 

01:18:50 Uh hmm. 

01:18:50DR. JOAN ZWEBEN …work out better, ah, in, in a therapy context. 

01:18:55 I have a sort of a follow-up question on that. I, what I noticed is that a, the, ah, question of commitment kept coming up… 

01:19:05DR. JOAN ZWEBEN Uh hmm. 

01:19:05 …and he jumps straight from the first two steps into the action step, skipping the third step about making a decision completely. And I was wondering how you might address something like that that, ah, might be a block very early in these first three steps in, ah, in ah, your work with him, whether you’ll see him again? 

01:19:20DR. JOAN ZWEBEN Wait. I’m not, I’m not, you were talking about different steps, not the 12 Steps, right? 

01:19:25 The 12 Steps. 

01:19:25DR. JOAN ZWEBEN Oh. 

01:19:25 Oh, yeah. He talked, said no problem with the first two steps, and then he went straight into the action steps, four onward, and just completely glossed over the third step, made a decision to, ah, ah, turn the wheel in their lives over to the care of God, as we understood him. And commitment seemed to be a big theme, ah… (crosstalk) 

01:19:403-13 

01:19:40DR. JOAN ZWEBEN Uh hmm. 

01:19:40 … in his, ah, discussions. And I was wondering how you might help him work through a, a or focus on that or would you also just kind of. 

01:19:50DR. JOAN ZWEBEN Well, no. I would, I think that part of the task in working, ah, ah, with him is to help him develop more, ah, awareness of and ability to articulate his feeling states. And for someone like that, the action is the commitment, and, ah, then, but once he does that, getting him to sort of slow down and, and just begin to describe his experiences more would bring out those other issues and the ambivalence about it, and am I doing it wholeheartedly? Or just going through the motions and some of those kinds of things. So, uhm, that’s how I think something like that would, would proceed with him. 

01:20:30 I am wondering, uhm, if you get a client who says, “AA doesn’t work for me, I’ve tried it,” I’m wondering how you responded? Is there a generally a common theme, a reason why they say that? 

01:20:403-14 

01:20:40DR. JOAN ZWEBEN  Well, there’s many different reasons for others to say that. First of all, I, I’m glad you, you raised that because I never, ah, get into this position, ah, that people do of saying if you won’t do the 12 Step, I won’t see you. (crosstalk) 

01:20:55 Hmm. 

01:20:55DR. JOAN ZWEBEN I, I, I think our task is to facilitate their ability, ah, to use those resources in the community. So I, ah, ah, I want to know what happened. When you went to AA, what happened, you know? For example, ah, ah, sometimes people have very negative experiences there that are negative by anybody’s standards. Other times, if you or you explore the issue with them, they’ll come up with something like, “Well, you know, I hate most of all getting up there and saying I’m so and so. I’m an addict.” (crosstalk) 

01:21:25  Uh hmm. 

01:21:30DR. JOAN ZWEBEN You know, so it’s basically a confrontation with their stage and recovery and what their issue is that they are resisting and, and once you explore that and bring some of that out into the open, some of the resistance dissipates. A lot of it is practical. People need to find most- 

01:21:453-15 

01:21:45DR. JOAN ZWEBEN – of the time they, they need to find groups with people that they can identify with, (crosstalk) 

01:21:50DR. JON CARLSON Uh hmm. 

01:21:50DR. JOAN ZWEBEN that are like themselves. Sometimes that’s scary. I’ve had people say to me, “You know I went to these meetings and the women were all like me and that was terrifying.” So, you never know how it’s gonna work out, but in general people like it when they hear their story in the meeting and they, they feel they can benefit more. I tell people, “Look, if you can get clean and sober standing on your head in Embarcadero Center, that’s fine with me. (crosstalk) 

01:22:10 Uh hmm. 

01:22:10DR. JOAN ZWEBEN Ah, but you got to tell me how you are gonna accomplish these two things, what you can get out of 12 Step,” and you can get out of other things, but you have to work at it harder are these two things. You get a sub-culture that supports the recovery process and you have a process for personal development that doesn’t have any financial barriers. So if you’re gonna reject it, I need to know how you’re gonna do that. So, I, I put it back on them and turn to the tasks. 

01:22:35DR. JON CARLSON And, and would you attend to that that sub-group that they are already a part of? (crosstalk) 

01:22:40DR. JOAN ZWEBEN Uh hmm. 

01:22:40DR. JON CARLSON He made a few references to his wife, and his daughters… (crosstalk) 

01:22:453-16 

01:22:45DR. JOAN ZWEBEN Uh hmm. Uh hmm. 

01:22:45DR. JON CARLSON …and, you know, that, that family. 

01:22:45DR. JOAN ZWEBEN  If I were seeing them, I, I always want to see the mate and get the mate’s perspective on what’s going on, and there’s a whole lot of things you need to know in terms of, ah, ah, where the mate is? How, was there alcohol in the house? 

01:23:00DR. JON CARLSON Sure. 

01:23:00DR. JOAN ZWEBEN How disgruntled she is with what he’s doing? There’s a whole realm of things that I didn’t even go down that path ‘coz I wanted to. (crosstalk) 

01:23:05DR. JON CARLSON More in the social area. Yeah. (crosstalk) 

01:23:05DR. JOAN ZWEBEN Yeah, and family. The family… (crosstalk) 

01:23:10DR. JON CARLSON Uh-huh. 

01:23:10DR. JOAN ZWEBEN …is the, the, is a very important piece, or the significant other family like structure, whatever they’ve got going is a very important piece of the recovery process that often gets neglected. 

01:23:20 I’m gonna be a bit of a devil’s advocate, ah, with, ‘coz the two things you just mentioned that, ah, you can get from, ah, AA or some other 12-Step Program, if there were in that community another volunteer… (crosstalk) 

01:23:40DR. JOAN ZWEBEN Uh hmm. 

01:23:40 program, ah, that also provided a subculture… (crosstalk) 

01:23:40DR. JOAN ZWEBEN Uh hmm. 

01:23:40 …supporting recovery, (crosstalk) 

01:23:45DR. JOAN ZWEBEN Uh hmm. 

01:23:45 ah, it seems to me that- 

01:23:453-17 

01:23:45 – there are two parts of 12 Step that, that fit into a, uhm, that, that are problematic for him. And, I mean, it’s true that he’s had a good experience but it’s also true that he only get so far. So, ah, in, in his current history today with 12 Step and one of them is the commitment issue, ah, when it’s phrased in religious terms, which it is in the 12 Steps, tends to not look at, uhm, motivational enhancement, but tends to say, “You just got to make this commitment,” you know, ah, Step Three. And the other is the, ah, fact that he brought up the fear of judgment so much, and yet 12 Step demands a kind of, “I’m absolutely powerless” a kind of, ah, ah, you know the, the more shame there, the more guilty I am, the more powerful God is kind of theology. Uh? 

01:24:45DR. JOAN ZWEBEN Ah, that’s not inherent. People, ah, read- 

01:24:453-18 

01:24:45DR. JOAN ZWEBEN – that in as many different ways as there are people in AA, and I, I understand how… (crosstalk) 

01:24:55 Right(ph). 

01:24:55DR. JOAN ZWEBEN …people get there. But, uhm(crosstalk), I, I don’t think that’s inevitable. I think there’s, ah, a, a way of, uhm, working with those steps that gets people focused where it belongs. So, if I want control over my life, I’ve got to give up the effort to, to do controlled drinking. So, I, ah, well, you had about three or four questions in there. Do you wanna just a… (crosstalk) 

01:25:20 You know I don’t wanna believe, essentially those two, one of the things I loved about your encouraging the 90-day bit is it almost forces hunting for his 12-Step Program that won’t be as shame-based, or won’t be a… (crosstalk) 

01:25:35DR. JOAN ZWEBEN Uh hmm. 

01:25:35 A pushing for more commitment than he has explored. 

01:25:35DR. JOAN ZWEBEN  Uh hmm. And I think that, that little interaction illustrated something else, that people, ah, do repeat things by rote without really understanding… (crosstalk) 

01:25:50 Understanding. Yeah. 

01:25:503-19 

01:25:50DR. JOAN ZWEBEN …why, ah, those sayings are so common and it’s, ah, it’s useful to just start from ground zero and find out what he, how he really understands that, and then in that case, it really paid off, ‘coz he had heard it and, and could repeat it, but he didn’t really understand why they said that. 

01:26:05 Uh hmm. But could you imagine perhaps not with him, but with, ah, at some time saying I want you to go to a lot of meetings as, you don’t want need one that repeats these patterns that have hung you up in the past? 

01:26:20DR. JOAN ZWEBEN No, I, I would, ah, he actually understood that he needs to be willing to be uncomfortable… 

01:26:25 Uh hmm. 

01:26:25DR. JOAN ZWEBEN But he was struggling with the fact that too much harshness wasn’t gonna work for him. (crosstalk) 

01:26:30 Uh hmm. 

01:26:30DR. JOAN ZWEBEN So, I, I usually approach that by going several steps backward and, and say you need to go to the meetings ’til you feel in your gut that you can learn something here. 

01:26:40DR. JUDY LEWIS Could I ask something, if this isn’t, maybe this is too simplistic and concrete, but you’re talking about the commitment. 

01:26:503-20 

01:26:50DR. JUDY LEWIS Isn’t the really frightening commitment that he’s grappling with the commitment that tomorrow he’s not going to drink? 

01:26:55DR. JOAN ZWEBEN  Uh hmm. 

01:27:00DR. JUDY LEWIS And that’s the ultimate meaning of his commitment to look for these meetings, uhm, is that he knows that that relates to not drinking. Isn’t that, isn’t that the aspect of the commitment that’s most difficult? 

01:27:20DR. JOAN ZWEBEN No, I don’t think so, because he said, I am able to get nine to 12 months fairly easily, and he doesn’t… (crosstalk) 

01:27:25DR. JUDY LEWIS Uh hmm. 

01:27:25DR. JOAN ZWEBEN …describe that although it may turn out differently if you saw him over time as, as the hardest part. Now, I think for him it’s all those, those growth issues that, uhm, have to be faced… (crosstalk) 

01:27:35 Uh hmm. 

01:27:35DR. JOAN ZWEBEN  once you remove the anesthetic… (crosstalk) 

01:27:40DR. JUDY LEWIS Oh, that then… (crosstalk) 

01:27:40DR. JOAN ZWEBEN …that he’s talking about. 

01:27:40DR. JUDY LEWIS …then, he is ready for it at that point… (crosstalk) 

01:27:45DR. JOAN ZWEBEN Right. 

01:27:45DR. JUDY LEWIS …it’s that aspect of the commitment that’s difficult. 

01:27:453-20 

01:27:45DR. JOAN ZWEBEN  The, the, the other kinds of inner work of- 

01:27:503-21 

01:27:50DR. JOAN ZWEBEN – recovery is where he’s bogging down. I think he told us that, I think he, he actually did have, ah, an understanding of, some understanding of where he, (crosstalk) 

01:28:00DR. JON CARLSON Uh hmm. 

01:28:00DR. JOAN ZWEBEN uhm, went astray. 

01:28:00 In working with people that have this type of history that are able to abstain for a certain period of time, and then go back to active drinking and abstain for a period of time, and go back to active drinking, what are some of the methods that you are, that you may use with the system and getting over that, ah, over that block, I mean, maybe Antabuse or anything else? 

01:28:20DR. JOAN ZWEBEN Uhm, early in the, in the treatment, I would, I would ask him to pick the most re, recent episode, relapse episode, and reconstruct for me, ah, what was going on in his life during that time, and I would come back to it over several sessions, because when you start asking people questions, they start having memories and dreams and all kinds of other stuff that bear on it. So I would make it kind of a project so let’s see if we can understand in, in really considerable detail taking our time what happened- 

01:28:503-22 

01:28:50DR. JOAN ZWEBEN – ah, in the several months preceding the last relapse? What you were doing? What you were thinking? What you were feeling? What you are happy about? What you are unhappy about? What was really going on here? Now Antabuse, I of, I, ah, tell people about as a tool that they can use if they want, uhm, ah, to get through that kind of period. Ah, Antabuse is tricky, because, ah, you probably know, Antabuse is a, ah, medication that could, people can take as a deterrent to impulsive drinking. And for some people, it is an enormous relief, ah, but it’s such a relief, that they don’t do anything else then. (crosstalk) 

01:29:30DR. JUDY LEWIS Uh hmm. 

01:29:30DR. JOAN ZWEBEN They don’t look at, well, if I weren’t on Antabuse, what would I have to do not to drink during this period? For someone like him, I would suggest that, ah, we could go one of two ways. If, if we can be discussing, you know, ah, regularly what’s going on for you and your life, what thoughts, feelings, fantasies you may be having about drinking, you may be fine without any- 

01:29:503-23 

01:29:50DR. JOAN ZWEBEN – medication assistance. If you think it would be useful for you to block that escape hatch, ah, so that your feelings would become more vivid, then you can do Antabuse. So, I would leave that kind of thing entirely up to him at that stage. There are other people who, early in recovery, it is really life or death for them to do Antabuse and then I would be more insistent. 

01:30:10DR. JON CARLSON Uh hmm. And it seems to have a lot to do with relapse prevention. Do you have, ah, active relapse prevention program that you use in your work? 

01:30:20DR. JOAN ZWEBEN I think relapse prevention is embedded in good treatment. (crosstalk) 

01:30:25DR. JON CARLSON Uh hmm. 

01:30:25DR. JOAN ZWEBEN It’s not something separate, (crosstalk) 

01:30:25DR. JON CARLSON Uh hmm. 

01:30:25DR. JOAN ZWEBEN ah, but there definitely are skills for relapse prevention, ah, breaking it down into two phases. One, we call relapse a wide variety of things but, in fact, I think it’s useful to think about a failure to establish abstinence, in other words… 

01:30:40DR. JON CARLSON Right. 

01:30:40DR. JOAN ZWEBEN …people who drink or use in the first three to six months versus- 

01:30:45Joan Zweben, Ph.D. INTEGRATION WITH 12 STEP PROGRAM 3-23 

01:30:45DR. JOAN ZWEBEN – a resuming of alcohol and drug use after they have a, a period of considerable sobriety. I think the issues are different and some- 

01:30:553-24 

01:30:55DR. JOAN ZWEBEN – of the tools are different and I, I would approach that differently. So, yeah, I mean, I, I realize that it’s, it’s and it, is in some ways very useful to talk about relapse prevention, but it should be a part of any good treatment… (crosstalk) 

01:31:05DR. JON CARLSON Uh hmm. 

01:31:05DR. JOAN ZWEBEN …integral. 

01:31:05DR. JON CARLSON I’ve heard of people even planning relapses. 

01:31:10DR. JOAN ZWEBEN Oh, sure. 

01:31:10DR. JON CARLSON ‘coz that’s the time that it often happen is at nine months to 12 months. (crosstalk) 

01:31:15 Uh hmm. 

01:31:15DR. JON CARLSON Would you do something like that with, ah, this man? 

01:31:15DR. JOAN ZWEBEN What do you mean planning? (crosstalk) 

01:31:15DR. JON CARLSON To plan a relapse. 

01:31:15DR. JOAN ZWEBEN  No, I wouldn’t do that. No, what I would plan with him is that we need to give you the kind of observational skills which you, he clearly has the ability to do this… (crosstalk) 

01:31:25 Uh hmm. 

01:31:25DR. JOAN ZWEBEN  uhm, so that you see the build-up. And that we, by reconstructing your previous relapse episode, identify some of the red flags for you, you know, in that. 

01:31:40 I, I heard you mention two phases for the relapse prevention skills. (crosstalk) 

01:31:45DR. JOAN ZWEBEN Uh hmm. 

01:31:45 Did you? 

01:31:45DR. JOAN ZWEBEN  Ah, I break it down into, ah, what I would refer to as a failure to establish abstinence. 

01:31:553-25 

01:31:55DR. JOAN ZWEBEN In other words, using early in the process when they really don’t have a, a foundation of abstinence. That’s a different set of issues and I think, ah, when using somewhat different tools that varies, ah, then somebody who’s had say three years and then has a relapse. Ah, so, those are different. I, I also wanna include, we’ve been talking a lot about 12 Step programs because they are the largest self-help system in the world. You can’t beat it for comprehensiveness. But there are other self-help groups, ah, Secular Organizational for Sobriety, and some others that have sprung up, which depending on what community you’re in, ah, people may find more acceptable. Again, I’m more focused on the goals of going to self-help not, I’m not gonna quarrel about the method if they can achieve the goals. But what I do caution people, is I do want them to give 12 Step a fair try, because- 

01:32:553-26 

01:32:55DR. JOAN ZWEBEN – it is such a comprehensive system. Uhm, and, and usually with none of the other systems can you get seven days a week, practically 24- (crosstalk) 

01:33:05 Uh hmm. 

01:33:05DR. JOAN ZWEBEN hour-a-day coverage. And for times like the holidays, heavy relapse periods, that can be really crucial. 

01:33:10 And then, uhm, what, do you have a general timeframe for the fair try or is that more attitude and. 

01:33:20DR. JOAN ZWEBEN Ah, it’s more attitude, yeah. (crosstalk) 

01:33:20 Okay. 

01:33:20DR. JOAN ZWEBEN Yeah. No, its not so much time frames as what happens when you go there? 

01:33:25 Okay. 

01:33:25DR. JOAN ZWEBEN Because very, very, very frequently, more often than not, it is a complete mirror of their attitude about acknowledging that they have a problem. 

01:33:35 In cases where you have, ah, a gentleman who just has gone to the meetings, uhm, has had a period of abstinence, abstinence but always seems to, uhm, avoid the intimate social contact, which is a, you know, a legitimate part of the recovery process. 

01:33:50DR. JOAN ZWEBEN Uh hmm. 

01:33:50 How would you work with him as far as having, you know, take that risk of exposing himself to a, the members of the group? 

01:33:553-27 

01:33:55 Uhm, say in a social setting, like, he mentioned that he had problems with the hugging and the, ah, (crosstalk) 

01:34:05DR. JOAN ZWEBEN Uh hmm. 

01:34:05 going out to coffee afterwards, and ah, I’ve heard that a lot of the meeting, a lot of real therapeutics of the meeting takes places in those types of settings. (crosstalk) 

01:34:10DR. JOAN ZWEBEN Uh hmm. 

01:34:10 So, how would you work with him about, getting over that barrier of, of going out to coffee and, ah, being receptive to, to the feelings that are being offered? 

01:34:20DR. JOAN ZWEBEN I would probably start by validating his right to set boundaries wherever he’s comfortable… (crosstalk) 

01:34:25 Uhm. 

01:34:25DR. JOAN ZWEBEN …and, and practicing with him, ah, how you turn down a hug if you don’t feel like hugging somebody. Ah, because I think once people feel confident about that, then they can allow others in more. And, and, I do think that, uhm, we in the helping professions place a very high premium on closeness and intimacy that may not be shared, and may not be essential for other people. So, I, I wanna, ah, challenge people in those areas to open up more to, you know, how would it be a- 

01:34:553-28 

01:34:55DR. JOAN ZWEBEN – uhm, ah, moving forward for you in your recovery process if you put yourself in these uncomfortable social situations more. I would challenge, but I also wanna remain respectful that people have varying distances that they like to be from other people and that’s okay. 

01:35:10DR. JON CARLSON  You know, I think we’ve already started to do this, but any general questions on the approach are certainly appropriate now as well. 

01:35:20  How would you connect to a client with AA who says that they are an atheist? 

01:35:25DR. JOAN ZWEBEN  Tsk, well, in any large urban community, there is variability about how much, ah, of that God stuff… (crosstalk) 

01:35:35 Uh hmm. 

01:35:35DR. JOAN ZWEBEN  ah, there is, in the meetings. There are actually ace, atheist meetings and humanus(ph) meetings and other kinds of meetings like that in certain communities. There’s take, emphasizing take what you need and leave the rest. Now when people say they’re, ah, they are atheists, uhm, or they hate that God stuff, which is very common and- 

01:36:003-29 

01:36:00DR. JOAN ZWEBEN – they’re unable to take what they need and leave the rest, I also wanna explore what their experiences are with institutionalized religion and childhood. Or the, the nature of the parental figures because some of the time, ah, that’s, that’s a, baggage they’re bringing in from before, and if you just do a little bit of exploration around that, uhm, ah, the resistance goes away. For some people, ah, as one of my clients, ah, said after we went through a long ah, series of trying to help her with that issue, she would go to the meetings and come back fuming about all that God stuff. She, she finally worked it out (laughs) for herself by saying, “You know, I finally figured it out. God is not my father.” God is God and my father is my father. So sometimes, it’s worth just treating out as an ordinary clinical issue. Now, you, that touches on something that, that maybe difficult for some, ah, ah, professionals. Uhm, the people who look at spirituality have done studies that indicate that- 

01:37:003-30 

01:37:00DR. JOAN ZWEBEN – as professionals, we are much less likely to be involved with some sort of spiritual pursuit, religious, ah, regular, ah, church or synagogue attendance than the general population. In other words, there is a discrepancy between us as a profession and of general public out there. And one of the things I happen to like but maybe other people don’t, is this notion of spirituality is in, integral to the human process whether it’s psychotherapy or addiction or anything else. But if that’s something that’s uncomfortable for the therapist, they’re less like to be able to help the client find a place where they can feel at home with it. 

01:37:35 Uhm. 

01:37:35  Uhm, it seems to me ah, uhm, hugging and recovery… (crosstalk) 

01:37:45DR. JOAN ZWEBEN (laughs) Yeah. 

01:37:45 in AA is to guns and killing in America. How do you re, you know, so I’m wondering. (crosstalk) 

01:37:50DR. JUDY LEWIS What an analogy. (laughs) 

01:37:50DR. JOAN ZWEBEN  Oh, boy. 

01:37:55 It’s, it’s, it seems to me that this, this guy, ah, that’s a crude analogy there and I think that- 

01:38:003-31 

01:38:00 – and the more this guy doesn’t accept hugging in AA, if he could, if he’s for ready for reco, for anything to do with AA recovery in AA. That’s, that’s why I brought that analogy is because, it’s like, living in America you have to kill because there are guns all around. 

01:38:15DR. JOAN ZWEBEN Well, I, I, I would say what I say before, ah, I mean, I live in California and I, I think it’s sometimes very difficult for people to turn down hugs when they don’t wanna be hugged. 

01:38:25 Uh hmm. 

01:38:25DR. JOAN ZWEBEN Ah, and I think people have a right to do that, and that I would validate that right in him. At the same time, I would flag that as an issue to explore of, you know, the, from ancient childhood forward from accepting and, he’s very, ah, hard on himself and, and I suspect that when goodies come his way, he doesn’t let them in. So I would certainly have my eye on that whole frame of issues. But no, ah, I think you can go to AA meetings and not accept hugging and. (crosstalk) 

01:38:50 I’m not saying, ah, but I’m saying is, I’m trying to give a, make that a feedback, if, you know, for his therapy. That’s a good feedback toward the therapist… (crosstalk) 

01:39:00DR. JOAN ZWEBEN Yes. 

01:39:003-32 

01:39:00 …who’s working with the client… (crosstalk) 

01:39:00DR. JOAN ZWEBEN Yeah. 

01:39:00 …and to just, ah, you know, enumerate it when you said, well, you would flag that… (crosstalk) 

01:39:05DR. JOAN ZWEBEN Yeah. 

01:39:05 …for further exploration… (crosstalk) 

01:39:10DR. JOAN ZWEBEN Uh hmm. 

01:39:10 …about this person’s status… (crosstalk) 

01:39:10DR. JOAN ZWEBEN Uh hmm. Uh hmm. 

01:39:10 …in the context of the treatment in the here and now. 

01:39:10DR. JOAN ZWEBEN  Uh hmm. And I would encourage him to do more of what he’s already done to flag discomfort as a growth opportunity, to …(crosstalk) 

01:39:20 Uh hmm. 

01:39:20DR. JOAN ZWEBEN …reframe it as something that, (crosstalk) 

01:39:20 Hmm. 

01:39:20DR. JOAN ZWEBEN you know. 

01:39:20 Let me just ask another analogy, that is relapse an integral part of, ah, recovery. And I think I heard you say that, ah, relapse is not a part of, no, you said relapse is a not a separate from treatment. (crosstalk) 

01:39:35DR. JOAN ZWEBEN Uh hmm. 

01:39:35 How do you bring those two together? Because it seems to me that relapse is, if it’s an in, integral part of recovery, it is inevitable that one should have a separate relapse program in his or her mind as a therapist. 

01:39:50DR. JOAN ZWEBEN No, all I was saying is relapse prevention, ah, is embedded in good treatment, that, that, you don’t have to pry it out and say, now we’re gonna do relapse prevention. You can have a treatment… 

01:40:003-33 

01:40:00DR. JOAN ZWEBEN  that incorporates all of the elements needed for relapse prevention. I try not to say to people relapse is an inevitable part of recovery because it gives them permission to use or drink. And of course, we know that no matter what you say or how well you say it, people will take it in a variety of ways that is their own. But I wanna walk the line, I mean, some people do become abstinent and never drink or use again. They may do other things, they may spend compulsively or eat or do a variety of other things but, so I’m not gonna say to these people I expect you to relapse, it’s part of recovery. I am gonna try to, ah, ah, convey that it’s part of the learning that, that, you do when you relapse, it teaches you where you need to strengthen your recovery, except. (crosstalk) 

01:40:45 Integral, not inevitable. But I’m using the word integral rather… (crosstalk) 

01:40:50DR. JOAN ZWEBEN Okay. 

01:40:50 …than inevitable because… (crosstalk) 

01:40:50DR. JOAN ZWEBEN Uh hmm. 

01:40:50 They are two distinct words, in the sense that, ah, ah, people could relapse in thinking. 

01:40:55DR. JOAN ZWEBEN  Yes. Uh hmm. 

01:41:00 Which mean. (crosstalk) 

01:41:00DR. JUDY LEWIS Joan, what about? (crosstalk) 

01:41:00 Okay. (crosstalk) 

01:41:003-34 

01:41:00DR. JUDY LEWIS Oh I’m sorry. What about that abstinence violation effect? I mean some people… (crosstalk) 

01:41:05DR. JOAN ZWEBEN Uh hmm. 

01:41:05DR. JUDY LEWIS …have pointed out that the absolute insistence on abstinence may have problems in terms of relapse because if people have a slip, uhm, and they may, they may think that well, it’s, it’s all over, I’ve failed… (crosstalk) 

01:41:25DR. JOAN ZWEBEN Uh hmm. 

01:41:25DR. JUDY LEWIS …ah, as opposed to more flexible goals that, ah, give people permission to, uhm, do more or less well. 

01:41:35DR. JOAN ZWEBEN Are you talking about harm reduction approaches? 

01:41:40DR. JUDY LEWIS Well, or in, in particular the idea that if people are taught that it’s, that the only options are abstinence or complete relapse… (crosstalk) 

01:41:50DR. JOAN ZWEBEN Uh hmm. 

01:41:50DR. JUDY LEWIS …that if they have a slip, then what sometimes happens… (crosstalk) 

01:41:55DR. JOAN ZWEBEN Uh hmm. 

01:41:55DR. JUDY LEWIS …is that they become so overwhelmed with guilt… (crosstalk) 

01:41:55DR. JOAN ZWEBEN  And ashamed. 

01:42:00DR. JUDY LEWIS …and shame and hopelessness that, uhm, the relapse becomes inevitable for them at that point. 

01:42:05DR. JOAN ZWEBEN Or protracted. (crosstalk) 

01:42:05Joan Zweben, Ph.D. INTEGRATION WITH 12 STEP PROGRAM 3-35 

01:42:05DR. JUDY LEWIS How do you deal with that? Yeah. 

01:42:10DR. JOAN ZWEBEN Yeah, ah, I think the abstinence violation effect is real. And, for some people, their shame at facing the group makes it worse. 

01:42:15DR. JUDY LEWIS  Uh hmm. 

01:42:20DR. JOAN ZWEBEN The experience of individuals in AA or NA is variable that groups can be often very supportive… (crosstalk) 

01:42:25DR. JUDY LEWIS Yeah. 

01:42:25DR. JOAN ZWEBEN  of people who’ve relapsed. There’s scarcely anybody in the room who hasn’t relapsed at some point. So, again it’s sort of a combination of the individual dynamics and the group dynamics. Group, all, all the different groups have personalities, that’s why it’s incur, ah, important to encourage people to look for a group… (crosstalk) 

01:42:45 Right. 

01:42:45DR. JOAN ZWEBEN …where they feel they can learn a lot and they feel at home because the tone of them varies a great deal about issues like relapse. 

01:42:50 Uh hmm. 

01:42:50DR. JUDY LEWIS I, I’ve noticed some people who have, have 20 years of sobriety who are, ah, sponsors for a lot of other people… (crosstalk) 

01:42:55DR. JOAN ZWEBEN  Uh hmm. 

01:43:00DR. JUDY LEWIS …who are so overwhelmed with the slip that they just… (crosstalk) 

01:43:00DR. JOAN ZWEBEN Right. 

01:43:00DR. JUDY LEWIS …can’t bring themselves back. 

01:43:00DR. JOAN ZWEBEN  Uh hmm. No, I, I know and, and that’s sad, and… (crosstalk) 

01:43:05 Uh hmm. 

01:43:053-36 

01:43:05DR. JOAN ZWEBEN …and I think that it’s, ah, to the extent that people can really believe the important thing is you pick yourself up and, and start again, and that, that’s the best remedy for that. Sending an ambiguous, ah, message about whether it’s okay to drink or not has many problems to it. That’s appropriate in certain settings but, uhm, I, I, think there’s also many problems. 

01:43:30DR. JON CARLSON If I understood part of what you’re saying though, you’re saying that if AA doesn’t work for you, try another group. And… (crosstalk) 

01:43:35DR. JOAN ZWEBEN Well, no, when, ah, what do you mean? (crosstalk) 

01:43:40DR. JON CARLSON …keep moving on, keep moving around but, I know that, but you’re also sayin’ that if it doesn’t work in one context, try a different context because the mediums are so different… 

01:43:45DR. JOAN ZWEBEN Uh hmm. 

01:43:45DR. JON CARLSON …and the groups are different. 

01:43:50DR. JOAN ZWEBEN Yeah, but I want to understand what they mean by the statement… (crosstalk) 

01:43:50DR. JON CARLSON Sure. (crosstalk) 

01:43:50 Uh hmm. 

01:43:50DR. JOAN ZWEBEN …it doesn’t work for me… (crosstalk) 

01:43:55DR. JON CARLSON Uh hmm. 

01:43:55DR. JOAN ZWEBEN …because, yes, the groups are very different. Uh… (crosstalk) 

01:43:55DR. JON CARLSON Uh hmm. 

01:43:55DR. JOAN ZWEBEN And, and many things are, are possible now. If you, ah, run a program, you, you can have people take each other to meetings that you think would work… (crosstalk) 

01:44:05DR. JON CARLSON Uh hmm. 

01:44:053-37 

01:44:05DR. JOAN ZWEBEN …or they think would work. Ah, which is less, uhm, comfortable for many psychotherapists because of our training but it’s very much, ah, ah, tradition… (crosstalk) 

01:44:15DR. JON CARLSON Uh hmm. 

01:44:15DR. JOAN ZWEBEN …ah, to have people take other people to meetings and it can work extremely well, get people started. 

01:44:25 Okay. The, ah, title of this series, ah, is brief therapy. And I’m thinking about, how brief is brief and how would you see integrating this, particularly since this guy’s danger point is nine months down the line. Ah, how would you see your own role as a therapist dovetailing, and particularly, you know, with this case perhaps as an example, of sort of a treatment plan. How much, how often and with managed care doing what it does so, ah, how, how do you see the two of them being integrated here? 

01:44:55DR. JOAN ZWEBEN Well, I, I, I’ve, hmm, I don’t, tsk, I think of it in terms of brief intervention. Ah, there is nothing in the treatment outcome with returned addiction that suggests… 

01:45:053-38 

01:45:05DR. JOAN ZWEBEN  to me that brief therapy, selling brief therapy is a responsible approach because of the relationship between retention and positive outcome. So, if you are gonna have limited resources and circumscribe what you’re doing, ah, in terms of professional intervention, I would suggest to the guy that he put in a solid six-months, uhm, ah, working on the behaviors of abstinence and then that we do some professional work, starting around that time, looking towards, you know, what has been his barrier in the past, telling him about options like Antabuse, ah, that, that may be useful. The other issue we have not discussed at all is depression. With somebody who’s actively drinking, ah, most of them look depressed, so, ah, you’re not gonna find out much about it, through independent disorder at this point. After he’s been sober for a month, you’ll have a lot better idea, ah, of what’s going on here. Ah, one of my hypothesis was, well, the overconfidence that he described in the sort of denial club that sets in at- 

01:46:103-39 

01:46:10DR. JOAN ZWEBEN – nine to 12 months, is certainly probably an important element but I wonder if there’s an independent depression going on, if perhaps, his cycle, you know, he starts into a depression cycle at around that time and that’s part of what’s involved in the relapse that we don’t know. It’s something that I would wanna consider and keep an eye on. 

01:46:25 And would you do, after a session like this, would you see him next week or next month or, and then the six month kind of intensive re-grouping or with this, you think he’s launched? 

01:46:35DR. JOAN ZWEBEN  Oh, no. I, I would prefer to see him more regularly, ah, uhm, I… (crosstalk) 

01:46:45 Under managed care or group stuff? They, they think brief when they, you know. (laughs) 

01:46:50DR. JOAN ZWEBEN I understand that but I also remember the time when nobody expected insurance company to pay for their therapy. So, I do think it’s hard for people to shift gears back to that, but it is an idea that I like to plant that, just like, ah, some people go to an accountant to prepare their taxes, some people work on their psyche in this way and- 

01:47:103-40 

01:47:10DR. JOAN ZWEBEN – you may want to consider setting aside, ah, to do this, because your chances of succeeding are better, you know, at making this process meaningful if you invest upfront in it. So yeah, no, I would want to see him weekly until we mapped out a good plan, then I might want to put him in something like a professionally-led recovery group, ah, which is different from a 12 Step program in the sense that in 12 Step programs, you don’t have crosstalk at least in the meetings or there’s not supposed to be a feedback process, as a protection, ah, among other things. And, and in a professionally-led situation you can explore these issues in more detail. And I think in both context, he, he will hear and learn a lot from people who have exactly the same pattern that he’s had, ah, of relapse. And then in a professional situation, you can dig in a more focused way and find out, you know, ah, things that may help him, ah, do it differently. 

01:48:05 Okay. I have the opposite question of Patty(ph). I work in the prison system… (crosstalk) 

01:48:10DR. JOAN ZWEBEN All right. 

01:48:10 And majority- 

01:48:103-41 

01:48:10 – of our guys, believe in a Higher Power, (crosstalk) 

01:48:15DR. JOAN ZWEBEN Uh hmm. 

01:48:15 and the Higher Power is their coat of armor. How would you integrate your technique with their NA, AA program? 

01:48:20DR. JOAN ZWEBEN  Their, their code, their… (crosstalk) 

01:48:25 It’s like that. (crosstalk) 

01:48:25DR. JOAN ZWEBEN Higher Power, is what? (crosstalk) 

01:48:25  Yeah, they believe in a Higher Power as their coat of armor and it’s gonna help them get through their, their addiction, you know, I haven’t got a… (crosstalk) 

01:48:35DR. JOAN ZWEBEN You mean their psychological armor. (crosstalk) 

01:48:35 Right. And they believe that this Higher Power as long as they have this and they work the steps, this is gonna help them to recover, thus. (crosstalk) 

01:48:45DR. JOAN ZWEBEN So they don’t wanna get involved with therapy? 

01:48:45  Uhm, there’s actually very little therapy… (crosstalk) 

01:48:50DR. JOAN ZWEBEN Right. 

01:48:50 Offered to them. 

01:48:50DR. JOAN ZWEBEN Anyway. 

01:48:50  Right. (crosstalk) 

01:48:55 Uh hmm. Uh hmm. 

01:48:55 So, how do you integrate your therapy with the 12 Steps or with them… (crosstalk) 

01:49:00DR. JOAN ZWEBEN Well… (crosstalk) 

01:49:00 …in a prison system? 

01:49:00DR. JOAN ZWEBEN …prac, from a practically pur, practical purpose, what are you, uhm, I, I, you don’t have the latitude to doing individual therapy, right? 

01:49:10 Very little. (laughs) 

01:49:103-42 

01:49:10DR. JOAN ZWEBEN Yeah. 

01:49:10 Yeah. 

01:49:10DR. JOAN ZWEBEN What, what I would do is work with the quality of that Higher Power, uhm, ah, and I need to understand a little bit more about this armor and, and if necessary… (crosstalk) 

01:49:25 Well, uhm, bring them on. I have a guy that’s getting ready to get parole tomorrow. (crosstalk) 

01:49:25DR. JOAN ZWEBEN  Uh-huh. 

01:49:30 He has practiced 15 months of recovery but has been within the walls… (crosstalk) 

01:49:30DR. JOAN ZWEBEN Right. 

01:49:30  Of the institution. 

01:49:35DR. JOAN ZWEBEN Uh hmm. 

01:49:35 He has, he has no knowledge or, or, what’s he’s going to do once he walks outside… (crosstalk) 

01:49:40DR. JOAN ZWEBEN Uh hmm. Uh hmm. 

01:49:40 That door. You’re going back to the same community… (crosstalk) 

01:49:40DR. JOAN ZWEBEN Right. Right. 

01:49:40 …the same people, it’s just you and what you believe as your Higher Power… (crosstalk) 

01:49:45DR. JOAN ZWEBEN Uh-huh. 

01:49:45 …is gonna get you through that. It’s not going, I see it’s not going to work for him. And I try to sit down and, and pick out things like, what are, what are you planning on doing, ‘coz he gave me a list of things… (crosstalk) 

01:50:00DR. JOAN ZWEBEN Uh-huh. 

01:50:00 …he has to do. He’s already worried about his family and this, and my question was to him, what about you? 

01:50:05DR. JOAN ZWEBEN Right. And, and you can tell him because we do have research on the in-prison programs now, and one of the striking findings is- 

01:50:153-43 

01:50:15DR. JOAN ZWEBEN – you get twice as good an outcome if there’s a continuity between the in-prison program and community-based treatment. So that from his perspective, his success will be heavily dependent on getting connected with a recovery vehicle as quickly as possible and having thought about that before he leaves those prison doors. So I think you can encourage, help him make a plan to do that, ah, knowing that the good news is really good, people do succeed very well if they do that. But if they get out there and they’re just floating, ah, it’s just too big a, a transition for people to handle and, and maintain a successful. (crosstalk) 

01:50:50 So you’re saying earlier, earlier in his recovery, we should implement your treatment with AA. He’s attending AA. As a counselor, I should be trying to implement the therapy with his, uhm. 

01:51:05Joan Zweben, Ph.D. INTEGRATION WITH 12 STEP PROGRAM 3-44 

01:51:05DR. JOAN ZWEBEN Well, no, ah, what I’m saying is, ah, as a counselor, you’re not gonna be able to do much therapy in that situation, it sounds like. Uhm, ah, two to three months before his release, you need to be thinking with him about what is gonna be your program of re, recovery when you leave here, be it formal treatment, 12 Step program attendance, what else is gonna have to happen, you gonna have to get that alcohol out of your house, that sort of, the whole range of interventions to, uhm, make his recovery solid, ah, encouraging him to build on what he has gained and helping him have realistic expectations that, ah, it’s work. Recovery is spelled W-O-R-K. (laughs) 

01:51:45DR. JON CARLSON Well, we’ve had a lot, a lot of questions for you, and we’re, ah, almost out of time. Are there any final comments that you might care to make or things that, ah, you didn’t have an opportunity to share with our viewers? (crosstalk) 

01:52:00DR. JOAN ZWEBEN Oh, right. Yes, I think that for professional therapists, if you wanna connect people to 12 Step meetings, you have to go to meetings yourself. You can select an open meeting, ah, you can identify yourself as a guest. If you’re really kinda phobic, you can tell people you’re a therapist- 

01:52:153-45 

01:52:15DR. JOAN ZWEBEN – or you can give your name only. But I think if you will go to meetings, and I ask my staff to go to six to 12 meetings over the course of their first year with us, different kinds of meetings, you need to see what goes on there. Too often, therapists base their views of 12 Step program entirely on what they’ve heard, read or would like to believe. And there’s no substitute for actually being there. I think you’ll find it a very interesting experience. 

01:52:40DR. JON CARLSON Well, thank you. This was a very interesting experience for us. It helped us to really realize this resource… (crosstalk) 

01:52:45DR. JOAN ZWEBEN Uh hmm. 

01:52:45DR. JON CARLSON …that’s out there, that the therapeutic community tends to play down. 

01:52:50DR. JOAN ZWEBEN Uh hmm. 

01:52:50DR. JON CARLSON Thank you very, very much. 

01:52:50DR. JOAN ZWEBEN You’re welcome. Thank you. (crosstalk) 

01:52:55DR. JUDY LEWIS Thank you. (applause) 

01:52:55SPECIAL THANKS TO Christina Nolan and John Cebuhar Project coordinators for their hard work, dedication and creativity in carrying out this project All of the clients whose courage and generosity in sharing their personal stories made this series possible. The faculty and students in addictions studies, social work, psychology, and counseling who participated enthusiastically in this project. The practicing counselors, therapists, and social workers whose participation enhanced the quality of these sessions. Addison Woodward Chair of the Division of Psychology and Counseling Diane Alexander Dean of the College of Education for their support and encouragement. Arthur Durant Program director of Addictions Studies for his participation in and encouragement of the project Virginia Lanigan Editor for her support of this project Stephen G. Smith and David Sachetti for their support and marketing expertise Produced by: Governors State University for Allyn and Bacon A Pearson Education Company Copyright 2000 About Psychotherapy.net For information on ordering this and other videos in this series, please visit us at www.psychotherapy.net or call us at 800-577-4762. About Psychotherapy.net Psychotherapy.net produces and distributes the highest quality training video in the fields of psychotherapy, addictions, and psychology. Our online magazine features interviews with master psychotherapist, articles, continuing education, therapy humor, and other resources to inspire therapists. Please visit us at www.Psychotherapy.net, or call 800-577-5762. About Psychotherapy.net DVD Authoring by Ludlow Media Solutions Marin County, CA DVD Version Released by Psychotherapy.net 2007 

01:52:55  It sounded be like, what we would call getting the monkey off your back. 

01:54:10 I’ve been making some inquiries lately about getting back into the 12 Step programs that are in the area. 

01:54:15 I just reached back and got the bottle. 

01:54:20AN ALLYN & BACON PRESENTATION A and B Produced by Governors State University 

01:54:20  It’s- 

01:54:25A VIDEO SERIES Brief Therapy for Addictions 

01:54:25 – maintaining my weight. 

01:54:30COUNSELOR Uh hmm. 

01:54:30 And I don’t know you have them. 

01:54:35JON CARLSON Welcome to our program- 

01:54:35With Your Hosts Dr. Judy Lewis and Dr. Jon Carlson Governors State University Professors 

01:54:35JON CARLSON – on addictions. 

01:54:35Dr. Judy Lewis 

01:54:35JUDY LEWIS  Whether therapists specialized in substance abuse treatment or work with more general mental health issues. They are bound to see addiction problems among their clients. And working with those issues is never easy. 

01:54:50Dr. Jon Carlson 

01:54:50JON CARLSON There are a number of approaches for helping people who are grappling with addictions. This series explores several models and brief interventions and shows how they’re applied to the real world. 

01:55:05END TRANSCRIPT

The post DR. JON CARLSON Welcome to our program on addictions. In a minute, appeared first on PapersSpot.