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0 | reducing alcohol consumption | therapist | Thanks for filling it out. We give this form to everyone once a year regardless of why they come in. It helps us provide better care. Is it okay if I take a look at what you put down? | question | n/a |
0 | reducing alcohol consumption | client | Sure. | n/a | neutral |
0 | reducing alcohol consumption | therapist | So, let's see. It looks that you put-- You drink alcohol at least four times a week on average- | therapist_input | n/a |
0 | reducing alcohol consumption | client | Mm-hmm. | n/a | neutral |
0 | reducing alcohol consumption | therapist | -and you usually have three to four drinks when you do drink. | therapist_input | n/a |
0 | reducing alcohol consumption | client | Usually three drinks and glasses of wine. | n/a | neutral |
0 | reducing alcohol consumption | therapist | Okay. That's at least 12 drinks a week. | therapist_input | n/a |
0 | reducing alcohol consumption | client | Something like that. | n/a | neutral |
0 | reducing alcohol consumption | therapist | Okay. Just so you know, my role, um, when we talk about alcohol use, is just to share information about risk and to help patients who want help. This is different than telling them what I think they should do. I don't do that. | therapist_input | n/a |
0 | reducing alcohol consumption | client | Okay. | n/a | neutral |
0 | reducing alcohol consumption | therapist | Uh, what else can you tell me about your drinking. | question | n/a |
0 | reducing alcohol consumption | client | Well, I usually drink when I'm at home trying to unwind and I drink while I'm watching a movie. And sometimes, um, I take a bath but I also drink when I take a bath sometimes. | n/a | neutral |
0 | reducing alcohol consumption | therapist | Okay. So, can I share with you some information on alcohol use? | question | n/a |
0 | reducing alcohol consumption | client | Okay. | n/a | neutral |
0 | reducing alcohol consumption | therapist | Okay. So, there has been a lot of research on alcohol use and the guidelines we use in this country says that having seven or more drinks per week can raise the risk of health problems for women. | therapist_input | n/a |
0 | reducing alcohol consumption | client | Hmm. Seven? | n/a | neutral |
0 | reducing alcohol consumption | therapist | Seven. | therapist_input | n/a |
0 | reducing alcohol consumption | client | Wow. I knew my doctor didn't like me drinking the amount that I did but I didn't know that seven was the limit. | n/a | neutral |
0 | reducing alcohol consumption | therapist | Yeah, you're surprised to hear that? | question | n/a |
0 | reducing alcohol consumption | client | Yes. What-what kind of health problems? | n/a | neutral |
0 | reducing alcohol consumption | therapist | Well things like heart disease, cancer, liver problems, uh, stomach pains, insomnia. Unfortunately, uh, people who drink at a risky level are more likely to be diagnosed with depression and alcohol can make depression worse or harder to treat. | therapist_input | n/a |
0 | reducing alcohol consumption | client | Hmm. Well, that's not good news. | n/a | neutral |
0 | reducing alcohol consumption | therapist | Well, how do you think your drinking relates to the depression you've experienced? | question | n/a |
0 | reducing alcohol consumption | client | Well, to be honest, I drink sometimes when I'm feeling down and I find it more interesting and not so blur. | n/a | neutral |
0 | reducing alcohol consumption | therapist | Okay. And how do you feel after you drink? | question | n/a |
0 | reducing alcohol consumption | client | Well, then I feel blur again. | n/a | neutral |
0 | reducing alcohol consumption | therapist | So, there are some answers on this form here. Uh, less than monthly you drank more than you intended to. | therapist_input | n/a |
0 | reducing alcohol consumption | client | Yes on occasion. | n/a | neutral |
0 | reducing alcohol consumption | therapist | And sometimes you feel guilty after you drink. | therapist_input | n/a |
0 | reducing alcohol consumption | client | Sometimes I just don't like how much I drink. I sometimes finish a bottle in one night. | n/a | neutral |
0 | reducing alcohol consumption | therapist | So you're not proud of finishing a bottle? | question | n/a |
0 | reducing alcohol consumption | client | No, it's not like I get crazy or anything but I just don't like the amount that I'm drinking. | n/a | neutral |
0 | reducing alcohol consumption | therapist | Right. By the way, binge drinking is defined for women as having more than, uh, three drinks and there are about five drinks in a bottle. So, you enjoy drinking wine because it helps make things, uh, a little bit more interesting when you're feeling down but at the same time you don't like drinking when you have more than you want it to and then the depression returns after you drink. | reflection | n/a |
0 | reducing alcohol consumption | client | Mm-hmm. Yes, sometimes I feel worse after drinking. | n/a | neutral |
0 | reducing alcohol consumption | therapist | Where do you wanna go from here? What do you wanna change about your drinking habits? | question | n/a |
0 | reducing alcohol consumption | client | Well, I don't think that I'm ready to cut down to seven drinks a week. That seems like a lot but I would consider cutting back to two drinks a night. I think that would be my goal. | n/a | change |
0 | reducing alcohol consumption | therapist | If I gave you a scale from 0 to 10, 0 being not ready at all to cut back on drinking and 10 being very ready, what number would you be at? | question | n/a |
0 | reducing alcohol consumption | client | I'd say an eight. | n/a | change |
0 | reducing alcohol consumption | therapist | Okay. Why do you think it's not something less like a six? | question | n/a |
0 | reducing alcohol consumption | client | Well, I'm more ready than a six because I'm ready to cut back on my drinking and I don't wanna make my depression any worse. | n/a | change |
0 | reducing alcohol consumption | therapist | What would help you cut back to two drinks? | question | n/a |
0 | reducing alcohol consumption | client | Maybe having less wine in the house. | n/a | change |
0 | reducing alcohol consumption | therapist | Having less wine in the house will help? | reflection | n/a |
0 | reducing alcohol consumption | client | Yes. | n/a | change |
0 | reducing alcohol consumption | therapist | What else besides drinking helps you relax and unwind in the evenings? | question | n/a |
0 | reducing alcohol consumption | client | Well, I like to watch movies, read a book, and take a bath but sometimes I drink when I take a bath. | n/a | neutral |
0 | reducing alcohol consumption | therapist | So, it's not just wine that helps you relax. Um, there's reading a book, watching a movie, and taking a hot bath too. | reflection | n/a |
0 | reducing alcohol consumption | client | Mm-hmm. Yes. | n/a | neutral |
0 | reducing alcohol consumption | therapist | Okay. So, it sounds like you have some reasons to cut back on drinking and you have ways to relax besides drinking and it sounds like you're pretty ready to cut back. | therapist_input | n/a |
0 | reducing alcohol consumption | client | Yes. | n/a | change |
0 | reducing alcohol consumption | therapist | Great. I'd be interested to see how well you do on your goal in the next few weeks. Would you be willing to come back and talk to me about it? | question | n/a |
0 | reducing alcohol consumption | client | Sure. | n/a | change |
0 | reducing alcohol consumption | therapist | Great. So, let's see how well you're doing with these new meds. | other | n/a |
0 | reducing alcohol consumption | client | Okay. | n/a | change |
1 | reducing alcohol consumption | therapist | And before you leave, uh, is it okay if we go over this screening form that you filled out today on your alcohol use? | question | n/a |
1 | reducing alcohol consumption | client | Sure. | n/a | neutral |
1 | reducing alcohol consumption | therapist | Okay. Uh, thanks for filling this out. Uh, looks like you use alcohol two to three days a week? | reflection | n/a |
1 | reducing alcohol consumption | client | Yeah, but only on the weekend. | n/a | sustain |
1 | reducing alcohol consumption | therapist | Okay. And then when you do drink alcohol, you typically have five or six drinks. | reflection | n/a |
1 | reducing alcohol consumption | client | Yeah. Uh, maybe a couple more. | n/a | neutral |
1 | reducing alcohol consumption | therapist | Okay. Well, the reason why I like to talk to patients when they fill out this form is because sometimes, uh, alcohol use can impact our health. Um, and my role is to be helpful. I can share some information with you about alcohol use, um, but I don't tell anyone what to do. It's always up to the patient to decide what they wanna do about their drinking. Um, so is it okay if we talk a little bit more about your alcohol use? | question | n/a |
1 | reducing alcohol consumption | client | So, uh, are you saying I drink too much? | n/a | sustain |
1 | reducing alcohol consumption | therapist | How would you define drinking too much? | question | n/a |
1 | reducing alcohol consumption | client | Well, I-- If-if I was getting fallen down drunk or if I drink every night. Um, it's not like I get sloppy drunk or anything. | n/a | sustain |
1 | reducing alcohol consumption | therapist | Mm-hmm. Well, in this country, the guidelines are men can drink up to 14 drinks a week or up to four on one occasion and still be low risk. | therapist_input | n/a |
1 | reducing alcohol consumption | client | So I'm already at the week limit. And then I have four beers a night. Are you sure? | n/a | sustain |
1 | reducing alcohol consumption | therapist | So a limit of four a night doesn't feel right to you? | reflection | n/a |
1 | reducing alcohol consumption | client | I have five or six beers when I go out with friends to a bar. It's not a problem for me. | n/a | sustain |
1 | reducing alcohol consumption | therapist | You're not alone in feeling that way. Uh, binge drinking can feel normal to some people. | reflection | n/a |
1 | reducing alcohol consumption | client | Well, I don't consider my drinking binge drinking. | n/a | sustain |
1 | reducing alcohol consumption | therapist | Why is that? | question | n/a |
1 | reducing alcohol consumption | client | I don't chug a lot of beers in a row. I have about five or six beers throughout the entire evening. | n/a | sustain |
1 | reducing alcohol consumption | therapist | Mm-hmm. Well, technically, we define binge drinking as having more than four drinks on one occasion. | therapist_input | n/a |
1 | reducing alcohol consumption | client | But I'm healthy. What health problems are you talking about? | n/a | sustain |
1 | reducing alcohol consumption | therapist | Well, uh, we know if someone binge drinks over time, there's kind of two categories of risk. There's the short-term risk where someone who binge drinks is more likely to fall down, hurt themselves through an accident, uh, they're more likely to drive while under the influence. Uh, but over the long term, binge drinking can also, uh, cause things like heart disease, uh, different kinds of cancer, liver problems obviously, and then even mental health issues like depression and anxiety are more likely to happen. | therapist_input | n/a |
1 | reducing alcohol consumption | client | Well, I didn't know about those things. | n/a | neutral |
1 | reducing alcohol consumption | therapist | Can I ask you, uh, what do you like about drinking alcohol? | question | n/a |
1 | reducing alcohol consumption | client | Well, I-I like beer. I like the way it tastes, I like the way it makes me feel. Uh, like when I'm around friends and it's not a problem for me. | n/a | sustain |
1 | reducing alcohol consumption | therapist | And so what about your drinking do you not like or is there anything that worries you about your drinking? | question | n/a |
1 | reducing alcohol consumption | client | Well, that was fine until I came here, uh, but now that I know about the health risk, uh, I have something I gotta think about. | n/a | change |
1 | reducing alcohol consumption | therapist | So, on one hand, you like how beer tastes, uh, it's part of your social life to some extent, um, but on the other hand, you don't like the idea of it posing risks to your health over the long term? | reflection | n/a |
1 | reducing alcohol consumption | client | E-exactly. | n/a | change |
1 | reducing alcohol consumption | therapist | So weighing those things, you know, what you like about your drinking, what you don't like about your drinking, uh, where do you wanna go from here? Uh, what would you like to change about your drinking? | question | n/a |
1 | reducing alcohol consumption | client | Hmm, I'm not sure. Uh, something I have to think about. | n/a | neutral |
1 | reducing alcohol consumption | therapist | Well, how about hypothetically if I were to ask you, how would your drinking have to impact your life in order for you to be ready to change your drinking? | question | n/a |
1 | reducing alcohol consumption | client | Uh, I don't know. Maybe if I got sick or something, uh, maybe I'd wanna change things then. | n/a | neutral |
1 | reducing alcohol consumption | therapist | So if you experienced a negative consequence from your drinking, uh, that would feel meaningful to you? | reflection | n/a |
1 | reducing alcohol consumption | client | Yeah. | n/a | neutral |
1 | reducing alcohol consumption | therapist | Okay. Well, I like to give this handout to patients. Uh, it defines risky drinking, it talks about what the consequences are, uh, and it also lists signs of what an alcohol use disorder is. So thanks again for taking the time to fill this out and being honest with me, uh, to talk about it. I provide better care, uh, when I know about my patient's substance use. When we come back for a three-month follow-up appointment for your ADHD, I'd also like to talk to you and check in about your alcohol use too, if that's okay with you. | therapist_input | n/a |
1 | reducing alcohol consumption | client | Sounds good. | n/a | neutral |
1 | reducing alcohol consumption | therapist | Okay, great. See you next time. | therapist_input | n/a |
2 | weight loss; diet | therapist | Hi, John. Nice to see you again. So, tell me, how are things going? | question | n/a |
2 | weight loss; diet | client | Well, doc, I know you told me that I need to lose weight. And even though the scale didn't show today, I was able to lose about 5 pounds, but then I gained it right back. | n/a | neutral |
2 | weight loss; diet | therapist | Well, I appreciate you bringing your weight to the forefront. Do you mind if we explore this issue further? | question | n/a |
2 | weight loss; diet | client | No, by all means. I know we have to discuss it. | n/a | neutral |
2 | weight loss; diet | therapist | All right. Uh, well, it sounds like you've been struggling with your weight recently. And I understand how difficult it is to lose the weight and then have it come back again. So, tell me what you did to lose that initial 5 pounds. | reflection | n/a |
2 | weight loss; diet | client | I started watching what I ate and I ate less. I've been eating more fruits and vegetables. I've also been walking a lot. I'm walking up to 20 minutes a day now. I saw the weight come slowly off, um, and I felt better. But then when I watched it come back on again, you know, I gave up. | n/a | change |
2 | weight loss; diet | therapist | But you did have some success. Tell me how you felt when you lost the weight. | reflection | n/a |
2 | weight loss; diet | client | I felt great and I felt really proud of myself. I thought that this was something that I could do. | n/a | change |
2 | weight loss; diet | therapist | Okay. Well, it sounds like you realized that when you lost the weight you feel better and that it's gonna affect your overall health. So, tell me what you think changed that caused you to gain the weight back. | reflection | n/a |
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