Austin: Okay, I'm going to talk with Dr. Singh about writing you a small prescription, and we'll see how you're feeling in about two to three weeks. Then we can talk about next steps if necessary.
Antoine: That's it? I think I need more pills and maybe a stronger dose. I'm really in a lot of pain!
Austin: Let's see if Dr. Singh wants to start with this and see how you feel when you finish the prescription.
Coach: Antoine's insistence on a new prescription could be an indication of a substance use habit. Rather than discussing a prescription now, Austin should ask a few more questions to find out more about his situation. Let’s look at a more effective approach that Austin could take.
Austin: How long have you been having these nightmares?
Antoine: Well (nervous laugh), my wife kicked me to the couch the other day because she says she can't take it anymore, all the sweating and thrashing around.
Antoine: I guess I've been having them ever since I got back, which is like six months ago now.
Austin: About six months, okay. I bet the couch doesn't help with your back pain, either.
Antoine: Oh hell no!
Austin: So you haven't been back home that long. How's the transition back to civilian life been going?
Antoine: Oh I don't know, it's crazy. Between the back pain and not sleeping. I got this part-time job at the hardware store. It's BS work, you know? And now I might actually lose that job because I've been calling in more and more because of my back.
Antoine’s thought: I thought everything would be better once I got home, but it's worse than ever.
Austin: So, with your back pain and your sleeping issues, what makes you feel better besides the Percocet?
Antoine: Oh. Well, the, the Percocet really helps, takes the pain away and helps me sleep. Um, oh yeah! Wait, what was I saying?
Austin: Does anything else help with the pain?
Antoine: Um, just parking myself on the couch and being alone, having some beer, watching TV, trying to get back some of the time that I lost when I was deployed.
Coach: Antoine seems a bit distracted. If this continues, it could be a warning sign of some more serious issue.
Austin: How much do you need to drink before you start to feel relaxed?
Antoine: I don't know, probably doesn't start working 'til about beer number four.
Austin: And do you stop at beer number four?
Antoine: No. (laughs)
Austin: So how much do you typically have when you drink?
Antoine: Probably one or two six packs.
Austin: How often do you drink?
Antoine: I don’t know. Like, most nights, about five nights a week? I don't see what this has to do with my back, though.
Austin: Well, knowing about your drinking patterns will help Dr. Singh determine what kind of prescription to write for you. So tell me, how long has this been your pattern, drinking one or two six packs five nights a week?
Antoine: Since I've been back at home, I guess. But I deserve it! Those last few years were not easy. My wife complains about the drinking, but I think she's being ridiculous.
Austin: Antoine, you seem to have indications of a drinking problem. We can get you the help you need. Let's talk together about a few options.
Antoine: I do not have a drinking problem! Where I come from, if you have a few beers after you've worked hard all day, that's no big deal! Okay?
Coach: Labeling a client's alcohol consumption as a "problem" can make him defensive. Austin should try expressing his concern without applying a negative label. Let’s look instead at a more effective approach.
Austin: Besides the beer and Percocet, do you use any other substances to help with the pain and nightmares?
Antoine: (laughs) I'll be honest, um, I do smoke a little weed, you know, here and there when I can afford it. Takes the pain away.
Austin: Okay.
Antoine’s thought: I guess I can tell you that, right? Confidentiality and all that?
Austin: And do you ever wake up and feel like you need a drink to get yourself going for the day?
Antoine: (shakes head) No.
Austin: It's a good sign you're not having a drink first thing in the morning.
Antoine: Well, I do admit that I drink more than I did before I was deployed. I mean, I didn't watch TV or have beer for a long-ass time, so I think it's just pretty normal to wanna come home and have a few beers.
Coach: Telling Antoine "it's a good sign" is a judgment, and although positive, it's best not to make negative or positive judgmental statements when you're gathering information.