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1 BIO DATA Name: Age: Sex: Education: Occupation: No.

of Siblings: Birth order: Religion: Informant: REASON FOR REFFERAL The client was taken from the Addiction Ward of Punjab Institute of Mental Health and was referred for the purpose of psychological assessment and management. PRESENTING COMPLAINTS According to the clients: ___________________________________________________________________.1 ___________________________________________________________________.2 ___________________________________________________________________.3 ___________________________________________________________________.4 ___________________________________________________________________.5 ___________________________________________________________________.6 ___________________________________________________________________.7 ___________________________________________________________________.8 ___________________________________________________________________.9 According to the Informant: ___________________________________________________________________.1 ___________________________________________________________________.2 ___________________________________________________________________.3 ___________________________________________________________________.4 ___________________________________________________________________.5 A.S 23 Male Metric Jobless 2, (1 brother) 2nd Islam Uncle

2 ___________________________________________________________________.6 HISTROY OF PRESENT ILLNESS: Mr. A.S is 21 years old, unmarried male. The client has been suffering from the problems of increased intake of tobacco cigarette, and alcohol, insomnia, loss of appetite, weight loss, aggression, restlessness, agitation, low mood, easily fatigued, muscles aches/cramps, headaches, weakness, guilt/regret feelings. Due to excessive use of alcohol the client’s functioning decline and he was unable to do work. His health has declined alarmingly. The history of present illness started in 2008 when the client was 18 years old; he developed friendship with drug users and started to indulge in bad activities. The client was in metric class when he started to smoke cigrates along his friends and gradually become dependent of smoking. The client belonged to a family of high socioeconomic status and has excess of money. The clients friends also belonged upper class. The clients reported that his father had died when he was one year old child. After the death of his father, the clients mother was shifted to her brother home. The clients alone brother had went to the England for horse riding. These events made client freer. He had complete freedom to move with friends and spent his time with them. Nobody, at home, had ever asked him about his routine of life. The client completely had lack of parents monitoring. The clients reported that he used to move with his friends all the day and at night. They all mutually arranged parties in which they drink together. The client told that in these parties they invited their girlfriends and they enjoyed these parties. The clients friends had great fun at these parties. These parties attract the more and motivate him to drink more and more. The client and his friends had a great interest in the girls. They often go on dates with the girls. The client reported that he also engaged in these activities and get enjoyed. The client was happy overall at this sort of routine of life. But the clients problems started when he started to take heavy dosages of the alcohol. The clients reported that he was taking a normal dosage of alcohol but when he fall in love with his neighborhood girl; he started to take excessive alcohol. The client was in a mature age when started to love that girl.

3 He was made in his love. He often brought precious gifts, jewelry and cloths. They often go at dates and enjoyed the company of each other. During the interview the client had disclosed that he also had sex with her. On the other side, the girl showed that he was also in love with him but in fact she was betraying him. Soon, the client realized the feelings of his beloved. It was unbearable for the client and he became depressed. He started to take heavy dosages of alcohol. But the client was still serious about her and wants to marry with her. He told his beloved that he wants to marry with her and she also accepted his proposal. She asked him that she was ready to marry with him but his mother should come at her home with his proposal. The client agreed and promised the girl. When client told about his love story to his mother and asked her to go his beloved home with his proposal. The clients mother annoyed at his desire and refuse to go his beloved home. The clients mother told to client that they never marry in a low socioeconomic family and it is wise to him to forget her. This entire situation made the client depressed and distressful. He stopped to go outside the home and started heavy drinking. The clients mother became anxious at overall situation. The clients refused to take his meals and started to spent sleepless nights. He wanders whole the night along his friends and takes heavy dosages of drinks. The client reported that due the habit of wondering and alcohol usage he was arrested many times. But due to his strong and well to do family status he was resealed soon. The clients mother was too upset at the clients condition. She understands the client many times to avoid his friends company but he always ignored her advices. The circumstances were gone badly to clients mother and she did not like such attitude of his son. She decided to cure the clients drinking habit and she took him at the Punjab Institute Mental Health (PIMH) for proper cure of his alcohol addiction. Here the client was admitted after some assessment and now client was at the Drug Addiction ward of the PIMH. FAIMLY HISTROY: The client belonged to a well to-do family and had an upper socioeconomic status. They had all luxuries of the life. They were spending happy life with excess of wealth. They never bother for their expenses. They live in a nuclear family system.

4 The client reported that his father died in 1987 due to heart attack. At the death of his father he was one year old child. His father education was graduation. He had his own business. According to the client his father had a strong personality. He was the hardworking person. He loved his both children too much. His father was found of horse riding. He often had been gone to race course club for races. According to the client his father was the member of race course club. There he used to like drink with his friends. In the death of the clients father drinking was main contributing factor. His father’s relationships with this wife were congenial and satisfactory. understanding with her wife and cared for her a lot. The client’s mother was alive. Her age was 30 year and she was a house wife. Her education was graduation. She had been living in his brother’s house after the death of his husband. She had a kind and loving nature personality. She always takes care of his children. She had no conflict with his husband. But she had a conflict with the client on the issue of his marriage. The clients likes a girl and want to marry with her but his mother was not agreed. Overall she had a soft, loving and caring personality. Her physical and psychological health was quite good. The client had 2 siblings; 1 brother. The first born was his elder brother. He was 26 old male. He was unmarried. His education was graduation. He was a good horse rider. During his studies he had taken the horse riding training. After fully trained in horse riding he went to England. There, he joined the horse riding club and started to take part in the races. He was a professional horse rider and it was also his source of income. He was happy and living a good life. He was the sole earner of his family. He earned 1, 20,000 monthly which is enough for him and his family needs. According to the client his brother loved him too much. He always sends him his pocket money separately. He had a friendly and satisfactory relationship with client. He had a good physical and psychological health. The second borne was the client himself. He had good mutual

He had many friends in his life. All of his friends were drinker and they drink regularly. He used to spend most of his time with his friends outside the home. Social History: The client had strong social ties. crawling. They all fond of late night parties and attend them regularly. . The clients had happy and satisfactory relationships with his friends. The client started talking at the age of 9 month and same like client started sitting. He used to do wandering all the night with them. He also used to help them in their homework and in the preparations of the exams. Her birth weight was average and the mother didn’t suffer from any illness during pregnancy. But they released soon due to their status influence. The client reported that his social relations spoiled his life. According to the client he had been participating in extracurricular activities. She had no prenatal and postnatal problems.5 PEERSONAL HISTROY Birth and Early Childhood: According to the clients mother his birth was normal. He achieved all the milestones at the appropriate age. standing. They mutually go to clubs. According to the client he had friendly relations with all his class fellows and used to play with them. They mostly drink in a company. His teachers admired him and like him. He became easily angry at little things. The client reported that he likes the company of his friends. They often arrested due to their habit of drinking. He was happy at that time period. The client also drinks with them. They were happy with their habit of drinking. All of them belong to upper class. He had good relationships with his teachers. Educational History: The client got admission at the age of 5 years in school. The client reported that he was a bright student and always got positions. He spends much time with them. The client’s birth was normal at home. walking and using toilet at appropriate age. The health of client’s mother was good at the time of his birth. According to the clients mother he was very sensitive and aggressive child.

The girl belonged to a low socioeconomic status. She was not even refused but also warned him to remain away from her. money and cloth. The client reported that he often flirt the girls along with his friends. He was found of reading romantic novels and watching romantic movies. The client reported that he got his first sexual experience with a girl who lived in his neighborhood. She always demands gifts. He was exited at the developmental changes and not confused on these changes in body. He felt that he was unable to get this training. But the clients feelings and affections with her was true. The client had become blind in his love want to marry with her. He felt uneasy at the training. He was living a joyful life and spends most of his time with his friends. After his matriculation. he started to take training of horse riding like his brother. On the other side the client a source of money to her. He left the training after 3 months due to his drinking habit. PREMORBID PERSONALITY The client reported that his life before starting drinking was quite normal and happy. The client also took part in these activities. he wanted to marry with her. Overall. He had great interest in opposite sex. According to the client he uses to go outside on his motor bike with friends. he had no interest in work. Occupational History: The client reported that he was unemployed. He used to drink in heavy dosages. He was so upset at overall situation. But the excess of wealth and his bad company made it difficult for him. On the other side that girl also betraying him. He often used to gift her expensive articles. The client discussed all the matter with his mother and asks her. The client also reported that he also used to give her money. According to the client she was a beautiful girl and he was in love with her. But the clients mother did not accepted the proposal. His mother is happy with him . He still loves that girl but his mother was not agreeing to accept his proposal.6 Sexual History: The client reported that he reached puberty at age of 16 years. But he could not keep himself to carry on it. His brother wants to see him as horse rider. They had sexual relationships with many girls. He got information related to sexual information from his friends.

His height was normal but body weight was low. His nature and severity of the illness was been explored. His face was showing fatigue and tiredness. The color of the hair of client was black and texture was not good. He was wearing shalwar kameez. The client reported that he often remembers his father. The clients mother reported that his son is a good child but the bad company makes him sick. The clients reported that he is fond of horse riding and wants to become a horse rider like his brother. His father’s memory makes him sad. His facial expressions were sad. He reported that he was feeling pain in his body and there were crams as well.7 because he is an obedient son. She also reported that the client is a good student in his studies and also offer his prayers five times in a day. His uncle was also happy with him. The client was maintaining good eye contact. In different sessions the client was examined. ASSESSMENT  Informal Psychological Assessment • • • • • • • Clinical Interview Behavioral Rating of Client Symptoms Mental Status Examination Baseline Chart  Formal Psychological Assessment Intellectual Assessment (Standard Progressive Matrices Test) Personality Assessment (Rotter Incomplete Sentence Blank ) Diagnostic Assessment (Minnesota Multiphasic Personality Assessment) INFORMAL PSYCHOLOGICAL ASSESSMENT Clinical Interview Informal psychological assessment was carried out in the form of interview of the patient. He was . Mental status examination: The client was a weak boy of 21 years. He was not sitting in relax posture. He was cooperative and was not looking here and there. He was in uneasy posture.

The client was interested to indulge in conversation at a very good pace but his condition was not allowing him.5 7. No stammering or stuttering was observed. 1 2 3 4 5 6 7 8 9 10 Symptoms Insomnia Loss of apatite Aggression Wight loss Easily fatigued Work desire Headache Muscle crams Restlessness Low mood Client’s Rating 7 6 8 6 7 5 7 8 8 9 Informant’s rating 8 7 9 7 8 6 8 9 8 8 Mean score 7. The client’s memory was also intact and he was able to tell about recent. The rate of his speech was fast.5 5. The client had good attention and concentration as well.5 6. Stream of thought was good the thought content was his girl friend and substance he abused. is experiencing headache. The client clearly lacked in abstract thinking.5 8. place and person was intact and he answered correctly all the questions. His judgment was also good Rating of the symptoms of the Client Table: Client’s. Due to absence of drugs his motor movements were slow as he was feeling pain and crams in the body. For the client base line charts were designed measuring anger and headache.5 Base Line Charts: A baselines chart consists of repeated measurement of the natural occurrence of a target behavior prior to the introduction of the treatment (Splegler and Guevermont. He was speaking in high tone. The client rated his mood at 5 and he was looking quite upset.5 6. The client was friendly. The charts were made and rated for a week to observe and note down the client’s acts as a result of headache and aggression his average intensity of the thought was 10 in the . The volume of the client’s speech was good.5 8. The client’s orientation about time. and his Mother’s (0-10) Rating of the symptoms of the Client S. He was not been able to tell the meaning of proverbs.8 depressed. The motor movement of the client was good. No.5 7. According to the base line chart the client had lost pleasure in daily activities. The client showed no psychomotor agitation. No hallucinations or delusions were observed. recent past and remote memory. He was looking older than his apparent age.5 8 8. 1998).

He took 30 minutes to complete the test. The client was sitting on a chair and the instructions were given according to the manual. It indicates that the client is definitely average in intellectual capacity. in ventilated room. comprehension and reasoning ability. He was dressed up in Shalwar Kameez and was unshaved. . This means that he has surpassed 24 % of his age group and has below average intellectual capacity. The 25th percentile shows that the performance of the client is intellectually below average in the test. Quantities Analysis: Administration of the SPM Showing the Subject’s Score Analysis Raw Scores Percentile Grade 31 25 th discrepancies Time 0. He was cooperative and answered all the questions and was following the instructions that were given to him. It reflects that his capacity meaningless figures by seeing relationship between the working at adequate level. Behavioral observation: A.-1. 2011.1 Taken 30 minutes IV Qualitative Analysis: The subject total row score of 31 which corresponded to 25th percentile rank. He entered the room. FORMAL PSYCHOLOGICAL ASSESSMENT INTELLECTUAL ASSESSMENT Standard Progressive Matrices Test administration: The test was administered on April 13.S was a 23 years old male. And 75 % people of his age are above him. He took his seat and passed a smile. He was an averaged looking young adult of normal heighted and medium physique. He completed the test in 13 minutes. The percentile rank shows the position in contrast with high and low achievers. According to his percentile and row score he receives an “IV Grade”.1.9 whole weak.-2. walk fastly.

-2. The client was sitting on a chair and instructions were given according to manual. 1. 1. He made a good cooperation in spite of his boredom. The room was free of distractions. D. Test Administration The RISB was administered on April 13. The time taken by the client was considerably more than the normal subjects. B. C. After the some motivation given to him he was agreed to complete the test. He was anxious about test why it was so lengthy. The client result is reliable and indicates that the client is definitely below in average in intellectual capacity and can be correlated well with his background information. He was thoughtful and suspicious by his gestures. He was bored to hear about the test. -1. PERSONALITY ASSESSMENT Rotter Incomplete Sentence Blank Behavioral Observation Mr. He took 1hours and 30 minutes to complete the test. He was curious to know the reason of the test. He answered every question calmly. The client was given instructions according to the manual. & E is 0. The difference between the obtained and expected scores on set A. The client performance on Standard Progressive Matrices relate to his educational background and social status. Results Quantitative Analysis Positive responses P1 1 P2 8 P3 5 Total 14 Conflict responses C1 6 C2 6 C3 7 Total 19 Neutral responses N 6 Total 6 .10 The distribution of score on five sets shows that there are some discrepancies. S.These discrepancies show that client test performance is consistent and his intellectual capacity as indicated by test is valid.A was 23 years old young man. 2011 in a well-lit ventilated room in PIMH.

Item 14 showed the social attitude with his past school life as it was good that showed that the client was happy in the past but now a days he lose his mental health. He was really upset at his problems and felt regrets over his attitude. Item no 30 showed conflicts related to his related habit of drug addiction. Character Traits Some items showed his character traits for example items 1. . Social and Sexual Attitude The items showed by items 14 and 19 the conflict related to the social conflicts. Item no 9 showed conflicts related to his habit of drug addiction. he had to face the persuasion hate of family members. General Attitude Some items showed the conflict related to his general attitude.11 %age 35% %age 50% %age 15% Raw Score 126 Qualitative Analysis Familial Attitude Cut off Score 135 Remarks Normal There are some items like 2 and 30 showed the conflict related to the familial attitude. Item no 2 showed his conflict that due to his problem of drug addiction. These items showed the conflict related to his family and his habit of drug addiction. 18 and 32. For example items showed general attitude are 5 and 9. He was really upset at his problems. he had to face the persuasion hate of family members. Item no 5 showed his conflict that due to his problem of drug addiction. Item 19 showed conflicts related to the people as they scourge and hat him as he was addicted.

A was 23 years old young man. The client was sitting on a chair and instructions were given according to manual. After the some motivation given to him he was agreed to complete the test. He was thoughtful and suspicious by his gestures. The room was free of distractions. Item 32 showed his character trait related to his worries. He was curious to know the reason of the test. S. However. He was bored to hear about the test. He was anxious about test why it was so lengthy. He took 1hours and 30 minutes to complete the test. DIAGNOSTIC ASSESSMENT Minnesota Multiphase Personality Inventory (MMPI) Behavioral Observation Mr. had worries and his nerves were weak and he was may be target to stress and anxiety. The client was given instructions according to the manual. Item 18 showed his character trait related to his nerves as they were weak. he showed some conflicts related to his familial attitude as conflicts related to his family’s persuasion over his drug addicted behavior He also showed conflict related to social and sexual attitude as people showed hate to him. 2011 in a well-lit ventilated room in PIMH. The time taken by the client was considerably more than the normal subjects. General traits showed by him as he.12 Item 1 showed his characteristic related to his extrovert traits of personality as he likes to meet people and have their company. Test Administration The MMPI was administered on April 13. He answered every question calmly. He made a good cooperation in spite of his boredom. Summary The client score indicated that he is normal as his score as 126 below from cutoff score of 135. Quantitative Analysis .

entirely perfectionist view of himself. High score in this range is indicative of individuals who may be malingering. The score is also associated with the self confidence and willingness to admit minor faults and shortcomings. may be quite resistant to testing procedure or may be clearly psychotic by the usual criteria. ineffectiveness in dealing with problems of daily life. Low score is also seemed in unconventional normal people. self dissatisfaction. The client raw score is 4 and T score is 43 on this scale which is low score. It suggests whether or not an individual is presenting. exaggerating problems as a plea for help.13 Scales ? L F K 1-Hs 2-D 3-Hy 4-Pd 5-Mf 6-Pa 7-Pt 8-Sc 9-Ma 0-Si Raw Scores 22 4 16 09 20 33 24 39 19 24 33 26 30 30 T-Score 22 43 64 40 60 71* 59 88* 33 76* 72* 51 72* 48 Validity Scales L Scale The L scale encompasses 15 items and detects a deliberate and rather unsophisticated attempt on the part of the individual to present him in a favorable light. F Scale The F scale comprises of 64 items and identifies deviant or a typical ways of responding to the test items. either consciously or unconsciously. showing . Low K scores may be allied with faking bad profile. exaggerating symptoms as a plea for help. K Scale The client scored a raw score of 9 and T score of 40. critical towards self and others. The client obtained a raw score of 16 and T score of 64.

rebellious. and behaviors and suspicious about motivation of other people. Clinical Scales Depression (D-2) The 60 items in scale cover a wide array of behaviors and deals with psychotic symptoms. In Freudian terms. Carson (1969) suggested that a cut off score of +11 yields a more accurate identification of fake bad profile rather than 9. are unable to form close relationships. have difficulties in . (F-K) Gough (1950) suggested a method of invalidity by taking disparity of raw F and K scores and his difference could serve as a useful index for detecting fake bad profile. shy. The symptoms showed physical complaints weakness. People with high Pd score. It indicated that if the score is greater than +9 or less than -9 than the individual was either faking bad or faking good. The differences of raw F and raw K scores of the client are +7. Positive may point out that the client may be psychotic or severely disturbed. alienated and has strong disliking for rules and regulations. High scores described as introverted. showing that he has cold relationship with family and society. timed and secretive. ? Scale The question score is a validity covering of the total number of items put in the “Cannot Say” category. and impulsive. fatigue and loss of energy.14 little insight into own motives. The client did make use of cannot scale and it indicates that he has responded to all except 22. It is termed as high elevation. Psychotic Deviate (Pd-4) The prominent elevations of the scores appear on Scale-Pd where in the client has received the raw scores of 39 with corresponding T-score of 74. This can be supported by his case history that he is having symptoms of auditory hallucinations. these are individuals with little or no effective super ego they have been unable to incorporate the standards of society into their own consciences. A life style characterized by withdrawal and lack of intimate involvement with other people is common. angry. The client scored raw score of 33 and a T score of 71 which indicates depressed and blue. He is indecisive.

Two Point Codes 46/64 Patients with this 46/64 code are hostile. The client may be sensitive to what others think about him. The client may be moderately depressed. 33. and have severe problems with adjustment. The client may be immature and unrealistic. and other activities. The client may have a narrow range of interest and has limited intellectual ability. Such acts. and they may act out in distrustful ways. The world is seen as rejecting place. The client scored a raw score of 24 and T-score of 76. and socially isolated. aggressive and vigorous. hobbies. 59. but without the feelings of responsibility that are typically projected onto others. These individuals can be insecure. Paranoia (Pa-6) This scale consists of 60 items and deals with paranoid symptoms. The client may not interact well socially. as well as depressive feelings. They accept the little responsibilities for their own behavior and they rationalize excessively blaming their difficulties on other people. 5. The client may lack of self confidence. show poor judgment. 9 and 0 is 59. People may have delusions of reference. and 48 respectively which falls in the moderate range. The client has masculine preferences in work. Their behavior can be irritable and unpredictable. act impulsively and demonstrate egocentric tendencies. grandeur or persecution. Such patients are often angry or fearful and may plot revenge on others. The client may be tough. socially withdrawn. immature and emotionally distant. Other Scales The client’s score on scales 3. High score on scale 6 (Pa) suggests suspiciousness and over sensitivity and may indicate paranoid delusions. . They may be dangerous to others or even to themselves as a result. He may be reserved and timid. The client may report chronic fatigue and physical exhaustion. however are generally poor planned and impulsive. 6.15 marriage and work. and be vicious. anxious and tense.

After the some motivation given to him he was agreed to complete the test. The room was free of distractions. obtained error Score and difference between the expected error scores and obtained error scores according to the pre-calculated norms of administration “A” and remarks. The client was given instructions according to the manual.A was 23 years old young man. He took 1hours and 30 minutes to complete the test. Test Administration The BGT was administered on April 13. S. He was curious to know the reason of the test. He was anxious about test why it was so lengthy. according to age range of 15-49 years. He answered every question calmly. He was thoughtful and suspicious by his gestures. BVRT Scores on assessment Showing the expected Correct Scores. Age 21 Expected IQ 95-109 No of expected No of obtained Differen category correct score 9 correct score 8 ce 1 Average Remark s As Expected BVRT Scores on assessment Showing the expected error Scores. obtained Correct Score and difference between the expected correct scores and obtained correct scores according to the pre-calculated norms of administration “A” and remarks. according to age range of 15-49 years. 2011 in a well-lit ventilated room in PIMH. The time taken by the client was considerably more than the normal subjects. The client was sitting on a chair and instructions were given according to manual. He made a good cooperation in spite of his boredom.16 NEUROPSYCHOLOGICAL ASSESSMENT Benton Visual Retention Test Behavioral Observation Mr. Age Expected IQ No of expected No of obtained Differen categor error score error score ce y Remarks . estimate IQ. He was bored to hear about the test. estimate IQ.

The qualitative analysis showed that the client did not show any kind of error and fall in the category of none defective.17 21 95 -104 5 2 3 High Average Qualitative Analysis: The qualitative analysis showed that the subject obtained correct score was 8 which was dissimilar to the expected correct score with an Average IQ.90 Alcoholic Dependence Left 2 1 -----Right 1 ------Total 3 1 -----As Expected . visual memory. visual memory. It also provides an estimation of her IQ which is within the range of 95 . TENTATIVE DIAGNOSIS USING DSM-IV-TR Axis I 303. and visual perception skills were normal. 0Table 5: BVRT Scores on assessment Table 5 is showing the number of error according to the error category. Thus the differences between errors score 0. The subject’s score on BVRT indicated that he falls in Average category that suggests satisfactory visual retention. there was a change in his condition so it also showed by the scores that he did not show any kind of error. and visual perception. which indicate that the subject has no problem in visual retention. His visual construction skills. An analysis of the subject quantitative results further indicates that his number of obtained error score was 2 and the expected error score was 2. Due to his therapy and medication. Error Omission Distortions Perseveration Rotations Misplacement Size error Total Summary: The Benton visual retention test was used to assess the neurological functions of the client.105 categorized him as mentally High Average. The test assessed visual construction skills.

His speech and communication was appropriate though at some points he showed some pauses. CASE FORMULATION: The client was 21 years old single male with the education up to metic with the complaints of alcoholic dependency. He showed full co-operation in first meeting. Repeated episodes of Substance Intoxication are almost invariably prominent features of Substance Abuse or Dependence. neat and clean. He maintained proper eye contact and appropriate posture in all sessions.g “social” drinking) and from the use of medications for appropriate medical purposes. If the symptoms are judged to be a direct physiological consequence of a general medical . His . However. He appeared to be friendly and cooperative.09 No diagnosis None problems related to the social environment (influence of GAF= 31-40 (current) DIFERENTIAL DIAGNOSIS Substance disorder is distinguished from non nonpathalogical substance use (e. PROGNOSIS The client’s prognosis was promising and good because he appeared to be very motivated and showed full co-operation. He wanted to get relief as soon as possible and wanted to start a new life and has plan to get further education and then getting married. the appropriate Mental Disorder Due to a General Medical Condition should be diagnosed. one or more episodes of Intoxication are not sufficient for a diagnosis of either Substance Dependence or Abuse.18 Axis II Axis III Axis IV friends) Axis V V 71. The client was well dressed. so it seems to be have good insight to some extent.

Such adolescent drinkers are also more apt to underestimate the effects of drinking and to make judgment errors. 40 percent of 10th graders. 10th. 25 percent of 10th graders. gender. the RISB was administered on the client to assess his personality. MSE. person and place. and parental drug abuse history. MMPI was used to assess diagnostic/screening criteria for assessment and for intellectual functioning SPM was used. He also reported loss of energy. and 12th grades. . and to evaluate the personality of the client. 26 percent of 8th graders. family violence. The clients history suggested that the leading predisposing factors of his alcoholaddiction was his age. fluent and coherent.to fifteenyear-olds are at high risk to begin drinking. case history interview. Many researches indicate that the age is a common factor of drug abuse. (1995) results of an annual survey of students in 8th. and 30 percent of 12th graders. depression. For this kind of behavior society and peers group have strong impact. He explained his problems and history in detail and emphasized a lot on his friend’s role in his that current condition. He did not report any memory problem but reported lack of concentration in his school time and during job. and stressful life events. Binge drinking at least once during the 2 weeks before the survey was reported by 16 percent of 8th graders. He was overall well aware and well oriented with time. As the case. He was well aware that he has some problem and was ill and here to seek for psychological help and treatment so he cooperates in all things. People with a family history of alcoholism are also more likely to begin drinking before the age of 20 and to become alcoholic. As the child reaches in the adolescence he involved in such drug abusing behavior starting from smoking and taking beverages.19 speech was clear. and 51 percent of 12th graders reported drinking alcohol within the past month . But he wanted to get rid off from this situation as soon as possible. with client he belonged to an upper class family and had peer relationships with such guys whom are also belonged to upper class family and in the habit of drug abuse. According to Johnston. fatigue and stiffness of body and neck repeatedly. Young people at highest risk for early drinking are those with a history of abuse. BVRT used to assess the client’s neuropsychological functioning. such as going on binges or driving after drinking. Thirteen.

. Heath et al. 2003. Tomsen... Miller et al. 2003. Torgersen. particularly in large quantities. Makela et al. the greater the risk of abusive consumption and the development of serious problems. Men are much more likely than women to report diagnosable alcohol abuse. currently (e. 2004. Meyer et al. Yamamoto et al.. Men are also much more likely than women to report diagnosable alcohol dependence. 2002. clients gender is also a contributing factor of his problem. 2001). 2004.. Hasin & Grant. 1972). Dawson. Kringlen. Many researches indicate that the alcohol abuse is more common in males as compared with females.. Nghe. Evidence suggests that the earlier the age at which young people take their first drink of alcohol. surveys in many countries find that men are more than twice as likely as women to have alcohol use disorders.g. either currently (e.. & Stinson.g. A potentially powerful predictor of progression to alcohol-related harm is age at first use.. 2003). 2004. Kawakami et al. 2003. 1992). Janghorbani et al. 2001. 1997). The most common hypotheses to explain why men and women differ in their drinking behavior argue that alcohol consumption both symbolizes and enhances men's greater power relative to women (McClelland et al.. of at least 60 grams of ethanol in a day) (e.. ).. & Jaffe. 2000). 2003) or as a lifetime experience (Dawson & Grant. 2001. even when it leads to violence (Graham & Wells. & Lowe. 1995). surveys in many different populations consistently find that men are more than twice as likely as women to report heavy episodic drinking (or "binge" drinking.. Bijl et al. 2001. Mahalik. 2004. At the other extreme.. 1998. Bijl et al.20 than young drinkers without a family history of alcoholism. Hao et al. has been an emblem of male superiority. Malyutina et al. Spicer et al. this may encourage male drinkers to deny or minimize problems resulting from their drinking... including alcohol disorders (Chou & Pickering. Rehm et al.. Hao et al. Drinking is associated with displays of masculinity or male camaraderie. 2000.g. Rahav. 1993) or as a lifetime experience (Kawakami et al. Recurrent alcohol intoxication is much more prevalent and more frequent among men than among women (Hao et al. 2004.. Consistent with gender differences in heavy drinking. a privilege that men have often . & Cramer. Kawakami et al. 2000). 2004. Neumark. 2004. 2003. or to regard drunken behavior as normal or permissible (Capraro. 2004. Alcohol consumption. Meyer et al. Nayak. (Hingson & Heeren 2006). Welte et al. 2002.. 2004. Grant. 1997. 2001. Hunt & Laidler. As the age was concerned with onset of the clients alcohol abuse.

1994. who have identical genes. Nicolaides. Wang et al. If there is a genetic component in the risk for alcoholism. friends and availability of drug are main contributing factors in adolescence. Fraternal twins. According to the client. 1999). 2001. 1991). Researchers investigate possible genetic components of alcoholism by studying populations and families as well as genetic. 1996. 2000). 1992. The client also started to take drinks with them. The clients reported that his father has many friends at the race course club and he used to take drinks with them. his father was also a regular drinker. The client reported that he has many friends and all of them are alcohol users. Twin studies compare the incidence of alcoholism in identical twins with the incidence of alcoholism in fraternal twins (Hrubec. 2001. The idea that alcoholism runs in families is an ancient one. Purcell. 1988). Willis. Two major methods of investigating the inheritance of alcoholism are studies of twins and of adoptees (Pikens & sivkis. then identical twins.21 reserved for themselves and denied to women (Martin. Alcohol use continues to be an important . 1979). The third underlining factor of clients alcohol abuse was the genetically related to his problems. researchers using the twin method have found these expectations to be true. Social factors such as peers. studies documented that alcoholism does run in families (Goldwin & Cotton. 1990 and Mcgue. 1981 & Pikens. 1986). The precipitating factors of clients alcohol abuse are his social circle. Suggs. The genetic factor always played a significant role in developing psychological problems. and neurobehavioral markers and characteristics (Cloninger. would be more likely to differ in their tendencies to develop alcoholism. biochemical. In recent decades. friends and peer. 1944 and Goldman.. Alcohol consumption in allmale groups may affirm the privileged status of being a man rather than a woman (Campbell. would be expected to exhibit similar histories of developing alcoholism (or not developing alcoholism). science has advanced this idea from the status of folk-observation to systematic investigation (Roe. In general. who are genetically different individuals born at the same time. Many investigations showed that the genetic predisposition is related to the developing psychological problems later in the children. The researches indicate strong association in drug abuse and social influence. 1996. In the 1970s. 1991).

1977. 62% of 10th graders. and 40% of college students reported heavy episodic drinking. Research indicates that social influences to drink stem from both the initial selection of friends (i. modeling. The social environment selection have great role in developing alcohol abusive behavior.22 public health problem.. Although social influences typically have been conceptualized as directly shaping drinking behaviors in adolescents. perceived drinking norms. Selection of social environments that are conducive to drinking may play an important role in alcohol use and problems (Britt & Campbell. 1999). Psychosocial factors play a key role in the onset and developmental progression of alcohol use. 1987. but they also select the environments to which they are exposed. Adolescent drinking has been associated with alcohol-using peers in predominantly white samples (e. According to the clients the social environment in which is living is highly suggestive of such behaviors. 2000) and may account. 2000). These include social influences from parents and peers. and positive expectancies. Moreover. Hallak. 1986. for the effects on alcohol use of . research has shown that social influences to drink outranked cognitive and behavioral factors in predicting initial involvement with alcohol longitudinally (Ellickson and Hays. 22% of 10th graders. 25% onf12th graders. Kandel... imitation. According to Social learning theory (Bandura. it is likely that individuals are not passive recipients of environmental influences and that the association between environment and drinking behavior is reciprocal rather than unidirectional. that is. and social reinforcement. and 85% of college students have used alcohol (Johnston et al. in part. 1991). 73% of 12th graders. 1977) provides a useful theoretical framework for understanding the role of social influences.g. 2007). choosing friends) and the subsequent maintenance of friendships with positive reinforcement and other rewards (Windle. Recent national survey data indicate that 41% of current 8th graders. Sieving et al. suggesting that adolescent alcohol use is a learned behavior acquired through a process of observation. Peers and friends also exert a potentially powerful social influence on adolescent drinking behavior.e. Maddock. individuals are affected by social environments. Kandel and Andrews.. Even more troubling is that 11% of 8th graders. Wood. & Stevenson. Mitchell.

chosen as a result of the particular sociodemographic. Searles. 1996. 1995). The maintaining factor of clients alcohol abuse is his motivation for drinking. The clients reported that he had a great desire for taking alcohol.. Applications of motivational theory to drinking behavior have consistently supported the importance of motivational factors in alcohol use across adult (e. 1988). Wechsler. Legrand. many have stressed the role of specific motives for drinking in this population (Carey & Correia. He reported that the he used to drink to avoid his problems such as to forget his beloved response and his conflict with his mother. 2000. & Pattison. McGue. it is the only way to cope with his problems. Evidence from both the genetic and the social psychological literature suggests that individuals may present to a social environment with specific (possibly heritable) individual risk factors. Abbey. 1997. 1995. these selected environments may support and enhance predispositions to certain behavioral outcomes. MacLean & Lecci. 1999. 1995).. an environmental selection perspective suggests that dispositional or static characteristics may influence behaviors directly and indirectly by affecting the types of environments to which one “chooses” to be exposed (Robins. 1993. & Castillo. & Barnes. Baer & Carney. Fromme & Ruela. 1994. A large body of research on the etiology of adolescence drinking has identified social and psychological correlates of alcohol use and misuse (e. in fact. Furthermore. Carpenter & Hasin. or other types of characteristics of the individual who selects them (Robins et al. 2001. Davenport.. . Searles.g. personality. & Iacono. Within this interactive framework. Fitzgerald & Zucker. & Scott. adolescent (Bradizza. 1999.g. Stewart & Zeitlin. Reifman. 1993. Smith. He reported that he was unable to give up the drinking behavior. 2001). Dowdall. Elliott. Maisto. Carey. According to Motivational models assert that an individual’s reasons for engaging in a behavior are important in both the initiation and perpetuation of that behavior. & Bradizza. As a result. Recent work in the area of social network models of behavior points to evidence that social networks are. Researches indicate that the individual motivations plays important role in maintenance of alcohol abusive behavior. which may interact with the environment to result in increased alcohol consumption (e.23 certain demographic and personality characteristics that may influence social selection. 1988). 1998). 1999.g.. Karwacki & Bradley.

and each was linked to distinct emotion and expectancy antecedents. drinking to cope with negative emotion). such as alcohol outcome expectancies (i. Using structural equation modeling procedures. sensation seeking. Coping motives for alcohol consumption are presumed to operate on the principle of negative reinforcement and involve drinking to ameliorate negative emotions or to make . and Mudar (1995) proposed and tested a motivational model of drinking that was consistent with Cox and Klinger’s theoretical model. Jackson. 1996). intervening role in the relationship between more distal psychosocial factors. social enhancement and tension reduction). 1984) populations. However. Kassel. enhancement motives mediated the associations of sensation seeking and enhancement expectancies with alcohol involvement.. Different types of drinking motives have been delineated. Cox and Klinger posited a theoretical model of drinking motives that took into account the interplay between these motives and specific psychosocial antecedents. enhancement motives and coping motives were associated with alcohol use.e. These authors hypothesized that factors such as mood and mood-relevant expectancies contributed to the motivation to drink alcohol. playing a critical role in the determination of alcohol use..24 Windle. Frone. 2000. and college (Carey & Correia. drinking motives have been categorized according to affective dimensions (e.g. In 1988. coping style. Cooper. they tested whether distinct motives (enhancement and coping) were associated with alcohol involvement and whether they played a central. Strong empirical support for this model was demonstrated in cross-sectional samples of both adolescents and adults. Ratliff & Burkhart. and negative emotion. Most commonly. and coping motives mediated the associations of negative emotion and tension reduction expectancies with alcohol involvement. drinking to enhance or stimulate positive emotion. Furthermore. motives pertaining to social factors (social reinforcement) also have been thought to be important in understanding drinking behavior. 1997. Russell. & Unrod.

MacLean. 1997. Khavari. Psycho education to be done to his help the patient to understand the nature causes of illness. mode of treatment and his cooperative attitude in treatment. • Activity scheduling to be used to provide him structured and organized day by developing purposeful activities.. older adolescents or college students. Kassel et al. • Cost benefits analysis to be used to enhance his awareness about the advantages and disadvantages of drug use. Russell. Several studies of coping motives and alcohol involvement in college samples have suggested that drinking to cope is a particular risk factor for alcohol problems (Carey & Correia. . Frone. 2000. some evidence suggests that coping motives may affect alcohol misuse less strongly in drinkers for whom heavy alcohol use is more normative (i. MANAGEMENT PLAN • • • • • Psycho education Supportive Therapy Behavior Therapy Cognitive Therapy Family Therapy Short Term Goals • • Supportive work to be done to develop rapport and trust in patient. 1987.However. & Koutsky. 1999.e.25 such emotions more tolerable (Abrams & Niaura. 1992. Perkins. & Douglass. & Mudar. 1999).. 1999). • Relaxation techniques to be taught help him to overcome his angry feelings.. Collins. 1980). calm down and to respond appropriately to angry feelings when they occur. Farber. Cooper. Morsheimer. • Assertive training to be done to teach him to express his angry feelings in a direct and non confrontational manner. Bradizza et al. Skinner.

• To come to an awareness and acceptance of angry feeling while developing better control and more serenity. • To become capable of handling angry feelings in constructive ways that enhances daily functioning. • Establish firm individual self-boundaries and improved self worth. pleasurable and purposeful activities. • • Distraction techniques to be used to reduce craving. Assisting the client in restructuring his irrational beliefs by reviewing reality based evidence and misinterpretation. .26 • ABC model to be taught to explain the client his way of thinking and its emotional behavioral consequences. • Rational coping statements and encouraging phrases consistent with social reality to be used to reinforce the idea for him. • Problem solving skills to be taught to deal with his problems positively rather than depending on drugs. • Disputing to be used to help him to identify and debate his rigid and inflexible beliefs regarding drug addiction. • Mastery pleasure technique to be used to give him a sense of achievement by scheduling potentially. To decrease overall intensity and frequency of angry feelings and to increase se the ability to recognize and appropriately express angry feelings as they occur. Long Term Goals • • Regular follow up sessions. • Self management skills to be taught to enable him to modify his own life in relation to substance use.

There are several steps involved in psychoeducation. • To achieve reasonable level of family connectedness and harmony where numbers support. • To maintain consistent employment and demonstrate financial and emotional responsibility.27 • • Break away permanently from any abusive relationship. • To accept responsibility for own behavior and keep behavior with in the acceptable limits of the rules of society. Psychoeducation was first developed by Brain E. • To improve method of relating to the world especially authority figures. It consists of giving patients and other relative’s adequate knowledge about disorder and teaching illness self management skills so that people have a better understanding of their of their illness and its treatment. the rights for others and need for honesty. To decrease the present conflicts parents and siblings while beginning to let go or resolving past conflicts with them. It takes place in one-on-one discussion or in groups by any qualified health educator as well as health professionals. less defiant and more socially sensitive. Psychoeducation refers to the education offered to people who live with the psychological disturbance. 2005). • To develop and demonstrate a healthy sense of respect for suicidal norms. Therapeutic Techniques to Obtain Short Term Goals There are following therapies which will help in the treatment of the client Psychoeducation Psychoeducation can be beneficial in the treatment of patients who take drugs and alcohol (Tracey. help and concerned for each other. To focus thoughts on reality. Tomlinson in 1962. • • To increase goal directed behaviors. behave realistic. It involves first level partial .

28 objectives and second level partial objectives. problem solving skill and reinforcement. patient and his family is educated and given awareness about disorder. 2005). early detections of warning symptoms and adherence with treatment. adaptive skills and psychological functions (Tracey. It will beneficial for the client by reinforcing the patient’s healthy and adaptive patterns of thought behaviors in order to reduce the conflicts. activity scheduling. the client is expected to react negatively to the substance itself and to lose his craving for it. patient and family is asked to improve social and interpersonal activity between episodes and increasing well being and improving the quality of life. achieving regularity in life style and preventing suicidal behavior. At first level (elemental mechanisms). It includes aversion therapy. restore or improve self esteem. • Aversion Therapy Aversion therapy will be beneficial for the client by repeatedly presenting him with unpleasant stimuli while performing undesirable behaviors. . It is a dyadic treatment characterized by use of direct measures to ameliorate symptoms and to maintain. Behavioral Therapies Behavioral therapy will be beneficial for the client as it aims to identify and change aspects of behavior that may be implicated in the cause and maintenance of drug addiction. triggers of symptoms and treatment strategies. Supportive Therapy Supportive psychotherapy is an eclectic approach that integrates psychodynamic and cognitive-behavioral model and techniques. expected time course. pleasure and mastery technique. the patient and family is educated about controlling stress. After repeated pairings. covert sensitization. At second level (secondary mechanisms). Psychoeducation will be beneficial for the client by learning about the symptoms of drug addiction. It will help him and his family to know about the causes of the problems solving skills to better assist the client and his family in dealing with possible manifestations of the illness and thus promote improved outcome. assertive training. It will be beneficial for the client especially in the interpersonal context. At third level.

• Twelve Steps Paradigm There are twelve steps that are developed for addiction. repulsive and frightening scenes when he is taking drug. . The unpleasant feelings or sensations will become associated with that behavior (Turner. & Adams. • Motivational Enhancement Therapy Motivational Enhancement Therapy s designed to produce rapid. 1987).  We admitted we were powerless over alcohol in that our lives had become unmanageable. • Covert Sensitization Covert sensitization can be used for the client and in this therapy the target behaviors and aversive stimulus are associated completely in imagination (Turner. It will be beneficial. Calhoun. & Adams. It will be beneficial for him by encouraging positive behavior change such as abstinence by providing punitive measures when engaged in undesirable behavior.29 The client can be shocked or made nauseas while looking and reaching for a drug. It will require the client to imagine extremely upsetting. It will beneficial for the client by enhancing his motivation level to change his condition. • Contingency Management Therapy A contingency contract is a written agreement between a client and one or other people that specifies the relationship between a target behavior and its consequences (Turne. 1987). internally motivated change this treatment strategy does not attempt to guide and train the client step by step through recovery but instead employs motivational strategies to mobilize client’s own resources. for the client. & Adams. 1987). Calhoun. The idea of a twelve steps group is that each of the member rows to believe and then live through deeds each of the twelve steps. Calhoun.

1997).  Continued to take moral inventory and when we are wrong promptly admitted it.  Admitted to God. . and to another human being the exact nature of • Activity Scheduling Activity schedule can be used to keep precise and accurate record of the client’s activity so that frequency of all the behaviors is fare duly recorded.  Made a list of all persons we had harmed and became willing to make amends to them all.  Made a decision to turn our will and our lives over to the care of God as we understood him.  Sought through prayer and meditation to improve our conscious contact with God as we understood Him. and to practice these principles in all our affairs (Finley. to ourselves our wrongs  Were entirely ready to have God remove all of these defects of character. Those behaviors that need change/ modification can systematically taper off by exchanging them with desirable ones (Ellis & Dryden.  Made direct amends to such people wherever possible except when doing so would injure them or others. 2004).  Humbly asked him to remove our shortcomings.  Made a searching and fearless moral inventory of ourselves. praying only for knowledge of His will for us and the power to carry that out.  Having had a spiritual awakening as a result of these steps.30  Came to believe that a power greater than our selves could restore us to sanity. we tried to carry this message to alcoholics.

During the third stage. Problem solving technique serves a dual purpose by treating the immediate problems for which the client seeks treatment and preparing the client to deal on their own future problems and it teaches problem solving skills as a general coping strategy for dealing with problems that arise in course of daily life. defining the problem and setting goals. In early stages.31 • Assertive Training It can be helpful for the client by increasing his ability to communicate effectively with people and being able to express needs and feelings in a direct and non confrontational manner. • Problem Solving Skills Problem solving therapy was originally developed by Zurilla and Goldfried. 1998). Tarriier & Lwis. judiciously chooses the best of these solutions and then implements and evaluates the chosen solution. the therapist may employ cognitive modeling to demonstrate the problem solving process. generating alternative solutions. The basic stages of problem solving therapy include adopting a problem solving orientation. Problem solving refers to a systematic process by which a person generates a variety of potentially effective solutions to a problem. In learning to resist social pressure to take drugs.. the therapist prompts the client is facilitated with . relaxation training and stress management training along with bio feedback and a better diet can all help the client. • Behavioral Self Control The client can be taught ways to resist craving in situation where drug is available. deciding on the best solution implementing the solution and evaluating its effect. It will enhance his well being by learning how to meet others. give and receive criticism. talk to them. maintain eye contact. He will gain confidence and will share his feelings with others in order to clarify them and to gain insight as to causes. express feelings and improve his relationships with other people (Wykes. It will encourage the client in taking part in social activities.

It will help him to identify and correct his distorted and negatively biased thoughts. he can be trained in how to behave effectively in frustrating. • Progressive Muscle Relaxation Technique Progressive muscle relaxation is a technique for reducing anxiety by altering tensing and relaxing. by means of role-playing and role rehearsal. & Lewis. 1994). gestures. With the eyes closed. & Lewis. 1998). balanced voice tone (as the client is a stammered). The client may start by sitting or lying down in a comfortable position.32 behavior therapy procedures ( Wykes. It will encourage him to reframe the way he thinks about life. It will be beneficial for the client. socially inept behaviors and problems forming close interpersonal relationships. 1998). It will be beneficial for the client by teaching him how to deal with problems in life effectively. to be able to bounce back from failures more effectively and to recognize and take credit for the good . the muscles are tensed (10 seconds) and relaxed (20 seconds) sequentially through various parts of the body. Thus. The client lacks this skills to an extent that he has cold relationship with father and eldest brother. Tarrier. It will be useful for the client by reducing anxiety by alternately tensing and relaxing muscles. and improved in notion. Tarrier. In social skills training. eye contact. • Social Skills Training Social skills training are another technique that has its origin in social learning theory ( Bellack & Muen. the client can be taught conversational skills . distressing and threatening situations. It helps in decreasing symptoms and increases the adjustments. The whole PMR session takes approximately 30 minutes ( Wykes. The problems that can be targeted with this are the interpersonal inappropriate communication patterns. Cognitive Therapies Cognitive therapy will be beneficial for the client by altering maladaptive thought patterns.

33 things in his life. debate. and ultimately replace their rigid. logical and philosophical disputing. Functional disputing is used to question the practical application of the patient’s belief and their accompanying emotions and behaviors. • Rational Emotive Behavior Therapy Rational emotive behavior therapy is a comprehensive. Empirical disputing is used to evaluate the factual components of the clien t’s beliefs and to test the specific beliefs are consistent with social reality or not. logical disputing is focused on questioning the illogical leap the client is making from desires or preferences to demands in his irrational thinking. It includes rational emotive behavioral therapy. It allows the patients to identify. The task with an empirical dispute is to help the client to understand that he has been holding onto a belief which is insupportable and when questioned does not make sense. • Rational Coping Statements . It will help the client in evaluating the helpfulness and efficacy of his belief system and to change his irrational beliefs. Disputing can be at four levels including functional. empirical. Philosophical disputing address a life satisfaction issue. philosophically and empirically developed by Albert Ellis based psychotherapy which focuses on resolving emotional and behavioral problems and disturbances and enables people to lead happier and more fulfilling lives. It includes • Disputing Disputing is an active approach developed by Albert Ellis for helping clients to evaluate the helpfulness and efficacy of elements of their belief system (Dryden. 2003). It can be useful for the client by giving him awareness that behaviors and emotions are the result of what the person thinks about himself. The therapist systematically shows client how much they potentially have to gain from working at replacing the irrational beliefs with their more flexible and realistic rational beliefs. He will think that he has control over what happens to him. inflexible beliefs which are generally getting them into trouble.

The client can be asked to write down the positives and negatives or pros and cons of this habit and then choose what should be adopted or not by taking the decision (By Joseph Danish) • Cognitive Behavioral Therapy CBT was developed by Aaron T Beck and is psychotherapeutic technique that aims to solve problems regarding dysfunctional emotions. These factual. It includes • Double Column Technique Recoding cognitions and responses in parallel columns is a way to begin examining. It will help the client to repeat coping statements to reinforce idea for him. by brainstorming solutions with the client for problematic situations (Ellis & Dryden. It can be used for the betterment of the client. It will be beneficial for the client by reviewing potentially provocative thoughts and experiences which may contribute to relapse impulses. evaluating and modifying the cognitions. The written assignment may also include . 1997). and cognitions through a goal oriented systematic procedure. • Relapse Prevention Relapse prevention is a systematic method for teaching recovering patients to recognize and manage warning signs. • Referenting Refrenting can be executed to get the client rid of the chain smoking (including tobacco and charas-cannabis). 20033). The patient is instructed to write his cognitions. encouraging phrases are consistent with social reality and clients are encouraged to repeat them consistently to reinforce idea for them (Dryden.34 Rational coping statements are self statements which usually are implemented after forceful disputing has been accomplished but can also be used while the client is in the process of exploring his irrational beliefs. The patient is instructed to write his cognitions in one column and then write a reasonable response to the cognitions in the next column.

triple column and even the quadruple column. The therapist’s goal is to increase the patient’s objectively about his cognitions and unpleasant affect unproductive behavior (Beck. Wright. It will be beneficial for the client and he will begin examine. 1195). & Liese. Asking what a thought means to the patient often elicits an intermediate belief and usually uncovers the core belief (Beck. The therapist’s major task is to help the patient think of reasonable response to the negative cognitions.35 additional columns for describing the patient’s affect and behavior and the specific description of the situation or event which preceded the cognition. • Downward Arrow Technique The downward arrow technique is used to identify intermediate beliefs. He continues to do so until he has uncovered one or more important beliefs. It will be beneficial for the client in order to find out a core belief. The therapist identifies a key automatic thought which he suspects directly stemming from a dysfunctional belief then he ask the patent meaning of the cognition assuming the automatic thoughts were true. 1993). evaluate and modify his maladaptive cognitions. The rationale for the approach is to teach the patient more precise discriminations of his emotions and thoughts. Newmsn. Thus depending on the number of columns used the technique may be referred to as the double column. Specific Techniques for Craving There are some techniques used to reduce the aroused cravings and it includes: • • • • Distraction technique Flashcards Imagery technique Rational responding to urge related automatic thoughts Distraction Technique .

it will be beneficial for the client. image rehearsal and image mastery. relative or to the therapist. Generating coping statements can be helpful in getting patients through this critical period. Newmwn & Leises. Wright. The statements include d are “You feel more sane you do not use.36 The key goal of distraction techniques is to get patients to change their focus of attention from internal such as automatic thoughts. Another imagery technique is negative image replacement. memories and physical sensation to external. keep it that way”. 3) Patients can remove themselves from the cue laden environment. Refocusing is essentially a distraction technique. This image will be strong enough to dissuade them from taking the first drink. (Beck. It is helpful for patients to substitute a negative image regarding the many unfortunate consequences of taking the drug such as feeling helpless and hopeless. 4) Perform household chores as a positive distraction. This goal directed activity not only diminish their cravings but also enhances self esteem. The more they can focus and give details about external events. These techniques are quite simple but they help to diminish cravings. Neqwman. Positive image replacement is a related technique to help cope with cravings and urges the patients imagined themselves . Imagery Techniques Imagery techniques can be useful in the reduction of craving and these include image refocusing. It will be beneficial for the client in reducing his cravings. the more likely they are to focus less on the internal cravings.” “You look good physically. The usefulness of the coping statements can be enhanced by asking patients to write these statements on flashcards (3*5 index cards). 5) Encourage patient to recite a favorite poem or prayer (Beck. 1993). Wright. & Liese. Flashcards When cravings are strong patients seem to lose the ability to reason objectively. Refocusing can begin first by saying stop. 1993). negative image replacement. positive image replacement. There ere some steps involved: 1) Instruct patients to concentrate their attention on describe surroundings. Patients direct their attention away from internal cravings by imaging external events. 2) Talking can also b used as distraction and this involves starting a conversation with a friend.

Wright. Family Therapy Family therapy usually involves the whole family. It will be useful in the reduction of the craving of the client. . & Lieese. His father has a very complaining attitude towards the client. It is helpful to have patients carry a therapy notepad and a pen in order to write down these thoughts. Rational Responding to Urge-Related Automatic Thoughts Therapists start by training patients to self monitor automatic thoughts when they are having unpleasant emotions such as anger. Wright. Newman. 1993)). Later the patients are instructed how to assess their automatic thoughts while experiencing cravings and urges. The client’s parents and siblings can be involved in the rehabilitation process of the client. They are instructed to note any physiological distress and then write down their answers. 1993). It will be beneficial for the client to diminish his cravings. The family should be educated to treat him with love and affection. sadness or boredom. & Liese. to clarify any misconception related to the problem and to guide the whole family in how to resolve the conflicts in healthy way. The daily method is used to help patients (Beck. • • Environment should be adequate enough to get full attention of the client.37 in a positive state such as going back to work and to normal routine. Newman. The aim is to educate and make them aware of the state of the client. Patients are told that any time they experience strong cravings or unpleasant emotions they should ask questions to him self. Imagery rehhearsel should be used when patients are going to be in cue laden situation (Beck. SUGGESTIONS AND LIMITATIONS • There should be an increased number of sessions to get detailed information about the client. the client has so many problems regarding the family and home life. They can be educated about the nature of his problem and how they can build an understanding and warm relationship with him to win his trust and warmth. anxiety. In the current case. This may diminish cravings.

Environment was not adequate and it was difficult to gain full attention of the client. Diagnostic and statistic Manual of Mental Bandura.38 • Helping him to learn that sharing and feelings and emotions really help him in alternating memories about stressful life events. • Family can play an important role in altering the client’s behavior doing things are in mood consequence with the client. There were some limitations that were observed • • There was limited number of sessions. NJ: Prentice Hall. 1977. References: . The information was reluctant in giving information about the client. (2000). American Psychological Association. • • Client was aggressive and become angry over small things. Social Learning Theory. Upper Saddle River. A. .

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