Suzi is a 30-year-old female who had one previous addiction treatment 5 years ago. She was able to stay sober for 1 year. Her treatment was court-ordered because of a DUI. She has come to you for counseling because she recently started drinking heavily again after a visit home over the holidays (during the previous 4 years, she says her drinking was limited to the weekends, but now she is back to daily drinking). She wants to quit drinking and using drugs again, but she wants to do it through private counseling with you rather than a formal treatment center, which she believes is a financial rip-off. She warns you that she is a loser" when it comes to sobering up, because treatment did not work for her, nor did Alcoholics Anonymous or Narcotics Anonymous, and her family has always told her she is a loser who will never be able to make anything of herself. Suzi is single and lives alone. She is the middle child of three girls and denies any family history of alcoholism. She says that when she sobered up the first time, she started to have trouble having sex with men she dated, and she had bad dreams of her father forcing her to have sex with him. She does not remember specific incidents of sexual abuse beyond her dreams. She does not have these dreams when she is drinking (her drug of choice is alcohol, although she says she has tried "everything") and reports being afraid that she will have the bad dreams again when she sobers up for a while. Suzi states that she has problems when she visits her family, which she does only on holidays, when she is sober. She says her father has a habit of French kissing her "hello" and "good-bye," which she does not mind when she is drinking, but did mind that year that she was sober. She is unable to talk at length about what happened during her last visit home over the holidays: She begins to cry uncontrollably when she is asked about it. All she can state is, This time it was more than French kissing."
As her private therapist, answer the following six questions:
1. What are the high-risk situations for Suzi in her addiction recovery?
2. What is her abstinence violation effect?
3. What positive outcome expectancies do you think may precede Suzi's initial use?
4. What may need to change in terms of her coping responses and her environment for her to stay sober?
5. How might the observer role help Suzi learn to stay sober?
6. Which counseling techniques (decision matrix, mapping, 10 common dangers, TIPS for coping) would you use in your work with this client?