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Tom's Situation
Tom is a 38-year-old factory worker who entered a treatment center after being arrested for drinking and driving. His attorney has suggested that he quit drinking and enter treatment, at least until his trial, which is scheduled in 2 months. Tom does not anticipate serving jail time, but he believes that treatment could strengthen his legal case. After his first arrest for drinking and driving 2 years ago, he simply paid a fine and attended a special driver's education program for 6 weeks. Tom found the program to be "a waste of time." Tom has been married for 10 years and has two sons aged 8 and 6 years. He has had numerous arguments with his wife, concerning his drinking. He gets very angry and defensive when she confronts him about his heavy drinking, and asserts that he is not an alcoholic. He knows this is true because his father was an alcoholic and Tom says that he is not like his father. His father died as the result of a fight that occurred in traffic when he was drunk. Tom says that his father used to "beat the tar out" of him and his brother when he was drunk, and that his father always belittled, taunted, and threatened their mother, whether he was drunk or sober. Tom's work history is very good; he misses less than 1 day per year. He works the day shift on weekdays, putting in time-and-a-half overtime on most Saturdays. He is well regarded by his supervisors and peers at work. He is fearful that his employer will find out about his treatment (it is being covered by his HMO), and that people at work will learn about the second arrest. Tom drinks with his buddies from the plant, and does not think that his drinking is any more than what they do. He was just "unlucky" and got caught doing what everyone else seems to get away with. Tom's drinking is very predictable: he drinks 8 or 9 beers on a weeknight. Several of these are consumed at the bar with friends, the remainder at home over the course of the evening. He usually falls asleep in front of the television. On weekends, he often drinks 3-4 twelve packs between Friday and Sunday. A typical Saturday involves getting up at 10:00 a.m., playing soccer with friends, and going to the bar for the rest of the day and night. This pattern leads to arguments with his wife, who calls him a "lousy father." At times, Tom has had unsettling episodes of being unable to recall what happened while drinking. He has commented to friends that "maybe I overdo it a bit." Several times, he has attempted to cut down on his drinking, especially after the last arrest. He once attended a few AA meetings, but did not feel that it was helpful: "It was listening to a lot of guys whining" and he especially did not care for the prayers. Despite these attempts, Tom has experienced increased consumption levels over the past 2 years. He admits that, as a result of the drinking, he has become increasingly estranged from his wife and sons. Tom feels that his marriage has been basically good, but that he would not blame his wife for leaving him, the way things have been going lately. She will no longer "sleep" with him while he is intoxicated, which occurs regularly. She complains that the house is "falling apart" because he does not keep up with his chores. He believes that his marriage would become solid again if he stopped overdoing the drinking. Tom is not close to his remaining family members. His mother is very religious and wishes Tom would see religion as a way out of his problems. His siblings live in other communities and they rarely get together. His wife and sons regularly attend his mother's church, but Tom only attends on Christmas Eve and Easter Sunday. Tom is distraught about having to remain abstinent in preparation for the trial. He has trouble getting to sleep without alcohol. He also "gets jumpy" when he tries to stay away from drinking, feeling "closed in" or "like he is suffocating." He also cannot imagine how to explain to his buddies why he is not joining them in the bars.