Addiction: A Clinical Psychology Session

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    • 00:00

      [MUSIC PLAYING][Addiction: A Clinical Psychology Session]

    • 00:12

      NARRATOR: The session you are about to watchfeatures Dr. James Diego Rogers and his client, Mark.Mark is seeking treatment for drug and alcohol addictionas well as depression. [drug and alcohol addiction as wellas depression] Mark has been using alcohol mostlyon the weekends and recently startedusing cocaine. [Mark's Behaviors and Symptoms,Mark has been using alcohol mostly on the weekendsand recently started using cocaine.This substance use is affecting his work.He continues to struggle with significant sadness followingthe breakup with his long term girlfriend.In general, Mark is having a hard timemoving forward with his life.His way of coping with this involves alcohol and cocaineuse, and the frequency of use is escalating.]This substance use is affecting his work.

    • 00:33

      NARRATOR [continued]: He continues to struggle with significant sadness followingthe breakup with his long-term girlfriend.In general, Mark is having a hard timemoving forward with his life.His way of coping with this involves alcohol and cocaineuse, and the frequency of use is escalating.Dr. Rogers is a clinical psychologist

    • 00:54

      NARRATOR [continued]: and part-time faculty member at San Diego State University.[James Rogers, PhD, San Diego State University]He has diagnosed Mark with co-occurring disorders, whichinclude a moderate level of substance use disorderas well as a moderate level of depressive disorder. [Diagnosisof Co occurring Disorders, Moderate level of substance usedisorder, Moderate level of depressive disorder][Approach to Treatment]

    • 01:14

      NARRATOR [continued]: Dr. Rogers looks at both Mark's depression and substanceuse as co-occurring disorders.Co-occurring disorders describe the presenceof two or more disorders at the same time.[co occurring disorders describe the presence of twoor more disorders at the same time] Each disorderis treated equally and simultaneously.Dr. Rogers uses several approachesto treat Mark's disorders.[Treatment Approaches] First, he uses

    • 01:36

      NARRATOR [continued]: a biopsychosocial approach, which examines and discussesthe biological, psychological, and social factors thatare influencing and impacting Mark's situation.[Treatment Approaches, Biopsychosocial approach,Examines and discusses the biological, psychological,and social factors that are influencing and impactingthe situation] For example, Mark's multigenerational familyhistory of depression is an example of a biologicalinfluence. [Biological] Mark's choice of friends

    • 01:56

      NARRATOR [continued]: and their influence on his poor choices is an example of socialinfluence. [Biological, Social] Mark's beliefs, attitudes,and perception of alcohol, drugs,and depression is an example of psychological influence.[Biological, Social, Psychological]Second, Dr. Rogers uses the Stages of Change Modelby DiClemente and Prochaska.[Treatment Approaches, Biopsychosocial approach,Stages of Change Model by DiClemente and Prochaska]This model, which has various Stages of Change, helps

    • 02:20

      NARRATOR [continued]: Dr. Rogers understand Mark's willingness and commitmentto the therapeutic process in treating both his substanceuse and depression.Finally, Dr. Rogers uses motivational interviewing,which helps to increase the patient'sown internal motivation for changeand addresses the conditions in their lives that

    • 02:41

      NARRATOR [continued]: could lead to a better quality of life.[Treatment Approaches, Biopsychosocial approach,Stages of Change Model by DiClemente and Prochaska,Motivational Interviewing]The core skills used in MI are open questions, affirmations,reflections, and summaries-- better known as OARS.[Motivational Interviewing, Core skills are open questions,affirmations, reflections, and summaries (OARS)] The goalof MI is to engage clients, elicit change talk,and evoke motivation to make positive changes from

    • 03:01

      NARRATOR [continued]: the client.[Motivational Interviewing, Core skillsare open questions, affirmations, reflections,and summaries (OARS), Goal is to engage clients, elicitchange talk, and evoke motivationto make positive changes][Viewers are advised that the video they are about to watchcontains swearing and other strong language]This session you are about to seeis four weeks into treatment.

    • 03:12

      DR. JAMES DIEGO ROGERS: Well, Mark it's good to see you back.

    • 03:15

      MARK: Yeah.You, too.

    • 03:16

      DR. JAMES DIEGO ROGERS: How have things been going?

    • 03:17

      MARK: Good.Good.Yeah.You know, good.Had Thanksgivings, so I was off all week from school.And today, was my first day back.So it was all right.

    • 03:29

      DR. JAMES DIEGO ROGERS: And how'd that go?

    • 03:32

      MARK: It was a little rough.I was late again, so I just-- which isn't good.I had to call to let them know that I wasgoing to be a few minutes late.So that's the third time that I have been late in the last sixweeks, so they're OK about it.

    • 03:55

      MARK [continued]: Somebody goes to the room and takes attendanceuntil I get there.I told them I've been having car trouble.

    • 04:01


    • 04:05

      MARK: Yeah.

    • 04:06

      DR. JAMES DIEGO ROGERS: So it sounds like you told the schoolthat it was because of car trouble.[open-ended question] What contributed to you being latethis time?

    • 04:16

      MARK: Hung over a little bit.

    • 04:17


    • 04:18

      MARK: So my weekend got a little out of hand,and so kind of one thing led to another.And I ended up going out last night again, Sunday night.And so it wasn't good.I shouldn't have done it, but so I just

    • 04:40

      MARK [continued]: had a harder time this morning.

    • 04:42

      DR. JAMES DIEGO ROGERS: Mm-hmm.Mm-hmm.So it sounds like this has been someof the same patterns that we've talkedabout over the last number of weeks. [summary]And I do want to start out by commending youwith your honesty and talking about kind of what really wentdown over the weekend. [example of affirmation] Ican genuinely see you're a little bit tornor something's on your mind about how things went down

    • 05:02

      DR. JAMES DIEGO ROGERS [continued]: over the weekend and how you really feel about that.So I'm wondering if you could say more a little bit about,now that you had that week, what it feels like for you.

    • 05:11

      MARK: Well, so I went up to Anaheim.My brother lives up there and his wife and their son,so I went up there on Wednesday night and waswith them for Thanksgiving.And my oldest brother has quit drinking,and he's been sober for a couple years now.

    • 05:35

      MARK [continued]: So I don't see him all that often,so it's kind of weird when I go because I give him,you know, all the credit for quitting drinkingand I think it's been good for him.They're totally cool with me drinking, but it's just weird.

    • 06:02

      MARK [continued]: You know?Like, they had bought beer.They had beer.When I went-- and I don't want to make it weird.But he's like, just because I made this choice,you don't have to feel weird about it.And I'm fine with you drinking.

    • 06:22

      MARK [continued]: But like, if I'm going to have a beer,I just feel weird doing it in front of him.So I maybe go to the garage, or I went out in the backyard.Or then I kind of feel like I'm sneaking around,and that's not good.

    • 06:41

      DR. JAMES DIEGO ROGERS: So it sounds like, on the one hand,while your brother's been very respectful about saying just,because he made this life choice to stop drinking and be sober,that he doesn't want to impose that on you.[example of reflection] And at the same time,it sounds like you're feeling a little bitlike, when you were there and were drinking,you felt like you had to go to the garageor go to a different room.And you would try to be respectful of him

    • 07:03

      DR. JAMES DIEGO ROGERS [continued]: and not drink in front of him it sounds like.And at the same time, it sounds like thatled you to feel a certain way, like youwere doing something wrong.

    • 07:11

      MARK: Well, yeah.You know, like, it certainly wouldbe an option to not drink.[CHUCKLING]That is something I could choose,but it's just such a habit.And you know, it helps me relax.

    • 07:33

      MARK [continued]: I get a little more comfortable.I feel like a little more in my skin.I'm not so anxious.You know, so to a certain extent,it kind of helps me in that situation.You know?And I don't like this time of year.

    • 07:56

      MARK [continued]: It's hard.You know?He's there.He's with his wife.He's with his kids.They got this whole family thing and the house,and it's just very different from the life I have.

    • 08:10


    • 08:11

      MARK: And so I stayed for dinner on Thursday,and I spent the night.And then I left Friday morning and came back,and then I was here from Friday through the weekend.And it just-- things just kind of went downhill.

    • 08:30

      DR. JAMES DIEGO ROGERS: Mm-hmm.Mm-hmm.

    • 08:34

      NARRATOR: Dr. Rogers shifts topics from substance abuseto relationship issues.Since both are co-occurring issues,Dr. Rogers places importance on both.

    • 08:44

      DR. JAMES DIEGO ROGERS: And you did mention, a few sessionsback, that this time of year is hard for you because of the--

    • 08:50

      MARK: Well, yeah.It's been a year--

    • 08:51

      DR. JAMES DIEGO ROGERS: --breakup.

    • 08:51

      MARK: Yeah.It's been a year since Lucy left.And I thought-- I mean, when we ended,it wasn't a big-- she wanted to get married.I told her I'd done that once, and I didn'tthink it was a good idea.

    • 09:12

      MARK [continued]: I wanted to stay with her.You know?We've been living together for five years.I thought that was working well.

    • 09:21


    • 09:22

      MARK: I thought it was a good arrangement.And I didn't really think she would leave.So you know, so this is now a year.And I don't know.I suppose maybe being at my brother's house and his wife.

    • 09:44

      MARK [continued]: And like I said, they got this whole lifethat was kind of mine and maybe could have been mine.I don't know.I guess maybe I think maybe I made the wrong choice,maybe I should have agreed to get married.[SIGHING]You know?So it's just-- I just feel a little lost.

    • 10:08

      DR. JAMES DIEGO ROGERS: Mm-hmm.Mm-hmm.Yeah.It's understandable.I could see why you would feel that way.And I'm wondering how you've been managing.Certainly, it sounds like the drinking, as you've said,has helped you relax, helped you feel less anxious.At the same time, it seems like there'ssome other feelings about the drinking and maybe even

    • 10:29

      DR. JAMES DIEGO ROGERS [continued]: the relationship loss that has stirred up for you.[connecting the drinking with the relationship loss]

    • 10:34

      MARK: Well, I mean, I know enough to knowthat what I'm doing isn't good.

    • 10:39

      DR. JAMES DIEGO ROGERS: Say more about that.

    • 10:42

      NARRATOR: Dr. Rogers takes note of Mark's acknowledgmentthat his drinking is not good for himand encourages him to elaborate in orderto elicit change talk in Mark and evoke motivation to change.

    • 10:55

      MARK: So this weekend, I went out.I have a couple buddies that I drink with.Three other guys.Two of them are not married.One guy is married.So on Saturday, we went out.

    • 11:21

      MARK [continued]: We went downtown, and one of the guys had some blow.[blow = term for cocaine] And so that was brought out,and we did that.

    • 11:39

      DR. JAMES DIEGO ROGERS: What did that look like?

    • 11:41

      MARK: What do you mean?

    • 11:42

      DR. JAMES DIEGO ROGERS: In terms of how much did you useand all that kind of--

    • 11:45

      MARK: He had an eight ball, so between four of us.It was most of the night on Saturday.I didn't go home.We ended up staying-- we were downtown.

    • 12:09

      MARK [continued]: We ended up at some party, some loft or apartment.And I passed out there.And then on Sunday, I woke up there.I didn't know whose place it was, and two of my buddieswere gone.

    • 12:29

      MARK [continued]: So the other guy was still there.And so we ended up going for breakfastand had Bloody Marys, which turned into beers.We stayed to watch the game, which was more beers.

    • 12:49

      MARK [continued]: And we actually tried to find some more coke, whichwe didn't, thankfully.And so I got pretty drunk yesterday,and I took a Uber home.

    • 13:11

      DR. JAMES DIEGO ROGERS: Mm-hmm.You said you were thankful that you didn't find more cocaine.Say more about that piece of it.

    • 13:19

      NARRATOR: Dr. Rogers again takes note of Mark's acknowledgmentthat not finding more cocaine was a good thingand encouraging him to elaborate on this.Dr. Rogers is hoping to elicit motivation from Markto change his behaviors.

    • 13:33

      DR. JAMES DIEGO ROGERS: What were you thankful about?

    • 13:41

      MARK: Well, it's just-- it's not good to do.[CHUCKLING]So you know, it would have just been bad.It would have gone from bad to worse.

    • 14:03

      MARK [continued]: And I don't trust myself.When it's there, I'm fucking ravenous for it.And that is frightening.

    • 14:11

      DR. JAMES DIEGO ROGERS: Mm-hmm.It seems like you have a bit of an awareness that, as thingsprogress or as they get started with drinking, that they canprogress and escalate and even sound like it gets a little outof control and escapes you. [more reflection]And it also sounds like you're not quite sure of yourselfor trust yourself to be able to stop when you'd like to stop.

    • 14:34

      MARK: Yeah.That's true.Though, today then, at school, I have second graders.And I feel like such a fucking assholebecause they're so good and sweet and present and loving.You know?And I come in and I'm not-- it's like if they knew,

    • 15:07

      MARK [continued]: if they could see me, if they understoodthis other part of my life, I would be so ashamed.

    • 15:18

      DR. JAMES DIEGO ROGERS: Mm-hmm.Well, again, I want to commend younow for having that perspective. [more affirmation]That's a very powerful statement that you've made,and I could see-- both in your eyesand just as you're thinking about this-- that thathad a big impact on you.How would you like it to be different?

    • 15:39

      DR. JAMES DIEGO ROGERS [continued]: [open ended question to elicit change talk]

    • 15:48

      MARK: Well, I think my gut response isto say I would like it to stop.But then right after that, I thinkI don't know that I could tolerate it.I don't know that I could tolerate not having it.When I drink, when I get high, then I don't feel bad.

    • 16:14

      DR. JAMES DIEGO ROGERS: Hmm.Say more about what it is you can't tolerateif you were to stop using. [open ended questionto elicit change talk]

    • 16:23

      MARK: Loneliness.Feeling just so worthless.[SIGHING]

    • 16:43

      MARK [continued]: You know, feeling that I just got nothing to give.

    • 16:50

      DR. JAMES DIEGO ROGERS: And that's understandable.No one really likes to feel that way.How have you managed to deal with loneliness at other timesin your life that didn't include drugs or alcohol?[looking for positive examples of coping skills]

    • 17:10

      MARK: You know, I like to work out,and I like to go-- like, that's the onetime I can feel like-- when I work out, when I exercise,I do feel-- you always drag your ass to the gym.But then afterwards, oh, yeah.It's good.I feel better.You know?

    • 17:32

      MARK [continued]: I've had friends a time or two that I didn't drink with,that were sober, and were reflective.You know?Who did have their shit together.I could see that they had a different way to do it.

    • 17:54

      MARK [continued]: You know?I know that this is fucked up.I know that this isn't good.You know?My principal at school, she's great.But to be late three times in less than two monthsis not good.

    • 18:16

      MARK [continued]: I can see it with the kids I don't have the patiencewith them that I normally do.So I see it.I just-- you know.

    • 18:33

      DR. JAMES DIEGO ROGERS: And it's good that you see those things.It sounds like that side of you that'svery responsible, that likes what you do,that looks out at those children and sees how good and pure theyare at that age, that-- [more affirmation and reflection]

    • 18:48

      MARK: Yeah.

    • 18:48

      DR. JAMES DIEGO ROGERS: It sounds like you reallydon't want to jeopardize that.

    • 18:50

      MARK: Yeah.

    • 18:51

      DR. JAMES DIEGO ROGERS: And that thisis not sitting well for you to see these two sides of youthat, on the one hand, you could beso responsible and professional and love what you doand, at the same time, outside of work,doing things that don't live up to those same standards.

    • 19:05

      MARK: Yeah.

    • 19:06

      DR. JAMES DIEGO ROGERS: What would yoube willing to try to move closer to that side of you that wouldfeel more congruent or more in sync with how you see yourselfas a teacher?[questions to elicit change talk]

    • 19:28

      MARK: What would I be willing to try?

    • 19:30

      DR. JAMES DIEGO ROGERS: You mentioned some thingsbefore that-- when you were going to the gym, when you hadsome friends who were sober, thosewere times when you were able to managewith the loneliness and the feelings of worthlessnessthat didn't involve using.

    • 19:44

      MARK: Yeah.

    • 19:45

      DR. JAMES DIEGO ROGERS: I'm just wonderingif you'd be willing to try things at this point.What would those be?

    • 19:49

      MARK: Yeah.Yeah.I mean, those are both things that-- these guysthat I'm hanging out with now, they're good guys,but they're as fucked up as I. You know, they're not-- theydon't know anything either.So they're--

    • 20:10

      DR. JAMES DIEGO ROGERS: On the one hand,they sound like they're fun.

    • 20:13

      MARK: Mm-hmm.

    • 20:13

      DR. JAMES DIEGO ROGERS: And you have a good time with the.And at the same time, you're realizing that--[CHUCKLING]

    • 20:17

      MARK: Yeah.

    • 20:17

      DR. JAMES DIEGO ROGERS: You're kind of gettinginto some trouble and--

    • 20:19

      MARK: Yeah.

    • 20:19

      DR. JAMES DIEGO ROGERS: --having things not go exactlyas planned, that could lead to some potential--

    • 20:23

      MARK: Yeah.

    • 20:24

      DR. JAMES DIEGO ROGERS: --serious consequences.

    • 20:25

      MARK: Yeah.We kind of feed off of each other, I think.

    • 20:27


    • 20:29

      MARK: Everybody just kind of feeds off of each other.You know?So I would think having to limit or end those friendships--

    • 20:47

      DR. JAMES DIEGO ROGERS: On a scale of 1 to 10,10 being, yeah, these friends arenot good for me, I need to end it,and 1 being, no way, they're still great friendsand there's no problem here, where do you see yourselfon that scale of 1 to 10 in terms of how you would relatewith them? [scaling question]

    • 21:03

      NARRATOR: Dr. Rogers uses a scaling questionto better understand how committed Mark isto changing his behavior.

    • 21:10

      MARK: Well, closer to 10.I don't know.I don't really know what our friendship wouldbe if we weren't partying.

    • 21:19


    • 21:21

      MARK: You know?That's kind of what we do.

    • 21:23


    • 21:26

      MARK: You know, the shit we talk about,the stuff that we do all stems mostly from drinking.We get high a little bit.The coke is not a regular thing.

    • 21:40


    • 21:44

      MARK: But I think probably looking at ending or curtailingthose, I don't know.You know?I mean, if I were to say that I'm trying to go cleanand-- then may be done.

    • 22:08

      DR. JAMES DIEGO ROGERS: So-- yeah.It sounds like you're not sure howthey would respond if you were to come out and makethat commitment and choice to--

    • 22:15

      MARK: Yeah.

    • 22:16

      DR. JAMES DIEGO ROGERS: --to address the usingand try to stop using entirely.

    • 22:19

      MARK: Mm-hmm.Yeah.

    • 22:21

      DR. JAMES DIEGO ROGERS: At the same time,what kind of friendships would you like to have?What would they look like if you could paintthe ideal type of friendship?

    • 22:32

      MARK: Hmm.You know, trustworthy.You know, the thing that I do like about those guys isthat I like-- there's something about them like being

    • 23:02

      MARK [continued]: in the shit, like being in a struggle,and maybe knowing that or not on some subconscious level.What happens sometimes with my coworkersat school and in that arena is that we're so aware of the kids

    • 23:27

      MARK [continued]: and so aware of their innocence and their not yetliving in the shit that it then kind of becomes-- everythingbecomes whitewashed.Right?And that's not what I know life to be,

    • 23:48

      MARK [continued]: so there's actually something I value when people say, yeah.Things are fucked up and things are hard,and life is difficult. I value that actuallybecause that's what I understand to be true.Right?And not that the world is decimated.

    • 24:09

      MARK [continued]: It's just I appreciate it when someone can say or honor or ownthat the world is hard.You know?

    • 24:19

      DR. JAMES DIEGO ROGERS: Right.Right.

    • 24:20

      MARK: And to me, there's actuallysomething in that that makes it better, whenyou can own the darkness of it.

    • 24:31


    • 24:32

      MARK: And so within my colleagues,the folks I work with it at school, like that'slike too nuanced of a position to take with kidsor with other people's kids.So really, you have to kind of say it's all good.You know?

    • 24:50

      DR. JAMES DIEGO ROGERS: Mm-hmm.Mm-hmm.

    • 24:51

      MARK: And so a lot of teachers havethat persona or that facade.I think that's why I actually do wellwith kids is because I-- even at that age,they know that it's not all wonderful.You know?So in terms of friends, are we trying

    • 25:14

      MARK [continued]: to find someone that had that awarenessbut wasn't using or had found a way to be in the world sober.

    • 25:34

      DR. JAMES DIEGO ROGERS: Mm-hmm.So it sounds like, on the one hand,you would really value having friendswho could be authentic and genuine about life.[more reflection]

    • 25:43

      MARK: Mm-hmm.

    • 25:44

      DR. JAMES DIEGO ROGERS: Even the negative sides of lifeor the downsides of life to help counterbalance the fact thatMonday through Friday, when you're at school,you have to put on the happy faces, it sounds like.

    • 25:56

      MARK: Mm-hmm.

    • 25:56

      DR. JAMES DIEGO ROGERS: Have that kind of energy.

    • 25:57

      MARK: Yeah.

    • 25:58

      DR. JAMES DIEGO ROGERS: And, as yousay, "whitewash" the world for the young kidsto keep their curiosity and interest going.

    • 26:05

      MARK: Mm-hmm.

    • 26:06

      DR. JAMES DIEGO ROGERS: As being in your role as a teacher

    • 26:08

      MARK: Yeah.

    • 26:09

      DR. JAMES DIEGO ROGERS: And it also soundslike, at the same time, you're feeling like that's a facade.

    • 26:13

      MARK: Mm-hmm.

    • 26:13

      DR. JAMES DIEGO ROGERS: You mentioned the word "facade."That sounds like maybe there's a part of you thatfeels like you're putting on an actor you need to fake it Monday through Friday when,on the other hand, you've got some real life experiences thathave impacted you.And when we met on the first night,you talked a little about a family history of some familymembers with depression.

    • 26:34

      DR. JAMES DIEGO ROGERS [continued]: And you used words like "decimated" just now,and you described feeling hopeless and worthless.

    • 26:41

      MARK: Mm-hmm.

    • 26:42

      DR. JAMES DIEGO ROGERS: I know we brieflytalked about the possibility of some depressiongoing on for you.I'm just wondering how you feel about that thought as you'redescribing this right now?

    • 26:53

      MARK: Yeah.

    • 26:54

      NARRATOR: Consistent with the biopsychosocial approach,Dr. Rogers references Mark's family history of depressionto see if he can identify with the possibilityof a depressive disorder. [biopsychosocial approach]

    • 27:07

      MARK: Yeah.You know, I mean, that's kind of whatcomes when I'm not drinking.Or that's kind of what the drinking and drugs alleviate.You know?I'm in the same house/condo that Lucy and I were in.

    • 27:28


    • 27:29

      MARK: Which I don't know that's such a good idea.I come home, and it's just me.And I thought it would be fine.You know?I thought it would be OK, but even whenI'm not conscious of it, I'm conscious of the factthat she's not there.

    • 27:50

      MARK [continued]: You know?

    • 27:50

      DR. JAMES DIEGO ROGERS: Sounds like it'sa constant reminder for you.

    • 27:53

      MARK: Mm-hmm.Yeah.

    • 27:54

      DR. JAMES DIEGO ROGERS: When you come home and go back to--

    • 27:56

      MARK: Yeah.Yeah.You know, there just isn't any life there.And my brother drank and has now quit.My older sister, you know, is on Wellbutrin.

    • 28:16

      MARK [continued]: My dad, when he was alive, he was on Prozac and fuckingXanax and Wellbutrin.You know?So there's a line of it, so it wouldn't be unusualfor me to join in the party.

    • 28:38


    • 28:42

      MARK: I don't know.You know, it didn't seem to help my dad.And my sister, OK, I guess.I don't know.It doesn't seem to me to be the solution.

    • 29:04

      DR. JAMES DIEGO ROGERS: Hmm.Which part doesn't seem to be the solution?

    • 29:09

      NARRATOR: Often, treatment for co-occurring disordersconsists of both talk and drug therapy.In a previous session, Dr. Rogersgave Mark a referral to a psychiatristto get a prescription for antidepressants.You will see next that Mark is reluctant to geta prescription.Dr. Rogers picks up on Mark's ambivalence

    • 29:30

      NARRATOR [continued]: and emphasizes that this is a personal choice for Mark.

    • 29:34

      MARK: Like antidepressants and--

    • 29:35


    • 29:37

      MARK: I don't know.Like, I know we had talked about me trying them.

    • 29:42

      DR. JAMES DIEGO ROGERS: Yeah.I was wondering how that referral to the psychiatrist--

    • 29:46

      MARK: Well, I haven't called yet.

    • 29:48


    • 29:49

      MARK: I just-- I've been busy and blah, blah, blah.[SIGHING]

    • 29:56

      DR. JAMES DIEGO ROGERS: It also soundslike you might not be sure if that'swhat you want at this point.

    • 30:01

      MARK: Mm-hmm.Yeah.Yeah.You know?I don't know.I just haven't seen great success in my family with it,

    • 30:23

      MARK [continued]: so I'm a bit skeptical that it would do anything.

    • 30:26

      DR. JAMES DIEGO ROGERS: Sure.And that's understandable given whatyou may have observed from your perspective in termsof your family members and whether that worked or notand whether that fits for you.

    • 30:36

      MARK: Mm-hmm.

    • 30:37

      DR. JAMES DIEGO ROGERS: And that'scertainly a personal choice that it's up to youto make if that's something you would like to pursue.At the same time, I want to let you know, in terms of workingtogether with me, I'm OK with you not going at this point.And that's not something that I would expector try to push on to you.

    • 30:55

      MARK: Right.

    • 30:55

      DR. JAMES DIEGO ROGERS: I'd really like to be here with youand help you through making sense of all these thingsand figure out which direction is best for you.

    • 31:02

      MARK: Yeah.

    • 31:03

      DR. JAMES DIEGO ROGERS: Having said that, at the same time,it sounds like you do have a lot of things going on whether it'swith the drinking and the using and some of the sadnessand the struggles in terms of the relationshipending and kind of where you're at with that today.[summarizing session so far] And then on topof all that weight, trying to balance it outwith putting on that happy face Monday through Friday

    • 31:23

      DR. JAMES DIEGO ROGERS [continued]: and going in and being positive and high energy for the kids.

    • 31:30

      MARK: Yeah.You know, it gets to be exhausting.On Friday, like, all I want to do is just let go.

    • 31:54


    • 31:57

      MARK: And then I just feel like such a fucking-- you know.Yeah.

    • 32:05

      DR. JAMES DIEGO ROGERS: It sounds like a catch-22.

    • 32:07

      MARK: Mm-hmm.Yeah.

    • 32:11

      DR. JAMES DIEGO ROGERS: Come Friday, youwant to just relax and let it all hang down.And then you end up feeling bad about it--

    • 32:18

      MARK: Yeah.

    • 32:19

      DR. JAMES DIEGO ROGERS: --when it's all done.

    • 32:21

      MARK: Yeah.People have a glass of wine to relax.[CHUCKLING]You know?And I'm fucking passed out in a penthouse somewhere.

    • 32:32


    • 32:35

      MARK: That's a little more than relaxed.

    • 32:37

      DR. JAMES DIEGO ROGERS: Mm-hmm.Mm-hmm.

    • 32:39

      MARK: Yeah.

    • 32:39

      DR. JAMES DIEGO ROGERS: And it seemslike why you're giggling about it a little bit that-- I'msensing that deep down, it's actually somethingthat bothers you quite a bit.

    • 32:50

      MARK: Yeah.

    • 32:53

      DR. JAMES DIEGO ROGERS: So I'm wondering which direction you'dlike to go in.[SIGHING]

    • 33:09

      MARK: Well, like I said, I know enough to knowthat this is a dead end road and Iknow enough to know that this isn't going to work.And I feel like I'm getting further and further

    • 33:32

      MARK [continued]: down that road.

    • 33:33


    • 33:36

      MARK: Which is a little frightening.You know? [affirmation]

    • 33:44

      DR. JAMES DIEGO ROGERS: And it's good that you could see that.

    • 33:46

      MARK: Yeah.Part of me is-- I'm like, "Just fuck it."Get rid of those friends.Move out of that condo.Get a dog.Go to the gym.Become a fucking vegetarian.[CHUCKLING]You know?Just-- you know.

    • 34:04

      DR. JAMES DIEGO ROGERS: So you canimagine a lot of possibilities pretty quickly of justsome things that might--

    • 34:14

      MARK: I mean, something has to change.

    • 34:16

      DR. JAMES DIEGO ROGERS: Change things for you, yeah.

    • 34:19

      MARK: Something needs to change.But like I said, right now, to be honest, the thought of notbeing able to drink on Friday, to me,I'd just crawl out of my skin.

    • 34:37

      DR. JAMES DIEGO ROGERS: Mm-hmm.Sure.And I'm wondering if all these changes that you can identify--if there is something that might start out slow or onestep at a time versus painting a picture where you flipyour whole world upside down.

    • 34:54

      MARK: Mm-hmm.

    • 34:54

      DR. JAMES DIEGO ROGERS: All at once all together.

    • 34:56

      MARK: Right.

    • 34:56

      DR. JAMES DIEGO ROGERS: And like you said,that thought makes you feel like youwant to jump out of your skin.And I'm wondering if that even getsin the way of trying anything at all.

    • 35:05

      MARK: Yeah.Yeah.

    • 35:06

      DR. JAMES DIEGO ROGERS: So if you were justto think of one thing, taking it one step at a time,even if it's one foot further or closer to where you'dlike to be versus making a full fell swoop, what would that be?What could that look like?

    • 35:21

      NARRATOR: The line of questioning you just heardfrom Dr. Rogers is designed to elicit change talk from Markand evoke motivation for him to make positive changes.

    • 35:31

      MARK: Hmm.Well, I think that probably the easiest or the most accessiblething would be to start going back to the gym.

    • 35:52

      DR. JAMES DIEGO ROGERS: OK.So let's talk about that.What would that look like, to start going to the gym?

    • 35:59

      MARK: Well, I mean, there's a gym by my house.About four blocks.You know, I would have to go or call and find outhow much it is.

    • 36:19

      MARK [continued]: You know, I got all my shit, my bag, and clothes,and have to figure out if I was going to do weights or cardioor what-- come up with some kind of a-- Ido better with kind of like a structure.

    • 36:43

      MARK [continued]: Like if I know-- like a lesson plan for working out.You know?If I know this is what I'm doing-- this is when I'm going,this is what I'm doing, I do betterwith that than just kind of showing up and running around.

    • 36:60

      DR. JAMES DIEGO ROGERS: Sure.And you mentioned you used to go to the gym in the past.

    • 37:03

      MARK: Mm-hmm.

    • 37:04

      DR. JAMES DIEGO ROGERS: And that,even though it was a struggle to get there first,that you actually felt good once you were there.

    • 37:08

      MARK: Mm-hmm.Mm-hmm.

    • 37:08

      DR. JAMES DIEGO ROGERS: So what did you do in the pastwhen you went to the gym?

    • 37:11

      MARK: Well, when I went seriously, kind of what I said,I had a four-day workout routine.Upper body, lower body, split.You know?I had a little manual and kept track of-- Idid weightlifting, specifically.

    • 37:31


    • 37:33

      MARK: What I lifted, how much.You know?Progression on deadlifts and bench and so on and so forth.And so I had it kind of mapped out, and four days a week.And I just kind of fell off of that at some point.

    • 37:56

      MARK [continued]: So I would know how to get back into it.You know?I wouldn't be starting from scratch.

    • 38:03

      DR. JAMES DIEGO ROGERS: Yeah.It sounds like you know what you're doing there.

    • 38:05

      MARK: Mm-hmm.

    • 38:05


    • 38:06

      MARK: Yeah.I just haven't done it for a long time.

    • 38:09

      DR. JAMES DIEGO ROGERS: Mm-hmm. [assessing motivationfor change] So how likely do you see yourself getting reengaged?

    • 38:30

      MARK: I could do it.

    • 38:33

      DR. JAMES DIEGO ROGERS: Talk about how you would do it.

    • 38:35

      MARK: Well, so I guess that I'd have to call,find out how much it is.Get out my equipment.

    • 38:46

      DR. JAMES DIEGO ROGERS: Which it sounds like you already have.

    • 38:48

      MARK: Which I have.

    • 38:49


    • 38:51

      MARK: Sit down and pull up a workout.You know, and do like an eight-week-- startwith eight weeks.I would just have to-- because now, after school, I

    • 39:12

      MARK [continued]: just go home.I'm not-- I'm pretty good.I'm not drinking so much during the week.

    • 39:18


    • 39:19

      MARK: All right.But I just go home.You know?And do some chores-- dishes or laundry and then dinner.And then I watch TV.

    • 39:31


    • 39:32

      MARK: So I could go after work at 4:00.Be home by 5:30 or 6:00.Well, that would be OK.You know?

    • 39:44

      DR. JAMES DIEGO ROGERS: That's good that youcould be aware of the times during Mondaythrough Friday when you could possibly fit this in.[more affirmation] But I also wantto commend you that Monday through Fridayyou're not drinking or using, and that this is reallyreserved for the weekends at this point in terms of how youtend to blow off that steam.But there's some strength there and somethingto be said about being able to refrain Monday

    • 40:05

      DR. JAMES DIEGO ROGERS [continued]: through Friday, which I want to commend you for.And at the same time, that you're realizingthere might be some times in your scheduleduring the week to be able to work the gym back in.

    • 40:16

      MARK: Mm-hmm.Yeah.I don't-- yeah.I'm not doing much else.

    • 40:20


    • 40:21

      MARK: You know?And I kind of make up for the week on the weekend.

    • 40:25


    • 40:27

      MARK: So that's--

    • 40:28

      DR. JAMES DIEGO ROGERS: At the same time,you mentioned earlier tonight that, when you found yourselfin the past going to the gym more often,you felt less of that need to go out and use.

    • 40:39

      MARK: Yeah, that's true.Because it's hard.It's hard work when you go.So then in your mind, you're like, "Oh,I don't want to fuck everything--I'm going to have to do 50 more sit-ups if I get--if I eat this shitty food or"-- you know.So it does help.

    • 40:57


    • 40:59

      MARK: You know?

    • 40:59

      DR. JAMES DIEGO ROGERS: It soundslike you start questioning the value of the drinkingor the using when you're putting in all that extra effortto work out and get into shape.

    • 41:08

      MARK: Yeah.That's true.

    • 41:09

      DR. JAMES DIEGO ROGERS: Maintain that healthy sideof the lifestyle.Yeah.

    • 41:13

      MARK: Mm-hmm.

    • 41:13

      DR. JAMES DIEGO ROGERS: Yeah.That's true.

    • 41:15

      NARRATOR: Here, Dr. Rogers uses the scaling question about howcommitted Mark is to going to the gymin order to assess his readiness. [scaling question]

    • 41:23

      DR. JAMES DIEGO ROGERS: On a scale of 1 to 10, 10 being,I'm all in, I'm going to call that gymand start setting something up, how-- 10 being I'm all in.1, nice idea, but--

    • 41:38

      MARK: No.

    • 41:38

      DR. JAMES DIEGO ROGERS: --not going to do it.

    • 41:39

      MARK: Yeah.

    • 41:40

      DR. JAMES DIEGO ROGERS: What number would youput yourself at?

    • 41:41

      MARK: I would say 10.

    • 41:42

      DR. JAMES DIEGO ROGERS: Oh, great.Great.

    • 41:44

      MARK: OK.Like I said, something has to change.

    • 41:49

      DR. JAMES DIEGO ROGERS: Mm-hmm.So you really hit that place that youfeel this can't keep going on for you?

    • 41:56

      MARK: Yeah.Yeah.Mostly because I-- even now, I can justfeel how badly I want it.You know--

    • 42:15

      DR. JAMES DIEGO ROGERS: What's the "it" that you'rereferring to right now?

    • 42:17

      MARK: A drink or something.You know?

    • 42:19


    • 42:22

      MARK: And it feels like it's getting harder and harderto hold off to the weekend.

    • 42:32

      DR. JAMES DIEGO ROGERS: Sure.And drinking and addiction in generalcan progress into those stages where it starts outas a behavior, and then it could escalate and turninto a full on addiction or dependencywhere even the behavior is out of controlbecause, even on a biological, a physiological level--

    • 42:54

      MARK: Right.Yeah.

    • 42:55

      DR. JAMES DIEGO ROGERS: --the alcoholwill change the chemistry in your body.

    • 42:59

      MARK: Yeah.

    • 42:59

      DR. JAMES DIEGO ROGERS: And it soundslike you're afraid of seeing that that intensity mightbe growing for you, and it's making Mondaythrough Friday becoming harder and harderbecause you're waiting for that Friday nightto get here faster and faster.

    • 43:14

      MARK: Mm-hmm.I'm starting to jeopardize my job, whichis-- if I were to lose that job, if I were to be let go,I'd be fucked.

    • 43:35

      MARK [continued]: You know?I couldn't get another job.Nobody else would hire me.

    • 43:40


    • 43:41

      MARK: You know?

    • 43:41

      DR. JAMES DIEGO ROGERS: And it's good that you seeand that you value the seriousness of your joband that you're very concerned about that.

    • 43:49

      MARK: Yeah.There are these things that kind of keep me tethered,and they're becoming more vulnerable, more

    • 44:10

      MARK [continued]: in danger of breaking away.

    • 44:13

      DR. JAMES DIEGO ROGERS: And it soundslike also that the job is servingas-- you said the word "tether" or maybe as an anchor to keepyou from going even more out of controlwhere you find yourself on the weekends, things snowballingand escalating to a place where youdon't know how you ended up here, literally,and that the job helped serve that.And you mentioned that about the gym,too, that you do better with structure

    • 44:35

      DR. JAMES DIEGO ROGERS [continued]: and having some kind of plan and routinethat really keeps you focused on howyou would approach working out.

    • 44:43

      MARK: Yeah.

    • 44:43


    • 44:44

      MARK: Yeah.I see fucking homeless people, and I think, well, all right.I kind of understand how you got there a little bit.You know?Something breaks and that causes something else to break,

    • 45:06

      MARK [continued]: and then you don't quite have the frameworkto come back from that.And I mean, I know that there's oftena lot of mental illness with homelessness,but I don't mean that flippantly.But I do understand how people end up just wandering.

    • 45:31

      DR. JAMES DIEGO ROGERS: Mm-hmm.It sounds like not only can you understand it,but maybe you're concerned about that as wellin terms of how that may fit with your lifestyleif things were to keep going in that negative directionthat you see it going in.Well, Mark, we're going to need to wrap up herefor the evening, but I just want to recap a couple of thingsthat we talked about because I can certainly see

    • 45:51

      DR. JAMES DIEGO ROGERS [continued]: you're juggling quite a bit.And I just, again, want to start outby saying I see you as a brave strong person that you'vevalued before when talking about friends.[example of summarizing] You value havingfriends who could be in it.And I can certainly see and I get the sense from youemotionally that you're in it right now, in termsof recalling the relationship that's ended about a year

    • 46:14

      DR. JAMES DIEGO ROGERS [continued]: ago now, and that you're going back to your same houseand condo where you used to live together,and that's a constant reminder, that a party feels like you'rejust kind of really challenged with moving on and beingable to do the things you used to do that you enjoyed.For example, going to the gym and things like that.

    • 46:34

      DR. JAMES DIEGO ROGERS [continued]: And that at the same time, tryingto hang on Monday through Friday and put on that facadeand be positive and high energy for the kids, that,by the time Friday rolls around, there'sso much work involved in holding that together that you justwant to unwind and let it all go come Friday night.And that in by doing so, things escape you and things get worse

    • 46:57

      DR. JAMES DIEGO ROGERS [continued]: and you find yourself, by Sunday,looking backwards saying, "What the hell did I do?"[CHUCKLING]"How'd I end up here?"And talking about waking up in a loft where you kind of don'teven remember how you ended up there,and the people you started the weekend out with or the nightout with are no longer there.But yet, somehow, you're still there and tryingto make sense of all that.

    • 47:18

      MARK: Mm-hmm.

    • 47:18

      DR. JAMES DIEGO ROGERS: And while you'redoing that, I can see that you'regenuinely concerned about-- how far is this possibly goingto go?And we did talk a little bit alsoabout the referral to the psychiatristand that you're not quite ready for that at this point,and that's understandable.At the same time, the antidepressantsdo help and can help with depression.

    • 47:38

      MARK: Right.

    • 47:38

      DR. JAMES DIEGO ROGERS: Maybe not right away.It may take some time.And certainly, there's a lot of trial and errorand trying to figure out what's the right medicationand what's the right dose.

    • 47:45

      MARK: Right.

    • 47:46

      DR. JAMES DIEGO ROGERS: But I wantto let you know that, as long as we're working together,I'm happy to go at your pace.I just want you to know that's somethingto think about in terms of helping that energy come backand feeling the hopelessness and the worthlessnessthat-- some of those medications can help with that.

    • 48:02

      MARK: Right.

    • 48:02

      DR. JAMES DIEGO ROGERS: At the same time,it sounds like you've been able to change things behaviorallyin your life in the past.And you came right off the bat with some great ideas,like going to the gym and findingsome friends who were sober.It seemed like the gym was the best idea that you wereinterested in at this point.You sounded pretty committed.You put yourself at a 10.

    • 48:22

      MARK: Yeah.

    • 48:23

      DR. JAMES DIEGO ROGERS: To give them a call,you've got the gear.

    • 48:25

      MARK: I will.

    • 48:25

      DR. JAMES DIEGO ROGERS: You used to have a workout routine.

    • 48:27

      MARK: Mm-hmm.Yeah, I will.

    • 48:28

      DR. JAMES DIEGO ROGERS: I'm just reallyexcited and curious to see how it'sgoing to go next week and--

    • 48:32

      MARK: Yeah.I'll let you know.

    • 48:34

      DR. JAMES DIEGO ROGERS: And certainly,best of luck with that and let's seehow you do at the gym in this upcoming week.

    • 48:39

      MARK: Good.

    • 48:40

      DR. JAMES DIEGO ROGERS: All right, Mark.

    • 48:40

      MARK: Great.

    • 48:41

      DR. JAMES DIEGO ROGERS: Thanks a lot.

    • 48:41

      MARK: Thank you.

    • 48:42

      DR. JAMES DIEGO ROGERS: See you next time.[MUSIC PLAYING]

Addiction: A Clinical Psychology Session

View Segments Segment :


Dr. James Diego Rogers works with his patient, Mark, to address Mark's co-occurring disorders of alcohol/drug dependence and depression. Mark discusses his difficulty coping with the loss of his long-term girlfriend. Alcohol and drugs have become his main coping mechanism, and he's worried about losing the rest of his life to them. Mark and Dr. Rogers discuss willingness to change and make a plan for action.

SAGE Video In Practice
Addiction: A Clinical Psychology Session

Dr. James Diego Rogers works with his patient, Mark, to address Mark's co-occurring disorders of alcohol/drug dependence and depression. Mark discusses his difficulty coping with the loss of his long-term girlfriend. Alcohol and drugs have become his main coping mechanism, and he's worried about losing the rest of his life to them. Mark and Dr. Rogers discuss willingness to change and make a plan for action.

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