I have had clients tell me that they have a problem with cocaine, but that they don’t have a problem with alcohol. They also tell me they would never use cocaine when they are sober, but that it is the alcohol that alters their judgement and so they only use cocaine when they drink. It is important to point out the flaw in their logic.Some people have difficulty spotting the hole, but everyone eventually sees it after we’ve talked about it for a while. So here it is. If you don’t want to use cocaine, and you only use cocaine when you drink, then you do, in fact, have a problem with alcohol.
The problem is that they use cocaine when they drink, which means that they have to stop drinking in order to stop using cocaine.
Some people don’t want to hear this because it will involve significant changes that they often haven’t considered making. They initially sought counselling because they recognized they have a problem with cocaine, but they had never seriously considered stopping drinking. Which can leave them in a bind.
Some people tell me they don’t want to give up using alcohol because they need it to relax. I suggest that there are other ways to relax that they can learn to utilize. A couple of options might include using exercise to manage stress, working fewer hours, or changing jobs if their current job is too demanding. Similarly, options exist if they are in a difficult relationship, such as going for couples counselling or leaving the relationship.
Some people tell me they use cocaine at the end of an evening of binge drinking so they’ll be sober enough to drive home. They may tell me they use cocaine the morning after an evening of drinking to help them get over a hang-over so they can function the next day.
We discuss Prochaska’s Stages of Change, because it’s important to know where you are in the change process when you consider changing a problematic behaviour. Read more about How People Change. Are they Precontemplative about giving up alcohol (i.e., not yet considering making the change), and will they need to move to the next stage, which is Contemplative (i.e., thinking about making the change) to make progress? Might alcohol really be a problem?
We discuss the other negative effects of using cocaine: Do they know that using cocaine is associated with heart disease? Do they realize that cocaine users die younger than non-users? That a heavy cocaine user who is still alive after age 60 is considered old? That cocaine destroys the impulse control centres of the brain and that breaking a cocaine habit is difficult after you’ve handicapped your impulse control? Often, some of these reasons help them to increase their motivation to change.
Read more about How people change.
— Dr. Patricia Turner, Registered Psychologist, Calgary, Alberta