Common Questions

Here are some questions that I have been asked:

What if I’m afraid to find out (or admit) that I might be an alcoholic?

The question people sometimes wonder: “Am I an alcoholic?” may not be the most helpful question.

First of all, I don’t use the term, “alcoholic” when thinking about my clients. Instead, current research literature refers to to “problematic drinking behavior,” “alcohol misuse” and “alcohol-related problems,” for example. Alcoholic is a label that carries a lot of stigma and a lot of misconceptions, even in the medical and mental health fields. My clients and I work with clear descriptions of behavior, without having to condemn a person with a fuzzy, imprecise, inaccurate label.

Examples of more motivating, more relevant and more helpful questions include: “How can I deal with this behavior that is making me feel bad about myself?” Or, “How can I be happy, healthy, motivated and productive again?” Or what role does alcohol play in my life, how is it affecting me, and what do I want to do about it?” Or, how would my life be different without my habitual behaviors with alcohol?” Regardless of the words and labels we use, you know what behaviors, feelings and results you want to consider. I can help you sort all of this out.

What if I’ve already seen other medical professionals, psychologists, therapists, counselors, or have even been to 12-step meetings or rehab programs?

A number of my clients have been to rehab several times, along with 12-step meetings, and even private groups catering to CEOs, physicians, lawyers, teachers and other professionals. Many require and insist on the strictest confidentiality to protect their careers and their privacy in general. The people who come to see me have not found these previous (traditional) approaches very helpful. AA and 12-Step programs (dating from the 1930′s) are not the only options these days. There are some very interesting and exciting findings in recent research that point to newer ways to look at alcohol misuse and newer, more effective strategies for stopping or modifying drinking behavior.

But I’ve been to highly-respected experts in this field. Why didn’t they share these newer research findings with me?

It can take 15 to 20 years for even well-accepted and conclusive research findings to trickle down into clinicians’ common knowledge and clinical application. Many professionals rely on their original training and on the prevailing treatments. Some may not have sought out new approaches. They may see their approach as “tried and true.”

So regardless of what you’ve learned or been told before, there is probably plenty of newer, research-based information out there, and it might be very helpful and encouraging to add this to your present understanding.

Knowledge is power. Knowledge – not willpower – is extremely motivating.

What are your theories and models?

Some of the “theories and models” that guide my work include: Evidence-based approaches, some of which include: Motivational Interviewing/Motivational Enhancement, Stages of Change Model, Cognitive Behavioral Therapy, Brief Interventions, Behavioral Marital Therapy, Mindfulness-Based Relapse Prevention, Adjunctive Pharmacotherapy. All of these are supported by strong, consistent research findings.

Where I may have referred to newer, evidenced-based methods, these are in contrast to traditional 12-Step approaches based on AA (which dates back to the 1930′s, and continues to be the predominate approach). This traditional model includes: viewing “alcoholism” as a life-long, incurable disease; a requirement to “admit” to certain premises such as being “powerless” over alcohol, and owning up to being “an alcoholic.” Something like 90 to 95% of inpatient rehab programs use the 12-Step model as their foundation.

(An interesting aside here, I’ve noticed that in the marketing literature that these programs send to me, they have started to include some of the current “buzz” phrases, such as “Motivational Enhancement” and “Evidence-Based.” They state something to the effect that their evidence-based methods are incorporated into a strong 12-Step Foundation. I guess that’s a good way to cover all their bases. This move to include some evidence-based methods is partly in response to health-care reform and insurance companies refusing to pay for any treatment that is not “evidence-based.).

My position here is not that this is right or wrong; just that the disease model is more controversial than most people realize; and that “alcoholic” is an extremely emotionally-laden, stigmatizing, stereotypical, imprecise label, perhaps doing more harm than good to many people. Also, the percentage of those who stop drinking successfully via the 12-step treatment-aligned programs and/or with AA is about the same percentage as those who just stop on their own, with no treatment at all (or even lower, according to some studies; I suspect it depends on their belief and motivational systems).

Why don’t you accept insurance?

The therapeutic relationship between myself and my client is between just the two of us. The agreement is between myself and my client. The insurance company is a third party, with its own set of values and requirements. I have chosen not to delegate to a third party decisions concerning the value, mode or length of treatment.

A few of my clients do elect to submit a statement (which I will provide upon request) to their insurance company on their own, and to receive any eligible reimbursement directly. However, this does require a “Mental Disorder” diagnosis, which compromises confidentiality.

Furthermore, not everyone I work with would truly qualify as having a “Mental Disorder.” the standard diagnosis in Rehab Centers has been Alcohol Dependence DSM 303.90. I’ve worked with people who are not technically Alcohol Dependent. For them, Alcohol Abuse 305.00 is probably more accurate. However, it’s been my experience that insurance usually will not reimburse for this diagnosis. Most of my clients do not want either of these diagnoses in the data system and choose to pay fee for service without submitting anything to their health insurance provider.

With the advent of the latest Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5) Alcohol Abuse and Alcohol Dependence are no longer separate diagnoses. Now, the diagnosis for alcohol misuse is Alcohol Use Disorder – Mild, Moderate, or Severe.

How does your treatment differ from most of the rehab programs out there?

My programs are outpatient, in my private office, not inpatient, in a hospital, although most inpatient rehab facilities also provide IOP (Intensive Outpatient) programs and outpatient aftercare for “continuity of treatment.”

My therapy is not based on 12-Step philosophy, some would say ideology.

In fact, it is an alternative to the AA/12-Step model.

I don’t provide detox or groups.

Outpatient work with me allows patients and clients to work on things and apply what they’re learning in real-time in their real-life situations. As one Four-Week Program “graduate” emailed to me: “Yea me! 4 FULL WEEKS, and I’m ahead at living my life on the outside over attending a 28-day rehab.”

I don’t use the popularized terms, “alcoholic” and “alcoholism” (which is a large part of the appeal for my clients). Labels, such as alcoholic or addict, tend to categorize and define a person – even “brand” a person – and can entrench them in this identity, i.e., can become a self-fulfilling prophecy.

Hence – misuse or abuse of alcohol, problematic drinking behavior, excessive drinking, problems with alcohol – these are all more descriptive and factual in terms of behaviors that occur; not an “identity sentence.” Many people would prefer not to say “I am an alcoholic,” for the rest of their lives. Ex-smokers say “I used to smoke, but I quit.”

With my approach, it is not necessary for survival of a person’s self-esteem, self-dignity, self-respect to protect themselves through denial, or to get into debates over whether they are “an alcoholic.”

I don’t subscribe to the disease model.

I don’t banish people from treatment if and when they have slips or lapses (that never made sense to me).

I don’t use a confrontational, you’re-in-denial approach if someone disagrees with my view or suggestion.

I don’t require group attendance (although 2 of my recent clients chose to attend support groups as an adjunct to their work with me). As far as alcohol support groups go, I like SmartRecovery, but apparently there aren’t any nearby. Another one of my clients has chosen to attend an AA meeting periodically.

I see and treat people with alcohol-related problems as a heterogeneous group of people with different strengths and weaknesses, and differences in degree and intensity and variety of their symptom.

I work with the whole person, each of whom is unique in terms of a combination of factors, for example:

  • The amount, style (sip or swig?) and frequency of drinking;
  • Where they fall on the high-risk/low-risk drinking continuum;
  • Whether they choose abstinence or moderation;
  • What degree of depression, anxiety or self-esteem issues are also present;
  • Number and nature of personality and personal strengths they have access to;
  • Support system – family, friends, spouse, partner or significant other, religious/spiritual

What kinds of programs do you offer?

I offer an initial, 90-minute consultation which includes a preliminary assessment of your situation, and a collaborative discussion of your strengths and needs. At the end of this consultation we will have put together an initial plan for going forward.

I see many clients in the standard, 45-minute, weekly, individual format.

Other clients book double sessions, either weekly, or every other week.

I offer an intensive program of three times a week for four weeks for people who prefer individual therapy and follow-up to group programs such as Rehab After Work.

For some clients, an intensive half-day or full-day (with breaks) program has worked well. This way we can get a great deal accomplished in a very focused way.

I also offer four-session packages.

Each program is customized to the individual client, and in a collaborative way.

Do you also work with other problems, such as anxiety, depression, self-esteem, relationships?

Yes, absolutely.

Not everyone I work with has struggles with alcohol.

And not everyone (or anyone, really,) with alcohol misuse behaviors is free of other concerns, such as stress, anxiety, sadness, self-esteem, relationships, career concerns, etc.

Everyone I work with is a unique individual, who happens to want to feel better, be happier, achieve a goal, get rid of a bad habit, etc. They have various symptoms of stress, such as alcohol misuse, anxiety, sadness, moodiness, depression, low self-esteem, relationship challenges, work issues, etc.

How do I get started?

Pick up the phone and give me a call at 610-526-9111. If I’m not available, leave a message and I’ll get back to you as soon as I can. We’ll have a brief chat and figure out whether it makes sense to schedule a consultation.

I look forward to our conversation.

Give me a call at 610-526-9111.