DB PSYC 620

Treatment for Drug Abuse Using Motivational Interviewing

1: Session Opening

0 seconds DR. WILLIAM RICHARD MILLER

[00:00] DR. WILLIAM RICHARD MILLERPat, I understand from the little bit of information I have that there were some difficulties you want to talk about and that they had something to do with drugs a bit and so I wonder if you could tell me a little about what your concerns are?

14 seconds PAT

[00:14] PATWell, as far as drugs, I do do drugs sometimes. DR. WILLIAM RICHARD MILLER: Sometimes? PAT: Yeah. DR. WILLIAM RICHARD MILLER: And in what ways

24 seconds DR. WILLIAM RICHARD MILLER

[00:24] DR. WILLIAM RICHARD MILLERis that affecting you? What's good about that? What's not so good about that?

29 seconds PAT

[00:29] PATI do know, I would not say if there is anything good as far as money wise that affects me. DR. WILLIAM RICHARD MILLER: Costs a lot?

39 seconds PAT

[00:39] PATIt can kind of cost a lot of money. DR. WILLIAM RICHARD MILLER: So

44 seconds DR. WILLIAM RICHARD MILLER

[00:44] DR. WILLIAM RICHARD MILLERthat's one thing. How else has that affected you?

49 seconds PAT

[00:49] PATWell, some of the people in my life aren't too happy with , you know, me doing drugs or being with other people that do them. DR. WILLIAM RICHARD MILLER: So, you have taken some heat from some folks

1 minute 4 seconds DR. WILLIAM RICHARD MILLER

[01:04] DR. WILLIAM RICHARD MILLERwho are saying, "Look you need not do this." PAT: Yeah. DR. WILLIAM RICHARD MILLER: Yeah? Who are those? Who are the people that are concerned in that way? PAT: Oh, a couple of friends of mine

1 minute 14 seconds PAT

[01:14] PAT, my girlfriend, my brothers and sister. DR. WILLIAM RICHARD MILLER: So you got some

1 minute 24 seconds DR. WILLIAM RICHARD MILLER

[01:24] DR. WILLIAM RICHARD MILLERfamily who care about you? PAT: Yeah. DR. WILLIAM RICHARD MILLER: And a girlfriend who is saying it would be good idea if you didn't use the drugs. PAT: Yes. DR. WILLIAM RICHARD MILLER: And then you also have some friends who are more involved in the drug world and pull you the other way I imagine?

1 minute 44 seconds PAT

[01:44] PATYes. DR. WILLIAM RICHARD MILLER: So, you've have friends in both kinds of circles

1 minute 49 seconds DR. WILLIAM RICHARD MILLER

[01:49] DR. WILLIAM RICHARD MILLER. PAT: Yeah on either end. DR. WILLIAM RICHARD MILLER: Yeah, yeah. Some rooting for it and some rooting against. PAT: Right. DR. WILLIAM RICHARD MILLER: Yeah , and you are kind of in the middle getting pulled both ways, you know , and it costs a lot. PAT: Yeah. DR. WILLIAM RICHARD MILLER: But there must be something that you like about the drugs that you use. There must be something that is good about it, because if I understand you are still continuing in spite of the fact that it has costs you some. . So there must be something about it that draws you?

2 minutes 19 seconds PAT

[02:19] PATWell, the feeling. DR. WILLIAM RICHARD MILLER: Yeah. PAT: That it gives me, you know. DR. WILLIAM RICHARD MILLER: Yeah. It's the immediate reaction

2 minutes 24 seconds DR. WILLIAM RICHARD MILLER

[02:24] DR. WILLIAM RICHARD MILLER, immediate feeling does that lasts for a while PAT: Alright. DR. WILLIAM RICHARD MILLER: Right.

2 minutes 29 seconds PAT

[02:29] PATThat goes away and then you want to feel that way again . So...(crosstalk) DR. WILLIAM RICHARD MILLER: Yeah. So pretty immediate effect that feels really nice.

2 minutes 39 seconds PAT

[02:39] PATYeah. DR. WILLIAM RICHARD MILLER: And then that is gone and then you want to do it again

2 minutes 44 seconds DR. WILLIAM RICHARD MILLER

[02:44] DR. WILLIAM RICHARD MILLERand it costs you to do that. What else ? What else is attractive about the drugs that you use for you?

2 minutes 59 seconds PAT

[02:59] PATWell, nothing is very attractive, it is more of physically addicting thing . I use heroin sometimes and that's more of a physically addicting thing for me . This is what sometimes I'll need it and sometimes I don't feel that I need it, but I will have to have it because you get sick and...(crosstalk) DR. WILLIAM RICHARD MILLER: Alright. PAT: You know, it's not so good feeling. DR. WILLIAM RICHARD MILLER: Right

3 minutes 29 seconds DR. WILLIAM RICHARD MILLER

[03:29] DR. WILLIAM RICHARD MILLER. So, tell me about that. When was the last time that you felt such like that? When you felt like you really needed the drug. What was that like for you?

3 minutes 39 seconds PAT

[03:39] PATIt's not good. I just, you get anxiety feelings . I get depressed and sometimes physically ill. DR. WILLIAM RICHARD MILLER: Yeah. It's different for different people

3 minutes 54 seconds DR. WILLIAM RICHARD MILLER

[03:54] DR. WILLIAM RICHARD MILLER. Sometimes flu kind of stuff? PAT: Flu symptoms. Yeah.

3 minutes 59 seconds DR. WILLIAM RICHARD MILLER

[03:59] DR. WILLIAM RICHARD MILLERAnd feeling bad? Feeling nervous? PAT: Right. DR. WILLIAM RICHARD MILLER: And ancy , and if then if you get some of it, it is just kind of immediately relieves that for the time.

2: Identifying past motivators for misuse and use

4 minutes 9 seconds PAT

[04:09] PATRight. It takes it away. DR. WILLIAM RICHARD MILLER: How long does it take you to get through that if you ride it out of you

4 minutes 14 seconds DR. WILLIAM RICHARD MILLER

[04:14] DR. WILLIAM RICHARD MILLER. If you tough it out? PAT: Well

4 minutes 19 seconds PAT

[04:19] PAT, anywhere from three days to a week. DR. WILLIAM RICHARD MILLER: Yeah. Yeah. So, pretty long time to be

4 minutes 24 seconds DR. WILLIAM RICHARD MILLER

[04:24] DR. WILLIAM RICHARD MILLERuncomfortable. PAT: Right. It is. DR. WILLIAM RICHARD MILLER: When was the last time you did that ? Got through it? PAT: Oh, I say about a

4 minutes 34 seconds PAT

[04:34] PATmonth ago, and maybe a lot longer one month. DR. WILLIAM RICHARD MILLER: You got at least got three days at that time

4 minutes 44 seconds DR. WILLIAM RICHARD MILLER

[04:44] DR. WILLIAM RICHARD MILLERor how long was it? PAT: Yeah. That was probably seven days. DR. WILLIAM RICHARD MILLER: Yeah? So you got a whole week? PAT: Right. Yeah. DR. WILLIAM RICHARD MILLER: What was going on at that time that made you go for a week without using? So were you running out of money or? PAT: No

5 minutes 4 seconds PAT

[05:04] PAT, I just got sick and tired of it. DR. WILLIAM RICHARD MILLER: Got

5 minutes 9 seconds DR. WILLIAM RICHARD MILLER

[05:09] DR. WILLIAM RICHARD MILLERto a place where it didn't seem worth it? PAT: Right. DR. WILLIAM RICHARD MILLER: And the bad side of it or the down side of it, kind of outweighed even the immediate good feelings. PAT: Right. DR. WILLIAM RICHARD MILLER: That happens . Then you went back again? PAT: Yeah, unfortunately. DR. WILLIAM RICHARD MILLER: Yeah, yeah . So, it kind of again pulled two ways. PAT: Yeah. DR. WILLIAM RICHARD MILLER: Because part of you that says I can always try, I don't want to be dong this. This costs me in a number of ways. There are people, care about me who don't want me to be doing this , and also really feels good to do it. What are the things that you think tip the balance when you do decide to go for a few days or a week or whatever to get away from the drugs ? What are the things that have most tipped the balance for you to say, I want to knock this, I want to quit this? PAT: Well, as far as

6 minutes 14 seconds PAT

[06:14] PATwhy I didn't want to do it, ...(crosstalk) DR. WILLIAM RICHARD MILLER: Yeah, yeah. PAT: Well, just you can say feel it, I feel it in my bones and stuff that I know I have to quit it because it, it just gets to you. It just, I can't keep doing what I am doing without something going wrong with my body or something. So, I feel I need to just quit it altogether but then it is a hard thing to quit forever once you've done it for a while, it's very hard to completely quit.

6 minutes 49 seconds DR. WILLIAM RICHARD MILLER

[06:49] DR. WILLIAM RICHARD MILLERYeah, yeah. You feel it in your bones, it's that deep, you...(crosstalk) . PAT: Oh sure. DR. WILLIAM RICHARD MILLER: You know it at that level? PAT: Yeah.

6 minutes 59 seconds DR. WILLIAM RICHARD MILLER

[06:59] DR. WILLIAM RICHARD MILLERAnd then what happens that would draw you back to using again?

7 minutes 4 seconds PAT

[07:04] PATSometimes boredom. DR. WILLIAM RICHARD MILLER: Yeah?

7 minutes 9 seconds PAT

[07:09] PATJust being bored enough from the (inaudible). You just feel like you vomit. Go back and do a little bit of that, and then sometimes I feel I can just do a little bit today and it never turns out that way. Once you do it again, it's just you keep doing it over and over. DR. WILLIAM RICHARD MILLER: That's how it is for you? PAT: Yeah. DR. WILLIAM RICHARD MILLER: To not really

7 minutes 29 seconds DR. WILLIAM RICHARD MILLER

[07:29] DR. WILLIAM RICHARD MILLERend in between. PAT: No, not at all. DR. WILLIAM RICHARD MILLER: You know

3: Identifying motivators for change

7 minutes 34 seconds DR. WILLIAM RICHARD MILLER

[07:34] DR. WILLIAM RICHARD MILLER, one thing that people have told me that this reminds me of , is that to really get clear of whatever the drug , heroin or alcohol or whatever the person has preferred, life without it has to be better than life with it. It has to be more fun. Life without the drug has to be more fun than life with the drug, and the boredom thing that you said in particular just makes me think about that but if not taking a drug, it's just that it's not doing anything. PAT: Okay. DR. WILLIAM RICHARD MILLER: It's not terribly rewarding . It's not much fun. Now nothing has happened instead of at least a little excitement or whatever. So I wonder , I guess, what kind of life you might like to have that would be more rewarding than using drugs? How could you do that ? What would that look like? PAT: To

8 minutes 34 seconds PAT

[08:34] PATlead life without doing drugs? DR. WILLIAM RICHARD MILLER: Yeah. What would it take, because you have to have something to kind of fill in there

8 minutes 39 seconds DR. WILLIAM RICHARD MILLER

[08:39] DR. WILLIAM RICHARD MILLER. The space, you know. Something that you want to do, something you going toward, something that you want for yourself or for other people.

8 minutes 54 seconds PAT

[08:54] PATWell , probably be married and have a good family life would probably take that away, because as I said I am not married right now and I don't have children, so. DR. WILLIAM RICHARD MILLER: But there is a girlfriend. PAT: Yes. DR. WILLIAM RICHARD MILLER: So, to be

9 minutes 14 seconds DR. WILLIAM RICHARD MILLER

[09:14] DR. WILLIAM RICHARD MILLERsettled down, to have a family, to have kids. PAT: Right.

9 minutes 19 seconds DR. WILLIAM RICHARD MILLER

[09:19] DR. WILLIAM RICHARD MILLERThat's something to live for. PAT: Right. DR. WILLIAM RICHARD MILLER: And something to just stay clean for. PAT: Yeah, definitely.

9 minutes 24 seconds DR. WILLIAM RICHARD MILLER

[09:24] DR. WILLIAM RICHARD MILLERWhat else? PAT: To

9 minutes 29 seconds PAT

[09:29] PATmaintain a job and I can say and have a happy family life that would pretty much be it for me. DR. WILLIAM RICHARD MILLER: So, a job would help too

9 minutes 39 seconds DR. WILLIAM RICHARD MILLER

[09:39] DR. WILLIAM RICHARD MILLER. It's when you enjoy I presume something that you like doing. PAT: Yes, right.

9 minutes 44 seconds DR. WILLIAM RICHARD MILLER

[09:44] DR. WILLIAM RICHARD MILLERThat fills the time and family fills time.

9 minutes 49 seconds PAT

[09:49] PATRight. DR. WILLIAM RICHARD MILLER: Certainly. So, you are not just doing nothing

9 minutes 54 seconds DR. WILLIAM RICHARD MILLER

[09:54] DR. WILLIAM RICHARD MILLERbut you have got a full life in full life and someway if you get a job that you life, you've got the family that is close and mean something to you. A full life really without the drugs. PAT: Right. DR. WILLIAM RICHARD MILLER: That is kind of what is missing?

10 minutes 9 seconds PAT

[10:09] PATYes. DR. WILLIAM RICHARD MILLER: This girlfriend

10 minutes 14 seconds DR. WILLIAM RICHARD MILLER

[10:14] DR. WILLIAM RICHARD MILLER, it sounds like she is serious about you, if she is you are pretty connected? PAT: Oh sure. Very connected

10 minutes 24 seconds PAT

[10:24] PAT. She doesn't want to make any major commitments until I completely stay clean . That's part of the problem and it's hard for me to stay clean , so, kind of it stands still there. DR. WILLIAM RICHARD MILLER: And part of staying

10 minutes 44 seconds DR. WILLIAM RICHARD MILLER

[10:44] DR. WILLIAM RICHARD MILLERclean for you is to have a committed relationship? That's, it is something to live for, something to that is worth staying drug free for . PAT: Yeah. DR. WILLIAM RICHARD MILLER: So, that's a little bit of a locked up puzzle that you can't have the relationship until you stay clean, but you can't stay clean until you have a relationship that makes you worthwhile to do it. PAT: Yes. DR. WILLIAM RICHARD MILLER: It's a little bit of a stuck place . And then a job is that something you would enjoy. Something that you do that means something and you can make a good living. What might that be?

11 minutes 24 seconds PAT

[11:24] PATActually I would like to own my own business, like some kind of a trade business would be , where I am in control of it. DR. WILLIAM RICHARD MILLER: What do you

11 minutes 39 seconds DR. WILLIAM RICHARD MILLER

[11:39] DR. WILLIAM RICHARD MILLERenjoy doing? What kind of trade? PAT: Oh, probably electrical work

11 minutes 44 seconds PAT

[11:44] PAT. I enjoy electrical work.

11 minutes 49 seconds DR. WILLIAM RICHARD MILLER

[11:49] DR. WILLIAM RICHARD MILLERAnd that's one where you can be in charge of it. You can set your own schedule ...(crosstalk) PAT: Right. DR. WILLIAM RICHARD MILLER: And decide how much work you are going to be doing. PAT: Exactly. DR. WILLIAM RICHARD MILLER: And is something you could do well, you think. So , that's a picture maybe five years down the line or so to have an electrical business or (inaudible) doing that, and to have a family, and to have kids. And that might be worth it.

12 minutes 19 seconds PAT

[12:19] PATYeah. DR. WILLIAM RICHARD MILLER: Is that kind of, is it worth it to let go

12 minutes 24 seconds DR. WILLIAM RICHARD MILLER

[12:24] DR. WILLIAM RICHARD MILLERof something that feels pretty good. PAT: It would be definitely

12 minutes 29 seconds PAT

[12:29] PAT. DR. WILLIAM RICHARD MILLER: You are pretty sure that would be. PAT: Well, I am positive. DR. WILLIAM RICHARD MILLER: Yeah.

12 minutes 34 seconds PAT

[12:34] PATOh yeah. DR. WILLIAM RICHARD MILLER: Okay. Fine. Yeah because not everybody is, you know, I think

12 minutes 39 seconds DR. WILLIAM RICHARD MILLER

[12:39] DR. WILLIAM RICHARD MILLERyou know, there is a process of saying I don't know, if I want to let go this or not . This feels pretty good and I am not sure if it is worth it or not , but you are pretty clear in it. If you could have that, if you could get to that at least that would definitely be worth it

4: Identifying negative consequences of misuse

12 minutes 59 seconds DR. WILLIAM RICHARD MILLER

[12:59] DR. WILLIAM RICHARD MILLER, and then I was just starting to ask you little bit about the downside of using heroin and whatever other drugs you are using, and I know you mentioned that maybe create some conflict without your family and your girlfriend that they want you to get away from that and it costs you money certainly . What else in what other ways has using the drugs been a hassle for you or caused you some trouble? PAT: Well

13 minutes 29 seconds PAT

[13:29] PAT, it's caused me some trouble with the law. DR. WILLIAM RICHARD MILLER: In what way?

13 minutes 34 seconds PAT

[13:34] PATI have been arrested for trying to buy it one time for having it for possessing the drug and that alone is a big problem right there. DR. WILLIAM RICHARD MILLER: Yeah. Those things can kind of pile up. PAT: Yeah.

13 minutes 54 seconds DR. WILLIAM RICHARD MILLER

[13:54] DR. WILLIAM RICHARD MILLERDid you get some time or a probation ? What happened there with that?

14 minutes 4 seconds PAT

[14:04] PATCommunity service I think I got for one charge and the other one was a fine and a week in jail it caused me. After that I stayed clean for probably a month. DR. WILLIAM RICHARD MILLER: After the jail?

14 minutes 24 seconds PAT

[14:24] PATYeah, because I was in (inaudible) up there . DR. WILLIAM RICHARD MILLER: Yeah. What was that week like? That was the first time for you. PAT: Yeah. It was terrible . I don't want have to ever go through that again for , you know, little bit of powder. It is not worth it . It was a lot, I guess, once in a while I go back to it and it is hard to just completely get that out of your mind to not do it . So, ...(crosstalk) DR. WILLIAM RICHARD MILLER: That can happen pretty fast.

14 minutes 59 seconds PAT

[14:59] PATYeah. DR. WILLIAM RICHARD MILLER: Using again before you realize it. PAT: Right . Really fast, you know. DR. WILLIAM RICHARD MILLER: So, it's worth it to stay out of jail

15 minutes 9 seconds DR. WILLIAM RICHARD MILLER

[15:09] DR. WILLIAM RICHARD MILLER. That wasn't too pleasant for you. PAT: Not at all.

15 minutes 14 seconds DR. WILLIAM RICHARD MILLER

[15:14] DR. WILLIAM RICHARD MILLERYeah. I mean, some people don't seem to mind, but for you that was, "No thanks . I don't want to have."

15 minutes 24 seconds PAT

[15:24] PATIt is not a good thing. DR. WILLIAM RICHARD MILLER: What else?

15 minutes 29 seconds PAT

[15:29] PATOn the downside of it? DR. WILLIAM RICHARD MILLER: Yeah. PAT: I get depressed a lot, thinking really on how things could be yet they are not, because I am doing the stuff and it just seems to get nowhere. Life seems to go nowhere. DR. WILLIAM RICHARD MILLER: Yeah. I can see that

15 minutes 54 seconds DR. WILLIAM RICHARD MILLER

[15:54] DR. WILLIAM RICHARD MILLER. That is another one, there has little traps. PAT: Yeah. DR. WILLIAM RICHARD MILLER: That you get the feeling bad about using and then using relieves the bad for a while and kind of go around the circle. PAT: Right. DR. WILLIAM RICHARD MILLER: You can see how you are stuck and in some ways with the relationship and also with your feelings . It is like another way out the woods, but getting out of this seems to be difficult.

5: Identifying skills that have worked

16 minutes 24 seconds PAT

[16:24] PATYeah. DR. WILLIAM RICHARD MILLER: What has worked for you so far? You said you've had some times when you've, you know

16 minutes 29 seconds DR. WILLIAM RICHARD MILLER

[16:29] DR. WILLIAM RICHARD MILLER, got away from the drugs, and how that and what worked for you?

16 minutes 34 seconds PAT

[16:34] PATJust getting to a point where you have to say, forget it, it is just not worth it . I just got to that point where I had to quit or I felt something bad would happen, you know. DR. WILLIAM RICHARD MILLER: That feeling in your bones

16 minutes 54 seconds DR. WILLIAM RICHARD MILLER

[16:54] DR. WILLIAM RICHARD MILLER. Right? PAT: Yeah. (inaudible) with the police things, the more you get in trouble

16 minutes 59 seconds PAT

[16:59] PATand you get convicted on things, the more that adds up and the more you are looking at doing a lot of time in jail. That kind of thing, and then it is just not worth it . So, I just felt that things were around the horizon and I have to get away from it.

17 minutes 14 seconds DR. WILLIAM RICHARD MILLER

[17:14] DR. WILLIAM RICHARD MILLERAnd when you've got into that moment, when you've got into that place of saying okay , this is what I want. How do you do it? How did you get through the week? PAT: When I quit? DR. WILLIAM RICHARD MILLER: Yeah. PAT: Well

17 minutes 29 seconds PAT

[17:29] PAT, it wasn't easy. DR. WILLIAM RICHARD MILLER: Right. PAT: I guess I relied on other things more like coffee, cigarettes , but it's a lot of will power to quit but it's really hard for me to completely quit, but I proved to myself that I can quit. DR. WILLIAM RICHARD MILLER: Even on your own.

17 minutes 54 seconds PAT

[17:54] PATYeah, I was all on my own. It just takes a lot of will power , you know. It is just; I haven't had that train of thought to keep it going that way. DR. WILLIAM RICHARD MILLER: Well, yeah. I hear that you get to the place where

18 minutes 9 seconds DR. WILLIAM RICHARD MILLER

[18:09] DR. WILLIAM RICHARD MILLERyou are convinced, you know, that what you are doing is not what you want, and you want to go in a different direction , and you do it even without help. You get through that initial point . So, so far it's so good, and then somewhere down the line, something comes up or something happens and you use again , and using a little bit doesn't work for you, and you get that do not stay there and so that draws you back into the (inaudible) again real quickly . So, it's the staying away really that's a challenge even when you've got into the point of saying I know what I want. I know this is not the life I want for myself , you know. Now, within the last year, say what's the longest time you've gone without using drugs? PAT: You know, last year

18 minutes 59 seconds PAT

[18:59] PATprobably to be honest I would say about five or six weeks.

19 minutes 4 seconds DR. WILLIAM RICHARD MILLER

[19:04] DR. WILLIAM RICHARD MILLERIt's pretty long. PAT: Yeah. I have (inaudible). DR. WILLIAM RICHARD MILLER: Pretty good. How did you do that? Really, It is a long time. PAT: Actually, I went to Florida

19 minutes 14 seconds PAT

[19:14] PATfor five or six weeks, and...(crosstalk) DR. WILLIAM RICHARD MILLER: Got away

19 minutes 19 seconds DR. WILLIAM RICHARD MILLER

[19:19] DR. WILLIAM RICHARD MILLERfrom the friends, got away from the street. PAT: Yeah, friend and all thing.

19 minutes 24 seconds DR. WILLIAM RICHARD MILLER

[19:24] DR. WILLIAM RICHARD MILLERThat's interesting. PAT: That seemed to work, but when I came back

19 minutes 29 seconds PAT

[19:29] PAT, and not long after that I fell back into the same old problems. DR. WILLIAM RICHARD MILLER: You know, sometimes it is that complete

19 minutes 39 seconds DR. WILLIAM RICHARD MILLER

[19:39] DR. WILLIAM RICHARD MILLERchange of, you know, even where you live and what you do , that it seems to take and it is interesting thing that it was going somewhere else , away from all the things that remind you about drugs and the friends in the streets and so forth, like just stay drug-free for a while. What else have you tried to stay drug-free during this times or when you want to get away from it?

20 minutes 9 seconds PAT

[20:09] PATJust staying in the house and not going anywhere. DR. WILLIAM RICHARD MILLER: So, it's kind of tough it

20 minutes 19 seconds DR. WILLIAM RICHARD MILLER

[20:19] DR. WILLIAM RICHARD MILLERon yourself. Kind of guy. PAT: Right, and just stay in and

20 minutes 24 seconds PAT

[20:24] PATnot think about it, of course you have to have a job where you can do that too. DR. WILLIAM RICHARD MILLER: Right, and having a job would fill

20 minutes 34 seconds DR. WILLIAM RICHARD MILLER

[20:34] DR. WILLIAM RICHARD MILLERyour time in someway too, you said so. PAT: Yeah. DR. WILLIAM RICHARD MILLER: What happened in separate ways ? How much get to the job that you want? I don't know what the steps are for getting your own business as an electrician. How do people do that?

20 minutes 54 seconds PAT

[20:54] PATHow do they go about? DR. WILLIAM RICHARD MILLER: Yeah. If you want to become

20 minutes 59 seconds DR. WILLIAM RICHARD MILLER

[20:59] DR. WILLIAM RICHARD MILLERan independent electrician, what are the steps you would go through?

21 minutes 4 seconds PAT

[21:04] PATWell, you have to have your own tools , probably some kind of a truck or work van or something a little bit of know how, and a good word that you reliable and (inaudible) and take it from there, you can start building up a small business that way.

21 minutes 29 seconds DR. WILLIAM RICHARD MILLER

[21:29] DR. WILLIAM RICHARD MILLERRight, and you let the know how now or I don't know...(crosstalk) PAT: Somewhat. DR. WILLIAM RICHARD MILLER: A little some to tell you. PAT: Somewhat. DR. WILLIAM RICHARD MILLER: You need to get some more know how. PAT: Yeah.

21 minutes 39 seconds DR. WILLIAM RICHARD MILLER

[21:39] DR. WILLIAM RICHARD MILLERAnd there is kind of big investment of providing with a truck and tools and things like that to get to. PAT: Oh sure. DR. WILLIAM RICHARD MILLER: Right . So, if there is this life out there that you can imagine five years from now with a family and a job and stability and really no need to use drugs . Is that kind of draws you and also cause you would like to be there ? It has just kind of been hard to get there past a week or a few weeks of staying away from drugs . You are pretty clear that that's what you need to do to get there. It sounds like that the way of the forest is to get clear of drugs and stay free , and it's been that sort of stick and do it that has been difficult.

6: Support Self-Efficacy

22 minutes 39 seconds DR. WILLIAM RICHARD MILLER

[22:39] DR. WILLIAM RICHARD MILLERLet me just tell you a few things that people have done successfully , coz I've talked to quite a few people over the years who have been in situation like this and have done it. We have gotten primitively away from drugs and stuck with it and built the life that they were looking for , and people doing in all different sorts of ways. So there is not any one formula for it , but a variety, and so, I guess what I am thinking of is to suggest different possibilities and just see which of those might make sense for you. PAT: Yeah. DR. WILLIAM RICHARD MILLER: What you said ? Some you may know about, some you may even have already tried, I don't know , but I can just tell you some of the things that have helped people with. You know, about methadone. Do you? PAT: Yes. Yeah. DR. WILLIAM RICHARD MILLER: So I mean this is one way in which people stabilize if they find that don't want to or just find it too difficult to let go of opiates altogether. Maintaining a methadone does let people hold down a job, does let people have a family. You don't have the big ups and downs so much of heroin and you can maintain on that. So that's one option. At a downside of that is , it's although hard to get off of it, just as these with heroin, but there are quite a few people maintaining successfully for a long time on methadone and you can function well with that. There also is a medication you can take called naltrexone and what it does is to prevent your body from reacting to heroin. So, if you are taking this medication, you could actually shoot up and nothing would happen . So, it's sort of insurance against a slip in a way, because it just blocks the, what it called, the receptors in your body that let heroin take its effect and plugs them up. So, as long as you are taking that, heroin is not going to do anything for you and it's kind of an insurance policy . It doesn't make you sick. It doesn't, you know, really do much of anything to you except that if it happens that you go back to just trying on, does happens in a moment, nothing happens to you , it can't do anything for you. You couldn't do those two things together , because it is for methadone or naltrexone, but it's something that people have found useful . I think, in part of around this problem, I know I want it, I know I want to get there , and then something happens, and oops before you know it, you've got shooting up again . So that's a (inaudible) too. PAT: I don't use the needles

25 minutes 24 seconds PAT

[25:24] PATbut doing it is the same thing whether you are...(crosstalk) DR. WILLIAM RICHARD MILLER: Sure, and it will bump

25 minutes 29 seconds DR. WILLIAM RICHARD MILLER

[25:29] DR. WILLIAM RICHARD MILLERthe effects regardless. PAT: Yeah. Right. DR. WILLIAM RICHARD MILLER: Yeah. You probably know about the 12-step programs like narcotic synonymous or alcoholic synonymous and sometimes people find that those are helpful, particularly if they don't have a network of friends or family that support them in getting away from drugs. Now it sounds like you do really, you've got some family rooting for you. You've got a girlfriend root for you, you are still connected with. So, you've got some of that, but sometimes people find that's useful also. Ever gone to meetings or sampled that at all? PAT: I have. DR. WILLIAM RICHARD MILLER: And what was your experience ? PAT: Well, for me it didn't work

26 minutes 19 seconds PAT

[26:19] PAT. They saw I didn't have the will power to you know , completely quit. I mean I could go through all steps and it all sounds good, but you know, when I was out I just felt the need to do some. DR. WILLIAM RICHARD MILLER: Sure. You know, it's not magic. PAT: That's right. DR. WILLIAM RICHARD MILLER: It's not magic

26 minutes 39 seconds DR. WILLIAM RICHARD MILLER

[26:39] DR. WILLIAM RICHARD MILLER. You keep coming back to will power and also when there is a sense in certainly which is your decision, then nobody makes that decision for you , and there are other things you can do kind of help that will power. So, we wouldn't ask a person with diabetes for example to get over it by a will power. Help now with some insulin and also they need to eat right and exercise and do the things that make him healthy, but it's not just toughing it out completely on your own. It would get a person through diabetes, and in a way I am suggesting maybe some balance like that for you that there that there may be some other things that you can do it that will help you with that will power , and also it i's true that ultimately you decide it , but we talked about methadone, we talked about naltrexone , we talked about the 12-step groups. Sometimes people find it useful to sit as we are sitting and just talk over their life situations and develop plans and move step by step in that direction. It's very common to make some progress and slip back and make some progress and slip back. That's kind of human nature in a way, but to keep making a little more progress over time and sometimes either with a counselor or with a group, it's helpful to have some support like that . Sometimes, it is useful to bring in the girlfriend or family members and work together, and use these people

7: Treatment recommendations and selection

28 minutes 14 seconds DR. WILLIAM RICHARD MILLER

[28:14] DR. WILLIAM RICHARD MILLERwho are supporting you and rooting for you. I wonder if any of those things that I've suggested feel like, Yeah, there is some hope in that " which might make sense for you. PAT: For me the

28 minutes 29 seconds PAT

[28:29] PAT, I am not sure if there was a naltrexone. DR. WILLIAM RICHARD MILLER: Yeah that was the one that prevents heroin from

28 minutes 34 seconds DR. WILLIAM RICHARD MILLER

[28:34] DR. WILLIAM RICHARD MILLERhaving an effect. PAT: That would sound like I would consider trying

28 minutes 39 seconds PAT

[28:39] PAT. The methadone I have friends that are on that and for them it doesn't work. I mean they use both. DR. WILLIAM RICHARD MILLER: It does happen. Yeah.

28 minutes 49 seconds PAT

[28:49] PATDefeats the purpose, but I can't see putting myself on some other kind of drugs. It's that this drug and...(crosstalk) DR. WILLIAM RICHARD MILLER: Yeah. Okay. PAT: It's just that won't be the answer, but that thing that stop the effects would be something I would be interested and I've never heard of it before although. DR. WILLIAM RICHARD MILLER: Oh, is that right. Okay. PAT: Yeah, I don't know anything about that.

29 minutes 9 seconds DR. WILLIAM RICHARD MILLER

[29:09] DR. WILLIAM RICHARD MILLER(inaudible) it really works. It really completely works. PAT: This has to be with doctor's prescription

29 minutes 14 seconds PAT

[29:14] PATor something? DR. WILLIAM RICHARD MILLER: Yes indeed. So, a physician would just check you to make sure that physically

29 minutes 19 seconds DR. WILLIAM RICHARD MILLER

[29:19] DR. WILLIAM RICHARD MILLERit's safe for you to take, but it's quite a safe medication . You can have a few side effects, some stomach upset or something at the very beginning . Usually most people have little difficulty with it and then in the long run , and it is just that kind of insurance policy that blocks the effect for a while . So, you can't that day decide you are going to use and immediately get the effect, it will be a little bit of insulation, little extra will power. PAT: So, what is that really

29 minutes 49 seconds PAT

[29:49] PATwhatever that is a pill or whatever that...(crosstalk) DR. WILLIAM RICHARD MILLER: Yeah. PAT: Do you take if you feel you are going to some that day?

29 minutes 54 seconds DR. WILLIAM RICHARD MILLER

[29:54] DR. WILLIAM RICHARD MILLERYou take it everyday. PAT: Oh, everyday. DR. WILLIAM RICHARD MILLER: Yeah. Take it like insulin. You just got to take it everyday, and then maybe not for the rest of your life, but often it's getting through the first six months, or getting through the first year drug free and getting your life to the place where it is rewarding, it is fun without drugs. Getting the place for yourself, "I wouldn't give this up. I won't go back. Why would I do that?" You know , and getting stabilized in that way. So, that one kind of but it sounds , appealing to you that maybe that would be helpful. What else might be helpful , the things I mentioned or other things that you've thought about?

30 minutes 34 seconds PAT

[30:34] PATI (inaudible) pretty much so (inaudible) . DR. WILLIAM RICHARD MILLER: So maybe it would be worth it to give that one a try. And

30 minutes 44 seconds DR. WILLIAM RICHARD MILLER

[30:44] DR. WILLIAM RICHARD MILLERthat that is going to make sense because you are at a place where you want out , you want to be free. You can do it for a week. You can do it for six weeks . Yeah. And if you don't slip and you don't have one of those just kind of moments you know a moment of difficulty or weakness or whatever we want to call it, you are using, it draws you back in, if you can somehow prevent that from happening, might just get you far enough to be able to get a job and move toward the family that you want, you know . It would be important I think to be taken some steps than during that time to get the electrical job you want or some other job that you are enjoying , because otherwise it is just kind of boredom and emptiness in life , and that's no fun. (inaudible) involve going back to school for a while perhaps. Trades school just to learn the electrical trade. PAT: Maybe at some school

31 minutes 54 seconds PAT

[31:54] PAT(inaudible) could get you there.

31 minutes 59 seconds DR. WILLIAM RICHARD MILLER

[31:59] DR. WILLIAM RICHARD MILLERAnd there wasn't anything else that seemed to appeal to you in terms of having someone else support you 12-step groups or a counselor or a group of some kind. You really want to do this on your own?

32 minutes 19 seconds PAT

[32:19] PATOh yeah. Definitely. DR. WILLIAM RICHARD MILLER: And you know most people do actually

32 minutes 24 seconds DR. WILLIAM RICHARD MILLER

[32:24] DR. WILLIAM RICHARD MILLER. Most people who get through drug problems do so without professional help and I don't think that's unrealistic. I think it's worth a try for you. You could find out some more about naltrexone and give that a shot and see how it goes for you , and if that is not working then think about some other options. I think that's the , you just try things until you find what works . What most often happens is you get longer and longer periods of being drug free and if there are periods of use they get shorter and shorter. PAT: Yeah.

33 minutes 4 seconds DR. WILLIAM RICHARD MILLER

[33:04] DR. WILLIAM RICHARD MILLERThey don't last so long and not so severe. You more quickly get to the place of saying this is not what I want and kind of get back on being drug free . Probably no miracle will happen that just suddenly things will change for you but over time that what happens . You just get longer and longer and longer periods of being free and if you do go back to using that tend to not last so long . Perhaps you've noticed that already kind of when you had six weeks as you were without using this. PAT: Oh yeah. I actually felt very good

33 minutes 44 seconds PAT

[33:44] PATafter those six weeks of not doing anything and one day I slept in my bag and kicked myself on the butt for doing it. DR. WILLIAM RICHARD MILLER: So it is

33 minutes 54 seconds DR. WILLIAM RICHARD MILLER

[33:54] DR. WILLIAM RICHARD MILLER(inaudible) word naltrexone might really have been helpful to you.

33 minutes 59 seconds PAT

[33:59] PATSure. Yeah. DR. WILLIAM RICHARD MILLER: You felt really good after six weeks in what ways?

34 minutes 4 seconds PAT

[34:04] PATWell I was thinking clear and you know, I was back on a normal sleeping schedule and wake up schedule. DR. WILLIAM RICHARD MILLER: Yeah.

34 minutes 14 seconds PAT

[34:14] PATI was eating pretty good.

34 minutes 19 seconds DR. WILLIAM RICHARD MILLER

[34:19] DR. WILLIAM RICHARD MILLERWhen you get there even six weeks. When you get there, it's like this is alright and remember what it is like to feel normal . PAT: Alright (inaudible). DR. WILLIAM RICHARD MILLER: Because the drugs do mess up your sleep too, and you don't eat right , and all that course then feeds into not feeling as well . Big whirlpool kind of draws you down.

34 minutes 44 seconds PAT

[34:44] PATYeah. It's a lot of bad side effects with it.

34 minutes 49 seconds DR. WILLIAM RICHARD MILLER

[34:49] DR. WILLIAM RICHARD MILLERYeah. So, putting together another six weeks could get back to the place of feeling pretty good, and maybe with a little extra help to the will power with something like naltrexone, you can get even longer . It sounds good. PAT: Yeah. DR. WILLIAM RICHARD MILLER: Is there anything else that might be helpful for me to talk to you about or anything you are wondering about?

35 minutes 19 seconds PAT

[35:19] PATWell, in case about the naltrexone and stuff because that seems to have sounds like something I would be try, wanting to try. I have tried anything else so I guess I can quit for so long and for so many reasons but the staying off it is you know, because occasionally you get the urge to do something and...(crosstalk) DR. WILLIAM RICHARD MILLER: Right. Exactly. PAT: It is easily accessible in the areas , you know, it is not too far away to get and...(crosstalk) DR. WILLIAM RICHARD MILLER: It doesn't take long.

35 minutes 54 seconds PAT

[35:54] PATRight. DR. WILLIAM RICHARD MILLER: And boom. PAT: Yeah. DR. WILLIAM RICHARD MILLER: And

35 minutes 59 seconds DR. WILLIAM RICHARD MILLER

[35:59] DR. WILLIAM RICHARD MILLERif it were just that one time wouldn't be a big deal, but what you find is you get immediately drawn back onto using again. PAT: Oh yeah. Yeah, also I do it

36 minutes 9 seconds PAT

[36:09] PAT. I just can't stop.

36 minutes 14 seconds DR. WILLIAM RICHARD MILLER

[36:14] DR. WILLIAM RICHARD MILLERWell there are parts in the brain that I mentioned called receptors are like a keyhole and heroin just fits right into them and turns the key, you know, and that's how you get the good feeling , that's how you get the rush that you are talking about, and what this does is just block the keyhole , so the key won't fit in anymore. Won't go in there . That sounds pretty good. PAT: Yeah.

8: Session summary and ending

36 minutes 49 seconds DR. WILLIAM RICHARD MILLER

[36:49] DR. WILLIAM RICHARD MILLERWell, let me just kind of go back through what we've talked about then and see if that's what you want . You are pretty clear, more clear sometimes than others that you want to get out of the drug using lifestyle that you are in and there is something you are going toward which is family, you know, good relationship, having a job, stable life, feeling good, sleeping, eating right , feeling healthy, you know, that is the area you know, you can do that, you know, you can have that , and you have made good steps in that direction of having a week or two weeks or four weeks or six weeks together . What happens is that something comes up and oops, you are going to slip and use and it quickly draws you back in again and what would be really handy you think would be something that would help you not to take that slip. And if you can get through those moments, those urges and just kind of surf through those urges to use without using or without it having an effect and get past that. String it out a few more weeks to get closer and closer to which you want to do. So you are thinking you would like to find out more about naltrexone and see if that might help you . That sounds good to me. PAT: So, I quit for that six weeks

38 minutes 24 seconds PAT

[38:24] PAT. Almost that I had it finished, you know, I thought it would be out of my life . DR. WILLIAM RICHARD MILLER: Yes. Yeah. PAT: I (inaudible) someone that would start talking about it and then it just right there that got me thinking . That was part of the problem and then I just (inaudible) a little bit and I go. DR. WILLIAM RICHARD MILLER: It's so easy

38 minutes 44 seconds DR. WILLIAM RICHARD MILLER

[38:44] DR. WILLIAM RICHARD MILLERfor that to happen. It's you get the feeling like I got this licked or there is no problem and then bingo. PAT: Yeah. I was pretty close to feeling like that. DR. WILLIAM RICHARD MILLER: It happens that too cigarette smokers too and I mean they go for six months or a year even , you know, without smoking and then just light up for some reason and that they don't think about it particular, and are amazed how quick it happens and also how quickly you get drawn back into smoking again. Those drugs, heroin, nicotine, cocaine are kind of pretty strong pull to them, and so something that could insulate you a little bit from that first use from slipping back again could be really useful. Worth a trying?

39 minutes 34 seconds PAT

[39:34] PATYeah, I think so. DR. WILLIAM RICHARD MILLER: It sounds like

39 minutes 39 seconds DR. WILLIAM RICHARD MILLER

[39:39] DR. WILLIAM RICHARD MILLERa good plan. PAT: Yeah. DR. WILLIAM RICHARD MILLER: So, check it out.

39 minutes 44 seconds PAT

[39:44] PATYeah, I am willing to. DR. WILLIAM RICHARD MILLER: Yeah.

39 minutes 49 seconds DR. WILLIAM RICHARD MILLER

[39:49] DR. WILLIAM RICHARD MILLEROkay Pat, wish you all the best. PAT: Thank you. DR. WILLIAM RICHARD MILLER: Yeah.