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Addiction and Counseling Interventions in Flight: 

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Addiction and Counseling Interventions in Flight: 

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Analyzing Whip Whitaker's Struggle and Recovery

Jenny D.
CMHCP, TCSPP
CM585-B Addictions and Substance Abuse
Dr. Hickman
10/11/2023

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Name: Whip Whitaker
Age: mid/late 40's
Gender: Male
Marital Status: Divorced
Orientation: heterosexual
SES: Middle class
Disability: none
National origin: USA
Family: Estranged from his son
Presenting Issues: Whip Whitaker is a high-functioning alcoholic and cocaine drug user who is struggling with several interrelated issues.

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1. Unawareness of Negative Consequences: Whip presents as unaware of the negative consequences of his substance abuse. He initially fails to recognize the tangible or immediate harm that his addiction is causing to himself and his loved ones. This lack of awareness is a common feature of high-functioning alcoholics.

2. Divorce and Family Estrangement: Whip has experienced a divorce and the estrangement from his son, which contributes to his feelings of sadness and emotional distress. He may use alcohol and drugs to escape or numb this emotional pain. However, it's important to also consider that his addiction may contributed to the loss of his family

3. Justification of Substance Use: Despite his addiction, Whip appears to manage his professional responsibilities, like landing a malfunctioning plane under the influence of alcohol and cocaine. Work competence has allowed him to justify his substance use and deny its role in the plane crash, illustrating a pattern of rationalization and self-deception common among individuals with addiction (Galanter & Kaskutas, 2008).

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WILL: I’m telling you to leave.

WHIP: You are? Are you the man of the house?

WILL: You upset my mother. You gotta go.

WILL: (pulling open the door) I sure don’t.

WHIP: What did you say?

WHIP: I’m your father, tough guy.

WILL: You’re a drunk. Now get the fuck out!

WHIP: You don’t know who I am!

WILL: I said, “I sure don’t.” Why don’t

you tell me? Who are you? Huh? WHO ARE YOU?!

Scene demonstrates Whip's continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.

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Whip meets the criteria for F10.20 Alcohol use disorder (severe) according to the DSM-5-TR

Diagnostic Considerations:
Whip Whitaker should also be assessed for the following diagnoses as they could also apply in Whip's case:

Major Depressive Disorder

Potential post-traumatic stress disorder (PTSD) from the plane crash

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The DSM-5 further classifies AUDs by severity, determined by how many of the eleven diagnostic criteria are met. 

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The DSM-5 further classifies AUDs by severity, determined by how many of the eleven diagnostic criteria are met. 

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305.00 (FI 0.10) Mild: Presence of 2-3 symptoms.

303.90 (FI 0.20) Moderate: Presence of 4-5 symptoms.

303.90 (FI 0.20) Severe: Presence of 6 or more symptoms

These levels of severity are often used by clinicians when determining risk, eligibility for certain treatment programs, recommended treatment options, and cost (APA, 2022).

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Evidence of Addiction according to the DSM-5-TR (some examples in Whip's case)

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Evidence of Addiction according to the DSM-5-TR (some examples in Whip's case)

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- Craving, or a strong desire or urge to use alcohol

- Drug Dependency: Whip needs alcohol to cope and to function normally.
- Recurrent alcohol use in situations in which it is dangerous to drink.
- Recurrent alcohol use prevents Whip from fulfilling his role as a father, husband, and ultimately a pilot.
(APA, 2022)

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Based on this case conceptualization, Whip Whitaker may benefit from a comprehensive treatment plan that includes:

1. Substance Abuse Treatment: Engaging in a formal substance abuse treatment program that may include detoxification, therapy, and support groups.

2. Mental Health Counseling: Addressing his unresolved emotional issues and potential depressive symptoms.

3. Family Therapy: Exploring the possibility of rebuilding relationships with his estranged family members.

4. Safety Assessment: Ensuring that Whip is not in a position to jeopardize the safety of himself or others (Kress & Paylo, 2017).

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The recommended treatment approach for Whip, who struggles with alcohol and cocaine addiction, involves a combination of Cognitive Behavioral Therapy (CBT) and participation in Alcoholics Anonymous (AA) support groups.

1. Cognitive Behavioral Therapy (CBT): CBT is a versatile therapeutic approach that can be adapted to various clients, settings, and formats. It includes two main components:

Functional Analysis: This helps individuals like Whip identify the thoughts, emotions, and circumstances that lead to substance use. By recognizing high-risk situations and understanding the reasons for their substance use, clients can gain insight into their addiction triggers.

Social Skills Training: CBT equips clients with coping skills and self-awareness. It focuses on developing self-control, teaching effective coping strategies, and helping clients become more aware of their thoughts, feelings, and behaviors related to substance use. This approach is particularly helpful for individuals with dual diagnoses.

2. In Whip's case, CBT can address both his alcoholism and cocaine dependence by providing tools for symptom management, craving reduction, relapse prevention, and challenging unhelpful beliefs about substance use (Kress & Paylo, 2017; Whitlock et al.,2004).

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AA is a global, peer-based support network rooted in the Twelve Steps and Twelve Traditions. It aims to help members achieve and maintain sobriety. Research has shown that AA participation is associated with several positive outcomes, including reduced stress in early recovery and decreased alcohol use over time (Galanter & Kaskutas, 2008).

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Advantages of Alcoholics Anonymous (AA) for Clients and Providers

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Advantages of Alcoholics Anonymous (AA) for Clients and Providers

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Alcoholics Anonymous (AA) offers numerous benefits for both clients, like Whip, and providers in the field of addiction recovery.

For Clients (Whip):

1. Social Support: Research shows that group membership, as in AA, can provide individuals with significant benefits during times of stress by enhancing the extent to which they receive and benefit from social support. This is particularly important for Whip as he seeks to create a new social identity within a group dedicated to positive change.

2. Strengths and Protective Factors: Belonging to an AA group can increase Whip's strengths and protective factors.

3. Support Network: AA meetings enable individuals to develop a strong support network, fostering friendships and connections with people who have faced similar struggles (important for Whip who is estranged from family)

4. Accessibility and Availability: AA's widespread availability and accessibility make it a practical choice for Whip.

5. Sponsorship: AA emphasizes the importance of sponsorship, where experienced individuals in recovery, known as sponsors, offer personal stories, guidance, and one-on-one assistance to members. This mentorship and guidance can be particularly beneficial for someone like Whip (who may be used to/or comfortable with taking a subservient role in previous military training).

6. Acknowledging Powerlessness: The first step of AA requires individuals to recognize and accept their problem with substances and their powerlessness over alcohol use. This process can help Whip find self-efficacy in becoming a more compliant and dedicated patient.

7. Storytelling and Motivation: AA provides Whip with the opportunity to share his story with a peer group, motivating and inspiring him to view recovery as a positive accomplishment rather than an unimpressive outcome (Whitlock et al., 2004).

8. Psychoeducation: AA's additional assignments and therapy can help Whip understand that his inability to discontinue the use of alcohol and cocaine doesn't equate to failure. This understanding is crucial for self-acceptance and recovery.

9. Holistic Approach: AA addresses various aspects of recovery, including understanding the illness, building trust, developing coping skills, fostering relationships, and improving self-concept. It offers a structured framework for personal growth and change (Galanter & Kaskutas, 2008).

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1. Resources: AA provides valuable handbooks and content that can guide counseling sessions and interventions effectively, enhancing the quality of care provided to patients
2. Long-Term Efficacy: Research has shown that AA remains effective for participants even after long-term follow-ups, increasing levels of self-efficacy to reduce drinking
3. Social Support: The AA program encourages members to find sponsors and build personal connections, enabling client s to support their recovery
4. Online Community: AA offers an online community that allows members to stay connected and receive support from others, even outside of regular session days, providing flexibility and convenience (Miller et al.2019).

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Diversity, Multicultural, and Social Justice Issues

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Diversity, Multicultural, and Social Justice Issues

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Research shows that Black men are not more likely than White men to persist in frequent heavy drinking, contrary to earlier findings (e.g., Caetano and Kaskutas, 1995). In a 2017 study, researchers noticed a small increase in Black men’s heavy drinking frequency in their late 40s relative to White and Hispanic men. In this study there was a convergence in heavy drinking of all three racial groups by age 51 which suggested that other factors may influence heavy drinking frequency among men in middle adulthood (Mulia et al., 2017). Findings also show that parenthood tends to confer
greater protection for women than men. This could support the use of group therapy to strengthen protective factors for Whip. Finally, higher education offers protective effects on heavy drinking (reduces drinking) for men especially. This could be for several reasons, however, education typically offers people with opportunities to gain agency in their lives (Mulia et al., 2017). Considering this research effective interventions with Whip would involve empowering him and to help Whip acknowledge that he could still influence others and have a dynamic/positive identity after becoming sober.

Clinicians could also use the strategy of broaching as a way to demonstrate cultural humility when treating an individual suffering from addiction.

Example of questions/broaching to convey cultural humility:
“I noticed you indicated you are an ex-military pilot among men who were predominantly caucasian. Please feel free to share how that experience impacted, or continues to impact, you life"
or
"What would be helpful for me to know as we begin working together?,” “Would you like to discuss with me or
ask me anything about my identities and how they may impact our work together?”
And
“If at any time during our work together you feel as though I am not understanding your perspective or who you are, please let me know and I am open to discussing this with you, as it is not my intention to overlook your experiences" (Jones & Branco, 2021).

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Movie featured a high-functioning alcoholic. We, members of society and counselors, do not always recognize alcoholism when the presentation differs from the common stereotype of an addict or 'drunk'.

Fostering motivation for change is a critical element in Whip's journey toward sobriety (Turner et al., 2014). Within Alcoholics Anonymous (AA) approaches, this component is typically emphasized, aiding Whip in acknowledging the adverse consequences of his drinking on important aspects of his life, such as health, relationships, work, and finances (Whitlock et al., 2004).

To catalyze Whip's treatment progress, it may be beneficial to integrate other therapeutic methods (such as motivational interviewing, ACT components etc.) to the chosen individual therapeutic approach (Cox & Klinger, 2003). This integration places a strong emphasis on goal setting, self-reflection, motivation for change, and understanding the intricate connection between incentives and motivation. Tailoring the approach to Whip may be more effective in fostering within the client a sense of empowerment and the necessary motivation needed to achieve and maintain sobriety (Miller et al., 2019; Whitlock et al., 2004)

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- Alcohol Consumption Pamphlets
- Stress Management Pamphlets
- https://www.directline.org.au/ready-2-change offers self-assessment, support options information, and service locations near the user. My R2C Workbook Ready 2 Change and My R2C Workbook Skills Training by Hall et al., 2013 are also good resources (Directline, 2023).

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18:54 - CBT Model for Substance Use chart

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Beck Institute for Cognitive Behavior Therapy

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CBT for Substance Use During COVID-19 - Part 1

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“It is impossible to understand addiction without asking what relief the addict finds, or hopes to find, in the drug or the addictive behaviour.”
- Gabor Maté

“The best way out is always through.”
– Robert Frost

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Cox, W.M. and Klinger, E. (2003). A Motivational Model of Alcohol Use: Determinants of Use and Change. In Handbook of Motivational Counseling (eds W.M. Cox and E. Klinger). https://doi.org/10.1002/9780470713129.ch7

Diagnostic and statistical manual of mental disorders: DSM-5-TR. (2022). American Psychiatric Association Publishing.

Galanter, M., & Kaskutas, L. A. (Eds.). (2008). Research on Alcoholics Anonymous and Spirituality in Addiction Recovery The Twelve-Step Program Model Spiritually Oriented Recovery Twelve-Step Membership Effectiveness and Outcome Research (1st ed. 2008.). Springer New York. https://doi.org/10.1007/978-0-387-77725-2

Jones, C., & Branco, S. (2021). Multicultural considerations in addiction treatment. Addiction Counseling. https://doi.org/10.1891/9780826135865.0014

Kress, V., & Paylo, M. (2017). Treating Those with Mental Disorders A Comprehensive Approach to Case Conceptualization and Treatment (2nd ed.). Pearson Education, Inc.

Miller, W. R., Forcehimes, A., & Zweben, A. (2019a). Treating addiction: A guide for professionals. The Guilford Press.

Mulia, N., Karriker-Jaffe, K. J., Witbrodt, J., Bond, J., Williams, E., & Zemore, S. E. (2017). Racial/Ethnic Differences in 30-year Trajectories of Heavy Drinking in a Nationally Representative U.S. Sample. Drug and Alcohol Dependence, 170, 133–141. https://doi.org/10.1016/j.drugalcdep.2016.10.031

WHITLOCK, E. P., POLEN, M. R., GREEN, C. A., ORLEANS, T., & KLEIN, J. (2004). Behavioral counseling interventions in Primary care To reduce risky/harmful alcohol use by adults: A summary of the evidence for the U.S. preventive services task force. Annals of Internal Medicine, 140(7), 557–568. https://doi.org/10.7326/0003-4819-140-7-200404060-00017