RP and SC

I enjoyed the readings this week because substance abuse and sleep problems are two interesting topics that I don't know much about and because I think they are going to be really relevant to our clinical work. I can imagine that a large percentage of people experiencing emotional distress, for instance, use drugs and alcohol as a coping mechanism AND have difficulty sleeping. However, I would venture to guess that are rarely the topics that are talked about in therapy, especially in the beginning. If someone comes to therapy because he/she is extrememly depressed, experiencing suicidal thoughts, and is drinking every night to deal with these horrible thoughts, the therapist probably won't target the person's drinking right away (maybe because drinking is the only thing keeping the person alive at the moment). However, I think there comes a point in therapy when they need to be addressed. In addition, I think it is important to evaluate a client's everyday habits and routines (i.e, how much sleep they get, how much caffeine/alcohol they drink, how much stress they are under at work) because these things could really be driving thier problem and probably get overlooked alot of the time.

I appreciated the acknowledgement by Witkiewitz & Marlett (2004) about the complexity of relapse and thought they did a great job reconceptualizing relapse as a dynamic process. I know that their model does not presume that one factor has more influence than another, but the whole time I was reading the article, I kept thinking about personal experiences and conversations that I've had with past substance abusers. A few of my uncles and cousins were involved with drugs and/or alcohol addictions and they've unanimously said that they attribute their ability to overcome the addiction to the support of family and friends. Granted, it is most likely not the sole factor in their recovery and it was probably most helpful AFTER they worked on other things like self regulation, fighting cravings, avoiding risky situations, etc. but I think interpersonal determinants (as the article calls them!) are more important than the article gives them credit for.

One final comment: I was laughing to myself when I read the SC article because I read it in my bed right before I went to sleep the other night... and I kept thinking that I should get up and read it in another room or else my bed would become a cue for arousal and not sleep! Then I rememebered that I've been reading in my bed for years and it hasn't been a problem since. But if I ever develop sleeping problems, I'll know why! Anyway, SC seems very practical, but as the article mentions, one main problem is compliance. I know I would have a tough time getting out of bed every night, especially in the winter time. The article gave some suggestions (such as setting up slippers and a robe next to your bed), but I'd be interested to know the percentage of clients who say they follow the instructions but actally don't, as well as strategies that a therapist could use to increase compliance.