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services utilized by two separate groups for the treatment of substance
abuse. The clients in the self-help group had decreased alcohol consump-
tion by 70% over 3 years and consumed 45% less health care services
(about $1,800 less per person) than the clients receiving professional sub-
stance abuse treatment.
Case Study: A Young Worker Deals with Substance Abuse
Albert White is a 26-year-old associate at a law firm in Chicago. Albert
had an excellent record as a law student at a prestigious law school in the
midwest but his current work has been anything but stellar. He is per-
petually late, blaming it on traffic and car problems. A number of his
colleagues have seen him in bars after work and late into the night; he
has asked many of them to join him. Although his work is generally
adequate, the firm's general manager has begun to think that Albert is
a liability to the firm and a potential embarrassment should his drink-
ing affect his work at some point. There has been talk of releasing
him from his job, an action that would have a highly negative impact
on his future job prospects.
After an evening of heavy drinking, he was taken to the emergency
room when his car spun out of control and hit an embankment. Three
passengers in the car were slightly injured. Albert and his friends had
been binge drinking. All four friends were highly intoxicated and had
walked a block and a half from a party they were attending to their car
wearing tee-shirts in zero degree weather. Albert sustained minor inju-
ries. After he became sober enough in the emergency room to recognize
the seriousness of the accident and that his blood alcohol level was in
excess of 0.25%, three times the allowed drinking and driving level of
0.08%, he became antagonistic and withdrawn.
A social worker and nurse met with Albert three times over the
course of a 2-day stay in the hospital. They gave out information about
the health impact of drinking and did a screening test to determine
Albert's level of abusive drinking. They concluded that Albert was at
very high risk of becoming a substance abuser because his drinking
impaired his judgment, affected his work and was thought to be responsi-
ble for high blood sugar readings consistent with early onset diabetes and
moderately high blood pressure. A psychosocial history taken by the
social worker revealed that Albert had begun experimenting with alcohol
at age 10 and was frequently using it at home and with friends from age
13 and on. He was drinking several bottles of hard liquor a week. As a
result of the accident and subsequent blood level readings, Albert's dri-
ver's license was revoked by the court and, on the basis of the report
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