Crisis in the Afternoon - The Intoxicated Caller
It’s Wednesday and the middle of the week. I have dealt with all the busy pace of a Monday and Tuesday; I am a little more productive, more focused. Wednesday is really the day when I feel like I have settled in to the week, I am energetic and eager. Most calls have been “routine” requests for mental health services. When I say routine I mean non-emergent or high risk callers. I do not mean uninteresting or lacking in uniqueness. Of course, what happens when this is said out loud, a high risk caller presents on the other side of phone.
“Good afternoon, how many I help you?” “Yes, I am calling to talk to someone.” “I am sorry I am having a hard understanding you.” He repeats that he is calling but his speech is somewhat slurred and he seems cognitively impaired. He has difficulty focusing. I am trying to figure out if he is developmentally disabled or intoxicated.
He says, “I…I…just neeed to talk to yoooou. I am soo depressed. I can’t do anything right. My family doesn’t care about me. I can’t keep a job and now, my own mother is threatening to kick me out..out...”
“Wow, it seems that you are struggling with multiple stressors in your life and I am wondering if alcohol is one of them.” My voice is steady, gentle and unassuming. He becomes immediately defense and short, “Why does everyone say I am a drunk?! It’s always about my drinking.”
“When do you drink, what triggers your drinking?” “When I am depressed and something bad happens in my life. Alcohol makes me feel better.”
“You have mentioned your feelings of depression several times and with all the stressors in your life, I was wondering if you had been thinking about harming yourself?” “Aahhh, nah, I…I...just need to talk, talk…..now where am I calling?”
“Tell me about you past self harmful behavior?”
“I drink…it is killing me but I don’t know what to do.”
He is tearful and crying on the phone. I talked with him about coming in to see someone and getting involved in treatment and attending meetings. He is afraid to stop using. We discussed other ways of coping exercise, meditative practice, support groups, etc. He agreed to come in for an appointment. I encouraged him to call back and walk-in if needed. He agreed to let me talk with his mother. She was aware of the appointment and seemed happy that he was trying to get some help.
The intoxicated caller can be very high risk. Even though this patient was intoxicated at the time of call it was important to assess risk factors to self and others and history of these. I also asked to talk with his mother, who was sober and appeared to be one of the only supports he had at the time. With her we discussed the importance of treatment, a crisis intervention plan, access to services and referrals.
Phew…..ok again this was not all of the conversation, assessment or intervention but a glimpse……so much for saying things out loud!....
“Good afternoon, how many I help you?” “Yes, I am calling to talk to someone.” “I am sorry I am having a hard understanding you.” He repeats that he is calling but his speech is somewhat slurred and he seems cognitively impaired. He has difficulty focusing. I am trying to figure out if he is developmentally disabled or intoxicated.
He says, “I…I…just neeed to talk to yoooou. I am soo depressed. I can’t do anything right. My family doesn’t care about me. I can’t keep a job and now, my own mother is threatening to kick me out..out...”
“Wow, it seems that you are struggling with multiple stressors in your life and I am wondering if alcohol is one of them.” My voice is steady, gentle and unassuming. He becomes immediately defense and short, “Why does everyone say I am a drunk?! It’s always about my drinking.”
“When do you drink, what triggers your drinking?” “When I am depressed and something bad happens in my life. Alcohol makes me feel better.”
“You have mentioned your feelings of depression several times and with all the stressors in your life, I was wondering if you had been thinking about harming yourself?” “Aahhh, nah, I…I...just need to talk, talk…..now where am I calling?”
“Tell me about you past self harmful behavior?”
“I drink…it is killing me but I don’t know what to do.”
He is tearful and crying on the phone. I talked with him about coming in to see someone and getting involved in treatment and attending meetings. He is afraid to stop using. We discussed other ways of coping exercise, meditative practice, support groups, etc. He agreed to come in for an appointment. I encouraged him to call back and walk-in if needed. He agreed to let me talk with his mother. She was aware of the appointment and seemed happy that he was trying to get some help.
The intoxicated caller can be very high risk. Even though this patient was intoxicated at the time of call it was important to assess risk factors to self and others and history of these. I also asked to talk with his mother, who was sober and appeared to be one of the only supports he had at the time. With her we discussed the importance of treatment, a crisis intervention plan, access to services and referrals.
Phew…..ok again this was not all of the conversation, assessment or intervention but a glimpse……so much for saying things out loud!....
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