Vignette 1

Isabella is a binge drinker and drinks excessively during her manic phases. She has no insight into the consequences of her usage. Isabella has no interest or motivation to stop drinking at this time.

Isabella drinks alcohol but does not use drugs. She drinks sporadically depending on whether she is feeling "upbeat" or "down". When feeling "upbeat" Isabella drinks 1-2 bottles of wine and 6-7 mixed drinks in an evening 3-4 times a week. Isabella does not drink when she is "down" or anxious" and drinks only on special occasion when she is feeling "normal". When in a manic phase and drinking Isabella increases her gambling, spending and "hooking up" with several partners. Family and friends have expressed concerns regarding her drinking. Isabella feels "alcohol helps balance her" when she is "too upbeat" and is not a problem. However, as Isabella explores her Buddhist religious roots she is considering limiting or eliminating alcohol for religious reasons. She has not attended twelve step support groups but is familiar with the concepts.