Substance Use & Ambivalence
Carlos, 38, electrician, self-referred
Presentation
Drinking 6-8 beers nightly, more on weekends. Two DUIs in three years. Wife gave an ultimatum. Says: 'I don't think I'm an alcoholic — I just drink to unwind. But I can't lose my family.' Minimizes consequences but showed up voluntarily.
History
Mexican-American, first-generation. Father was a heavy drinker ('but he worked every day'). Started drinking at 15 with cousins. No prior treatment. Union job with high-stress culture where drinking is normalized. Two kids, ages 4 and 7. Wife is Anglo, non-drinker.
Where Approaches Genuinely Disagree
Ambivalence is the natural state of change. Explore it — the client's own reasons are more powerful than pressure.
Ambivalence can be the disease talking. The person needs to surrender the illusion of controlled use.
Philosophical Lenses
These are not treatment plans. They are ways of seeing — philosophical perspectives that illuminate aspects of this case that clinical modalities may not address directly.
Carlos drinks 6-8 beers nightly. His father drank. His union culture normalizes it. Every clinical lens sees this as a problem to be solved. Bataille would see something else: sovereignty. The restricted economy — work, family, responsibility, the electrician who shows up on time — demands that every expenditure of energy produce a return. Drinking is the expenditure that refuses utility. It is what Bataille called the accursed share: the energy that cannot be absorbed by the system and must be squandered. Carlos's 'I don't think I'm an alcoholic — I just drink to unwind' is not denial. It is an inarticulate recognition that some part of human experience resists being made productive. The DUIs, the wife's ultimatum — these are the restricted economy reasserting its claims. The therapeutic question Bataille would pose is not 'How do we stop the drinking?' but 'What would a form of sovereignty look like that doesn't destroy the things Carlos also needs?'
Carlos is Mexican-American, first-generation. His father was a heavy drinker who 'worked every day' — the functional alcoholic as model of masculinity in a community where men's value is measured by labor and endurance. Fanon would locate Carlos's drinking not in individual pathology but in the colonial inheritance that structures working-class masculinity: the demand to produce, the denial of interiority, the anesthetizing of a body that is valued only for what it can do. The union culture where drinking is normalized is not incidental — it is the social reproduction of a workforce that must numb itself to sustain exploitation. Carlos's wife is Anglo, non-drinking. The ultimatum enacts a cultural collision that neither partner fully understands. Treating Carlos without addressing the structural conditions that produce 'the functional drinker' as a cultural ideal treats the individual and ignores the system.
Baldwin wrote that people cannot change anything until they face it, and they cannot face it until they can talk about it honestly. Carlos showed up voluntarily — that matters. But he arrived already performing: 'I don't think I'm an alcoholic.' This is what Baldwin would recognize as the artful dodge of a man who knows the truth but has not yet found a language for it that does not destroy him. Carlos's father drank but 'worked every day.' That phrase is a complete moral system — it means the drinking is forgiven as long as the body produces. Baldwin would ask what would happen if Carlos were allowed to speak about his actual experience without the script of masculinity and cultural loyalty that currently organizes his self-presentation. The ambivalence is not a clinical obstacle. It is Carlos standing at the threshold between the story he inherited and one he might tell for himself.
7 Formulations
Select 2–3 modalities to compare side by side:
Sources & Method
This is a composite fictional case — no real client is depicted. Formulations represent how each modality would typically conceptualize and approach a case with this presentation, based on published clinical literature and training materials. Each formulation draws on the modality's own theoretical framework, key texts, and clinical principles as documented on its modality page. Full source citations for every modality are available on the Sources page.