Treating Individuals with Addictive Disorders

A Strengths-Based Workbook for Patients and Clinicians

Donald Meichenbaum

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000070279
• Edition: 1
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Integrating client stories, research and evidence-based strategies, this Workbook offers educational information, clinical tools and coping techniques to assist addiction patients on the journey toward recovery.

Chapters include psycho-educational information on the science behind addiction and examine how patients engaging in resilience behaviors can alter brain functions. A set of three appendices then evaluates what "works" for the treatment of individuals with addictive disorders including ways to engage patients in the treatment process and ways to assess residential treatment programs. Lastly, a glossary of the "language of recovery" terms provides patients and their family members with the guidelines to monitor treatment gains, support their journey of recovery and bolster their resilience.

Healthcare providers and those suffering from addictive disorders alike will benefit from the approachable discussion of the science and history behind addiction, the personal case-studies and the patient-friendly set of coping toolbox-activities designed to develop lasting behavioral changes.

Module IX

Relapse Prevention Skills

Exercise 1: Taking Stock and Considering Lessons Learned

Exercise 2: Creating My Personal Risk Diary

Exercise 3: Coping with Urges and Cravings

Exercise 4: How to Plan Ahead

Exercise 5: Implementing My Relapse Prevention Plan

Consider the following chronic re-occurring medical conditions such as diabetes, hypertension, asthma and arthritis, each of which may result in further episodes. When such re-occurring medical instances happen, we do not call them “relapses”. William Miller (2015) compares addictions, which are also a chronic relapsing condition to such medical re-occurring disorders, and he proposes that we should not label substance abuse lapses as “relapses”. He highlights that:

“the term ‘relapse’ invokes potentially demoralizing overturns of shame, blame, and failure that are unlikely to inspire change.” (Miller et al., 2019, p. 333)

The concept of “relapse” conveys a sense of failure to patients, significant others and to the Treatment Team.

Now staying with the medical analogy, consider a patient who has a chronic medical condition such as diabetes and who, for a variety of reasons, is not adherent to his/her collaboratively agreed-upon treatment protocol. The diabetic patient does not monitor on a regular basis his/her glucose level, fails to self-administer insulin, does not exercise, nor follow a proscribed dietary plan and do foot care. The diabetic educator and the Healthcare Professional Team will likely work with the diabetic patient to determine the factors, obstacles and challenges that undermine the patient’s treatment non-adherence.

The Healthcare Professional may help the diabetic patient develop a “risk diary” of both external and internal triggers (activities, places, people, negative and positive emotions) that contribute to such lapses. The Treatment Team will help the diabetic patient develop and deliberately practice a set of coping skills in order to learn how to anticipate and address such interfering factors. This type of intervention is known as Relapse Prevention Training.

This Module IX is designed to provide examples of how Relapse Prevention Training can be employed with individuals with various addictive and co-occurring psychiatric disorders. How can individuals come to view any such lapse as a “learning opportunity”, and as a “teachable moment”, and not “catastrophize”, and view it as a “failure” and fall back to a point of total relapse?

Thus there is a need to draw a distinction between the pejorative, judgmental, demoralizing use of the term “relapse” that conveys a sense of failure, versus the clinically valuable use of Relapse Prevention Skills that help addictive individuals learn how to continue their journey of recovery.

This module provides a “game plan” on how to develop and implement Relapse Prevention Skills to reduce the likelihood of such lapses becoming relapses. It focuses on how you can develop a Sobriety Script that you can plan ahead in order to avoid and cope with “high-risk” temptation situations and develop coping resources.

This module will help you take charge of your life and exert personal control, making safe choices. It will guide you in ways you can exercise the frontal lobe of your brain and use executive Type II thinking skills, so you can achieve your treatment goals.

Remember, you are not a mere “victim” of circumstances, of your feelings and thoughts, your urges and cravings, social pressures and interpersonal stressors. You have the power to become a “survivor”, and even a “thriver”. You can become the decider of your own path.

Ways to Develop a Sobriety Script

One can think of human behavior consisting of people having different “scripts” in their head that they follow. For example, we learn cultural scripts on how to behave in restaurants, attend funerals, date, discipline children and the like.

In order to help individuals to remain abstinent and resist temptations, cope with cravings and urges, it is helpful to develop a Sobriety Script in order to reduce the likelihood of “slips” and lapses. A Sobriety Script can reduce the likelihood of a single lapse escalating into a full blown relapse. This module will ask you to put together in written form, a carefully prepared, personalized Script of self-statements and behaviors that you can use to remain substance free and cope with stress and urges to use. The more detailed the Script or recovery plan, the greater likelihood it will be carried out and work.

Moreover, you will be asked to write down the important reasons for developing and following your Sobriety Script. What might get in the way of you following your Sobriety Script, and how can you learn to anticipate and handle these potential obstacles should they arise?

Remember the description of the golfer Jack Nicklaus that was included in Module IV. He described how he played a movie “inside his head” – a Script. He started with his goal and worked backwards. In his mind he took himself on a journey “backwards in time”. Can you do this in thinking through and planning ahead for how you can handle “high-risk” situations? It is important that you not only write out these steps, but that you share your Script and the accompanying reasons with the Treatment Team, fellow patients and significant others in your life.

In your effort to share your Sobriety Script with others, you are making a public commitment and can help convince yourself of the value of following your “game plan” or Script.

Should a lapse ever occur, you can revisit your Sobriety Script and figure out what went wrong and how you can use such slips as a “learning opportunity”. The notion of having Scripts in mind can be applied to any stressful event that you might have to deal with. For example, consider the Script you might call upon to “ask your boss for a raise”, or how you might “apologize to someone who you have hurt in the past”.

Part of raising children is to teach them how to develop and implement Scripts. Having Scripts in your head is like going on a journey. It is like having a GPS in your head and when needed, you can “recalibrate”.

Exercise 1. The first step in developing a Sobriety Script is to take stock of your past efforts. What Scripts have worked and not worked in the past?

In Exercise 2, you will be asked to identify current and future high-risk situations, and learn how to become your own “personal detective” and develop a risk diary. We will consider what are potential triggers or cues that lead to urges and cravings, and how you can reduce their impact and eliminate them from your life.

In Exercise 3, you will learn how to cope with urges and cravings and how to “talk back” to the part of your lower emotional brain that is trying to “hijack” your ability to exert personal control and that interferes with and undermines your decision making processes.

In Exercise 4, you will explore the variety of specific coping and recovery strategies you can use in your journey to sobriety and well-being. How...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Prologue
• Module I: The Stories We Tell Ourselves
• Module II: Psycho-Education: What You Need to Know
• Module III: Collaborative Goal-Setting: Ways to Nurture Hope
• Module IV: Ways to Strengthen Your Emotional Coping Tool Box
• Module V: Ways to Strengthen Your Cognitive Coping Tool Box
• Module VI: Ways to Strengthen Your Interpersonal Coping Tool Box
• Module VII: Spiritual and Religious Meaning-Making Activities
• Module VIII: Attending to Your Personal Clinical Needs: Ways to Bolster Your Resilience
• Module IX: Relapse Prevention Skills
• Module X: Active After Care
• Appendix A: Treatment of Individuals with Substance Abuse Disorders: What Works?
• Appendix B: Taking Stock: An “Honest” Assessment of My Motivation to Change
• Appendix C: How to Choose a Residential Treatment Center (RTC) for Individuals with Substance Abuse Disorders
• Glossary: The Language of Recovery
• Bibliography for General Readers
• Bibliography for Professionals
• Website Resources
• About the Author
• Author Index
• Subject Index