Relapse Prevention

Failure to utilize the tools of recovery and make a sufficient commitment to recovery- oriented behaviors.

Client makes a commitment to recovery-oriented behaviors and identifies with recovery community.

Encourage identification with peers, bonds to TX group. Client does identification exercise, discussing group skills development in 1 to 1. Do a Good First Step.

Lacks information regarding relapse mechanics and is in denial for cross addiction.

Client increases information regarding relapse and cross addiction and internalizes this information.

Read A Look at Cross Addiction, Relapse Mechanics, see movie Relapse and discuss in 1 to 1. Client interviews 10 members in community who have relapsed and discusses findings in 1 to 1.

Client experiences cravings for crack cocaine.

Client increases information regarding relapse mechanics of crack cocaine and develops a method of management.

Client listens to Cocaine and Relapse, Reads Managing a Cocaine Craving, and discusses this material as part of a relapse prevention session.

Euphoric recall interferes with TX progress.

Realistic self-assessment.

Make a list of the negative consequences of addiction with details of incidents. See movie Dependent Denial.

Support group involvement not sufficient to maintain abstinence.

Client explores lifestyle issues leading to relapse and identifies problem behaviors.

Refer to Relapse Group and discuss insights resulting. See movie Relapse.

Cross-addiction to marijuana.

Recognizes the relapse potential of marijuana.

Read Pot and Cross Addiction.

Denial

Denial that addiction is a problem.

Decrease denial.

See movie Dependent Denial, Read BB chapters 1-5 or NA 1-4, discuss in 1 to 1, give Jellinek and discuss and confront dishonest statements.

Denial is used as a way of avoiding facing addiction.

Recognizing real negative consequences of addiction.

Make list of negative consequences of addiction. Complete powerlessness Inventory. See movie Dependent Denial.

Definition of addiction which the client can identify with is lacking.

Client defines addiction in a realistic and personal manner.

Interview 10 clients as to their definition of addiction and discuss in 1 to 1. See movie Disease Concept.

Education

Lacks information regarding addiction, recovery and 12 step program and internalization of 12 step values.

Increase information regarding addiction, recovery and 12 step program as well as internalization of 12 step values.

Client reads NA Book chapters 1-3 or BB chapters 1-5, 12 & 12 chapters 1,2, and 3. Client sees Disease Concept, Relapse, Dependent Denial, and reads 12 Steps for Anybody Who Really Wants Them.

Client is cross addicted to alcohol and cocaine.

Client increases information regarding a cross addiction to alcohol and cocaine.

See movie Alcohol and Cocaine, The Secret Addiction.

Client is cross addicted to alcohol and heroin.

Client increases information regarding a cross addiction to alcohol and heroin.

Complete Quitting Heroin Workbook & discuss in 1:1 and see movie Heroin and Other Opiates

Lacks information regarding addiction, recovery, 12 step program.

Increase information regarding addiction, recovery and 12 step program

Read BB Chapters 1-5 or NA book chapters 1-4. 12 & 12 Steps 1,2, see movie Disease Concept, Dependent Denial, Relapse.

Group Relations

Failure to bond to appropriate support group.

Client bonds to appropriate support group, 12 step community and TX group.

Encourage identification with peer TX group. Client does identification exercise in group. Client interviews 10 members of TX community and in 1 to 1 discusses things discovered in common.

Relationships are dysfunctional.

Recognition of role of addiction in relationship dysfunction.

Discuss in 1 to 1 and Tx group. Spend 45 minutes with each member of group and report on findings in Tx group

Authority problems.

Decrease problems with authority.

Set clear limits on house rules, discuss in 1 to 1 and in group. Give copy of house guidelines and fraternization policy. Send to new client orientation

Aggression mobilized inadequately in terms of following TX plan.

TX plan progress made.

Daily schedule with specific daily goals set and client to follow plan. Discuss structure in recovery as necessary to accountability

Manipulation by acting superior.

Recognition of defensive posture.

Read Letting Go of the Need to Control. See Dependent Denial. Confront superior behavior.

Sharing in group difficult for client.

Client shares spontaneously.

Client shares one feeling each group session, writes daily insight. Summarizes group dailey

Spirituality

Spiritual dysfunction, confusion, or denial.

Develops a personalized concept of a Higher Power.

Kiss Steps 2 and 3, and read Spirituality and Relapse and discuss 1 to 1.

Lack of trust, spiritual apprehension, foreboding about the future, social anxiety.

Increase in trust, lowering of fear level.

Read 12 & 12 Steps 2 and 3 and. Spirituality and Relapse. Ask 10 clients where they get their hope, discuss in 1 to 1. Read Relaxation a Natural High.

Psychological

Easily influenced, uses chemicals to lower inhibitions.

Client recognizes role of social anxiety in relapse and begins to develop the ability to manage social stresses more effectively.

Give Stress Management Worksheet, read Relaxation, A Natural High, have client spend 30 minutes with each group member and discuss above in 1 to 1.

Limited insight into own identity.

Increases sense of identity as recovering person.

Do a Good First Step, read If You Really Knew Me Would You Really Like Me, read The Joy of Being Sober and discuss in 1 to 1.

Shame, guilt and low self-worth

Increase in self-worth and lowering of level of guilt.

Recognition of role of disease in value incongruence and learning to forgive self as a result. Listen to Acceptance tape and discuss in 1 to 1. Client interviews 10 peers as to how they deal with their guilt and shame. Interviews are discussed in 1 to 1.

Unresolved grief and loss.

Grieving proceeds naturally.

Encourage grieving and ventilation of feelings of sadness in both group and in individual session

Hopeless feeling.

Decrease in sense of hopelessness.

Read Step 2 in 12 & 12, read Here Comes the Sun, ask 10 peers or staff how they got hope in their program and discuss in 1 to 1.

Poorly controlled anger interferes with function in group and community.

Reduction in anger. Anger ceases to interfere with functioning in Tx

Write down angry feelings in group. Ask peers to give a hand signal when they see you getting worked up. Limits are set on expressions of anger. Teach doing the opposite as a strategy

Reality is avoided.

Faces reality and is able to verbalize this recognition. Becomes accountable to Tx group for avoidant behavior

Confront client on avoiding behavior and solicit group recognition of problems.

Problem solving is difficult.

Increase in problem solving abilities.

Client does Change Sort Exercise in Tx group

Self-defeating behavior appears to be a feature of clients HX.

Identify self-defeating behaviors.

Do a Good First Step and discuss it in 1 to 1 in terms of self-defeating behaviors that can be identified by client and develop appropriate strategies to productively counter behaviors.

Goal orientation and follow-through lacking in client’s life.

Goal setting behavior and follow through increases in terms of TX and aftercare.

Client does Change Sort exercise either as a part of a group or individually. Discuss progress on following through on goals.

Feelings are identified and shared with difficulty.

Feelings are identified and shared.

Client given feelings vocabulary sheet, agrees to share feelings in group at least once per session and follows through.

Lack of appropriate method to express anger and resentment.

Identify and express anger consistently.

Listen to or read Of Course You are Angry. Do Impulse Control exercise, keep daily journal and discuss resentments in 1 to1.

Self-assertion in terms of getting most out of the TX experience is lacking.

Increase self-assertion in TX.

Verbalizes signs and symptoms of disease of addiction in group. Full participation in TX is encouraged with clear consequences if less than full. Client’s attitude is improved.

Parenting

Poor parenting skills

Parenting skills increase

Client writes a definition of being a parent and reads to Tx group. Is engaged about definition and actual behavior

Employment

Employment deficit.

Increase employment options.

Give MRS handout

Negative work environment supports addiction.

Develop options to current work situation.

Give MRS handout and discuss in 1 to 1.

Legals

Legal problems.

Legal problems are seen as negative consequence of lifestyle associated with addiction.

Discuss in 1 to 1, contact appropriate legal bodies and referral.

Family/Co-dependants

Family alienation.

Recognition of alienation as by-product of addictive process.

Read Alcoholism in the Family. Read Resentment. Discuss in group.

Enabling by spouse or significant other.

Identify enabling behaviors as recovery barriers and verbalize this recognition.

Read or listen to Codependent No More , See movie When a Man Loves a Woman

Codependent behaviors interfere with recovery and develop relapse prevention plan to combat.

Listen to or read Codependent No More. Discuss enabling in 1 to 1

Discuss in 1 to 1 uses results in relapse prevention planning, refer spouse to appropriate support group.

Reading and Writing

Difficulty with reading and writing.

TX proceeds despite problem and provision for remedy is obtained.

All written assignments are on tape where possible and use of group support and tutor are assigned in order to complete assignments.

Social activities that encourage drinking.

Develop chemical-free social activities

Refer to Activities Focus Group and complete Leisure Activity Worksheet

AA/NA/Support Groups

AA exposure is limited.

Increase exposure to AA.

Refer to outside meeting and in house meeting attendance and refer to AA coordinator to assist in obtaining a sponsor. Discuss in 1 to 1 and group difficulties arising out of exposure.

Lack of support systems.

Identify support systems necessary and make appropriate referrals.

Discuss in 1 to 1.

Housing

Housing of an appropriate type is lacking.

Increase living options.

Refer to ¾ and discuss possible options

Finances

Financial difficulties.

Explores available resources, taking care to avoid placing financial needs ahead of recovery.

Discus SSI grant in 1 to 1. Determine effect on recovery and discuss other options.