With all the information (and a lot of misinformation) floating around these days, SF Intervention considers it important to provide one location for you to find reliable facts about addiction, mental health and various treatment options. We hope that you will come away empowered with the truth about addiction and feel equipped to choose the best treatment for you.
A comprehensive assessment uses extensive procedures that evaluate the severity of the substance abuse problem, elicit information about other contributing factors, and assist in developing treatment and follow-up recommendations.
What Does An Assessment Involve?
Each person with a substance use problem is likely to have a unique constellation of symptoms and factors, so several areas must be included in a comprehensive assessment, including:
- Complete substance abuse history, including all substances past and recently used
- Modes of use, frequency, and amounts
- Full addiction treatment history including when, where, and how long
- Significant physical and mental health history, including medications of ongoing care needs and any suicidal thoughts or attempts
- Family history and current family issues, including marital status and family support
- Emotional and psychological history
- Spiritual or religious issues
- Lifestyle concerns
- Socioeconomic factors
- Prior community resource use
- Cognitive capacity and behavioral functioning
- Readiness for treatment
The American Society of Addiction Medicine (ASAM) Criteria is a clinical guide to improve assessment and outcomes-driven treatment and recovery services. The ASAM Criteria is used to match clients to appropriate types and levels of care.
ASAM’s six dimensions of multidimensional assessment:
1. Acute intoxication and/or withdrawal potential: Assesses what type and intensity of withdrawal management services are needed
2. Biomedical conditions and complications
3. Emotional, behavioral, or cognitive conditions and complications
4. Readiness to change: This dimension assesses the degree of need for motivational enhancement services to engage a person and begin the recovery process. Treatment approaches and intensity should be tailored to the assessed stage of change.
5. Relapse, continued use, or continued problem potential: This dimension assesses the need for relapse prevention services. How difficult is it for the client to maintain stability and make progress in recovery? This dimension focuses on previous periods of sobriety or wellness and what worked to achieve this.
6. Recovery/living environment: This dimension assesses the need for specific, individualized family or significant-other support and services. Assessment of this dimension should recognize the importance of identifying recovery and environmental supports for each significant co-occurring condition. Treatment should include consideration of how supportive a person’s current or future environment is to recovery.
Treatment Levels of Care/Level of Care Placement
Length of stay must be individualized, based on the severity of the client’s illness and the client’s level of functioning at the point of service entry and the response to treatment and progress made to desired outcomes.
Levels of care represent intensities of service along a continuum.
For both clinical and financial reasons, the preferable level of care is that which meets treatment objectives and provides safety and security for the client.
The ASAM criteria describe treatment as a continuum marked by four broad levels of service and an early intervention level.
1. Level 0.5: Early Intervention
- Early intervention services are designed to explore problems or risk factors that appear to be related to substance use and addictive behavior, and to help the individual recognize the harmful consequences of high risk for substance use and/or addictive behavior.
2. Level 1: Outpatient Services
- These services are provided in regular scheduled sessions of usually fewer than nine contact hours a week for adults, and fewer than six hours for adolescents.
- Level 1 services are tailored to each client’s level of clinical severity and function and are designed to help the client achieve changes in his or her alcohol, tobacco, or other drug use or behaviors.
3. Level 2: Intensive Outpatient (IOP)/Partial Hospitalization Services (PHP)
- These types of programs provide essential addiction education and treatment components while allowing clients to apply their newly acquired skills within real-world environments.
- Many Level 2 programs have the capacity to effectively treat clients who have complex co-occurring mental and substance-related conditions. These programs also have the capacity to arrange for medical and psychiatric consultation, psychopharmacological consultation, medication management, and 24-hour crisis services.
- Intensive Outpatient Programs (IOPs) generally provide 9 to 19 hours of structured programming per week for adults, and 6 to 19 hours for adolescents, consisting primarily of counseling and education about addiction-related and mental health problems.
- Most IOPs have less capacity to effectively treat clients who have substantial unstable medical and psychiatric problems than do PHPs.
- PHPs, known in some areas has day treatment, generally feature 20 or more hours of clinically intensive programming per week.
4. Level 3: Residential/Inpatient Services
- Level 3 programs offer organized treatment services that feature a planned and structured regimen of care in a 24-hour residential setting. Treatment services adhere to defined policies, procedures, and clinical protocols.
- All Level 3 programs serve individuals who, because of specific functional limitations, need safe and stable living environments and 24-hour care. This is needed to develop, practice, and demonstrate the recovery skills necessary so that clients do not immediately relapse or continue to use in an imminently dangerous manner upon transfer to a less intensive level of care.
- The duration of treatment always depends on individual progress and outcome.
5. Level 4: Medically Managed Intensive Inpatient Services
- Level 4, medically managed intensive inpatient services, is an organized service delivered in an acute-care inpatient setting. It is appropriate for clients whose acute biomedical, emotional, behavioral, and cognitive problems are so severe that they require primary medical and nursing care.
- Level 4 program services are the most intensive in the continuum of care; the principal focus is the stabilization of the client and preparation for his or her transfer to a less-intensive setting for continuing care.
Finding Appropriate Treatment
The best approach for treatment of addiction is a multidisciplinary approach, tailored to the particular needs of all involved.
- Treatment should involve the family.
- Treatment should be focused on the long-term process of recovery this may require multiple levels of care.
- Treatment requires changes in the client’s lifestyle and behavior.
- Treatment should start with the least restrictive level of intervention, yet one that ensures for the client structure and safety, both physical and psychological.
The TEAM Model
TEAM Therapy is an advanced form cognitive behavior therapy (CBT) that places emphasis on four areas: Testing, Empathy, Agenda Setting, and Methods. The TEAM therapy approach was developed by Dr. David Burns, MD, a professor at Stanford University School of Medicine and author of the best-selling book Feeling Good. Based on his many years of clinical experience and research at the University of Pennsylvania and at Stanford, Dr. Burns identified the four areas involved in TEAM as the keys to therapeutic effectiveness.
SF Intervention uses a therapeutic model called TEAM, which is an acronym for the model’s four areas of focus:
T = Testing
E = Empathy
A = Agenda Setting
M = Methods
How the TEAM Model Works
To do cutting-edge work, we conduct a comprehensive assessment of the important facts around the client’s addiction and work to establish a warm and trusting therapeutic alliance. The highly motivated client who’s willing to work hard to bring about dramatic change rounds out the picture. Bringing these ingredients together may be easier said than done, though, since many clients are ambivalent about treatment and may not be at that point where they are fully motivated to change their lives.
SF Intervention uses the TEAM model, as follows, to guide the process in the most effective way possible.
SF Intervention tracks the progress and monitors the quality of the therapeutic relationship accurately at every session. We observe closely how our clients feel and how much progress is being made.
Empathy is the capacity to accurately understand what someone is thinking and feeling at any given moment. Research and practical experience shows that clients who rate their interventionist, coach or therapist as warm and trustworthy tend to make the most improvement.
There is no doubt that without trust, coaching or intervention is going to be superficial and ineffective, no matter what type of method is being used. We know that clients generally come to us in great pain and at the same time have become quite skilled at disguising it. SF Intervention’s goal is to help alleviate that often-disguised pain as much as possible.
When it comes to addiction treatment, no one will change unless motivated to do so. It’s common for clients to come into treatment with one metaphorical foot in the water and one on the shore. We understand that the prospect of making changes can be anxiety-provoking and overwhelming. Some of this cannot be avoided but steps can be taken to diminish it. For example, we believe it is important to set an agenda for treatment and have this completely disclosed at the outset so there is full awareness of everything that is being done every step of the way. Having this knowledge eases some of the discomfort and uncertainty that is normal at the beginning treatment.
SF Intervention recognizes that each person we work with is dealing with a unique and complex set of issues. We honor that uniqueness by drawing from a large repertoire of powerful methods and tailoring treatment specifically to each person and his or her changing needs. Treatment is far from an endeavor in which one size fits all and SF Intervention’s goal is to find the targeted approach that will lead to the best results.
Families and Addiction
Addiction is very much a systemic issue, which means the family and environment often play a big role.
Family and environmental risk factors that may increase the likelihood of addiction include:
- Poor bonding
- Highly chaotic home
- Family conflict and violence
- Financial strain
- Parental substance abuse
- Parental neglect
- Parental mental illness
New family skills, such as better communication and conflict resolution, relapse prevention, stress management, and coping strategies are all needed for enhanced family functioning.
Five common strengths of families who accept coaching even though they feel hopeless are:
- They show up
- They care about preserving the family
- The parents sincerely want what’s best for their children
- Someone in the family is concerned about the problem and wants to do something about it
- They are resilient and have survived and stuck together up to this point
Resilience is an important factor when it comes to successful treatment. Families without resilience would not have survived as a family unit and certainly would not have enough cohesion to be in coaching together.
Why Work with the Family?
Nine reasons family work is valuable in addition to individual coaching:
- Everyone in the family is affected and is forced into an unhealthy role by the addiction; each member needs support.
- Involving the family motivates the addicted individual to recover.
- The family usually has a more lasting influence on the individual than outsiders (including treatment professionals).
- The family’s reaction to the addicted individual and various behaviors could be perversely helping to maintain it. A trained professional’s ability to observe and help change these negative interactions is one source of improvement.
- Treating the family may prevent problems in future generations by helping to break addictive cycles.
- When sobriety is achieved and other changes are initiated, the family needs help in learning to readjust its patterns of interacting with one another. Ironically, the family needs to learn how to live without the problem.
- An inclusive family approach is often much less time intensive than individual coaching and more cost-effective.
- The family must learn that the addict’s behavior doesn’t mean the addict doesn’t care for his or her family very much:
- The progress the client makes in treatment can be hindered or even reversed if family dynamics don’t change, which is why family work is such an important part of addiction treatment.
a. The motivation to procure and use substances becomes much more powerful than the motivation to be responsive to the family.
b. The desire for the substances is equivalent to the extreme hunger one has for food when one is starving to death; it is so powerful that it functions like a survival signal.
Of course, in some cases, families minimize the seriousness of their loved one’s addiction and see no need to continue recovery work as soon as their loved one shows improvement. This type of denial works against recovery and can be addressed directly during family coaching.
Adolescents and Addiction
- Adolescents must be approached differently than adults because of differences in their stages of emotional, cognitive, physical, social, and moral development.
- The progression from casual use to a high-severity substance use disorder can be more rapid in adolescents than in adults.
- Adolescents often demonstrate a higher degree of co-occurring psychopathology, which may not subside with abstinence. These limitations severely inhibit the ability of adolescents to arrest their addiction and address the central developmental task without external assistance and support.
- Adolescent use of substances frequently impairs their emotional and intellectual growth. Substance use can limit a young person’s ability to complete the maturational tasks of adolescence, which involve personal relationships and social skills, identity formation, individuation, development of a full repertoire of coping skills, education, employment, and family role responsibilities.
- Adolescents have a very narrow view of the world, with little capacity to appreciate long-term consequences for their actions.
- Adolescents often require more intensive levels of care.
- The likelihood of developing a substance use disorder fluctuates throughout the course of life. However, adolescence is the period of life where an individual is most likely to develop a substance use disorder.
This group is particularly vulnerable for numerous reasons:
- The developing brain is more susceptible to changes induced by addiction
- The likelihood of exposure to substances of abuse increases at this time
- Immaturity makes it more difficult to cope with peer pressure
- Underdeveloped judgment (typically generating a sense of invulnerability) makes desire for risk-taking greater
- Transitional stressors moving toward adulthood increase the need for alternative coping options
- Hormonal and other developmental changes induce further instability
There are actually a number of factors that contribute to adolescents’ tendencies toward impulsiveness, unruly behavior, and risk-taking. The combination of limited life experience, high energy, a concomitant desire for external stimuli and engagement, and a predisposition to peer influences may easily add up to the potential for substance-seeking and excessive substance use.
Of primary influence, however, is neurological immaturity. Key portions of the brain that manage judgment and emotional control are among the last to mature. The prefrontal cortex, where impulse control, reasoning, and foresight are managed, does not mature until early adulthood, which for most people appears to be the early-to-mid-twenties.
Emotional or behavioral risk factors among adolescents include:
- Low self-esteem
- High independence needs
- Relationship problems
- Use of gateway drugs
- Poor academic performance
Specific substance-related behaviors that parents of adolescents should be aware of are:
- Trouble meeting obligations
- Mood changes and reactions that don’t fit with a particular situation
- Unexplained money problems
- Lack of interest in work, school, or other activities
- Misdirected anger and blame
- Defensiveness when asked about substance abuse
Before deciding to move forward with an intervention, it’s important to meet with a professional interventionist, therapist or substance abuse counselor who can help family members weigh their options and make a plan.
An intervention should not be characterized by anger, blame, and threats, which can alienate an addict who already feels defensive and attacked, but by expressions of love, concern, empathy, and support.
Some interventionists have had no formal training and can unknowingly cause harm. In particular, there is evidence suggesting that the aftereffects of overly dramatic and confrontational interventions linger on in damaging ways and that those who have been subjected to this type of intervention are more likely to relapse after their initial treatment episode.
Types of Interventions:
- With this method, the meeting is a surprise to the person using substances.
- Usually each participant shares a prepared statement about why he or she believes the person needs help, citing incidents or problems they’ve witnessed. This is typically paired with appreciation for who that person could be or has been in the past.
- An ultimatum about starting treatment (usually immediately) is then issued, and the treatment is typically residential rehabilitation.
ARISE Model Interventions
- A more collaborative type of intervention, it invites the substance user to participate in the process from the start, and if he or she declines, it is with the understanding that the family will meet anyway.
- The ARISE approach discourages confrontation and surprise tactics.
- The ARISE approach treats the person with respect and invites his or her perspective. Its collaborative orientation lines up with evidence-based approaches.
Systemic Family Intervention
- An effective, research-based model focused on the issues affecting the family system, rather than the individual afflicted with addiction.
- By reframing the way one looks at addiction and the family system, it allows the family to come back together as a unit.
- This program is educational and therapeutic with respect to helping families understand how addiction has affected them and how to develop and implement healthy coping strategies, especially when feelings of anxiety and fear arise.
Community Reinforcement and Family Training (CRAFT)
- CRAFT teaches the use of healthy rewards to encourage positive behaviors and focuses on helping both the substance user and the family.
- Goals with this method include education about how to encourage your addicted loved one to reduce substance use and enter treatment. The other goal is to help you enhance your own quality of life.
- This non-confrontational approach teaches you how to figure out the best times and strategies to make small but powerful changes, and it will show you how to do so in a fashion that reduces relationship conflict.
Super Information Nuggets about Addiction
- Addiction is a committed, but destructive relationship, and gives a false sense of fulfillment.
- Addiction implies compulsive use, loss of control over using the substance, a preoccupation with obtaining and using the drug, and continued use despite adverse consequences.
- Degrees of severity: many people believe that you either abuse drugs or you don’t, and that drug dependence is something you either have or don’t have. The truth is, chemical dependence lies on a continuum and has different degrees of severity.
- Associations have been found between drug use and psychological characteristics, such as low self-esteem, low self-confidence, and low self-satisfaction. Addiction and substance abuse also tend to be associated with a strong need for social approval, high anxiety, low assertiveness, and self-regulatory deficiencies.
- People start moving into addiction when they decide to seek out mood-changing experiences for relief.
- In active addiction, the addict’s core relationship is with an object alcohol or other drugs and all other relationships are manipulated to support the addiction.
- As addiction progresses, the addict loses the ability to sustain clear thinking, emotional stability, and interpersonal relationships.
- Though nearly all addicts initially believe that they can stop on their own, most of the time their attempts fail to achieve long-term abstinence.
- There is evidence that use of chemical substances may actually alter brain chemistry. With habitual substance abuse, natural chemicals may no longer be produced in the brain, resulting in dependency on alcohol or other drugs to avoid discomfort.
- Brain reward mechanisms: Certain areas of the brain, when stimulated, produce pleasurable feelings. These pleasurable feelings become positive reinforcers that drive the continued use of substances.
- Dependent/addicted persons are ultimately unlikely to experience euphoria or other pleasant effects from the drug; continued use is needed to continue to achieve a state of homeostasis feeling normal or not having pain.
- Once the stage of dependency/addiction is reached, the individual has acquired a chronic relapsing disorder that most professionals believe can never be cured. Return to earlier stages of controlled use is no longer possible.
- Treatment for addictive disorders is effective, but no single treatment model or level of care is appropriate for all individuals. It is critical to provide a range of options tailored to meet a client’s needs.
- Matching treatment settings, interventions, and services to each individual’s particular problems and needs is critical to his or her ultimate success and ability to return to productive functioning in the family, workplace, and society. [National Institute on Drug Abuse, NIDA]
- Your loved one’s needs and preferences should be optimally matched with available resources, intervention types, level of care, and service intensity. This service increases client retention in treatment and improves the overall success of the treatment provided.
- Client-placement criteria provides guidelines for the conditions required for substance-abuse treatment at admission, criteria for continuing treatment at each designated level of care, and the criteria that must guide client movement between various levels of care or release from a given treatment program or facility.
- The American Society of Addiction Medicine client-placement criteria is the most helpful to find the right placement level for people seeking treatment: level-one outpatient services; level-two intensive outpatient/partial hospitalization services; level-three residential/inpatient services; level-four medically managed intensive inpatient services.
- Screening and Assessment information provides a basis for placement into treatment. Domains to be measured included: alcohol and other drug consumption; preoccupation and loss of control; adverse consequences; tolerance and withdrawal; and problem recognition.
- Early intervention tends to produce the best treatment outcome.
- Treatment provides the medical, psychological, and behavioral support necessary for individuals to stop using drugs and to allow their brain processes to return to pre-addiction functioning.
- Treatment is just the introduction to recovery from addiction.
- Treatment for longer periods of time is strongly associated with better outcomes.
- Research indicates that, while substance abuse is not a curable disorder, treatment does work. With treatment, substance-dependent persons enjoy healthy and productive lives.
- Short-term intensive treatment requires long-term follow-up tailored to the needs of the individual. Inadequate follow-up is a key contributing factor to relapse.
- There are no magic bullets or miracle cures for substance use disorders. One size does not fit all. A continuum of treatment and supportive services is needed for adequately meeting the full extent of the needs presented by addicted people.
- The most appropriate level of care is the least intensive level that can accomplish the treatment objectives, while providing safety and security for the client.
- The Center for Substance Abuse Treatment recommends that substance abuse be treated like a chronic condition, such as diabetes or hypertension. To this end, treatment needs to be realigned to allow for a gradual recovery with regular check-ups to ensure that the condition remains in control.
- Recovery is a philosophy of living that has four essential components: acceptance, honesty, open-mindedness, and willingness.
- Abstinence is getting sober; recovery is getting well.
- Physical health is an important foundation for recovery. Proper rest, nutrition, and exercise are essential to the best health and performance of our bodies. The health of our bodies affects our mental, emotional, and spiritual functioning.
- Recovery is not a static condition; it is an ongoing process.
- To recover, addicts must learn a new mode of living. They must slowly exchange the addictive way of life for a new lifestyle where they have meaningful relationships with people rather than substances.
- A person recovering from a substance-use disorder must take an active part in changing attitudes and abandoning a long-held belief that alcohol or other drugs can treat life problems and uncomfortable psychological states.
- Relapse signs: going into high-risk situations; avoiding social support systems; feeling cured after a few weeks of abstinence; desire to test control; switching from drug of choice to another drug, also known as switched addiction; negative moods including anger, impatience, boredom, restlessness, loneliness, exhaustion, and lack of self-care.
- Relapse contributing factors: inadequate skills to deal with social pressure to use substances; high-risk situations; inadequate skills to deal with interpersonal conflict or negative emotions; desires to test personal control; recurring tempting thoughts or desires to use drugs or alcohol.
- A person may be more vulnerable and susceptible to the seductiveness of the addictive process due to the loss of a loved one or other losses such as loss of friendship, of status, of ideals and dreams, loss of friendships, new social changes, times of social isolation, leaving family. Vulnerability is also increased in times of trial and stress that play out over prolonged periods and in times when one is coping with major physical injuries.
Relapse Prevention Fast Facts
The subject of relapse can be both confusing and frightening. The facts given below are meant to provide a better understanding of relapse the urges, feelings, and behaviors and what you can do to prepare yourself mentally, emotionally, and physically.
- Relapse is a symptom of addiction but it is preventable.
- The first 90 days of recovery/sobriety are the most vulnerable time.
- If you can sustain sobriety for one year, it becomes much easier to sustain permanently.
- Research suggests that primary inpatient or outpatient treatments should be at least 90 days.
- After 90 days, patients’ relapse rates drop steadily the longer they stay in treatment.
- Research shows that it does get easier.
- Recovery is difficult at first because your body is deprived of the substance upon which it became dependent. It can take months or longer for the brain’s receptor numbers to rise back to pre-drug figures.
- Yale researchers concluded that it takes at least three months of abstinence for the brain’s prefrontal cortex to be able to process fully and effectively the information needed for good decision-making.
- Urges to use are common you are not helpless in overcoming them.
- Urges are temporary. They peak after a few minutes and then die down like an ocean wave.
Common Relapse Triggers
Just because you have committed to your recovery and a life of sobriety does not mean the things that triggered you to use cease to exist. It is an important part of recovery to recognize your personal triggers so that you aren’t blindsided by them and can create an effective strategy to manage them when they arise.
The following are common relapse triggers for many people:
1. Stress: A Primary Cause of Relapse
Neuroscientists have shown that stress including negative emotions like anger, sadness, self-doubt, and anxiety shifts the brain into a reward-seeking state, which includes the desire to use. This means that stress increases your vulnerability and is a primary cause of relapse. Below is a list of ineffective approaches to reducing stress. (Effective strategies can be found in the section below on relapse preventions strategies.)
- Playing video games
- Surfing the Internet
- Watching TV or movies for more than two hours
2. Social Pressure
Being around people who undermine your recovery goals is extremely risky and should be avoided whenever possible. It will be very hard to maintain sobriety if you remained enmeshed in a social network where substance use is the primary focus. As hard as it might be, you should cut or at least greatly diminish ties with anyone who doesn’t support your recovery.
3. Memories The Good Old Times
- Euphoric recall: remembering only the positives
– Solution: list the negatives of using
- Preoccupation: obsession with or excessive focus on using
– Solution: talk to a clinician; engage in new activities; attend a mutual-help group
4. Slippery Places
- Places or people associated with addiction (i.e. bars and drug dealers)
5. Difficult Situations
Major transitions such as romantic break-ups, moving, changes of school or jobs, leaving your family, and deaths of loved ones create stress and other negative emotions that can lead to relapse. While in most cases it is impossible to avoid these transitions, one should be aware of the dangers they pose and remain committed to a daily recovery program of action.
- Many studies have shown that self-criticism is consistently associated with less motivation and worse self-control.
– Solution: Examine the evidence, the progress you’ve made. Everybody make mistakes and experiences setbacks. How we handle these setbacks matters more than the fact that they happened. A setback does not mean there is something wrong with you.
- Self-compassion: Being supportive and kind to yourself, especially in the face of stress and failure, is associated with higher levels of motivation and better self-control.
- Isolation from emotionally supportive relationships is a major red flag.
- Loneliness, separation from others, increases risk of relapse.
- Animal studies have demonstrated that isolation leads to changes in brain receptors and an increased propensity for drug use. It also reduces the activity of dopamine-dependent nerve cells.
– Solution: Establish and maintain relationships with recovering or sober friends and attend a mutual-help group.
Relapse Prevention Strategies
To be successful in any endeavor, a tested and proven strategy is essential. Preventing relapse is no different. The following strategies have proven to be the most effective at supporting your mental, emotional, and physical wellbeing and reducing the odds of a full relapse.
1. Stress Management
Stress is the number-one contributing cause of relapse. Fortunately there are numerous ways to deal with stress. The American Psychological Association has identified the following as the most-effective stress-management strategies:
- Exercising or playing sports
- Spiritual practice
- Listening to music
- Spending time with friends or family
- Getting a massage
- Going outside for a walk
- Meditating or doing yoga
- Spending time with a creative hobby
2. Social Support
- Connecting with a significant other may substantially facilitate change.
- Family, friends, and others in recovery play a vital role in supporting recovery. A strong community of family and friends who support healthy habits and addictions increases the likelihood of long-term success in recovery.
- Research shows that attending mutual-help groups is a strong factor in increasing the chance of long-term success. Groups vary widely in structure, content, and social climate. Plan to sample several groups before identifying the one or ones you want to attend. There are no requirements to speak. Feel free to take what works and leave the rest.
- Make a public commitment: announce the intention to change.
- Break ties with non-supportive friends.
- Learning social skills to meet healthy individuals is an essential element of an addiction-free life.
- Learn specific strategies for refusing direct offers of drugs/alcohol.
3. Building a New Life
Overcoming addiction involves finding something equally rewarding to replace it.
- What would recovery or a good life mean?
- What in life gives me the most satisfaction? Family? Work? Hobbies?
- What would I like to learn to do?
- What have I left behind that used to give me satisfaction?
- After I am gone, what would I like people to think and say about me?
- How can I engineer my life to support these things?
It’s important to realize that it can take months or years for people’s brains to recuperate after addiction. This is why recovery is so difficult to sustain over the first months, the first year, and beyond.
The Difference Between a Lapse and a Relapse
- Is a single incident of substance use.
- May or may not result in a relapse (regular use) depending on how one responds to the initial incident.
- A lapse should be viewed simply as a mistake and an opportunity for further learning.
- Is a complete resumption of a drug abuse lifestyle.
It is most important to recognize that a lapse does not necessarily lead to relapse. Many people are unable to reach lasting recovery because they interpret a lapse as falling off the wagon, which they believe means that they have failed to achieve recovery and all is lost. This is untrue! This mistaken belief will often lead to feelings of hopelessness and shame, which create a self-fulfilling prophecy and makes it much more difficult to actually recover. For example, this mistaken belief might lead one to say: I’ve blown it. I might as well keep drinking.
What to Do If a Lapse or Relapse Occurs
If a lapse or relapse occurs, you should take five immediate actions:
1. Stop all drug use immediately
2. Leave unhealthy situations or environments
3. Call someone for support
4. Recommit yourself to abstinence and recovery
5. Disclosing cravings
- For relapse prevention efforts to be effective, clients must feel free to tell their counselor or self-help group about lapses or cravings they have experienced.
Relapse Behavioral and Cognitive Coping Strategies
Behavioral coping strategies include:
- Leaving the situation
- Throwing away drug paraphernalia
- Using relaxation skills
- Repeating motivational statements aloud
- Writing down thoughts and feelings in a journal
- Calling a therapist, sponsor, or other individual for support
- Rehearsing planned behavior in role plays
Cognitive coping strategies include:
- Reviewing reasons for quitting
- Reflecting on progress made to date
- Using positive mental imagery
Common Addiction Treatment Terms and Definitions
ASAM definition of Addiction: Addiction is characterized by an inability to consistently abstain from substance use; compulsive use of the drug; obsession and preoccupation with the drug; loss of control while using more than intended, despite conscious efforts to control use; serious consequences due to use; and continued use despite the consequences; impairment, and behavioral control; craving; diminished recognition of significant problems with one’s behaviors and interpersonal relationships; and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse in remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.
Addictive logic:I don’t drink any more than my friends. Or I need my drinks to relax me; I’m just too tense (rationalization). I work so hard, so I deserve to play hard (entitlement). I can stop anytime I want; I just don’t want to right now (denial).
Alcoholism is a primary, chronic disease. Genetic, psychosocial, and environmental factors influence its development. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with alcohol and use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of the symptoms may be continuous or periodic.
Assessment tools: Addiction Severity Index (ASI); Alcohol Dependence Scale (ADS); Alcohol Abstinence Self-Efficacy Scale (AASE); Alcohol Effects Questionnaire (AEQ); Situational Confidence Questionnaire (SCQ); Burns Easy Diagnostic System (EASY)
Avoidance of pain: If using alcohol or other drugs helps someone who is suffering (physically or emotionally), he or she is likely to use the substance again when experiencing the same distress, and a strategy for coping with pain and stress develops that is dependent on the use of alcohol and other drugs. Substance abusers may be motivated by a desire for relief from pain, anger, anxiety, or depression, and alleviation of boredom.
Binge drinking: Any drinking occasion in which an individual consumes five or more standard drinks.
Case management: Activities that bring services, agencies, resources, or people together within a planned framework of action toward the achievement of established goals. Case management focuses on the whole individual and stresses comprehensive assessment, service planning, and service coordination to address multiple aspects of a client’s life. Functions that generally comprise case management include assessment, planning, linkage, monitoring, and advocacy.
Cognitive behavioral therapy (CBT): Posits emotional and behavioral reactions are largely learned responses and that alternative responses can be learned. The CBT approach teaches clients how to recognize and limit relapse risks; behaviors to maintain abstinence; and techniques to improve self-efficacy while identifying cues or triggers that may promote substance use.
Co-occurring disorders: Cases in which the individual has both a substance use disorder and mental health disorder, such as depression.
Detoxification: A set of interventions aimed at managing acute intoxication and withdrawal. The goals of detoxification are to provide safe and humane withdrawal from substances and to foster the client’s entry into long-term treatment and recovery.
Drug addiction is a chronic illness characterized by compulsive, uncontrollable drug craving, seeking, and use, even in the face of enormous negative consequences.
Effective helping: Allowing a loved one to learn from their natural consequences; teaching them responsibility for their own actions; giving them strong incentive to change; loving them enough to let them skin their knees; and preparing them to take charge of their life.
Elements of sanity: A sensible schedule of sleeping and waking, nutritious food, and scheduled meals, exercise, something to do, and people to be with.
Family: An interdependent group or pair of significant others who are important to one another because of relationships, social involvement, legal ties, common goals, or financial security, and you have enough of a past together to suggest a future.
Five critical components of effective treatment: Assessment, client treatment matching, comprehensive services, relapse prevention, and accountability.
Good sleep hygiene: Regulate bedtimes; restrict daytime naps; use the bedroom only for sleep and sexual activity; avoid alcohol and caffeine; reduce evening fluid intake and heavy meals; limit exercise immediately before retiring; use behavioral relaxation techniques.
Hitting bottom: The idea that every individual must hit bottom in order to be ready to successfully complete treatment is a common misconception among the general population, and even in the substance-abuse treatment field. Research reveals that, even when individuals enter treatment for the wrong reasons (external pressures), their treatment outcomes are roughly equivalent of those who enter for the right reasons (a true desire to change).
Intervention: Without some form of intervention, compulsive alcohol and drug users typically are unable to stop their use for more than a few days at a time. In situations of high ambivalence or where your loved one is a non-voluntary participant, an intervention is designed to increase the likelihood of him or her accepting treatment.
Loss of control: The inability to predict with accuracy what will happen when a person takes a drink. Not knowing if one drink will be all that is consumed, or if one drink turns into many.
Miracle question: If a miracle occurred and the problem went away, what would be the first sign, and then what signs would follow?
Motivational Interviewing (MI): Developed by clinical psychologists. Designed to explore and lessen the uncertainty about accepting treatment by using a goal-oriented, empathic, client-centered, yet directive counseling approach. The counselor serves as a coach or consultant, not as an expert or authority figure. Four basic MI principles are empathy, discrepancy identification, resistance reduction, and supporting self-efficacy.
Patient-treatment matching: Different people respond to various approaches in diverse ways, making individualized treatment matching an essential component of intervention. When individuals receive the treatment that is most appropriate for their needs, they are more likely to respond positively, remain in treatment longer, and begin recovery.
Physical dependence: A state in which the presence of the drug is required for the user to function normally. The body has adapted to the presence of the drug and the body views this as normal and necessary.
Positive reinforcement of substance abuse occurs because of pharmacological effects – a sense of euphoria, social rewards, peer acceptance, and increased self-esteem.
Preoccupation: An individual spending an inordinate amount of time and energy concerned with substance use. Thinking about it, planning activities around it, consuming it, and recovering from the effects of substance use all constitute a major part of the individual’s life.
Project MATCH Study: Found CBT to be as effective as both motivational enhancement therapy and 12-step facilitation in reducing drinking and other alcohol-related problems. All three therapy modalities resulted in positive improvements in participants’ outcomes that persisted for as long as three years following treatment.
Psychological defenses: There are several psychological defense mechanisms commonly employed by the chemically dependent: denial, repression of feeling, expression of anger, blaming, minimization, projection, and displacement.
Recovery: The process of initiating abstinence from alcohol or other drug use with intervals of making personal and interpersonal changes.
Referral: Identifying the needs of the client that cannot be met by the counselor or agency and helping the client to access and use the support systems of community resources available.
Screening: The purpose of screening is to methodically review clients’ presenting circumstances so as to determine the appropriateness for placement or referral for further assessment and evaluation. Screening tools are also used to identify the presence or absence of co-occurring disorders, particularly those that might contribute to substance abuse.
Self-medicating: Some individuals who have psychiatric conditions, such as anxiety or depression, use psychoactive substances to alleviate the symptoms they experience.
Treatment planning: The process by which the counselor and the client identify and rank the problems needing resolution; establish agreed-upon immediate and long-term goals; and decide on treatment methods and resources to be used.
Tolerance: The need for greater amounts of alcohol and/or drugs to obtain the same desired effect.
Withdrawal: The physiological reaction that may occur by discontinuing the use of a drug or alcohol for which one has developed a tolerance.