Adult Treatment Planner

Objectives and Interventions

• Describe the type, amount, frequency, and history of substance abuse.
  • Gather a complete drug/alcohol history from the client, including the amount and pattern of his/her use, signs and symptoms of use, and negative life consequences (e.g., social, legal, familial, vocational).
• Complete psychological tests designed to assess the nature and severity of social anxiety and avoidance.
  • Administer to the client an objective test of drug and/or alcohol abuse (e.g., the Alcohol Severity Index, the Michigan Alcohol Screening Test [MAST]); process the results with the client.
• Participate in a medical examination to evaluate the effects of chemical dependence.
  • Refer the client for a thorough physical examination to determine any physical/medical consequences of chemical dependence.
• Cooperate with an evaluation by a physician for psychotropic medication.
  • Arrange for an evaluation for a prescription of psychotropic medications (e.g., serotonergic medications).
  • Monitor the client for prescription compliance, side effects, and overall effectiveness of the medication; consult with the prescribing physician at regular intervals.
• Identify the negative consequences of drug and/or alcohol abuse.
  • Refer the client for a thorough physical examination to determine any physical/medical consequences of chemical dependence.
  • Ask the client to make a list of the ways substance abuse has negatively impacted his/her life; process the medical, relational, legal, vocational, and social consequences (or assign "Substance Abuse Negative Impact versus Sobriety's Positive Impact" in Adult Psychotherapy Homework Planner, 2nd ed. by Jongsma).
• Decrease the level of denial around using as evidenced by fewer statements about minimizing amount of use and its negative impact on life.
  • Assign the client to ask two or three people who are close to him/her to write a letter to the therapist in which they each identify how they saw the client's chemical dependence negatively impacting his/her life.
  • Assign the client to complete a First Step paper and then to process it with group, sponsor, or therapist to receive feedback.
• Verbalize "I statements" that reflect a knowledge and acceptance of chemical dependence.
  • Model and reinforce statements that reflect the client's acceptance of his/her chemical dependence and its destructive consequences for self and others.
• Verbalize increased knowledge of alcoholism and the process of recovery.
  • Require the client to learn more about chemical dependency and the recovery process (e.g., through assignment of didactic lectures, reading, films); ask the client to identify and process key points.
  • Assign the client to meet with an AA/NA member who has been working the 12-step program for several years and find out specifically how the program has helped him/her to stay sober; afterward, process the meeting.
• Verbalize a commitment to abstain from the use of mood-altering drugs.
  • Develop an abstinence contract with the client regarding the termination of the use of his/her drug of choice; process client's feelings related to the commitment.
• Attend Alcoholics Anonymous/Narcotics Anonymous (AA/NA) meetings as frequently as necessary to support sobriety.
  • Recommend that the client attend AA or NA meetings and report on the impact of the meetings; process messages the client is receiving.
• Verbalize an understanding of factors that can contribute to development of chemical dependence and pose risks for relapse.
  • Assess the client's intellectual, personality, and cognitive vulnerabilities, family history, and life stresses that contribute to his/her chemical dependence.
  • Facilitate the client's understanding of his/her genetic, personality, social, and family factors, including childhood experiences, that led to the development of chemical dependency and serve as risk factors for relapse.
• Identify the ways being sober could positively impact life.
  • Ask the client to make a list of how being sober could positively impact his/her life; process the list (or assign "Substance Abuse Negative Impact versus Sobriety's Positive Impact" in Adult Psychotherapy Homework Planner, 2nd ed. by Jongsma).
• Identify and make changes in social relationships that will support recovery.
  • Review the negative influence of the client continuing his/her alcohol-related friendships ("drinking buddies") and assist him/her in making a plan to develop new sober relationships including "sobriety buddies"; revisit routinely and facilitate toward development of a new social support system.
  • Assist the client in planning social and recreational activities that are free from association with substance abuse; revisit routinely and facilitate toward development of a new social support system.
• Identify projects and other social and recreational activities that sobriety will now afford and that will support sobriety.
  • Assist the client in planning social and recreational activities that are free from association with substance abuse; revisit routinely and facilitate toward development of a new social support system.
  • Plan household, work-related, and/or other free-time projects that can be accomplished to build the client's self-esteem and self-concept as clean and sober.
• Verbalize how living situation contributes to chemical dependence and acts as a hindrance to recovery.
  • Evaluate the role of the client's living situation in fostering a pattern of chemical dependence; process with the client.
• Make arrangements to terminate current living situation and move to a place more conducive to recovery.
  • Facilitate development of a plan for the client to change his/her living situation to foster recovery; revisit routinely and facilitate toward accomplishing a positive change in living situation.
• Identify positive impact that sobriety will have on intimate and family relationships.
  • Assist the client in identifying positive changes that will be made in family relationships during recovery.
• Agree to make amends to significant others who have been hurt by the life dominated by substance abuse.
  • Discuss the negative effects the client's substance abuse has had on family, friends, and work relationships and encourage a plan to make amends for such hurt.
  • Elicit from the client a verbal commitment to make initial amends now to key individuals and further amends when working steps 8 and 9 of the AA program.
• Participate in Behavioral Marital Therapy to learn and implement ways to resolve conflicts and communicate effectively.
  • Refer the client to or provide Behavioral Marital Therapy (see Intimate Relationship Conflict chapter in this Planner, and "Behavioral Marital Therapy" by Holzworth-Munroe and Jacobson in Handbook of Family Therapy by Gurman and Knickerson [Eds.]).
• Learn and implement coping strategies to manage urges to lapse back into chemical use.
  • Teach the client a "coping package" involving calming strategies (e.g., relaxation, breathing), thought stopping, positive self-talk, and attentional focusing skills (e.g., distraction from urges, staying focused on behavioral goals of abstinence) to manage urges to use chemical substances.
• Identify, challenge, and replace destructive self-talk with positive, strength building self-talk.
  • Explore the client's schema and self-talk that weaken his/her resolve to remain abstinent; challenge the biases; assist him/her in generating realistic self-talk that correct for the biases and build resilience.
  • Rehearse situations in which the client identifies his/her negative self-talk and generates empowering alternatives (or assign "Negative Thoughts Trigger Negative Feelings" in Adult Psychotherapy Homework Planner, 2nd ed. by Jongsma); review and reinforce success.
• Undergo gradual repeated exposure to triggers of urges to lapse back into chemical substance use.
  • Direct and assist the client in construction of a hierarchy of urge-producing cues to use substances.
  • Select initial in vivo or role-played urge-producing cue exposures that have a high likelihood of being a successful experience for the client, using behavioral (e.g., modeling, rehearsal, social reinforcement) and cognitive restructuring strategies within and after the exposure (or assign "Gradually Reducing Your Phobic Fear" in Adult Psychotherapy Homework Planner, 2nd ed. by Jongsma); process the exposure results.
• Implement personal skills to manage common day-to-day challenges and to build confidence in managing them without the use of substances.
  • Assess the client's current skill in managing common everyday stressors (e.g., work, social, family role demands); use behavioral and cognitive restructuring techniques to build social and/or communication skills to manage these challenges (or assign "Restoring Socialization Comfort" in Adult Psychotherapy Homework Planner, 2nd ed. by Jongsma).
  • Assign the client to read about general social and/or communication skills in books or treatment manuals on building social skills (e.g., Your Perfect Right by Alberti and Emmons; Conversationally Speaking by Garner).
• Implement relapse prevention strategies for managing possible future situations with high-risk for relapse.
  • Discuss with the client the distinction between a lapse and relapse, associating a lapse with an initial and reversible use of a substance and relapse with the decision to return to a repeated pattern of abuse.
  • Identify and rehearse with the client the management of future situations or circumstances in which lapses could occur.
  • Instruct the client to routinely use strategies learned in therapy (e.g., cognitive restructuring, social skills, exposure) while building social interactions and relationships (or assign "Relapse Triggers" in Adult Psychotherapy Homework Planner, 2nd ed. by Jongsma.
  • Recommend that the client read material on how to avoid relapse (e.g., Staying Sober: A Guide to Relapse Prevention by Gorski and Miller; The Staying Sober Workbook by Gorski).
• Develop a written aftercare plan that will support the maintenance of long-term sobriety.
  • Assign and review the client's written aftercare plan to ensure it is adequate to maintain sobriety (or assign "Aftercare Plan Components" in Adult Psychotherapy Homework Planner, 2nd ed. by Jongsma).