Adult Treatment Planner

Objectives and Interventions

• Verbalize a commitment to abstinence/sobriety.
  • Discuss with the client the specific behaviors, attitudes, and feelings that led up to the last relapse, focusing on triggers for the relapse. Obtain a clear, firm commitment to renewed sobriety.
  • Assess the client for ability to reestablish total abstinence and refer to more intense level of care if he/she is not able to detox and stay sober.
• Outline and implement a daily routine that is structured and includes AA involvement.
  • Teach the importance of structure and routine that have either been abandoned or never been present in the client's daily life and then assist the client in developing and implementing a balanced, structured daily routine.
  • Urge the client to attend AA consistently as a part of the routine structure of his/her life.
• Reestablish ongoing relationships with people who are supportive of sobriety.
  • Assist the client in reuniting with his/her AA sponsor.
  • Ask the client to find a second AA/NA sponsor who is an opposite of the primary sponsor (e.g., if the primary is mainly supportive, seek another who is more confrontive) and meet regularly with both sponsors on at least a weekly basis.
• Verbalize feelings about the loss of sobriety.
  • Assist the client in expanding his/her ability to identify feelings, process them, and then express them in a timely, healthy way.
  • Assign the client to read The Golden Book of Resentment (Father John Doe) or readings on resentment from As Bill Sees It (Bill Wilson); choose three key concepts that he/she feels relate to him/her and process them together.
• Identify people and places to be avoided to maintain recovery.
  • Assist the client in identifying the negative influence of people and situations that encourage relapse, and ways to avoid them.
  • Assign the client to read a book or pamphlet on recovery. Select items from it that relate to him/her and process them together.
• Identify the specific behaviors, attitudes, and feelings that led up to the last relapse, focusing on triggers for the relapse.
  • Assign the client to complete a relapse workbook (e.g., The Staying Sober Workbook by Gorski), and process it with him/her.
  • Assign the client to do a focused autobiography dating from his/her first attempt to get sober to the present. Then have him/her read it aloud for feedback as to triggers for relapse.
  • Ask the client to gather from significant others an observation list of the client's behavior or attitudes prior to his/her returning to using; process the feedback in group therapy or in individual session.
  • Develop a symptom line with the client that looks at each relapse in terms of when it happened (i.e., time of year, dates, and their significance) and what was occurring in regard to self, spouse, family, work, and social activities.
• Identify behavior patterns that will need to be changed to maintain sobriety.
  • Ask the client to develop a list of behaviors, attitudes, and feelings that could have been involved in the relapse, and process it with him/her.
  • Assign the client to read Many Roads, One Journey: Moving Beyond the 12 Steps (Kasl-Davis) or Stage II Recovery (Larsen), and process the key ideas with him/her.
• Identify positive rewards associated with abstinence.
  • Assist the client in identifying positive rewards of total abstinence.
  • Assign the client to complete and process with therapist a "Cost-Benefit Analysis" (see Ten Days to Self-Esteem! by Burns) on his/her return to substance abuse.
• Complete medical assessment for Antabuse or antidepressant medications.
  • Refer the client to physician/psychiatrist for an evaluation for Antabuse or antidepressant medication.
• Cooperate with acupuncturist for treatment to reduce the urge to use mood-altering substances.
  • Refer the client to acupuncturist for treatment on a regular basis and monitor effectiveness.
• Comply with medication recommendations as prescribed and report any side effects to the therapist and/or physician.
  • Monitor the client for compliance with medication orders or other treatments and possible side effects, and answer any questions he/she may have.
  • Confer with the prescribing physician on a regular basis regarding the effectiveness of the treatment.
• Verbalize insights learned from talking and listening to successfully recovering chemically dependent people.
  • Ask the client to interview NA/AA members who have been sober for three or more years, focusing on what they have specifically done to accomplish this, and if they have relapsed, what they have done to get back on track to stay. Process the client's findings with him/her.
• Meet with a spiritual leader to make progress on AA Steps Two, Three, and Five.
  • Refer the client to a pastor, rabbi, priest, or other spiritual leader with knowledge of substance abuse and recovery to work through any blocks regarding Steps Two and Three or to complete Step Five.
• Report increased tolerance for uncomfortable emotions.
  • Teach the client various methods of stress reduction (e.g., meditation, deep breathing, positive imagery) and assist him/her in implementing them into daily life.
  • Ask the client to develop a list of ways of coping with uncomfortable feelings; process the list with him/her.
• Implement assertiveness skills to communicate feelings directly.
  • Assist the client in developing assertiveness techniques.
• Develop in writing two possible coping strategies for each specific relapse trigger.
  • Ask the client to develop a list of ways of coping with uncomfortable feelings; process the list with him/her.
  • Assist the client in developing two coping strategies for each identified trigger to relapse.
• Verbally describe the family and relationship conflicts that played a role in triggering relapse.
  • Conduct conjoint and/or family sessions that identify and resolve relationship stress that has served as a trigger for relapse.
• The spouse or significant other verbalize an understanding of constructive actions that can be taken in reaction to the client's relapse and recovery.
  • Conduct sessions with spouse or significant other to educate him/her regarding relapse triggers and instruct them on how to be supportive of sobriety. Encourage him/her to attend Al-Anon on a regular basis.
• Participate in rituals that support recovery.
  • Assist the client in developing and establishing rituals in life that will enhance sobriety and be a deterrent to relapse (e.g., receiving AA/NA coins, regular membership in a Step Study Group, coffee with sponsor at set date and time).
• Identify successful sober living strategies of the past.
  • Utilize a brief solution-focused approach with the client to identify specific things he/she did when sobriety was going well and then select and direct the client to increase the use of the identified behaviors. Monitor and adjust direction as needed.
• Verbalize principles to live by that will support sobriety.
  • Assign the client to read a fable or story such as "The Boy Who Lost His Way," "The Prodigal Son," or "Three Little Pigs" (see Stories For the 3rd Ear, by Wallas), and then process it together to identify key concepts connected to staying sober.
• Develop written continuing aftercare plan with focus on coping with family and other stressors.
  • Ask the client to complete and process a relapse contract with significant other that identifies previous relapse-associated behaviors, attitudes, and emotions, coupling them with agreed-upon warnings from significant other as they are observed.
  • Assign the client to develop and process a written aftercare plan that specifically addresses previously identified relapse triggers.