Summary
Highlights
Substance abuse counseling in the active treatment stage focuses on clients' unique cues that lead to substance use and the resulting consequences. Cognitive behavioral counseling and skills training are key. Clinicians assist clients in changing thoughts, emotions, behaviors, and cravings related to substance use by teaching coping, social, leisure, and work skills.
A clinician helps a client named Mark manage caffeine cravings. The techniques involve having Mark create new thoughts emphasizing negative consequences and identifying alternative behaviors for perceived positive effects. Mark identifies walking, listening to music, watching movies, and window shopping as alternative activities that uplift his mood and energy without caffeine.
The clinician guides Mark to balance the positive feelings associated with coffee with its negative consequences, like anxiety. They discuss how exercise can provide a mood and energy boost without the negative side effects of caffeine. Mark also suggests drinking water as a direct alternative to a caffeinated beverage. The concept of cravings coming in 'waves' is introduced, emphasizing that distraction for a short period can help diminish the craving.
Clinicians also help clients identify and manage external cues like people, places, activities, and things that trigger substance use. Examples include friends who use drugs, bars, or drug paraphernalia. Many clients need to learn new leisure activities to enjoy without substances, as they may have neglected other interests.
A clinician helps a client identify people who trigger his cocaine use. The client struggles to say no to certain individuals, Bob, Daryl, and Keith, who historically provided him with cocaine and pressured him. Through a role-playing exercise, the client practices refusing cocaine offers, experiencing the real pressure but also the ability to decline.
The clinician reinforces the client's progress in reducing cocaine use. They discuss triggers like receiving money and engaging with certain people. The client expresses fear about finding work again due to past pressures and temptations. The clinician emphasizes setting plans, acknowledging potential slips, and continuously working on coping strategies even if slips occur to prevent full relapse.
The client discusses a job offer where he has historically been paid in drugs, recognizing it as a trigger. He chose to stay in bed to avoid the trigger but acknowledges this is not ideal. The clinician encourages him to seek support from friends or groups instead of isolating himself. The client finds peace in gardening, an activity that does not trigger his desire to use substances.
Despite the challenges, the client expresses his determination to continue his recovery journey. The clinician acknowledges the difficulty of the process and reminds the client of his past progress and the hard work he has put in.