The Advocate Magazine Fall 2021 - Page 18

How to Help Clients Tolerate a Moderate or High-Risk Situation Without Relapsing
Helping Clients Manage Their Cravings continued from page 17

How to Help Clients Tolerate a Moderate or High-Risk Situation Without Relapsing

One of the biggest challenges for clients in the process of extinguishing conditioned cue craving ( see page 17 ) is assessing which environments are safe for them in early recovery . Clients in treatment for substance use will have already made a list of triggers that might initiate a craving . Next , they need to develop a specific skill set to use when they intentionally place themselves in a situation that has relapse potential .
The skill set ’ s success begins with accurately determining the risk — low , moderate , or high — of being in a particular situation . If the risk is determined to be moderate or high , the following four steps are a good place to start :
1 . First , the client has to decide if intentionally placing themselves in a high-risk environment in early recovery is in their best interest . Should they go or not ? In the context of 12-step recovery , the question is : “ Are they spiritually fit ?” The “ spirituality ” mentioned here isn ’ t necessarily religious . It could indicate whether the individual is grounded and capable of answering in a way that builds on the progress made toward recovery . The answer can only come from the individual , but others — including sponsor , therapist , and peers — can provide much-needed insight . If the client consistently hears that going to an event is ill-advised and plans on attending anyway , this speaks to a continued struggle with impaired decision-making .
2 . If the answer is “ Yes , I am going ” ( usually regardless of the spiritual fitness question ), the next step would be to put safeguards in place . Safeguards include things like having an escape plan , truly listening to that inner voice that says “ it ’ s time to leave ,” and having a friend along whom they trust will remain abstinent . Other safeguards include taking craving medications such as disulfiram ( Antabuse ), or setting up random drug-testing while at the event . Some clients might benefit from making a contract , whether written or oral , with a loved one agreeing not to use substances and agreeing that if a lapse does occur , they will leave the situation immediately to prevent a full-blown relapse .
3 . Most of the time , clients can resist for a period of time while in a high-risk environment . A lingering risk is the emotional hangover that results from having had to “ be on their toes ” for such an extended time . The residual stress from this particular type of trigger can leave them vulnerable to a relapse in the days and weeks after the event .
4 . The analogy of a bank account can be useful : Each time someone does something for their recovery ( goes to a meeting , talks to their sponsor , completes a step , attends therapy , changes eating habits , begins exercising , takes medicine , notices a mood change , etc .), a small deposit is made into a recovery account . Slowly over time , the balance grows , but when that individual goes into a high-risk environment , a large withdrawal is made . If there aren ’ t enough funds in the account , it overdraws , and a lapse occurs or there ’ s the potential to suffer an emotional hangover . In this strengths-based approach for determining “ spiritual ” fitness , it could be helpful to highlight what deposits have been made into the recovery account to determine the balance .
The more a client practices this skill set , the better they will get at it . After a time , the skill becomes muscle memory or instinct . Clients no longer have to actively think through it ; they just inherently know it . This is what 12-step programs refer to as one of the “ Promises ”: We will intuitively know how to handle situations that used to baffle us . — Doug Paul
18 The Advocate Magazine Fall 2021 American Mental Health Counselors Association ( AMHCA ) www . amhca . org