1. List and describe five (5) of the eleven (11) relapse warnings signs that were discuss in class.
1. Change in Attitude may occur and the recovering person may stop attending meetings or have lack of participation at their meetings. They may engage in addictive thinking (“stinkin thinking”). 2. Elevated Stress may happen if little things begin to build up over time, especially if they are not handles with healthy coping skills or are all together overlooked or ignored. This can also happen when a recovering person choose to over react to life changes. 3. Reactivation of Denial happens when stressors begin to take root ad get to the recovering person back into feeding their old ways of thinking. They could begin to think they need their substance(s)every once in a while or tell themselves they CAN’T stay sober all the time, or even lie to themselves and let themselves think a little won’t hurt, or one time won’t make a difference etc. (feed into denials).
4. Recurrence post-acute withdrawal symptoms might begin to surface again and a recovering person may experiences sleeplessness, increased anxiety, and even memory loss. Depression usually can continue long after abstaining from drugs/alcohol. 5. Behavior Changes such as slight changes in the routine or altering the already established method that had previously been working without real reason for making such changes. 6. Social breakdown is when the recovering person may start to feel uncomfortable around others. They may see or call their sponsor less to prevent anyone from noticing these changes. They may avoid family or friends who may try to intervene or just feel like the are unable to relate to people the same not that they have experienced so much. They may have fears of letting others in or telling too much and this can cause somewhat of social isolation with gives more opportunity for the recovering person to lie to themselves.
7. Loss of Structure is once the recovering person completely abandons the daily routine that they had developed during their early sobriety as ways to keep themselves sober and on the right track. This could also happen is some major event such as losing a job or having to move or loss of an apartment or current living situation. 8. Loss of Judgment is seen when the recovering person has trouble making decisions and has a difficult time managing feelings and emotions. 9. Loss of Control is when the individual makes irrational decisions choices an is unable to interrupt or alter the choices they are making. They may start to cut off people who were once positive persons or would be able to offer help and may think he/she can return to social drinking or minimal rug use recreationally.
10. Loss of Options is seen once the recovering person begins to limit their available options and stops attending meetings with counselor and support system. Addicted person may have feelings of loneliness, frustration, resentment and anger. 11. Relapse is when the individual actually attempts reusing/substituting use. The addict may think this is controlled “social” or “short term” alcohol/drug use but ultimately is still a relapse in recovery. Disappointment at the results follows almost immediately and the individual experiences shame and guilt and may even use these feelings as an excuse or reason to continue using if they do not seek out help.
2. Identify six (6) client engagement/counseling techniques discussed in class and discuss how they could potentially increase the client counselor relationship.
1. Establishing the relationship may be one of the initial barriers you may have to overcome. This can be done by having authentic conversations or using a sense of humor to help the client relax. Listening is the counselor’s main focus and primary role though. Listening to a client may be something they are not always use to. Many people probably tell them what they should be doing or how they are doing things wrong; but they might not often get the opportunity to think for themselves. When it is not the drug/alcohol controlling them, it is often others around them. Use the opportunity to ask your client what they think of things and asking them what they want or what is their perspective. Taking the time to invest in your client by considering their response gives them time to discover for themselves what are issues they may have or want to work on. Be careful to remember it is about them, not you. Once the client sees they can trust you they will begin to open up and this potentially is the very beginning or real change and becoming accountable for their own story (if you listen without being judgmental).
2. Empowerment is felt by the client if the counselor helps find was or the client to take power over their own actions. Helping the client see they are not being forced to do anything, and they can ultimately decide what they want to do creates a feeling of being in control. Sometimes a client may be court ordered and if they don’t want to talk and don’t make them, let them sit there and they may begin to have a conversation out of bored. Letting them know they get to decide to do whatever it is that they want to and they can make the most out of it if you want to. One the client begins to see they are responsible for their own outcomes they become more accountable and more involved in their own recovery. The harder they work for it, the more motivated they will be to keep up with all their hard work because they earned it and it wasn’t given to them.
3. Helping the client discover their vulnerabilities (times they may feel most weak such as when they are hungry, angry, lonely, tired etc) and triggers allows the client to identity a time they may need to have a support plan for. One a problem area is discover the client can begin to make a plan as to what they can do to over time these times which will help them get better results. Each occasion they are prepared for will help them be more successful at overcoming and thus building up their own belief in themselves.
4. Helping the client gain positive support is curial for recovery. Just by investing time in your own client you become a part of this support system. Also helping them find other groups that appeal to them (not every meeting is right for everyone and being understanding when they have negative feed about one group, being sure not to punish their feelings but to encourage searching for another group etc) may give them the added support they need in between sessions and may also help with finding new friends who have similar goals at achieving sobriety is great reinforcement.
5.Helping the client establish goals for themselves help gives short term objectives to not only keep them working the program (even when they’re not in the meeting or in sessions) but keeps their brain focusing on treatment. Helping and encouraging the client to make realistic and achievable goals that they are likely to be successful with is helpful in feeling empowered and builds self-esteem and self-worth along with adds to feelings that sobriety is possible (if you take one step at a time, one day at a time etc).
6. Assisting the client in further development with life skills such as stress or anger management help gives the client alternatives and healthier coping skills. Giving the client the ability to make good decisions by advancing their knowledge and education often increases the likeliness they will make positive decisions. This often acts as a coaching mechanism and teaches the client there are other options and reinforces they have choices are responsible for their actions.
3. Discuss the advantages of the ‘group’ modality of treatment? The advantages of group treatment is they often instill hope by hearing other success stories or even hearing others having similar struggles and knowing that they are not alone is helpful. They help individuals accept themselves for who they are or what life they have and give strength to one another in a group effort. The shared experiences add effectiveness and make the struggles seem more normal or manageable as you see everyone work on similar goals.
The group meetings usually offer education and support and because there is no hierarchy or leader and they are self-governing; there are roles of group responsibility. Every person then becomes equally important and serves a purpose. Because most groups are free they are available to anyone and because they are offered just about everyone (including online) they are accessible to everyone regardless of income or having insurance or a vehicle. The group setting promises anonymity which opens the doors to being more honest without fear of reprimand or condemnation. This can help reduce level of shame in knowing there are others who have mad the same mistakes and are working toward resolving them and still have hope.
4. When is individual counseling a preferred modality of treatment? Individual counseling is available and is recommended as another element of therapy and recovery for each individual, but is not necessary or required in order to recover. Individual counseling is often a preferred modality of treatment for those whose demographic (are minorities: teens, women, bi, lesbian, gay, transsexual communities, particular religious groups/extremes etc) can have a profound impact upon the patient’s ability to confront underlying problems (social acceptance, past physical/emotion/sexual abuse, traumatic experiences etc) and establish a solid foundation for recovery.
At times courts also offer individual counseling in order to determine if there are underlying issues (such as mental health/ developmental disabilities). Clinicians who work with specialty programs should have training in the issues pertaining specifically to that population and should be trained in different specialty programs that will have sensitivity to those issues that the majority and average clinicians may not have.
5. List five (5) mental health disorders that are commonly associated with addictive disorders? The most common mental health disorders that are commonly associated with addictive disorders are antisocial personality disorders, post-traumatic stress disorder (PTSD), bipolar disorder, schizophrenic disorder, and bulimia. 1.Anxiety Disorders (ADHD, generalize anxiety)2.Psychotic Disorders (schizophrenia)3.Mood Disorders (bipolar and major depression)4.Personality Disorders (borderline and antisocial)
6. Give five (5) reasons that persons with mental illnesses might stop taking their medications. There are many reasons why someone might stop taking their prescribed medication, but especially those with mental illnesses seem to struggle with regular medication maintenance for reasons such as simply forgetting to take their medications, the cost of their medications (especially if they have no health insurance or are in poverty), they may even have he distorted perception and the belief that they are cured or may simply miss the “positive” symptoms (such as the manic phases of bipolar) or sadly, may have gotten misguided advise from others in recovery that medication is not needed.
7. What are the family rules, identified by Claudia Black, that have been associated with families that have been impacted by addiction and the purpose they serve? Don’t talk, don’t trust, don’t feel, are common rules for children in families with addicts. These rules are often not written or verbalized (unspoken), but work almost like understood laws known by the family of those suffering from addiction. They know better than to talk about someone illness in their family, including talking to others within the family about the family problems. Silence is learned as demonstrated by these who serve role models in the family and the children learn to minimize, discount, rationalize, and pretend things are different than how they really are and often don’t learn how to express themselves.
The reasons behind learning these unspoken rules serves as a way to hide shame, embarrassment, protection from being blamed for something they didn’t do, and almost serves as a way of loyalty to the family unit. These children often experience many disappointments that results in learning not to count on others or believe promises made anyone. Children are not given a way to express the feelings the stem from this environment and ultimately learn its better not to have feelings to talk about. Sadly, this is often a cycle and often times, these children, end up the addicts of the next generation.
8. List and describe the family ‘roles’ that have been associated with addiction and other high stress family dynamics. Addiction is a disease the effects the entire family, not just the addict themselves. Often times, those within the family take on certain roles if struggling with dysfunction or addiction; some of those role are: The “star”-who is the addict themselves and is often controlling the entire family, the enabler-who is often the spouse of the addicted person and act dependently with them, the hero-often times is the oldest or older child who tries to help the family by being perfect and over achieves to make up for the lack of others, the scapegoat-often acts as a person to blame for the problems in the family and may often cause trouble to draw attention away the bigger issues of the family, the forgotten child-often is the younger child who doesn’t get the attention that they need because of the bigger issues taking priority, and the clown can be any person in the family who tries to make light within the stressful times as a way for everyone to cope.
9. Discuss why Harm Reduction as a concept that is somewhat controversial in the treatment /recovery profession. Harm reduction is the concept of no longer attempting to help the individual abstain from chemicals (after years or multiple failed intervention/recovery programs based on the assumption that it is possible to change behaviors over time) but immediately help reduce consequences of their continued substance abuse (until, hopefully, the individual accepts abstinence as a goal) meanwhile reducing the damage being done by their continued use of chemicals. Examples of such models are nicotine replacement therapy, needle exchange programs, and methadone maintenance programs.
These programs are considered providing replacements chemicals in a controlled manner so that the individual is less likely to share or reuse dirty needles or engage in criminal behaviors and activities in order to obtain the substances to abuse which ultimately is thought to help reduced the spread of infectious diseases as well as reduce some cost to Medicare/Medicaid and other insurance premiums of users who destroy their health as well as abuse ER/hospitals as a way to get prescription etc. Harm reduction does have some obvious advantages, but likewise also had the potential to be an enabling way for users to continue use.
Many 12 step programs teach about the important of consequences serving as motivation for change and believe harm reduction serves as a way to prolong the user’s efforts to get the help they need. Others argue that this serves the community more so than the addict, while helping the addict continue to kill/hurt themselves for the benefit of the community by hoping to decrease (unpreventable/uncontrollable) criminal behaviors. It is argued that addicts will still continue to use dirty needles, get additional drugs, and also participate still in illegal activity and that harm reduction just adds to the addiction.