Interactive Avatar Substance Abuse Program
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Copyright 2016 pending; filed with the US Copyright Office, Washington, D.C.
All written and/or printed materials included.
Patent pending; filed 2015 USPTO, Washington, D.C. for software technology/avatar based substance abuse program.
All rights reserved. No original part of this manual may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system without permission in writing from Gloria K Manley, MD.
Interactive Avatar Substance Abuse Program
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CONTENTS
I INTRODUCTION
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CONTENTS
II Orientation
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III UNDERSTANDING SUBSTANCE ABUSE AND ADDICTION
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IV Early Intervention
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IV Early Intervention
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V COPING IN EVERYDAY LIFE
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V COPING IN EVERYDAY LIFE
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VI RECOVERY
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VII PREVENTING RELAPSE
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VIII APPENDIX
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IX REFERENCES
CONTENTS
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ACKNOWLEDGEMENTS
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We would like to express appreciation for the professional contributions and dedicated services of all those who served and still serve on the IASAP team. For without their help this project could not have been achieved.
IASAP TEAM
Concept/Development Gloria Manley, MD, Pres, Interactive Health
Concepts, Inc
Scottsdale, AZ 85255 www.Media-Medicine.com
Technical/Program Development Charles A Keemer, Owner, Keemer Says
Upper Marlborough, MD www.KeemerSays.com
Clinical Program Consultant Catherine A. Roberts, MS,LCAS, LPC, CCS
Greenville, NC 27834 CABroberts@gmail.com
Clinical Program Consultant Latasha R. Green, MS,LCAS.LPC,CCS
Greenville, NC 27834 Latashargreen@gmail.com
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ACKNOWLEDGEMENTS
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IASAP TEAM
Software Development Revery Tech Pasig City, Metro Manila, Philippines
Business Planning Larry Edmonson, CPA, Los Angeles, CA 1-310-722-8362.
Technical Assistant James McGill, Phoenix, AZ email@jmacgill.com
Research & Slide Development Devin M. Manley, Tillery, NC
Marketing/Networking Arline Woodbury, MD, Atlanta, Ga
Artist Stephen McIntyre. Greensboro, NC
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Interactive Avatar Substance Abuse Program
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Interactive Avatar Substance Abuse Program
WELCOME to interactive world of IHC - Interactive Health Concepts, Inc.
and Our new AVATAR program, IASAP – Interactive Avatar Substance
Abuse Program. IASAP is a software tool, designed for remote outreach
and to assist those who are struggling with alcohol and substance use
disorders. It provides anonymity between clients and real time
interactions via mobile devices such as cellular phones and tablets. It is
web based, cloud hosted, data encrypted, meets HIPPA standards and can
be implemented on both android and ios devices.
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I INTRODUCTION
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IASAP should be used by trained, licensed, substance abuse counselors
who are already familiar with standard best practice 12 week intensive
outpatient substance abuse (SA) programs. Although a basic clinical
template is included in this App, it is still necessary for the therapist to
explain the concepts, assign homework, implement practice exercises, set
the agenda and regulate the time structure. This Program will work best
when accompanied by treatment manuals with written practice exercises
and checklists.
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I INTRODUCTION
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IASAP is designed primarily for use on mobile devices such as cell phones
and tablets. For this reason, we suggest modifying the standard two (2) 90
minute sessions per week to three (3) one hour sessions. The App has a
built in scheduler that will allow the controller (therapist) to assign clients
to one hour appointment slots on MWF (Monday, Wednesday, Friday) or
TThS (Tuesday, Thursday, Saturday). An intake and screening process is
still necessary to determine if the client is appropriate for services. For
your convenience the commonly used screening tools, the AUDIT and DAST
10 are included in the Appendix. This App can be customized. For
additional fees other screening, testing instruments may be added
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I INTRODUCTION
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OPERATING this software: The therapist is not only the group leader but also the controller of this software. We allow only one controller per license.
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For both technical and clinical reasons, we recommend limiting your remote group size to a total of eight (8) members, i.e. one (1) therapist and seven (7) clients per session..
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The controller is free to move about to any slide or any avatar scene at any time. This allows an avatar practice exercise to be utilized several times in any session to ensure that all clients get to engage and play in all roles.
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In this 1st version the 3d avatars are limited to scenes.
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I INTRODUCTION
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Avatar Scenes: For additional fees both the avatars and the scenes may be customized to meet your needs. This may include changing their style of dress, racial features, sex and the surroundings.
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We strongly recommend preparing your clients prior to using the avatars in learning relaxation exercises, using the SUDS (Subjective Units of Distress Scale) and managing their triggers.
- We have spent many hours preparing this App and feel that not only can it better engage and hold the attention of your clients but will also allow more qualified therapists to reach those in rural, remote and greatly underserved areas.
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What To Expect From This Program
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To learn skills to obtain abstinennce from drugs and/or
alcohol
Self Discovery
II ORIENTATION
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Questions you might have:
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Who leads the group?
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What are the topics for each discussion?
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How long is the meeting?
II ORIENTATION
THE GROUP EXPERIENCE
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Questions you might have:
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How do I know when I can speak?
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Who else is in this group?
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Do any special rules apply?
II ORIENTATION
THE GROUP EXPERIENCE
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Other Questions you may have about groups
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What should happen -if I get too tired, have problems comprehending what is being said, or can’t seem to pay attention?
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Consult the leader of the group and explain issues. The first step in the problem is admitting and making a plan.
II ORIENTATION
THE GROUP EXPERIENCE
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Other Questions you may have about groups
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Your group is prearranged, set at a specific time on specific days.
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You will be notified of the next assignment and the topics to be discussed at the end of each meeting.
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Be prepared –Rest up and have your homework materials prepared prior to the start up meeting time.
II ORIENTATION
THE GROUP EXPERIENCE
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Rules and guidelines for groups
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Confidentiality- This is important because sensitive/private information is shared. Never divulge names or personal information to anyone outside the group.
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Express Empathy- Open your mind to accept others ideas and be open to feedback.
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Begin your sentences with the word, “I,” it makes the experience personal to you.
II ORIENTATION
THE GROUP EXPERIENCE
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Rules and guidelines for groups
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Be respectful- Treat others the way you would like to be treated. Respect should be shown both by you and the leaders of the group.
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Be honest- Honesty is the best policy and the only way to achieve good results.
II ORIENTATION
THE GROUP EXPERIENCE
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Rules and guidelines for groups
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One at a time –Be polite. Allow the speaking person to complete their question or comment.
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Conversations not pertaining to the main topic shouldn’t be happening.
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Since the group does have a time limit, the leader may occasionally have to interrupt if one person is taking too long.
II ORIENTATION
THE GROUP EXPERIENCE
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III UNDERSTANDING SA AND ADDICTION
In the beginning there was light
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Motivation is a key factor if change is going to occur
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Why have you decided to change?
DECIDING TO CHANGE
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The most common response to this question will be the reason you were referred to this Program
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The Matrix Institute surveys showed these responses to include:
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I was arrested, and it was either this or jail.
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My wife says if I don’t stop, we are finished.
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DECIDING TO CHANGE
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Last time I used I thought I was going to die.
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They are going to take the children from us unless we stop.
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I’ve been using for years, I want to change.
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I can’t return to work until I complete this program.
DECIDING TO CHANGE
The Matrix Institute surveys showed these responses included
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Reasons for deciding to change could be anything from personal goals you wish to accomplish, improving your health, mending relationships, pursing a new career/activity, etc.
DECIDING TO CHANGE
Matrix Institute Survey Responses
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It is important to keep these goals in mind as you begin your new path
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Know that change is not always easy but it is surely possible
DECIDING TO CHANGE
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Financial – Loss of funds and an inability to meet your financial obligations or being able to support your family
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Legal – This Program or jail? This surely is the better choice
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Keep your goals nearby, review them daily, never forget what you wish to achieve and most importantly –
DECIDING TO CHANGE
Other factors that may have motivated your desire for change could include:
Never Give Up
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Avoid people who use drugs/alcohol
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Change your phone number
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Avoid bars/clubs
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Refrain from alcoholic beverages
CHANGING
The new path you have chosen requires commitment and dedication.
Below is a list of helpful recommendations to aid your success:
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Get rid of and Stop using all illegal drugs and/or alcohol.
CHANGING
- Avoid using all narcotics or regulated drugs. Discuss your substance abuse issue with your physician and request to use nonnarcotic medication when possible.
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Destroy all drug paraphernalia and associated items
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Identify your addictive behaviors and triggers
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Avoid triggers when possible (See Section IV: Triggers)
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Learn and use thought stopping techniques for cravings (See Section IV: Preparation For Change)
CHANGING
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Exercise daily
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Learn and use natural relaxation techniques (See Section IV Preparation For Change: Relaxation and Visualization)
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Schedule your daily activities and follow through
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Budget monies and pay financial obligations promptly
CHANGING
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Have your money deposited directly into bank accounts
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Attend all program groups
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Honestly reveal your thoughts, feelings and behaviors in all sessions
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Try new activities that are drug free (local library, churches, community centers, etc.)
CHANGING
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What do they do to the body
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Different kinds of drugs and how they effect a person
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Behaviors exemplified when on drugs
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Possible consequences of these behaviors
THE EFFECTS OF DRUGS AND ALCOHOL
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Street Names: Hard liquor, Beer, Wine, Boot leg, Grain Alcohol
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Possible Health Effects: Reduce social anxiety, reduce pain, Sense of well being
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Negative Effects: Poor judgement, liver damage, heart damage, permanent brain damage, confusion, impaired memory, slurred speech, loss of balance, impaired concentration, birth defects, seizures, poor impulse control, More likely to be involved in vehicular accidents, alcohol poisoning and death
Alcohol
EFFECTS OF DRUGS AND ALCOHOL
III UNDERSTANDING SA AND ADDICTION
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Downers, Reds, Phennies, Yellows, Red birds
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Possible Health Effects: Stops seizures , improves sleep, lowers anxiety, sedation, Slower pulse and blood pressure
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Negative Effects: Confusion, lack of concentration, unusual fatigue, lack of good judgement, blackouts, withdrawals, death by overdosing
Barbiturates
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EFFECTS OF DRUGS AND ALCOHOL
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Street names: Weed, Smoke, Pot, Grass, Mid, Loud, Gas, Blunt, Tree, Ganja, Dank
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Possible Health Effects: Decreased anxiety, decreased pain sensation
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Negative Effects: Coughing, Slow thinking, loss of motivation, poor coordination, fast heart rate, altered perceptions (especially in time), hallucinations, disinhibition and poor judgement
Marijuana
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EFFECTS OF DRUGS AND ALCOHOL
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Street names: Liquid ecstasy, Georgia home boy
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Possible Health Effects: Sense of well being, decreased anxiety, increased sex drive
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Negatives Effects: Poor memory, nausea, poor judgement, dizziness, confusion, severe drowsiness, seizures, coma, death from overdose
GHB (Gamma-hydroxyl butyrate)
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EFFECTS OF DRUGS AND ALCOHOL
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Street names: Smack, H-train, Boy, horse, H, Dogfood, Heron, Black tar
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Possible Health Effects: Pain relief, sense of well being, sedation, improved sleep
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Negative Effects: Hepatitis risk, HIV risk, confusion, slowed heart rate, swelling of the gums, skin and brain abscesses, leaky heart valves, enlarged heart, death from overdose
Heroin
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EFFECTS OF DRUGS AND ALCOHOL
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Street names: Blow, Snow, Coke, White, Whitegirl, Powder, Sniff, Yayo, Nose Candy, Line, Bump
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Possible Health Effects: Sense of brighter mood and increased energy
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Negative Effects: Mania, anger, violent/aggressive behaviors, paranoia, increased heart rate, heart arrhythmias, increased blood pressure, heart attack, stroke, coma, increased erratic behavior, nasal congestion, melting and sores in the nasal walls, runny nose, death from overdose
Cocaine
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EFFECTS OF DRUGS AND ALCOHOL
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Street names: Rock, Base, Ball, Jellybean, Nuggets, Candy, Raw, Hard, Product
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Possible Health Effects: none
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Negative Effects: Respiratory problems, seizures, sexual dysfunction, infertility, malnutrition, tooth decay and loss of teeth, heart failure, increased blood pressure, liver failure, melting and sores in the nasal walls, constant runny nose, depression, hallucinations, paranoia, aggressive and violent behaviors, death from overdose
Crack
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EFFECTS OF DRUGS AND ALCOHOL
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Street names: Meth, Glass, Crank, Crystal, Ice
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There are no health benefits of methylated amphetamines. It is often confused with dextro-amphetamines, such as the medication Adderall. Adderall and others similar are used to treat ADHD and extreme cases of obesity
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Negative Effects: Permanent disturbing hallucinations, increased blood pressure and heart rate, loss of appetite, unpredictable and violent behaviors, vomiting, tremors, clenching of the jaws, seizures, obsessive skin picking resulting in sores and ulcers, depression, heart attacks, death
Methamphetamine
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EFFECTS OF DRUGS AND ALCOHOL
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Street names: Ecstasy, Peace, X, E, Molly, Beans
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Possible Health Effects: Feeling of empathy and well being, increased sexual desires, increased pleasure from touch
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Negative Effects: Heart damage, poor memory, kidney failure, liver damage, increased blood pressure, hot or cold flashes, dangerous changes in body temperature, tightness in jaw, death by heatstroke, overdose, hyponatremia (low salt from drinking too much water)
MDMA
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EFFECTS OF DRUGS AND ALCOHOL
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Street Names: Special K, Super acid, Jet, K , Cat Valium
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Possible Health Effects: Decreased anxiety, improved mood, mind altering changes
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Negative Effects: Increased heart rate, numbness, increased blood pressure, “near death experiences”, amnesia, hallucinations, death from respiratory complications
Ketamine
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EFFECTS OF DRUGS AND ALCOHOL
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Street names: Acid, Cubes, Blotter
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Possible Health Effects: Changes in perception
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Negative Effects: Hallucinations, permanent psychosis, fast heart rate, increased temperature, nausea, flashbacks, tremors, sleeplessness, death
LSD
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EFFECTS OF DRUGS AND ALCOHOL
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Street Names: Angel dust, Boat, Love boat, Wets, Purple tear drops
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Possible Health Effects: Numbness, perception changes
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Negative effects: Fast heart rate, high blood pressure, hallucinations, delusions, permanent psychosis, violent outbursts, death from overdose
PCP
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EFFECTS OF DRUGS AND ALCOHOL
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What substances have you abused?
What did these substances do to you?
HELPING TOOLS: SELF CHECK IN
Workbook Exercise:
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What lingering health problems have you had because of drugs or alcohol?
What problems concern you about discontinuing your use?
HELPING TOOLS: SELF CHECK IN
Workbook Exercise:
III UNDERSTANDING SA AND ADDICTION
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- It may be a common belief that we already know our own selves well
IV EARLY INTERVENTION
UNDERSTANDING YOURSELF
"Hello Me"
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- Still, Let's be sure. Let's not forget that the mind has that subconscious or hidden side
IV EARLY INTERVENTION
UNDERSTANDING YOURSELF
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- We must learn to recognize how we feel and the beliefs that contribute to these feelings – Our
- Our is how any situation or circumstance is viewed
- Our determines our opinions and actions
IV EARLY INTERVENTION
"Hello Me"
Point Of View
Point Of View
Point Of View
UNDERSTANDING MYSELF
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IV EARLY INTERVENTION
Fact , fiction.....excuses?
Self control is a learned skill
(I'm helpless, really?)
- I can't control my emotions
Learn to self assess and when to take a relaxation break - I can't control my behavior
Create schedule and allot something productive for every hour of the day
UNDERSTANDING MYSELF
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IV EARLY INTERVENTION
- Point of View: Is your viewpoint from uphill with an easy climb down or downhill rough climb up?
UNDERSTANDING MYSELF
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IV EARLY INTERVENTION
Fact , fiction.....excuses?
- "I'm nothing like (another addict) they definitely need help I don't"
- "My addiction affects me only and no one else"
- "Life without drugs or alcohol is boring"
UNDERSTANDING MYSELF
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IV EARLY INTERVENTION
Fact , fiction.....excuses?
- “I don’t care about my life nor if my addiction kills me”
- “I’m in control and I can stop whenever I want”
- “Without drugs or alcohol, I can’t manage my problems effectively”
UNDERSTANDING MYSELF
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IV EARLY INTERVENTION
Fact , fiction.....excuses?
(I'm Powerful)
- I know when to stop
UNDERSTANDING MYSELF
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IV EARLY INTERVENTION
Fact , fiction.....excuses?
- It’s (all the negatives) not going to happen to me
- Using results in a chaotic lifestyle with many loses and failures
- Using often results in alienation of love ones and sometimes homelessness
UNDERSTANDING MYSELF
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IV EARLY INTERVENTION
- Following your schedule prohibits impulsive behaviors and gives you a sense of accomplishment and satisfaction
UNDERSTANDING MYSELF
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IV EARLY INTERVENTION
UNDERSTANDING MYSELF
Fact , fiction.....excuses?
How thoughts and emotions are connected...
"For as he thinks in his heart, so is he..." Proverbs 23:7
- Thought "It's a dreary day outside"
Emotion - I feel sad and depressed - Question - Must you feel sad because the day is cloudy?
Perhaps this a day to build up energy vs using energy as we often do on
bright sunny days
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IV EARLY INTERVENTION
Fact , fiction.....excuses?
Drugs help me:
- Get to sleep
- Deal w/ stress
- To relax, socialize, have fun
- Feel better or feel normal
MYTHS, JUSTIFICATION, NEEDS VS. DESIRE
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IV EARLY INTERVENTION
Fact , fiction.....excuses?
Drugs help me: Do they really or is this a fairy tale that ends badly?
MYTHS, JUSTIFICATION, NEEDS VS. DESIRE
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IV EARLY INTERVENTION
Fact , fiction.....excuses?
Drugs help me:
- Not feel depressed
- Block out unwanted thoughts
- Not to worry
MYTHS, JUSTIFICATION, NEEDS VS. DESIRE
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IV EARLY INTERVENTION
Fact , fiction.....excuses?
FACT: Real outcomes of drug and/or alcohol use
- Legal problems
- Not to think through my decisions carefully or to understand how I, my family, or my work will be hurt
MYTHS, JUSTIFICATION, NEEDS VS. DESIRE
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IV EARLY INTERVENTION
Fact , fiction.....excuses?
- Financial loss and financial problems
MYTHS, JUSTIFICATION, NEEDS VS. DESIRE
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IV EARLY INTERVENTION
Fact , fiction.....excuses?
FACT: Real outcomes of drug and/or alcohol use
- Personal losses of living quarters, auto, job, friends, alienation of family members
MYTHS, JUSTIFICATION, NEEDS VS. DESIRE
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IV EARLY INTERVENTION
Fact , fiction.....excuses?
FACT: Real outcomes of drug and/or alcohol use
- Family arguments
MYTHS, JUSTIFICATION, NEEDS VS. DESIRE
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IV EARLY INTERVENTION
Fact , fiction.....excuses?
FACT: Real outcomes of drug and/or alcohol use
- Increase the chance of accidents
- Hurt or injured myself and/or another person
- To do something I'm ashamed of
MYTHS, JUSTIFICATION, NEEDS VS. DESIRE
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IV EARLY INTERVENTION
MYTHS, JUSTIFICATION, NEEDS VS. DESIRE
Fact , fiction.....excuses?
FACT: Real outcomes of drug and/or alcohol use
- Damaged my reputation personal and/or professional
- Loss control-forgot what I did
- Loss self control or control of my anger
- Found my problems were still there after I cleaned or sobered up
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IV EARLY INTERVENTION
EFFECTS OF USING
Fact , fiction.....excuses?
FACT: Real outcomes of drug and/or alcohol use
You may experience on or more of the following problems:
- Remembering faces or names becomes difficult
- Forgetting simple things
- Trouble with directions or getting lost in familiar places
- Feeling fatigued when you shouldn't be
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IV EARLY INTERVENTION
EFFECTS OF USING
Fact , fiction.....excuses?
FACT: Real outcomes of drug and/or alcohol use
- Trouble problem solving or making mind up about certain things
- Being disorganized or leaving tasks unfinished
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There may be others that are not listed here but do apply to you.
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Workbook Task: Identify which of the above outcomes apply to you
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IV EARLY INTERVENTION
HELPFUL IDEAS
Addressing issues one by one vs trying to tackle them all
together is the best way to solve the problem.
Problem Fixers:
Inability to think clearly or stay focused
- Work out - Exercise is very essential in increasing blood flow to the brain. This increased blood flow helps to improve your memory.
- Get rid of distractions - Turn off the TV, radio and place your cell phone on silent. Find a quiet place, try to focus on a single task.
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IV EARLY INTERVENTION
HELPFUL IDEAS
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Be Organized - Keep your notebook, pen, glasses, keys and important items in the same place. Get rid of the clutter, create a calendar (can make your own) and write down your appointments and planned activities
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IV EARLY INTERVENTION
HELPFUL IDEAS
- Write notes and reminders to yourself
- Repeat instructions or important information
- Healthy Eating - Eat foods rich in antioxidants (red/black/blue berries, tomatoes, green vegetables) and Omega 3 &6 also helps increase blood flow to the brain
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IV EARLY INTERVENTION
Stay Busy; Stop Using
- Schedules should be created to prevent idle or too much free time
- Schedules should be written down and not exclusively in ones’ head to avoid repeatedly changing them
- It’s key to schedule substance free activities with substance fee people
- Play virtual games including “Second Life”
HELPFUL IDEAS
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IV EARLY INTERVENTION
Stay Busy; Stop Using
- Consider if it’s best for you to engage in old hobbies/activities; or if getting involved with new activities keeps you more interested Examples may include learning new sports, visiting a new museum, etc.)
HELPFUL IDEAS
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IV EARLY INTERVENTION
Stay Busy; Stop Using
- Call friends or family member who does not use drugs or alcohol
- Get Plenty of Rest – It is hard to focus when you are tired. Counteract this by getting the recommended 7 to 8 hours of sleep every night
- Take breaks when you need them, have a glass of water, stretch/move around, say hello to your pet
HELPFUL IDEAS
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IV EARLY INTERVENTION
In social interactions: Difficulty Remembering Names/Faces:
- Use the repetition technique - Repeat the names of people you just met then use it several times in the conversation.
- Find a connection – Look for hints in the person’s face or name or perhaps you may find something memorable about the encounter.
- Pay attention to the face- Its important to simply pay attention and not focus on what’s coming next. Keep the focus on what is important which at the time would be the person’s face or name
HELPFUL IDEAS
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IV EARLY INTERVENTION
Workbook Exercise:
- Which of these situations or problems do you feel most apply to you?
- What solutions to these problems will you implement?
- How can the counselors be of help?
PUT IT TO USE
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IV EARLY INTERVENTION
Self Esteem: Purpose
- Understanding self esteem and why it is important
- Tactics used for increasing self esteem
- Understanding that is your responsibility to improve your self esteem
SELF ESTEEM
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IV EARLY INTERVENTION
Self Esteem
- Understanding how low self esteem can negatively impact your
- (See slide 59)
- Success tends to go hand in hand with people who generally feel good about themselves. In recovery, improving self esteem is very important. There are methods that may increase self esteem and those that may cause harm.
SELF ESTEEM
Point Of View
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Self Esteem
- Everyone wants to feels better about themselves, although some may hide behind a mask, saying, “I feel fine.”
SELF ESTEEM
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Which of the following ways do you use to build self esteem?
- Think about myself in a positive way
- Admit my wrong doings and move on (You can not change yesterday but you can change today and tomorrow’s outcomes)
- Don’t harshly criticize or judge myself or others (Learn to forgive)
- Accept positive comments
SELF ESTEEM
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- Take care of yourself emotionally and physically
- Don’t feel that everything has to be “Perfect”( Just do the best you can)
- Express kindness towards others (Everyone needs love)
- Spend time with respectful people and also respect myself
SELF ESTEEM
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Have you been hurting your self esteem by:
- Not believing in myself
- Constant critical self talk and talking down to myself
- Letting everyone run over me and not standing up for myself
- Not letting go of negative habits or negative behaviors
- Trying to do everything myself and not asking for help when needed
SELF ESTEEM
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The following are methods may help to boost your self esteem:
- Make a list of what I’m good at
- Dress and present myself in a way that is appealing
- Give a helping hand or give compliments to another person
-
Write down obtainable goals and strive to accomplish them
- Can you think of Other techniques?
WORKING ON YOUR SELF ESTEEM
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List at least 5 strengths that you have:
What healthy things make me feel good:
HELPING TOOL: BUILDING POSITIVE FEELINGS
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Methods for stopping craving thoughts:
- It involves wearing a rubber band on your wrist and “popping” yourself each time you have a thought about using
- It is important to say “no” to those negative thoughts and think about something positive
- Your progress can be measured by decreasing the number of times you pop because you are decreasing the negative thoughts you have about using substances or drinking
PREPARATION FOR CHANGE
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PREPARATION FOR CHANGE
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Relaxation - This technique can be used to for feelings of anxiety and panic
- Use deep breathing
- Slowly fill your lungs up completely with air
- Hold your breathe for 5 secs then slowly exhale
- Feel your whole body relax each time you exhale
- Repeat this exercise 3 (three) times
PREPARATION FOR CHANGE
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Visualization
- Begin this exercise after you have relaxed with deep breathing
- Choose your most peaceful setting:
Nearby a crystal clear mountain lake on a bright, cool day. You are surrounded by tall green trees, see the bright multicolored flowers, birds flying contented overhead across a bright blue sky with big white fluffy clouds. You can smell the fresh scent of alpine air. You have no worries, no concerns or problems
PREPARATION FOR CHANGE
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Visualization
- A tropical seaside – in your own private paradise on a bright warm day. The palm trees wave as a gentle tropical fragrant breeze blows by. You’re lying contently in a hammock, can see and hear the gentle sea waves break upon the shoreline
or - Make up you own – Discuss with the group
- When not in group or time permits, enhance your relaxation experience by relaxing in a warm (not hot) bath and using soothing aromas such as sage lavender or eucalyptus
PREPARATION FOR CHANGE
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- As part of your recovery, you must be aware that thought stopping is a you must make
- There is a sequence that happens that is part of the thought stopping technique
- Making the choice to use or not to use is illustrated by Thought-Stopping Technique demonstrated by this diagram from the Matrix Institute
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- Trigger---Thought---Thought stopping techniques..is the way you want to go
- Trigger---Thought---Continued Thoughts---Cravings---Use... This way you can go if you thought stopping techniques
CHALLENGES: Triggers
DON'T USE
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- Triggers can be people, feelings, circumstances, objects and/or things that can cause cravings and a desire to use or drink.
- Examples include: Money, being around people who use, being in a place or situation where using is common
- Identify your triggers
CHALLENGES: Triggers
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- “Relapse Justification” is when you make a decision to stop using substances or drinking alcohol, but end up doing it anyway.
- There are usually two thoughts inside your head: To remain abstinent or to give in to “relapse justification” and make excuses to start using again
- (Review your fact, fiction or excuses and Myths and Justification)
CHALLENGES: Triggers
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- Just because you think about a craving or have an urge to use, you still can make a decision not to. If you allow yourself to continue, giving in to cravings and keep using, you are making a decision to relapse
- Remember the sequence of Trigger---Thought---Craving--- Try to prevent your relapse by using the thought stopping techniques. When you first have a negative thought or craving, go straight into the thought stopping so that the craving doesn’t become too strong
CHALLENGES: Triggers
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How thoughts and feelings can impact substance abuse:
- Do thoughts and feelings about drugs and alcohol impact the decision to use
- Which specific thoughts lead to abuse
- Consider: In any given situation, what coping methods work best for me
CHALLENGES: Triggers
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External Triggers
- Parties or Celebrations
- Being home alone
- Concerts
CHALLENGES: Triggers
These include particular situations, settings, people, or activities that may influence you and when around them are more likely to cause you to use. The following are some examples. Which ones apply to you?
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External Triggers
- After payday
- After passing a particular street
- Weekends
- Before sexual activites
CHALLENGES: Triggers
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Internal Triggers
- Angry
- Bored
- Afraid
- Overwhelmed
CHALLENGES: Triggers
can be activated by certain emotions or feelings you may have that cause you
to want to use. Here are a few examples. Which ones apply to you?
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Arguments and turmoil in the home and seeking an escape maybe a trigger
CHALLENGES: Triggers
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Internal Triggers
- Nervous
- Hungry
- Happy
- Insecure
CHALLENGES: Triggers
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After you have identified your triggers and what leads you to want to drink or use, now you can begin to plan to not use
-
If you are bored, remember to find important things to do with your time.
- If you feel like you are alone, remember to find people who are supportive of you. The point of this is to not get into situations where you may use again
TOOLS TO MANAGE TRIGGERS
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PLAN AHEAD
- Plan Ahead: Create scripts of responses you can use in difficult situations
- Example – Say, “No thank you” to an offer for an alcoholic party drink and request a soft drink or other beverage
- Activity: Say no to drug using friends who want to hangout or visit. Create scripts using avatars
TOOLS TO MANAGE TRIGGERS
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TOOLS TO MANAGE TRIGGERS
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Which of these skills would you prefer to get you on a better trak?
- Learn how to deal with anger or stress
-
Working out and exercising more
- Developing a better diet and eating healthier
TOOLS TO MANAGE TRIGGERS
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Finding a mentor
- Learning better time management techniques
TOOLS TO MANAGE TRIGGERS
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- Sleep better
- Learn how to manage money or finances better
TOOLS TO MANAGE TRIGGERS
Now with the help of your counselor, choose an item that you can work on and try to set goals to continue with your recovery
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- Sometimes the cravings can be weak and thinking about something else is easy
-
Sometimes the cravings are so severe all you can think about is using
Cravings happen when you think about wanting to drink alcohol or use substances
CHALLENGES: CRAVINGS
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- Almost everyone who stops drinking or using substances will have cravings and want to start back
The good news is that cravings are not the end of the world. Just because you are having cravings doesn’t mean that you have to start using. If you think about the positives as to why NOT use substances, .
cravings will eventually go away
CHALLENGES: CRAVINGS
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There are positive thoughts you can use to get over your cravings, such as:
- I can do this
- Cravings will not hurt me
- The longer I go without substances or alcohol, the more the cravings will go away
- I have worked hard to remain substance free, I do not want to mess it up now
CHALLENGES: CRAVINGS
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Do any of the following common triggers of substance abuse apply to you:
Physical:
- Fatigue
- Feeling sick
- Pain or discomfort
SELF CHECK IN
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Relationship problems:
- With husband or wife
- With mom or dad
- With sister or brother
- With friends
SELF CHECK IN
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Social Occasions or Having a good time may create a very challenging situation:
- Hanging out with friends
- Special occasions, like weddings, birthday parties, special holidays
- Rewarding yourself for success
SELF CHECK IN
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Emotional Issues:
- Bored
- Angry
- Sad
- Frustrated
SELF CHECK IN
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Since Beginning This Program I Have:
- Destroyed all drug paraphernalia
- Avoided people who use drugs and alcohol
- Avoided bars, clubs and old hangouts
- Stopped using all drugs and/or alcohol
SELF CHECK IN
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Since Beginning This Program I Have:
- Begun daily exercise and drinking at least 8 oz of water upon arising
- Avoided my triggers (when possible)
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Used Stop Thought Techniques for cravings
- Paid my bills regularly
SELF CHECK IN
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Since Beginning This Program I Have:
- Honestly discussed my thoughts, feelings and behaviors
- Seen my physician for a physical exam
- Scheduled daily activities
SELF CHECK IN
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Coping Skills
- There are many everyday situations that may challenge your ability to stay abstinent or sober.
- Some of these challenges may include becoming bored; getting angry with a family member, boss or coworker; increased stress or feeling overwhelmed by too many bills, having insufficient time to meet all obligations or feeling guilty that all responsibilities were not completed.
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- What is it?
- What are Associated risks?
- What to do
BOREDOM
Boredom is lack of interest or the feeling to want to do something different than what you're currently doing
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- The associated risks of boredom could be using drugs/alcohol more frequently, being in a depressed mood, eating more than usual, etc.
- When bored, there are plenty of things you can do to be productive. Simple things such as exercising, cooking, and reading a book or playing a virtual game like Solitaire can help. If you want to get more advanced, travel somewhere you’ve never been, learn a new language, volunteer to work with animals or create a website.
BOREDOM
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BOREDOM - TRY READING
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- Feeling bad about something you’ve done or failed to do
- Having done something that doesn’t fit your morals or beliefs
GUILT AND SHAME
V COPING IN EVERYDAY LIFE
Workbook Exercise:
What are somethings you feel guilty about?
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Techniques to Release These Feelings:
- Apologize; Request forgiveness
- Know that you can't change the past but can change yourself
- Lingering on the past is not going to help anyone
GUILT AND SHAME
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Demanding Job Employment
- Recovery must be your first priority even when you have a job that requires long hours, difficult tasks, or a changing schedule.
IN THE WORKPLACE
There can be challenging situations within the work place that sometimes cause difficulty in the treatment and recovery process. A few examples are listed below:
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Job Situation is making Recovery difficult:
- You make work at a job where people drink or use other drugs on breaks or at lunch. Remember that recovery is your first priority. Avoid these challenges by scheduling your breaks or lunchtime at a different time or go to a different location. Stay away from these type of situations.
IN THE WORKPLACE
- It seems your job is becoming overwhelming while trying to recover:
Talk with your manager or boss and see if you can work out a solution
Try adjusting your schedule or availability if this is an option
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Job Situation is making Recovery difficult:
- Perhaps your job requires handling large amounts of cash and that may tempt you to do something you shouldn’t. Again, remember that recovery comes first, giving in to these temptations could not only lead to a relapse, but also possible jail time for theft.
- If the pressures of these type situations prove to be overpowering or too much for you, a change in jobs may be best for you
IN THE WORKPLACE
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Unemployed:
- Being out of work, may change your priorities; treatment may not be the first thing on your mind, getting a job is foremost.
-
While unemployed, you have more time on your hands, meaning there is a chance you may go to using to kill time
IN THE WORKPLACE
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Unemployment makes treatment difficult for a number of reasons
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Unemployed:
- There are also limited resources when you don’t have a job, meaning the excuses you have to use substances will be plentiful. Remember treatment is only successful if you choose to put it first. There are no easy fixes, just dedication and commitment on your part.
-
What interventions can you use to keep busy? (See previous slides,
)
IN THE WORKPLACE
IV Early Intervention: Helpful Ideas: Stay Busy; Stop Using
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Stopping the use of alcohol can be very challenging because:
- Everywhere you go it seems as if people are drinking. How can you be in a social setting and refrain from drinking?
- It seems as if you feel better if you drink alcohol. What feelings or situations make you want to drink?
AROUND ALCOHOL
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- Combined with other drugs, alcohol may not seem like a problem (but in reality it has added to your problem list).
- What problems have you encountered when trying to stop drinking?
- When drinking alcohol, thinking becomes cloudy.
- Describe how it is when you are sober and see people drink.
AROUND ALCOHOL
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- Holidays such as New years, parties, anniversaries, etc. mark days where alcohol is used to celebrate. What events or which holidays apply to you?
- Sometimes alcohol is used to relieve stress or feel comfortable in a situation. What situations or events occur in your life? (Enter in your workbook)
- Sometimes alcohol is used as a sort of initiation or to feel apart of a group.
AROUND ALCOHOL
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- If you have nothing to do, using substances becomes an option and thinking about past use becomes a trigger. Has free time ever been a trigger for you to use?
- If having free time has led to you using again, how can you prevent this in the future?
- Did you ever want to be alone and use substances?
STAYING BUSY
It is important to be sure to schedule positive activities and things to do in your spare time. It is important to remain busy everyday for a number of reasons.
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STAYING BUSY
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- How did being alone affect your substance abuse?
- In recovery, does being alone remind you of past experiences when you were by yourself and decided to use?
- For Interventions refer to previous slides from
STAYING BUSY
IV Early Intervention: Helpful Ideas: Stay Busy; Stop Using
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Being honest is a very important part of your recovery process
- Describe some ways you were not truthful when using substances
- Has being honest been difficult in your recovery process?
BEING HONEST
V COPING IN EVERYDAY LIFE
As you use, more and more, your usual everyday tasks become less important. When this happens, you may do or say anything to get more of the addictive substance. In most cases this includes not being honest.
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Telling The Truth
- Told people what you think they want to hear
- Tell people what you wish was the truth
- Tell less than the whole truth
BEING HONEST
V COPING IN EVERYDAY LIFE
Some may think that not telling the whole truth or being partly honest is the same as being honest. It is not.
Have you ever done any of the following?
Not being honest will make recovery from substance abuse very difficult
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- It is important to have healthy supportive relationships as well as healthy boundaries in these relationships
- Boundaries are defined by the amount of privacy shared between people or the amount of sharing that goes on between them
- Learning to not intrude on personal boundaries is just as important as having supportive relationships
POSITIVE RELATIONSHIPS
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- Personal Space is the amount of physical contact that is comfortable for each person and the amount of physical space needed for comfort
- Some people greet family with hugs and kisses while others prefer nothing more than a hand shake or perhaps air kisses
POSITIVE RELATIONSHIPS
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- Healthy boundaries clearly state, “ We care but we are separate ; each with our own needs
- Blurred boundaries are uncertain and beg the question, “Who am I and who are you?”
- Rigid boundaries questions, “Do I know you?”
POSITIVE RELATIONSHIPS
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- I let someone hurt my feelings
- I try to please other people before myself
- I open to people I just met too easily
- I allow outsiders to tell me how to think or feel
POSITIVE RELATIONSHIPS
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Self Check In
Do you display any signs of poor boundaries such as:
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- I never ask for help when I need it
- I don't allow people to become close to me
- I don't open up about my feelings with anyone
- I feel that if the only person trustworthy is myself
POSITIVE RELATIONSHIPS
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Do you show any signs of rigid boundaries:
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- Always show self respect
- I don’t tolerate being abused or used
- I can respectfully decline an opinion if I don’t agree
- I treat others the way I would like to be treated
POSITIVE RELATIONSHIPS
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Display healthy boundaries:
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- Why are boundaries important in my relationships with my family?
- Why are boundaries important in my relationships with my friends?
- Why are boundaries important in my relationship with my husband or wife?
POSITIVE RELATIONSHIPS
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Helping Tool:
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- What changes do I need to make in my relationships to aid in my recovery?
- How has my substance abuse changed my relationships?
- What must I do to make improvements in my relationships?
POSITIVE RELATIONSHIPS
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Helping Tool:
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- Thoughts, can be controlled but it is first necessary to become aware of your thinking (or to become conscious of them). They must be moved from your subconscious mind to your conscious mind.
THINKING, FEELING, BEHAVING
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Its no secret that constant substance abuse can affect your behavior, thoughts, and feelings. There are different ways that this can affect the process of recovering.
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After you become aware of your thoughts you can then block out those negative ones about using
THINKING, FEELING, BEHAVING
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- Feelings; are the emotions associated with thoughts. If, however, you are not conscious of your thought, then it may feel that the emotion came from nowhere – out of the blue
- You can control what you do with your feelings and not using substances has to be a top priority
-
(See previous slides #58 and #52
)
THINKING, FEELING, BEHAVING
V COPING IN EVERYDAY LIFE
IV Early Intervention: Understanding Yourself, Fact, Fiction....Excuses? How Thoughts and Emotions are Connected
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- Behavior; is simply what you decide to do. Going to play sports, work, even going to substance treatment are all behaviors
- Recovery occurs when you push your thoughts and emotions away from substance use
- The object is learn how to control your thoughts and feelings so that your behavior results in improving your life
THINKING, FEELING, BEHAVING
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- Addictive behaviors are those shown to sustain your substance use and to maintain control
- The longer you have been using substances, the harder it is to have control over your life.
- Sometimes these behaviors only occur when people are using. The earlier you recognize these behaviors starting to occur, the better you will fare in the recovery process
- Which are addictive behaviors for you? (See the following list)
THINKING, FEELING, BEHAVING
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Addictive Behaviors
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- Stealing
- Lying
- Isolating
THINKING, FEELING, BEHAVING
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Addictive Behaviors
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- Being irresponsible or unreliable
- Missing or tardiness for treatment/work/picking up children, etc
- Losing Interest in matters such as hygiene, appearance, other people, etc
THINKING, FEELING, BEHAVING
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Addictive Behaviors
may include:
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- Drugs can alter the brain’s ability to perform important functions that are necessary for life. (Autonomic functions - heartrate, breathing, senses, etc)
- Drugs affect the brain by interrupting the communication systems and changing how information is sent, received, and processed (Executive function)
- Drugs target the brains reward system by flooding it with dopamine, a neurotransmitter that also controls movement, motivation, emotions and feelings of pleasure
THE BRAIN
VI RECOVERY
The brain and its Role in Recovery
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- By flooding the brain with dopamine, drugs produce a euphoric effect and the user must use more and more to try to get that feeling again. This is called Tolerance and addiction
- Trying to recover from a substance use disorder is a process that takes time and effort.
-
The brain has been affected by the use. (The brain is a very delicate organ which is why it is heavily shielded by the skull. It is easily damaged by drugs and chemicals.) It now requires healing.
THE BRAIN
The brain and its Role in Recovery
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- Use your rescue remedies
- Do a fun activity
- Contact your counselor or someone that has been supportive to help get your mind off using
COMMON RECOVERY OBSTACLES
If you become upset and the first thing you want to do is use:
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Create your list of remedies, help aids or techniques that you can use when cravings occur. Keep this list nearby and visible to you at all times. Use these as your Rescue Remedies.
COMMON RECOVERY OBSTACLES
Rescue Remedies
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- There are several phases in the recovery period. The length of the phase will vary based on the substance used, the amount of substance used, how long you have used and your overall state of health
- During the beginning phases of recovery, emotional and physical problems are to be expected because the body requires time to adjust to being without the drugs
RECOVERY
THE PHASES
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- Alcohol users may suffer with symptoms of insomnia, nausea, shakiness, forgetfulness and trouble remembering, life threatening seizures, and hallucinations. (A medical detox program is recommended prior to entering rehab)
RECOVERY: THE PHASES
Withdrawal Phase
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- Prescription drug users may include abuse or sedatives such as Xanax, sleeping pills, and/or use of opioids pain relievers such as Vicodin, Percocet or Morphine. Non prescription heroin also falls in this group. A physical withdrawal syndrome with seizures, very low or high blood pressure, hallucinations, intense pain, nausea, stomach cramping, diarrhea, and other physical discomforts can occur along with severe depression. (A medical detox is recommended)
RECOVERY: THE PHASES
Withdrawal Phase
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- During the first couple of days, the symptoms experienced can be very difficult.
- For stimulant users: difficulty concentrating, restlessness, cravings of the drug , low energy, sleeplessness, feeling angry and irritable, feeling depressed and perhaps experiencing a desire to hurt or injure yourself.
RECOVERY: THE PHASES
Withdrawal Phase
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- Alcohol users experience recovery in the brain during this period, even though the absence of substances still takes some getting used to. ( You’re not just changing your brain, you are changing your lifestyle too)
- Prescription drug users experience some of the same symptoms as alcohol users which basically results in slow improvement.
RECOVERY: THE PHASES
Early Abstinence Phase
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- Often called the “honeymoon phase”, this is when stimulant users feel like they are good to go and whatever symptoms they have are cured.
- Feelings of being over confident and physically good may be experienced.
- Its important that these good feelings are used as a basis to continue recovery because a relapse otherwise is very likely to occur.
RECOVERY: THE PHASES
Early Abstinence Phase
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- After going through the initial phases, it is important to lead a life that is positive and fulfilling
- The brain has improved significantly, but because cravings are not as common, clients may think they can go back into the same environments as before and be successful. (Ask yourself, “Why risk temptations, are not my difficulties already sufficient?)
RECOVERY: THE PHASES
The Readjustment Phase:
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- Choose the right path and continue to focus on recovery
RECOVERY: THE PHASES
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- Symptoms such as difficulties with feelings and thoughts are common during this phase.
- Lack of enthusiasm, depression, not being able to concentrate are other symptoms that are experienced
- Cravings become more pronounced and relapse risk is high if the client does not remain focused on recovery
- During this period, exercise is highly recommended
RECOVERY: THE PHASES
The Wall Phase:
The roller coaster ride when using has ended
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COMMON RECOVERY OBSTACLES
Although everyone is different, there are some difficult situations that can’t be easily avoided and could place you right back in the using mode. Some of these situations and possible solutions:
You stay in a home where there are other drug users:
VI RECOVERY
- Ask the others to refrain from using around you
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COMMON RECOVERY OBSTACLES
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- If there are loose drugs or paraphernalia or alcohol laying around, dispose of it
- If these things don’t work, explore the possibility of moving in with a family member or friend or somewhere else that is drug free. (Ask your counselor or others for help in locating a halfway or recovery residence.)
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COMMON RECOVERY OBSTACLES
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VI RECOVERY
Do you...
- Have feelings of self pity ( Alcoholics Anonymous : Poor me, poor me, pour me a drink)
- Expect a lot out of other people
- Feel frustrated at times
- Become overconfident
Say "NO" to Relapse Triggers
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VI RECOVERY
HALT
4 of the most common triggers known to those in the 12 Step Program can be described by the acronym HALT: Hunger, Anger, Loneliness, Tiredness:
Hunger – When using people often do not eat regularly and can even become malnourished. The body requires proper nutrition to obtain both physical and emotional stability.
Anger –The anger emotion is often both the cause and consequence of using. An irritable mood can occur after using most drugs. It is important to learn how to relax and to release anger.
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VI RECOVERY
HALT
Lonely – While using relationships with many friends and/or family may be irreparably damaged resulting in your being either alienated or alone. It also may become necessary to give up associations with those who are still using. Be prepared to create new friendships.
Tiredness – Irregular sleep patterns are often a result of using drugs. A lack of sleep can result is feelings of tiredness, fatigue and exhaustion. The sleep cycle will most likely return to normal over time. Discuss this problem with your primary care physician. Be sure to make him or her aware that you are in a recovery program.
Always remember, Relapse is a choice
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VI RECOVERY
12 STEPS ALCOHOLICS ANONYMOUS
- We admitted we were powerless over alcohol - that our lives had become unmanageable.
- Came to believe that a Power greater than ourselves could restore us to sanity.
- Made a decision to turn our will and our lives over to the care of God as we understood Him.
- Made a searching and fearless moral inventory of ourselves.
- Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
- Were entirely ready to have God remove all these defects of character.
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VI RECOVERY
12 STEPS ALCOHOLICS ANONYMOUS
- Humbly asked Him to remove our shortcomings.
- Made a list of all persons we had harmed, and became willing to make amends to them all.
- Made direct amends to such people wherever possible, except when to do so would injure them or others.
- Continued to take personal inventory and when we were wrong promptly admitted it.
- Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
- Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.
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VIII APPENDIX
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VIII APPENDIX
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1. Addiction Treatment Planner 5th Edition – Perkinson, Robert R., Jongsma Jr, Arthur.E., Bruce, Timothy J., 2014
2. AUDIT/DAST10 - SAMHSA-HRSA Center for Integrated Health Solutions
http://www.integration.samhsa.gov/clinical-practice/screening-tools
3. Cognitive Behavioral Therapy http://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral
4. Coping skills client workbook
http://www.brainline.org/downloads/PDFs/SUBIClientWorkbook.pdf
IX REFERENCES AND RESOURCES
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5. DSM-IV-TR Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association, 2000.
6. Post Acute Withdrawal Syndrome (PAWS)
http://www.tlctx.com/ar_pages/paw_part1.htm
7. Secular Organization for Sobriety (SOS)
8. Substance Use Brain Injury Bridging Project, Toronto, Canada
9. Women For Sobriety
IX REFERENCES AND RESOURCES
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IX REFERENCES AND RESOURCES
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IASAP Manual
By artpologabriel
