Commit self to an action plan directed toward termination or reduction of substance use. (1, 2, 3)
Encourage and support the client's self-efficacy for change toward the goal of developing an action plan for termination of substance use to which the client is willing to commit.
Assign the client to write a list of reasons to be abstinent from addiction (or supplement with “Alternatives to Addictive Behavior” in the Addiction Treatment Homework Planner by Lenz, Finley, & Jongsma).
Develop an abstinence contract with the client regarding the termination of the use of his/her/their drug of choice; process the client's feelings related to the commitment.
Attend Alcoholics Anonymous/Narcotics Anonymous (AA/NA) meetings as frequently as necessary to support sobriety. (1)
Recommend that the client attend AA or NA meetings and report on the impact of the meetings; process messages the client is receiving toward facilitating positive change.
Verbalize increased knowledge of alcoholism and the process of recovery. (1)
Conduct or assign the client to attend a chemical dependence didactic series to increase his/her/their knowledge of the patterns and effects of chemical dependence; ask him/her/them to identify several key points conveyed in each didactic and process these points.
Cooperate with exploration of increasing satisfaction in areas of life that can support sobriety such as employment, recreation, and relationships. (1, 2, 3)
Facilitate development of a plan for the client to change his/her/their living situation to foster recovery (or supplement with “Assessing My Needs” in the Addiction Treatment Homework Planner by Lenz, Finley, & Jongsma); revisit routinely toward positive change in the client's living situation.
Teach the client skills necessary for finding a job, keeping a job, and improving satisfaction in a job setting (or supplement with “A Vocational Action Plan” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce).
Consistent with a community reinforcement approach, assist the client in identifying new alternative sources of reinforcement (e.g. reinforcing personal, social, and/or recreational activities) that do not involve substance use; reinforce gains; problem-solve obstacles toward sustained and effective implementation (See A Community Reinforcement Approach to Addiction Treatment by Meyers & Miller; or supplement with “Alternatives to Addictive Behavior” in the Addiction Treatment Homework Planner by Lenz, Finley, & Jongsma); use problem-solving and communication skills to overcome obstacles.
Participate in behavioral couple's therapy designed to increase the non-substance-using partner's reinforcement of sobriety and to reduce relationship conflict. (1, 2, 3, 4)
Develop a sobriety agreement with the couple that stipulates an agreement to remain abstinent; limits the focus of partner discussions to present-day issues, not past hurtful behaviors; identifies the role of other interventions such as AA meetings, Antabuse use, “trust discussions”; and/or schedules a daily time to share thoughts and feelings.
Ask each partner to make a list of pleasurable activities that could be engaged in together to increase positive feelings toward each other (or supplement with “Identify and Schedule Pleasant Activities” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce); process the list and assign implementation of one or more activities before the next session.
Teach the couple problem-solving skills (specifically defining the problem, brainstorm possible solutions, list and evaluate the pros and cons of each solution, select and implement a solution, evaluate all parties' satisfaction with the action, adjust action if necessary); role-play the use of these skills applied to real-life issues of conflict for the couple (or supplement with “Applying Problem-Solving to Interpersonal Conflict” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce).
In light of the recovery contract, review the client's sobriety experience and the couple's interaction since the last session; address any relationship conflicts, assisting the couple in improving their communication skills (e.g. “I messages,” reflective listening, eye contact, respectful responding, etc.) by using role-play in the session.
Earn rewards by submitting drug-negative urine samples. (1)
Implement a prize-based contingency management system for drug-free living by rewarding the client's drug-negative urine samples with desired prizes starting at the low end of a $1–$100 range and increasing with continued abstinence (see Contingency Management for Substance Abuse Treatment by Petry).
Learn and implement relapse prevention strategies. (1, 2)
Instruct the client to routinely use strategies learned in therapy (e.g. problem-solving, stimulus control, social skills, and assertiveness) while managing high-risk trigger situations (or supplement with “Aftercare Plan Components” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce).
Assist the client in developing a detailed, written recovery plan (e.g. treatment activities, daily routine, basic self-care, relationships, spirituality, work stress, finances, family issues, etc.) that will identify supports and strategies that will be used in maintaining sobriety (or supplement with “Personal Recovery Planning” in the Addiction Treatment Homework Planner by Lenz, Finley, & Jongsma).
2. DIAGNOSIS
ICD-10-CM
DSM-5 Disorder, Condition, or Problem
F10.20
Alcohol Use Disorder, Moderate
ADULT-CHILD-OF-AN-ALCOHOLIC (ACA) TRAITS
BEHAVIORAL DEFINITIONS
1 Has a history of being raised in an alcoholic home, which resulted in having experienced emotional abandonment, role confusion, abuse, and a chaotic, unpredictable environment.
2 Has a history of unresolved childhood trauma caused by family addiction.
3 Reports an inability to trust others, share feelings, or talk openly about self.
4 Demonstrates an overconcern with the welfare of other people.
5 Passively submits to the wishes, wants, and needs of others; is too eager to please others.
6 Verbalizes chronic fear of interpersonal abandonment and desperately clings to relationships that can be destructive.
7 Tells other people what they think the other persons want to hear, rather than telling the truth.
8 Verbalizes persistent feelings of worthlessness and a belief that being treated with disrespect and shame is normal and to be expected.
9 Verbalizes feeling unwanted, unimportant, or unloved due to experiences of abandonment and abuse.
10 Reports strong feelings of panic and helplessness when faced with being alone.
11 Tries to fix other people before concentrating on his/her/their own needs.
