Discuss with the client the distinction between a lapse and relapse, associating a lapse with an initial, potentially temporary, and reversible return of worry, anxiety symptoms, or urges to avoid, and relapse with the decision to return to previous fearful and avoidant patterns in a more sustained manner.
Identify and rehearse with the client the management of future situations or circumstances in which lapses could occur (i.e. high-risk times).
Instruct the client to continue using his/her/their new and effective therapeutic skills (e.g. relaxation, cognitive restructuring, exposure, and problem solving) in daily life to address emergent worries, anxiety, and avoidant tendencies.
Develop a “coping card” or other reminder on which new and effective worry management skills and other important information (e.g. “Breathe deeply and relax,” “Challenge unrealistic worries,” “Use problem solving”) are available to the client for later use.
Schedule periodic “maintenance” sessions to help the client maintain therapeutic gains.
Identify the fears that were learned in the family of origin and relate these fears to current anxiety levels. (43, 44)
Probe the client's family-of-origin experiences for fear-producing situations; help him/her/them relate these past events to current anxious thoughts, feelings, and behaviors; encourage and support the client's verbal expression and clarification of his/her/their feelings that are associated with past rejection experiences, harsh criticism, abandonment, or trauma.
Assign the client to read books on resolving painful early family experiences (e.g. Healing the Shame That Binds You by Bradshaw or Facing Shame by Fossum & Mason); process key concepts learned from the reading.
Write a specific plan to follow when anxious and subsequently craving substance use. (45, 46, 47)
Assist the client in developing a list of 10 positive statements to read to oneself several times per day, particularly when feeling anxious (or supplement with “Positive Self-Talk” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce).
Using a 12-step program's Step 3 exercise, show the client how to turn over problems, worries, and anxieties to a higher power and to trust that the higher power is going to help him/her/them resolve the situation.
Help the client develop an alternative constructive plan of action (e.g. relaxation exercises, physical exercise, calling a sponsor, going to a meeting, calling the counselor, talking to someone) when feeling anxious and craving substance use (or supplement with “Coping with Stress” in the Addiction Treatment Homework Planner by Lenz, Finley, & Jongsma).
Write an autobiography, detailing those behaviors in the past that are related to current anxiety or guilt, and the subsequent abuse of substances as a means of escape. (48, 49)
Probe the client's family-of-origin experiences for fear-producing situations; help him/her/them relate these past events to current anxious thoughts, feelings, and behaviors, and discuss alternative approaches to relating to them.
Using a 12-step program's Step 4 exercise, have the client write an autobiography detailing the exact nature of his/her/their mistakes; teach the client how to begin to forgive himself/herself and others (or assign the client to complete the Step 4 exercise from The Alcoholism and Drug Abuse Client Workbook by Perkinson).
Develop a program of recovery that includes regularly helping others at recovery group meetings. (50)
Help the client develop a structured program of recovery that includes regularly helping others at 12-step program recovery groups (or supplement with “Aftercare Plan Components” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce).
Family members verbalize an understanding of anxiety and addiction and discuss the ways they and the client can facilitate the recovery process. (51, 52)
Provide the family members with information about anxiety and addiction and the tools that are used to assist the client in recovery.
Assist each family member in developing a list of three things that he/she/they can do to assist the client in recovery; hold a family session to facilitate communication of the actions on the list.
Complete a survey to assess the degree of satisfaction with treatment. (53)
Administer a survey to assess the client's degree of satisfaction with treatment.
