process; reach agreement on the goals and expectations of therapy; demonstrate consistent empathy toward the client's feelings and struggles; verbalize positive regard toward and affirmation of the client; and collect and deliver client feedback as to the client's perception of his/her/their progress in therapy (see Psychotherapy Relationships That Work: Vol. 1 by Norcross & Lambert & Psychotherapy Relationships That Work: Vol. 2 by Norcross & Wampold).
Describe the type, amount, frequency, and history of substance abuse. (1)
Gather a complete drug/alcohol history from the client, including the amount and pattern of his/her/their use, signs and symptoms of use, and negative life consequences (e.g. social, legal, familial, and vocational problems).
Participate in a medical evaluation to assess medical health and the medical consequences of substance use. (1)
Refer the client for a thorough physical examination to determine any physical/medical consequences of chemical dependence (include tests for HIV, hepatitis, and sexually transmitted diseases, if warranted).
Explore and resolve ambivalence about entering treatment and changing substance use behavior. (1, 2, 3)
Use the nondirective, client-centered, empathic style derived from motivational enhancement therapy (or supplement with “Assessing Readiness and Motivation” in the Addiction Treatment Homework Planner by Lenz, Finley, & Jongsma); explore the client's motivation for change and whether he/she/they are ready to take active steps or would benefit from continued motivational interviewing (see Motivational Interviewing by Miller & Rollnick; Motivational Interviewing and Enhancement by DiClemente, Van Orden, & Wright).
Ask the client to make a list of the ways substance abuse has had a negative impact on his/her/their life (e.g. personally, medically, relationally, legally, vocationally, and socially) and the positive impact nonuse may have (or supplement with “Substance Abuse's Negative Impact Versus Sobriety's Positive Impact” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce; or “Consequences of Continuing Addictive Lifestyles” in the Addiction Treatment Homework Planner by Lenz, Finley, & Jongsma).
Using a 12-Step Facilitation Therapy approach (see Twelve-Step Facilitation Therapy Manual by Nowinski et al.), assign the client to complete an Alcoholics Anonymous Step 1 paper admitting to powerlessness over mood-altering chemicals and present it in group therapy or to therapist for feedback (see The Alcoholism & Drug Abuse Client Workbook by Perkinson).
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
process; reach agreement on the goals and expectations of therapy; demonstrate consistent empathy toward the client's feelings and struggles; verbalize positive regard toward and affirmation of the client; and collect and deliver client feedback as to the client's perception of his/her/their progress in therapy (see Psychotherapy Relationships That Work: Vol. 1 by Norcross & Lambert & Psychotherapy Relationships That Work: Vol. 2 by Norcross & Wampold).
