Drug Rehabilitation Centre, Maldives

2007 Core Values:

Drug Rehabilitation Centre

K. Himmafushi

Republic of Maldives

2007 Unwritten Philosophies:
Drug Rehabilitation Centre
K. Himmafushi
Republic of Maldives

******************************************************************

Aftercare

CONTINUUM CARE MODEL

Abdullah Baniyameen
baniyameen@aol.com
November 19, 2009

DEVELOPING A CONTINUUM OF CARE PLANNING EFFORT SEEMS TIMELY. THIS HELP FAMILY/SUBJECTS/CLINICIAN TO PRACTICE AND PROVIDE CARE IN MULTI–DIMENSIONAL VENUES. PLANS USUALLY TAILORED TO SUIT THE NEEDS OF BROADER CONTINUUM CARE.

AFTERCARE ISSUES:

To identify and to go through with family members, on issue pertaining to expected aftercare problem. Discuss with groups regarding aftercare expected problems confronting family and list it down:

• Losing interest attending self help group,
• Easily bored, frustration is evident,
• Reactivation of denial, lying,
• Rationalize the use of other substance,
• Chemical,
• Relationship, sex.

۩ Effective continuum care requires a continuous support from family members. Families should well plan ahead to provide continuum care back into family setting.

۩ Organized list of planning accordingly to domain and level of entry. A good model of aftercare plan includes, the good habit principal of daily living.

POINTERS FOR EFFECTIVE CONTINUUM CARE:

• USE OF MUTUAL – HELP PRINCIPLE,
• STRUCTURE,
• RULES,
• RESPONSIBILITIES,
• BEHAVIORAL EXPECTATION,
• ROLE MODELING,
• FEEDBACK MECHANISM,
• THERAPEUTIC LEARNING INTERVENTION.

LEVEL III RECOVERY (MAINTENANCE):

• Acceptance disease.
• Understanding of the Bio – Psycho – Social.
• Appraise valued in put in recovery, through daily structured activity.
• Gradually letting go of self defeating attitudes.Realistic expectation and rational thinking.
• Understanding and managing of high risk situation and previous relapse (ranking). (Intra, inter personal and environmental risk factor).

LEVEL III RECOVERY (RELATIONSHIP):

• To be able to demonstrate, caring, loving self and others.
• Formulate family philosophy.
• Defines roles, boundaries and approaches in new family.
• Rules – do’s – don’t.
• Appreciate differences of opinions, feedback, in a frank and open manner.
• Communicate accurately & listen attentively.
• Ability to express feelings appropriately.

LEVEL III RECOVERY (LIFE SKILLS):

• To be able to breakdown parts of problems.
• To synthesize or put parts of problems together.
• Able to manage money and time wisely.
• Accept responsibilities for own behavior / maintain healthy habits.
• Integrate new found skills into plans for problem solving.
• Identify and deal with feelings constructively.

LEVEL III RECOVERY (SPIRITUALITY):

• MAINTAIN AN APPRECIATE VALUES AND BELIEF SYSTEM,
• DEFINE WHAT’S OK AND NOT OK BEHAVIOR – A CLEAR CONSCIENCE,
• HONESTY,
• RESPONSIBLE CARE & CONCERNS,
• HUMILITY.

SUGGESTED ROLES OF PARENTS:

• Taking charge versus letting go.
• From control to freedom.
• Freedom to Responsibility.
  **As children grow up we must constantly keep redefining our roles as parents.

PARENTAL CALLS FOR RESPONSIBILITY:

• Encourages the children to do so.
• For the kids it means that they must learn that if they want freedom, they must take responsibility for those choices - must learn actions have consequences. When they choose the action, they choosing to accept the consequences…

PARENTAL CONSENSUS ON PRINCIPLES:

• It is absolutely essential that parents agree on these guidelines.
• Primary Goal > is to prepare our children for dealing with the real world.
• The methods we use: must be evaluated on how well that meets the children deepest human needs such as self – esteem, respect, reliance, meaningful relationship with others.

SETTING LIMITS:

WE DON’T LET BABY PUTS IT’S HAND ON A HOT STOVE TO LEARN WHAT HEAT MEANS. TO ADOLESCENT; LIMIT EXISTS TO BE TESTED. HOW SERIOUS IS MY PARENTS IN IMPOSING THE CURFEW OR BANS? HOW FAR I CAN REALLY GO?

CLEAR THROUGH DISCUSSION AND WRITING IT DOWN UNTIL THEY AGREES’ THEY’RE CLEAR. POST IT WHERE IT IS CLEAR WHERE IT IS EASILY REVIEW SUCH AS REFRIGERATOR, BULLETIN BOARD, OR FREQUENT ACCESSIBLE PLACE USED BY ALL.

NO TWO KIDS ARE ALIKE, MUST REFLECT THE CHILD UNIQUE NEEDS AND CAPACITIES, SUCH AS:

• Age. It has to come with maturity & responsibilities in handling them.
• Trust has been earned.
• They must earn our trust; we somehow put ourselves in their hands. Rely on them to do what’s right. They have to show they’re worthy of our trust.
• Trusting and loving them are two different things.
• Loving them is a commitment, it’s a natural part of a family life but they don’t have to earn our love.

ENFORCEMENT OF LIMITS:

• We must model it. We must have some idea what they are doing?
• Or going to class, at least when our kids says that there going to practice after school, we need to know when practice starts and ends and check with the in charge to see whether they attended.
• Check observance or non observance:
  i.e. Billiard, Café, Video Arcade, etc.
• We must follow through with definite consequences when they violates the limits.

SETTING CONSEQUENCES:

• When parents prepare a reasonable, clear set of consequences, that will predictably follow when kids acts inappropriately, kids can learn in a loving supportive, environment a lesson that the world are harsh that actions have consequences.
• When kids learned at home that actions have consequences, they’re more likely to consider what effects those decisions will have on themselves and on those they love.

QUALITY OF EFFECTIVE CONSEQUENCES:

• They’re related to the incident.
• They’re reasonable > that consequences usually exceed the violation.
• They’re timely > the sooner the better.
• Not to elaborate or to complicate.
• They’re enforced calmly, respectfully, without anger.
• Applied consistently - if parent don’t apply it consistently, it fails.

AVOIDANCE IN SETTING CONSEQUENCES:

• Seeking Revenge,
• Punishing Ourselves,
• Rewarding in Appropriate Behavior,
• Making Threats or Promises,
• Shaming,
• Over Emphasizing Consequences.

BUILDING FAMILY UNIT:

• Family Schedule,
• Family Activities,
• Family Events,
• Family Meeting,
• House Utilization Plan,
• House Keeping Duty.

FAMILY SCHEDULE:
SET UP A WEEKLY CALENDAR OUTLINING FAMILY ACTIVITIES.

FAMILY ACTIVITIES:
REGULAR ACTIVITIES, DAILY OR WEEKLY THAT ALL FAMILY MEMBERS ARE EXPECTED TO ATTEND – WORSHIP, DINNER, ETC.

FAMILY EVENTS:
PLAN SPECIAL ACTIVITIES, OUTING TO THE ZOOM, AMUSEMENT PARK, MOVIES, OR VACATIONS ETC.

FAMILY MEETINGS:
HOLD WEEKLY CONTACT TIME TO AIR FEELINGS OR CONCERNS, REVIEW PLANS AND FEEDBACK.

HOME UTILIZATION:
Bath rooms, living room, kitchen when such areas are to be used more frequently, and to develop special rules governing those areas.

HOUSEKEEPING RESPONSIBILITY:
Line up duties and make it clear that everyone is expected to do certain chores without expecting remuneration.

HANDLING MISTAKES AND OWN PROBLEMS:

• PROMPTLY ADMIT OUR MISTAKE,
• ADMIT OUR PROBLEMS,
• AVOID BLAMING OTHERS,
• BE WILLING TO GET HELP.

***********************************************************

From Despair to hope:

DEVELOPMENTS OF SELF – HELP GROUPS

Abdullah Baniyameen
baniyameen@aol.com
October 31, 2009



FOCUS:

• The History and Evolution of Self – Help.
  
• Self–Help Movement in Asia.
  
• Philosophies of Self – Help.
  
• Guidelines for Building and Sustaining Self – Help Groups.
  
• Role of Treatment Center's in Promoting Self – Help Groups.
  
• Framework on Organizing and Formation of Self – Help Groups.
  
• Framework on Sustaining Self – Help Groups.

“NO ONE IS SO INDISPENSABLE THAT HE CANNOT BE DISOWNED, NO ONE IS SO WORTHLESS THAT HE HAS NO ROLE TO PLAY”.

“NO ONE IS SO PERFECT THAT HE NEEDS NO ONE ELSE, AND NO ONE IS SO WEAK THAT HE HAS TO DEPEND ON OTHERS ALL THE TIME”.

DEVELOPMENTS OF SELF – HELP GROUPS:
Self–help is neither about a person helping his own – self nor about an individual getting help from a single helper, but about a group of people with similar problems, helping and supporting each other in reaching for a common goal. Mainly rehabilitation program still adopt the Medical Model whereby the change of heart among addicts can best be brought about through the efforts of professional staff.
Self–help is a promising alternative approach, which is widely known to be a more appealing way to stimulate changes needed for Whole Person Recovery. A true self–help group is peer–led and usually for outpatient clients. In circumstances where there are no senior self–helpers to run a relatively new peer support group in any locality, a staff–led group can be a practical alternative.
Nonetheless, self–help is not a panacea for all the problems of recovery. Even the very best peer group is a vehicle for only a part of the recovery journey.

THE HISTORY & EVOLUTION OF SELF–HELP:
In the autumn of 1922, the Lutheran minister, Rev. Frank N. D. Buchman, and a few of his friends, formed what they called, ‘A First Century Christian Fellowship’. His evangelical work, consist of carrying a message of life – changing by “getting right with God.”
Around 1927, Buchman began working in England. Several of his followers were connected with Oxford University; and when they began to tour South Africa, the press called the evangelical team ‘The Oxford Group’ as most of them were from Oxford University; but Frank Buchman was never officially connected in any way with Oxford University. In 1937, the group was officially incorporated in Great Britain as a not – for – profit entity, known as The Oxford Group.

ALCOHOLIC ANONYMOUS (A. A.):
On the 10th of June 1935, in Ohio, a stockbroker by the name of Robert Halbrook (Bob) Smith who had made a resolution to quit drinking needed a companion. He was suggested to call an alcohol – Self – dependent surgeon, Dr. William Griffith (Bill) Wilson. They ended up talking all night long. Strangely, as a person who was in need of a companion in the first place, Bob found himself playing the role of a messenger, promoting sobriety to another alcoholic.
Hence, the philosophy of AA came about. Today it has grown to include some 87,000 chapters existing in more than 150 countries. Then, the early members decided to write about their struggle to achieve sobriety, in order to share their discoveries with others.
The big Book of Alcoholics Anonymous Twelve Steps and Twelve Traditions were eventually published in 1939.

ELEMENTS OF ALCOHOLIC ANONYMOUS:
۩ In their exploration of why certain Self – Help groups are so effective, Roots and Aanes identified eight characteristics that seems to contribute to group’s success:

1. Members have shared experience, in this case, their inability to control their drug or alcohol use.
2. Education, not psychotherapy, is the primary goal of AA membership.
3. The groups are self – governing.
4. The group places emphasis on accepting responsibility for one’s behavior.
5. There is but a single purpose to the group.
6. Membership is voluntary.
7. The individual member must make a commitment to person change.
8. The group places emphasis on anonymity and confidentiality.

NARCOTICS ANONYMOUS (N. A.):

• As more and more recovering drug addicts were joining AA meetings, they began to feel the need for a separate group. So, in 1947, Narcotics Anonymous (NA) was born. NA basically does not differentiate their members by the type of mood – changing or mind – altering substances they abuse.
• Its members accept the commonality in their inability to overcome the problem of addiction. Similar to AA, NA has steadily become widespread. Today, NA groups may be found in almost all countries in the world. Both AA and NA members do not suggest that recovery is a cure for drug addiction. They do not speak of themselves as being recovered.
• While they believe that addiction is a disease whose progress may be arrested, they also acknowledge that it can never be cured.

1) AL – NON:

• In 1948, a special group was formed, meant for spouses of alcoholics. It was an effort to apply the same… Twelve Steps Program of AA to improve their lives.

2) ALATEEN:

• By 1957, in response to the recognition that teenagers presented special needs and concerns, Al – non it gave birth to a modified group for teenage children of alcoholics.
• Through Alateen, teenagers learn that alcoholism is a disease and are helped to detach emotionally from the alcoholic’s behavior, while still loving the individual. The group’s goal is to help members to learn that he did not because the alcoholic to drink and see that they can build a rewarding life despite the alcoholic’s continued drinking.

3) RATIONAL RECOVERY (R. R.):

• In 1986, a self – help group, which adopts different concepts and approaches from that of AA or NA was formed. The group’s main focus is on the attempts to reshape the self – defeating thinking pattern and perception of an individual. The program philosophy is derived from the Rational Emotive Therapy’s (RET) of psychology.

4) SECULAR ORGANIZATION OF SOBRIETY (S. O. S.):

• By 1986, a group of self – helpers who were uneasy with spiritual approaches of NA had set up a new kind of self – help group.
• The group’s main focus is on critical thinking and personal responsibility in recovery.

5) WOMEN FOR SOBRIETY (W. F. S.):

• It is a fraction group of AA, specially meant for female alcoholics. They feel that AA has a clear gender – bias inclination when its members generally do not acknowledge the differences between males and females in certain issues. The group’s main emphasis is on the development of self – esteem.

6) AA FOR ATHEISTS & AGNOSTICS (QUAD A):

• It is another fraction group of AA, which is formed specifically for recovering persons who do not believe in the existence of God or the Higher Power. The group’s main focus is on intrinsic motivation that may induce change in an individual.
• The group sessions are often filled with a heated discussion or debate on pressing issues experienced by its members.

SELF – HELP GROUPS ARE GROWING IN POPULARITY WORLDWIDE. IN ASIA, SELF – HELP GROUPS ARE INCREASINGLY BEING FORMED TO ADDRESS THE DRUG ABUSE PROBLEM. THERE IS A GROUP FOR ALMOST EVERY MAJOR LIFE PROBLEM LIKE SUBSTANCE ABUSE, CODEPENDENCY, COMPULSIVE GAMBLING, OBESITY, EXHIBITIONISM, ETC.

SELF – HELP MOVEMENTS IN ASIA:
APART FROM THE AA AND NA NETWORKS, REGIONAL SELF – HELP GROUPS HAVE BEEN INITIATED.

AMONG THEM ARE:

1. DAN SHU KAI IN JAPAN, 1987.
2. PUI HONG SELF-HELP ASSOCIATION ALUMNI ASSOCIATION IN HONG KONG, 1987.
3. KELLY’S GROUP IN HONG KONG, 1987.
4. DUANG PRATEEP FOUNDATION IN THAILAND, 1989.
5. PENGASIH ASSOCIATION IN MALAYSIA, 1991.
6. JALAYA IN SRI LANKA, 2001.

PHILOSOPHIES OF SELF – HELP:
One of the self – helpers’ popular slogans is; “You alone must do it but you can't do it alone!” It simply means unless an addict decides to change, no amount of encouragement, guidance, assistance or even pressure can change him and he will keep on resisting change. Recovering addicts need guidance; support and help from concerned others to make the long and challenging recovery journey.
They provide a purpose: by helping another person, one is actually helping one’s own self. A self – helper listens to similar problems of other members, pictures himself in their situations and encourages their efforts to change for the better. All those do more to enlighten and empower the doer in dealing with his problems.
Through mutual support, the success of one member inspires the others: “If he can do it, so can I”. Self – helpers mutually provide hopes and motivations. Their function as role models is acceptable and credible because they have passed through the same way earlier on. They are able to relate or be open to one another without shame and fear.
In other words, they have walked the walk, not just talked the talk. Dynamic interaction in a self – help group develops bonding among the members that deeply affect their feelings and attitude. The genuine care and concern mean a lot to them.
Acceptance and identification (not obtained from other sources initially) becomes the energy that drives them to move forward. While in a program, they are guided to set goals and to draw a plan or strategy to achieve them. Back in the community they find that working on recovery in real life is a lot harder than merely learning about it.
They need on site instruction, instant feedback, close monitoring and supervision and extra input on specific issues. Those needs are met when they attend a self – help group session regularly. For family and peer self – help group members, there are four elements that have been found to be powerful enough in prompting progressive changes.
The elements are called the four keys to change. They are Practical Guidance, Successful Role Model, Genuine Care and Concern as well as Social Learning. The four keys to change are dominant in a self – help group, for they bring about mental, emotional and behavioral changes in the group members.

FOUR KEYS TO CHANGE

1. PRACTICAL GUIDANCE: Empirical–based guidance that enable a recovering person to follow the recovery path of a successful role–model.
2. SUCCESSFUL ROLE MODEL: A peer who demonstrates an exemplary achievement that motivates other peers to pursue a specific positive change.
3. GENUINE, CARE & CONCERN: The compassionate acts or interactions that encourage reciprocal motivation.
4. SOCIAL LEARNING GROUP: The group functions as a medium that allows social learning process, relevant recovery, to take place continuously. It provide recovering person with an undying energy & drive to maintain their recoveries.

BENEFITS OF JOINING SELF – HELP GROUPS:
Self – help group members feel respected and dignified. They believe that the group is helping them, feel guided and supported as well as loyal and responsive. For active members, the group serves as a source of authority that enables them to acquired self–discipline. Thus, they are facilitated in over coming problems with authority and discipline. A good group, dedicated to its own set of beliefs and philosophies, provides the members with the sense of purpose and direction. Also by learning to see themselves in the eyes of others, they acquired a clearer self–concept that enables them to play the roles expected of them.
In the group they have the opportunity to try out the newly developed or re–developed social skills. Consequently, they became expressive and assertive; independent and tolerant; giving and caring; and positive productive. Their ability to adapt to the group norms and structure enhances their self–esteem and fulfill their need for the sense of achievement. They have a real social group that they feel belong to. The micro community becomes the very soil for personal growth. Such dynamics foster positive change in their thinking, feeling and behavior. Thus, gradually a new self – image and character is developed.

ROLE OF TREATMENT CENTERS IN PROMOTING SELF – HELP GROUPS:
Involvement in a self – help group is essential for every client but they can only be certain of doing so if they had pre – treatment exposure as well as in – treatment experience. They must see the group as one of the vehicles they need to take in order to make the journey to recovery.

TREATMENT PHASE;

PRE – TREATMENT PHASE:
EVEN PRIOR TO ENTERING TREATMENT, PROSPECTIVE CLIENTS IN SELF – HELP GROUPS

• Promote the self – help concept and highlight its significance.
• Provide information about existing self – help groups.
• Motivate clients on one to one basis to help during counseling sessions to attend meetings.
• Reinforce messages about self – help groups during lectures and group therapy sessions.
• Invite senior peers to share with clients the good feeling they experience when attending self – help groups.

DURING AND AFTER THE TREATMENT PHASE:

• Make arrangements for senior clients to attend meetings.
• Display literature like pamphlets, books and tapes for perusal by clients.
• Encourage clients to browse web sites hosted by self – help groups and participate in E-chatting sessions.
• Emphasize the need for clients to participate in self – help group meetings regularly after being discharged.
• Discuss issues relating to their self – help group involvement during counseling session.
• Encourage clients to look for sponsors or buddies to facilitate their recovery.
• Provide a room or hall where self – help group sessions can be held regularly.
• Invite guest speakers from existing self – help organizations.

GUIDELINES FOR BUILDING & SUSTAINING SELF – HELP GROUPS:

• Clarity of purpose. (clients attend sessions with a strong belief and trust that the group is helping them in going through their recovery process)
• Establishment of a common goal. (clients need to be guided to establish sound recovery and life goals)
• Fair and open leadership. (capable leaders will enable clients to gain benefits to the fullest)
• Norms that apply to all. (fairness helps to increase the clients’ self – esteem)
• Participatory decision making. (engaging in a collective decision – making heightens the clients’ sense of self – worth)
• Joint planning and implementation. (a strong team sprit strengthens the clients’ identification and sense of belonging)
• Active and sincere involvement. (a whole – hearted involvement enable clients’ to sustain their recovery growth)
• Sharing of credit and responsibility. (the broad spectrum of togetherness establishes unity and loyalty among clients)
• Focusing on commonalities. (by tolerating differences, clients’ develop bonding and cohesiveness among them)
• Focusing here and now. (guiding clients to accept reality and draw a realistic plan for a better future)
• Encouraging self / mutual change. (encouraging clients to exercise the true self – help value that is to provide mutual support)

IT IS CRUCIAL TO ENSURE THAT THESE SELF – HELP GROUPS, WHEN FORMED, DO NOT BREAK UP WITHIN A SHORT PERIOD OF TIME. THEREFORE, IT IS NECESSARY TO LOOK INTO THE METHODS AND STRATEGIES INVOLVED IN FORMING AND SUSTAINING THE GROUP.

TYPE OF GROUPS:
Traditional support groups;

• 12 Steps fellowship.
• Aftercare support group.
• Faith-based oriented support group;
  1. Open membership.
  2. Staff-led, Peer-led, Facilitator-led.
  3. Conducted by group members.

ACTION STEPS:

• Determine what you need from a support group.
• Find out if there is an existing group that meets your needs.
• Gather sources of information about support groups.
• Hold meetings on a regular basis.

EXPECTED OUTCOME:

• Sense of trust increased.
• Tolerant and respectful behaviors developed.
• Coping strategies and skills reinforced.
• Active participation achieved.

SUPPORT NEEDED:

• A safe, secure, and welcoming environment.
• Resources:
  1. Literature,
  2. Physical Setting,
  3. Equipment.
• Professional guest speakers.
• Strong community linkages.
• Support of family members, peers sponsors.
• Consultative linkages.
• Training opportunities.

TYPE OF GROUPS:

Relapse Prevention Maintenance Program;
Relapse prevention is designed in a systematic method to recognize and manage the recurrence of addictive behaviors.

1. Staff – led,
2. Peer – led,
3. Facilitator – led.

ACTION STEPS:

• Practical help to establish and maintain rapport.
• Daily contact with healthy peers.
• Practical help to maintain sobriety.
• Focused on identifying early relapse warning signs and its management.
• Structured and scheduled according to the needs.
• Exposure to senior self – helpers.

EXPECTED OUTCOME:

• A more healthy emotional, social, and spiritual life adopted.
• Coping skills developed.
• Recovery plan formulated and implemented.

FRAMEWORK ON ORGANIZING & FORMATION OF SELF – HELP GROUP:

TYPE OF GROUPS:
Special Groups;

• Gender specific issues,
• HIV,
• Sexuality,
• Cross Addiction.
• Partnership in Parenting…
• Life Skills.

ACTION STEPS:

• Determine the need.
• Draft the guidelines.
• Plan and structure the program.
• Build group culture.

EXPECTED OUTCOME:

• Sensitivity to issues related to addiction increased.
• Life skills enhanced.

ACTION STEPS:

• Establish common goals.
• Ensure the clarity of purpose.
• Establish norms.
• Encourage collective decision making.
• Focus on commonalities.

METHODS/STRATEGIES:

• Continue to develop potential leaders.
• Perform ongoing needs assessment, evaluation, and feedback concerning coalitions.
• Perform ongoing training and development of coalitions.
• Continue expansion and team building.

EXPECTED OUTCOME:

• Active and sincere involvement achieved.
• A functioning coalition established and sustained.
• Inter – organizational networking established and sustained.

SUPPORT NEEDED:

• Resources,
• Consultative linkages,
• Training opportunities,
• Technical assistance,
• Financial back – up.

FRAMEWORK ON SUSTAINING SELF – HELP GROUPS;
ACTION STEPS:

• Encourage mutual connection.
• Establish a good networking with other self – help groups.

METHODS/STRATEGIES:

• Engage in conflict resolution as needed.
• Redefine the norm as needed.
• Document and presenting success stories.
• Focus on here and now.
• Share of credit and responsibility.
• Fair and open leadership.

EXPECTED OUTCOME:

• Capacity to deal effectively with emerging issues demonstrated and enhanced.
• Number of members with strong recoveries increased.
• Members nurtured and supported.
• Sense of ownership developed.

*************************************************************

Relapse Prevention

STRATEGIES

Abdullah Baniyameen
baniyameen@aol.com
October 21, 2009

MYTH:

• MOST ADDICTS CONSIDER DRUG USING AS SOMETHING SO PLEASURABLE THAT NOTHING COMPARES TO IT.
• LIFE IN THE ADDICTS’ WORLD IS FULL OF HARDSHIP, YET, IRONICALLY THEY FIND IT VERY CONTENDING.
• TO SOME OF THEM, GOING IN AND OUT OF TREATMENT HAS BECOME PART OF THEIR LIFESTYLES.
• THIS IS SO BECAUSE THEY SELDOM OBTAIN PLEASURE OR SATISFACTION FROM CONVENTIONAL ACTIVITIES.
• THEY BELIEVE THAT LIFE WILL NEVER BE MEANINGFUL WITHOUT DRUGS!
• NOT EVERYONE CAN COPE WITH PROLONGED BOREDOM AND DISCONTENTMENT IN LIFE.
• RECOVERING PERSONS SHOULD LOOK FOR ALTERNATIVE SOURCES OF PLEASURE AND HAPPINESS.
• THEY HAVE TO LEARN TO EXPERIENCE JOY AND SATISFACTION WHEN ENGAGING IN CONVENTIONAL ACTIVITIES -- EXERCISING, WORKING, STUDYING, BEING WITH FAMILY, PRAYING, READING, DOING COMMUNITY SERVICE, ETC.
• THEY NEED TO BE PATIENT FOR THAT JOYFUL AND SATISFYING EXPERIENCE MAY NOT COME INSTANTLY.

FACTUAL MYTH:

• Recovering persons should look for alternative sources of pleasure and happiness. They have to learn to experience joy and satisfaction when engaging in conventional activities -- exercising, working, studying, being with family, praying, reading, doing community service, etc.
• They need to be patient for that joyful and satisfying experience may not come instantly.

A HOUSE WOULD NOT BE SAFELY HABITABLE IF THE MAIN PILLAR WAS NOT STRONG ENOUGH.
A recovering person may not develop SELF–RESILIENCE should he/she depends more on EXTERNAL MOTIVATION than on the INTERNAL MOTIVATION.

MAIN CAUSE OF RELAPSE:

• Having a powerful positive expectation about drug effects.
• Failure to recognise any high risk situations.
• Poor coping strategies.
• Not having an established social support network.
• Lack of experience living without drugs.
• Unprepared to handle “a slip”.

COMMON CAUSES OF RELAPSE:

• Faulty outcome expectancy.
• Ignorant of high risk situation.
• Coping skills deficits.
• Limited social support.
• Discontentment being sober.

POSITIVE EXPECTATION ABOUT DRUG EFFECTS:

• Sometimes only limited or half-hearted efforts are made to establish the negative expectation about drug effects that the positive one remain powerful and dangerous.
• At the same time, the positive expectation of abstinence is not well established to overpower the negative one.

FAILURE TO RECOGNIZE:

• Unprepared to face recovery challenges, the recovering persons may easily succumb to triggers in dangerous situations.
• The result is they break the resolution to remain abstinent and chose drug-using as a means of resolving the crisis.

POOR COPING STRATEGIES:

• Recovering persons may have learnt various techniques of facing recovery challenge but often in real life situations they simply unable to apply them effectively.
• Without having the efficacy to use them, preventing a relapse incidence may only happen by chance.

DEFICITS IN SOCIAL SUPPORT NETWORK:

• Inability to disclose and inferiority inhibit recovering persons from making creative moves in getting continuous support from various sources.
• Without it they do not get forewarned when their warning signs are flaring; they do not have sufficient practical guidance, genuine concern and honest feedback; role models, reliable companions and recovery partners.

LACK OF EXPERIENCE LIVING WITHOUT DRUGS:

• Having little experience in making new achievements and acquiring skill – based satisfaction prevent recovering persons from being convinced that living drug – free is fulfilling.

UNPREPARED TO HANDLE A SLIP:

• Limited knowledge and experience related to slips makes recovering persons unfamiliar with any rescue or remedial services and that delay them from getting immediate intervention.
• Guilt and shame often pull them down towards relapse and back into the vicious cycle.

COPING WITH RELAPSE:

• Outcome expectancy.
• Risk Management.
• Effective coping strategies.
• Expansion of social networks.
• Wholesome normative lifestyle.
• Ability to handle incident of slip.

OUTCOME EXPECTANCY:

• Establishing positive expectation of abstinence.
• Establishing negative expectation of drug use.
• Self – talk / self – affirmation.
• Developing an obsession for recovery (Statement of Commitment).
• Forming a recovery vision.
• Creating ‘HELL MEMORIES’.

ESTABLISH POSITIVE SOBRIETY EXPECTATION:

• Using ‘self–talk’/‘self–affirmation’:
  o “I’ll be close with my family again.”
  o “I may continue my education.”
  o “I’m sure life won’t be as hard as before.”
  o “I may be active in my soccer club again.”
  o “I won’t get into a conflict with others.”

ESTABLISH NEGATIVE EXPECTATION ABOUT DRUGS:

• Using ‘self–talk’/‘self–affirmation’:
  o “I don’t need that kind of life anymore!”
  o “I might be infected with HIV!”
  o “Sooner or later I’ll be troubling my parents!”
  o “My girl friend might walk out on me!”
  o “I may be readmitted into a rehab centre. I’m so tired of it!”

DIMINISHING NEGATIVE EXPECTATION OF ABSTINENCE:

• Using ‘self–talk’/‘self–affirmation’:
  o “There are friends who really want to be clean.”
  o “If I really change, they’ll trust me back.”
  o “If I make a real effort, I won’t fail.”
  o “Everyone supports my striving for recovery.”
  o “Without drugs, my life may still be happy.”

STRATEGIES:

• Using ‘self–talk’/‘self–affirmation’:
  o “That one time may lead to a relapse.”
  o “Drug high is far from a real happiness.”
  o “The consequence may be fatal this time!”
  o “One sip / one puff is as bad as a slip.”
  o “Taking pot, an alcohol or psychotropic pill as a substitute means my addiction is not yet over.”

IMAGINE HOW AN ARDENT FAN SPEAKS ABOUT HIS/HER IDOLIZED POP GROUP OR MOVIE STAR.

PICTURE YOURSELF LISTENING TO A SPEECH BY AN ACTIVIST.

RECALL ANY EVENT WHEN YOU WERE LISTENING TO A SERMON OR A RELIGIOUS TALK DELIVERED BY A MULLAH / A PRIEST / A SWAMI / A MONK.

AN ARDENT FAN, AN ACTIVIST AND A PREACHER, WHAT IS COMMON IN THE WAY THEY SPEAK?

• Enthusiastic and with strong feelings.
• Sincere, from the gut.
• Knows the subject well.
• Very forceful and convincing.
• Consistent.

A RECOVERING PERSON SHOULD SPEAK ABOUT HIS/HER RECOVERY IN A SIMILAR MANNER.

MEANINGFUL ACTIVITIES AS A WAY OF DISTRACTION:

• READING,
• WATCHING TV,
• WATCHING VIDEO,
• KARAOKE,
• PRAYING,
• VIDEO GAMES,
• SPORTS,
• PAINTING,
• CALLING FRIENDS,
• EATING,
• INDOOR GAMES,
• BROWSING OLD PHOTOS,
• WRITING,
• CLEANING UP,
• WASHING CARS/ BIKES,
• FAMILY OUTING,
• HOBBIES,
• CHATTING ON THE INTERNET,
• SURFING THE INTERNET,
• RELAXATION THERAPY.
  

STRATEGIES:
Visualization:

A METHOD OF DELIBERATELY USING IMAGERY TO MODIFY BEHAVIOUR, FEELING OR INTERNAL PHYSIOLOGICAL STATE;

VISUALIZATION NOT ONLY CAN HELP YOU TO ACT IN WAYS THAT IS LIKELY TO LEAD TO SUCCESS, BUT CAN ALTER SUBTLE INTERNAL PHYSIOLOGICAL STATES AS WELL. (O.C. Simonton, 1980)

DRUG URGES PENETRATE THE SELF THROUGH THE FIVE SENSES;

Therefore, the verbal images should contain sensory words wherever appropriate (visual, auditory, olfactory, etc.)

A VISUALIZATION SESSION SHOULD HAVE 03 PARTS:

1. Preliminary relaxation (5 -15 minutes).
2. The visualization itself.
3. Instructions for returning to an alert state of mind.

VISUALIZING ONE RIDING A BIKE DOWNHILL ALONG A STRETCH OF WINDING ROAD, BEING CHASED AFTER BY A FIREBALL PASSING THROUGH A FARM AND CROSSING A SMALL STREAM; AT A CERTAIN POINT, TAKING A SUDDEN TURN, DODGING THE FIREBALL THAT FLIES ON INTO OBLIVION; ENDING UP IN A VILLAGE CALLED ‘TRANQUILLITY’; THE FIREBALL SYMBOLIZES A DRUG CRAVING.

FORMS OF AVOIDANCE:

• Re – Scheduling; changing the Time.
• Re – Timing; changing the Duration.
• Re – Routing; changing the Route.
• Re – Sequencing; changing the Order.
• Re – Programming; changing the Activities.
• Re – Grouping; changing the Social Circle.
  

GROUP DISCUSSION:

1. Identify common dangerous situations for addicts in your area, especially any that are related to your own culture, society or specific local conditions.
2. Describe your experiences in handling relapse cases and making crisis interventions. What has seemed to help the most and the least?
3. Design a ‘Relapse Intervention Checklist’, that is, all the things staff should know from or about any client who experiences a slip or relapse.

• DETERMINE THE CAUSES OF RELAPSE~PRIMARY, SECONDARY.
• EXAMINE REALISTIC OPTIONS FOR SOLVING THE CRISIS.
• DRAW A PLAN OF ACTION~STEPS, PRIORITIES.
• FIX THE NEXT APPOINTMENT.

RELAPSE, CRISIS DIRECTLY RELATED TO DRUG USE:

• DRUGS:

o Type,
o Dose,
o When,
o Frequency.

• PSYCHOLOGICAL:

o Current symptoms.
o Precipitating event.
o Mood, lifestyle change.
o Self – inflicting tendency.
o Eating, sleeping disorders.

• COPING ABILITY:

o Personal strength & weaknesses.
o Support network.
o Limitations:
i. Finance,
ii. Housing, etc.

• REFRAMING:

o Clear picture of he related events.

DEBRIEFING:

• RECALLING AND RELATING THE RELAPSE INCIDENT:
  o Figuring out the causes of relapse.
  
• DETERMINING THE NECESSARY MEASURES TO IMPROVE RELAPSE PREVENTION SKILLS:
  o Drawing new insight and cognition from the incident.
  
• SPECIFYING THE FORM OF REDEMPTION.
• SETTING A CONTINGENCY PLAN:
  o Re – developing self – efficacy.
  
• GETTING BACK ON THE RECOVERY ROUTE -- BASED ON THE GOALS:
  o Doing special assignments.
  
• MONITORING AND EVALUATING PROGRESS.

SUGGEST GUIDES FOR CARE GIVERS:

RELAPSE FANTASY OR COVERT MODELLING:
GUIDING A CLIENT TO VISUALISE A DANGEROUS SITUATION AND PICTURE HIM/ HER GETTING OUT OF IT SUCCESSFULLY.

RELAPSE REHEARSAL OR OVERT MODELLING:
GUIDING CLIENTS TO SIMULATE A DANGEROUS SITUATION AND PRACTISE WAYS OF GETTING OUT OF IT,

PROGRAMMED RELAPSED:

A carefully planned exposure to a real dangerous situation in the company of reliable senior recovering peers, its impacts on the clients are later discussed in a group session and assessed by a clinical staff. It has to be done a few times until a client is confident enough to try getting into the situation on his own.

RESPONSE TO STRESSORS

• REPLACING IRRATIONAL BELIEFS WITH RATIONAL ALTERNATIVES,
• RELAXATION THERAPY,
• ANXIETY REDUCTION THERAPY:
  o Visualization,
  o Deep – Breathing Exercise,
  o Meditation, Acupuncture,
  o Progressive Muscle Relaxation,
  o Thought Stopping, etc.
• SPIRITUAL ENHANCEMENT:
  o Prayers,
  o Doing Good Deeds,
  o Preaching.

POSITIVE PLEASURE:
Recovering persons need to learn how to derive real pleasure from conventional activities. It does not come automatically. Sound life goals and a realistic plan to achieve them; provide the drive to strive on. Engaging in conventional activities helps them to adopt the mainstream values and facilitates their social reintegration. Recovery maintenance relates with the contentment gained from a responsible drug – free life.

SOCIAL SUPPORT NETWORK:
Recovering persons need to maintain their involvement in a peer support group for a long time. They have to make amend to the family to acquire familial support. Then, they have to work on expanding their support network to speed up their validation process. Recovery maintenance corresponds with the extent of their identification with positive social groups.

STEPS IN RESPOND TO RELAPSE:

1. STOP THE SLIDE IMMEDIATELY,
2. CONDUCT A DEBRIEFING AND DETERMINE WHAT WENT WRONG,
3. DETERMINE THE AREAS FOR IMPROVEMENT AND DRAW AN IMPROVISED PLAN/ STRATEGY,
4. OFFER ENCOURAGEMENT AND SUPPORT.
   

****************************************

Crisis Intervention

CUESES AND REACTIONS TO CRISES

Abdullah Baniyameen
baniyameen@aol.com
September 17, 2009

A. DEFINITION:

• A CRISIS IS A STATE OF MENTAL AND EMOTIONAL CONFUSION THAT IS CAUSED BY THE PERCEPTION OF THREAT,
• IT INVOLVES A SENSE OF URGENCY,
• IT MAY LAST A FEW HOURS TO A FEW WEEKS.

B. TRAUMAS THAT SET OFF CRISES:

• A trauma is an objective event that damages a person’s sense of well – being and creates anxiety,
• For a trauma to set off a crisis, the person has to perceive the trauma event as very threatening,
• There are four types of traumas that set off crises:
  1) Situational, 2) Development, 3) Intra Psychic, 4) Existential,

1) SITUATIONAL – the circumstances causes the upset:
e. g. THE DEATH OF A LOVED ONE, THE BREAK UP OF AN IMPORTANT RELATIONSHIP, SERIOUS ILLNESS, SERIOUS FINANCIAL PROBLEMS, FAMILY VIOLENCE ET CETERA.

2) DEVELOPMENT – the process of growing through life stages can cause upset:
e. g. PEER PRESSURE, MARRIAGE, CHILDREN, RETIREMENT,

3) INTRA PSYCHIC – thoughts and feelings can create upset:
e. g. IDENTITY CONFUSION, THOUGHTS AND FEELINGS CREATED DURING INTERPERSONAL FRICTION, SUICIDAL THOUGHTS.

4) EXISTENTIAL – a sense of emptiness and lack of purpose in life causes upset:
e. g. RECOGNITION THAT DAILY ACTIVITIES DON’T PROVIDE MEANING AND SATISFACTION IN LIFE AND AVOID OF FEELING EMPTINESS RESULTS.
REACTION TO CRISIS:
People in crisis perform some form of reactive behavior or to reduce emotions,
Common reactions;

a) SHOCK:

• Trauma may stun some people into a dazed and numb state,
• This numbness prevents other feelings from being felt,
• A person in shock may appear zombie – like have difficulty concentrating, feel helpless, and demonstrate increased suggestibility,

b) AXIETY:

• The trauma may overwhelm, some people they feel like they are falling apart,
• Trauma causes some people to act agitated or perform useless activity such as pacing, hand wringing, smoking, or drinking,
• Some people have symptoms of increased nervous system arousal; rapid heart beat, chest pains, difficulty breathing, dizziness, and sweating.

c) DEPRESSION:

• The traumas may flatten some people creating a sense of hopelessness,
• Some people are immobilized – they are preoccupied with the event, don’t attend to daily needs, have low energy level, or cry frequently.

d) ANGER:

• The trauma may outrage some people,
• They direct the anger outward onto others:

*The cause of the trauma,
*An easy target.
*They direct the anger inward leading to self destructive actions

e) INTELLECTUALIZATION:

• The trauma may cut off thoughts and feelings in some people,
• They use rational thinking to get through crisis,
• They are cut off from painful feelings,
• This will leave the trauma unresolved after the crisis has passed.

CRISIS INTERVENTION:

GOALS OF CRISIS INTERVENTION:

• To stabilize the individual so no further deterioration in functioning occurs,
• To relieve the individual of as much pressure as possible,
• To convert the emergency to a solvable problem and resolve it,
• To return the person to his / her pre crisis level of functioning.

PROCESS OF CRISIS INTERVENTION:

ESTABLISHING RAPPORT – this must be done rapidly at the beginning of the interview – the client must feel he / she has a knowledgeable ally who will see him / her through the crisis,

GATHER RELEVANT DATA:

a) To assess risk of danger to self and others,
b) To become informed about current problem,
c) MEDICAL:
*Current symptoms,
*Precipitating event,
*History of this medical problem (brief).
d) IF ALCOHOL AND DRUGS ARE INVOLVED:
*Include what drug, dose?
*Provide information immediately to medical personnel,
*Allow enough time to observe the client and then interview him / her after the substance level has decreased in order to collect history and plan treatment.
e) IF THE CLIENT PRESENTS WITH PSYCHOTIC SYMPTOMS, A MEDICAL

EVALUATION IS NEEDED:

Anti – psychotic medication may be given to control the psychotic symptoms,
Can assess that the client is out of crisis when he / she shows a marked decrease in thought disorder.
f) PSYCHOLOGICAL:
Current symptoms,
Precipitating event,
History of psychological problem (brief).
g) THE FOLLOWING COMMENTS MAY BE HELPFUL IN DECIDING IF THERE IS A PSYCHOLOGICAL CRISIS:
*Describe your present mood,
*Tell me about the changes in your life,
*Have you ever thought of harming yourself,
*Describe your eating and sleeping habits.

TO ASSESS CLIENT’S ABILITY TO COPE WITH THE CRISIS:
STRENGTHS:

a) Personal,
b) Support network; family, friends and employer,
c) Physical; finances, housing, and transportation (when relevant),
d) The fewer the resources the greater the danger.

WEAKNESS – SAME CATEGORIES AS STRENGTHS:

To form a realistic treatment plan.

REFRAME THE CRISIS INTO A SOLVABLE PROBLEM AND POTENTIAL GROWTH SITUATION:

a) Decrease the pressure on the client when a solution is possible – helps to increase level of functioning,
b) Enables the counselor to pint out:
*What the client is doing that worsens the problem and makes it less solvable,
*What the client is doing that lessens the problem and makes the problem more solvable.
c) Clarifies the focus problem that caused the crisis.

HELP THE CLIENT EXAMINE REALISTIC OPTIONS FOR SOLVING THE PROBLEM:

a) Weigh the advantages and disadvantages of each options,
b) Choose the most workable option,
c) Make a plan of action.

CONTACT NECESSARY SUPPORT INDIVIDUALS WHO CAN HELP CARRY OUT THE PLAN OF ACTION – POSSIBLE CONTACTS INCLUDE:

a) Family,
b) Friends,
c) Employer,
d) Physician or Psychiatrist,
e) Service Agencies.

COUNSELOR DANGER ZONE:
TAKING RESPONSIBILITY FOR THE CLIENT:

a) Once the intensity of emotions has decrease, most people are capable of making choices – the counselor assists in decision making but does not make the decision,
b) Family and friends need to be called upon to make choices for a person who is not capable of decision making – the counselor would make the decision if there is no one else to turn to for help.

GIVING FALSE ASSURANCE:

a) It is not appropriate to paint a brighter picture than really exists:
*The client will feel the counselor does not understand which leads to lack of rapport and trust,
*It sets up false expectations that may not come true leaving the client potentially more devastated.
b) A realistic assessment, phrased in a tactful manner, is more useful.

BECOMING ANXIOUS:

a) It is sometimes difficult to remain calm when dealing with an anxious, panicky individual – it is especially difficult when dealing with potential injury to self or others,
b) Knowing one’s limits and asking for help from others colleagues is a way to ensure appropriate help for the client and a clear head for the counselor.

FOCUSING ON PROBLEM, NOT SOLUTION TO RESOLVE THE CRISIS. IT MUST BE REFORMED AS A PROBLEM WITH SOLUTIONS:

a) Data is needed on the current crisis and sometimes past events,
b) Excessive focus on the crisis will fuel the client’s upset and produce no solution.

PROJECTING ONE’S OWN INTERPRETATION OF THE TRAUMA:

a) The intense feelings the client is experiencing are based on his / her thoughts and belief system. The counselor need to investigate these thoughts to understand the feelings,
b) It is not appropriate to interpret the thoughts based on the counselor’s personal experience – one feeling can be caused by many different and conflicting thoughts.

FACTORS AFFECTING CRISIS OUTCOME:
DURATION:

a) The sooner the person requests help after reaching the breaking point, the better the prognosis – because there has been little time for maladaptive behaviors to set in,
b) Ten to Fourteen days is the average length of time people struggle with a crisis before seeking help.

NATURE OF THE TRAUMA:

a) Generally the less severe the trauma is, as viewed by an uninvolved observer, the better the prognosis,
b) The counselor must remember that individuals have different abilities to cope – what appears to the uninvolved observer to be a mini trauma may have a profound impact on an individual with few coping skills.

CLIENT PERSONALITY:

A person who is normal and healthy prior trauma has a better prognosis that someone who has had previous emotional difficulties, adjustment problem, crises.

SUPPORT NETWORK:

The person who has good relationships with people who can be called upon during difficult times has a better prognosis than the individual who is alone.

QUALITIES OF AN EFFECTIVE CRISIS COUNSELOR:
EMPATHY:

a) Help to rapidly develop rapport,
b) Help client to relax.

GOOD QUESTIONING SKILLS:

a) Ability to gather information quickly for an individual who is in the midst of intense emotions,
b) Able to direct yet tactful.

RAPID ASSESSMENT:

a) Quickly and accurately pinpoints the big issues,
b) Determines risk factors,
c) Discovers option to solve the problem.

REALISTIC VIEWPOINT:

a) Does not make false promises to the client,
b) Knows own limits in being able to help so does not feel responsible for the client beyond professional duties,
c) Ask for help when needed to assure client will receive the best help available.

USERS RESOURCES AVAILABLE:

a) Client’s network,
b) Professional network,
c) Agency network.

SUICIDE:
RISK FACTORS:

Many people think about suicide but would never actually attempt it – others are potential suicide victims,
Certain circumstances increase the potential for suicide:

a) SUICIDE IS ASSOCIATED WITH DEPRESSION:
The signs of depression are not always obvious:
*Sadness, Guilt,
*Inadequacy, Hopelessness,
*Weight Loss,
*Loss of Appetite,
*Loss of Sexual Desire,
*Sleeplessness,
*Fatigue.

b) MEN COMMIT SUICIDE MORE FREQUENTLY THAN WOMEN THOUGH WOMEN ATTEMPT IT MORE OFTEN:
At greater risk are:
*Teenage boys,
*Men older than fifty years old,
*Older people rather than younger people,
*One who suffered a recent permanent loss,
*Someone who is seriously ill,
*Someone who does not have a network of caring people,
*People who have unstable relationships,
*Alcohol and drug dependent people,
*Impulsive people,
*Emotional “burned out” individuals.

CUES TO SUICIDE POTENTIAL:

IN TALKING WITH AN INDIVIDUAL, THE COUNSELOR NEEDS TO BE ALERT TO THE ABOVE LISTED RISK FACTORS,
THE COUNSELOR MUST ALSO NOTE THE FOLLOWING CUES OF IMMEDIATE DANGER:
a) The client has decided on a method, time and place – lethality increases with such methods as shooting jumping, and fast acting drugs,
b) Suddenness of the desire to kill oneself,
c) Depression:
*Especially if Sudden,
*If Combined with:
*Psychotic Thinking,
*Confused Thinking,
*Anger and Aggression,
*Sudden Improvement in Depression.
d) Confused thinking and feeling, indicating inability to cope,
e) Use of phrase like:
“Tired of living – won’t be long now”…
“Want out”…
“Family is better off without me”…
f) Previous suicide attempts – as a person gets older, the chances of succeeding increase,
g) Talking about suicide:
*It is not true that those who talk suicide never do it,
*Threats must be taken seriously.

DEALING WITH SUICIDE CRISIS:

a) THE COUNSELOR SHOULD FORM A RELATIONSHIP WITH THE CLIENT SO THE INDIVIDUAL WILL TALK ABOUT SUICIDE:
*Prepare him / herself for the flood of emotional confusion that will pour out,
*Don’t interrupt client to relieve his / her own feeling of discomfort about suicide – take care of own needs later with colleague,
*Act calm – keep any inner upset hidden because it will only agitate the client.
b) DO NOT ATTEMPT:
*To cheer up the client by minimizing his / her loss of pointing out what good things are left – *he / she will feel the counselor does not understand the possibly terminate the conversation,
To talk the client out of committing suicide:
*Request he / she postpone the deed for a day or so,
*Ask to discuss the situation again to be sure suicide is what the client really wants to do.
c) IDENTIFY THE KEY ISSUES:
Clarify what the precipitating event was?
Address the current problem in concrete terms – don’t shift focus to past problems which will minimize the importance of the current suicide issue.
d) ASSESS LETHALITY BASED ON:
*Concreteness of Plan,
*Sex,
*Age,
*Depression,
*Resources,
*Important Relationship,
*Losses,
*Evaluate the client’s strength and resources which can be called upon to decrease the threat of suicide.
e) DESIGN A TREATMENT PLAN AND PUT IT INTO ACTION:
Ask the client to postpone suicide and set a time to talk again – make yourself or agency available for contact before the date if the client finds it necessary,
Help the client begin to reduce stress by action, if appropriate.
Contact Resources:
Psychiatrist for Evaluation,
Inpatient Hospitalization,
Client’s Network.
Plan for Follow Up Treatment:
Provide hope at hat someone cares,
Provide hope that something can be done to make life bearable.
f) IF A CLIENT INFORMS THE COUNSELOR THAT HE / SHE HAS FREQUENT THOUGHTS OF SUICIDE AND A DEFINITE PLAN WHICH HE / SHE WILL CARRY OUT IF THE COUNSELOR TELL ANYONE, THE COUNSELOR SHOULD:
*IMMEDIATELY NOTIFY HIS / HER CLINICAL SUPERVISOR,
*FORMULATE A PROTECTIVE TREATMENT PLAN.

************************************************************

Relapse Prevention

BRIEF WARNING SIGNS

Abdullah Baniyameen
baniyameen@aol.com
September 13, 2009

INTERNAL CHANGE:

۩ I start using old way of thinking, managing feelings, and behaving that make me look good on the outside.
۩ I get more stress than usual, and my recovery program seems less important.
۩ Deep inside I start to feel like something is wrong, but I try to cover it up.
۩ My mood swing from feeling on top of the world to feeling like nothing is working out.

DENIAL:

۩ I stop paying attention to or honestly telling others what I’m thinking and feeling.
۩ I start worrying about the changes in my thinking, feelings, and behavior.
۩ I go into denial and try to convince myself that everything is alright when I know that it really isn’t.

AVOIDANCE & DEFENSIVENESS:

۩ I avoid people who will honestly point out the problems that I don’t want to see.
۩ I blame them for making me feel bad.
۩ I start using compulsive behaviors to keep my mind off of how uncomfortable I’m feeling.
۩ I start creating problems for myself by using poor judgment and impulsive doing things without thinking them through.
۩ I start feeling uncomfortable around others, so I spend more time alone, and begin to feel lonely and isolated.

CRISIS BUILDING:

۩ I start having problems that I don’t understand.
۩ No matter how hard I try, nothing seems to work.
۩ I begin to feel depress and try to distract myself by getting busy with other things and not talking about the depression.
۩ I can’t see the big picture and I start doing things that won’t really help.
۩ I stop planning ahead.

IMMOBILIZATION:

۩ I feel trapped in an endless stream of unmanageable problems.
۩ I get tied of putting time and energy into things that aren’t working.
۩ I exaggerate small problems and blow them out of proportion.
۩ I begin to feel like a failure that can’t do anything right.
۩ I start wishing I could run away or that something magical would happen to rescue me from my problems.

CONFUSION AND OVERREACTING:

۩ I have trouble thinking clearly and solving usually simple problems.
۩ I get irritated with other people because they don’t understand me and can’t seem to help me.
۩ I become easily angered and start to take it out on my friends and family.
۩ I start making bad decision that I wouldn’t have made if I were thinking clearly.

DEPRESSION:

۩ I get so depressed that I can’t do thing I normally do.
۩ I feel life is not worth living and sometimes I think about killing myself or drinking alcohol / using drugs as a way to end depression.
۩ I can’t get started or get anything done.
۩ I find it hard to keep appointments and plan ahead.

LOSS OF CONTROL:

۩ I start doing things that violate my values, hurt me, and hurt those I love.
۩ I find excuses to miss therapy and self help meetings.
۩ I get isolated that it seems there’s no one to turn for help.
۩ I feel trapped by the pain and start to believe I will never be able to manage my life. I see only three possible ways out of insanity, suicide, or going back to use.

THINKING ABOUT USING:

۩ I start to think that by using will help me feel better and solve my problems.
۩ Things seem so bad that I begin to think I might as well use because things couldn’t get any worse.
۩ I try to convince myself that I can use my addictive behaviors without losing control or developing serious problems, even though deep inside I know I can’t.

RELAPSE:

۩ I try to solve my problems and feel better by using.
۩ Although I rationalize my behavior, deep inside I know that by using drugs won’t work and will hurt me in the long run.
۩ I feel myself losing control and get disappointed because the using isn’t doing for me what I thought it would.
۩ The problem continues and get worse until I realize that I need help.
۩ At that point I decide to try recovery one more time.

*****************************************************

Involving families in treatment and rehabilitation of substance abusers

INVOLVING FAMILIES IN TREATMENT AND REHABILITATION OF SUBSTANCE ABUSERS

Abdullah Baniyameen
September 3, 2009
baniyameen@yahoo.com

INTRODUCTION:
Ø A systematic planning of rehabilitation process will normally include the family participation as a component of its program, but are normally the least involved in the actual implementation.
Ø The family can be the causative as well therapeutic factors in the rehabilitation process of recovering drug abusers.

LESSON LEARNT:
Ø In pursuit of a system to undertake the total rehabilitation of drug addictions, many variables have to be taken into consideration.
Ø Support in the recovery process is vital, as there is the tendency for society to attach a stigma on the recovering addicts. If we fail to prepare the family with healthy ways of interacting, it will affect the whole integrative phenomena of the rehabilitative process.

FAMILY INVOLVEMENT:
Ø The family should get involved in the rehabilitation process from the beginning.
Ø Family involvement is essential, as they have vast potential for the benefit of the individual growth and change. It can be considered as an important tool in achieving lasting effect in the rehabilitation process.

ROLE OF FAMILY:
Ø Some of the factors that lead to relapse revolve around the recovering addicts’ failure to readjust to his / her family and the family failure to understand the problem of drug addiction.
Ø Roles of family are not well defined and conflicting, and the sense of closeness and understanding among family members are lacking.

FORMATION OF FAMILY SUPPORT GROUP
STAGE 1:
Ø Covers a period of 2 months so as to build rapport with the family members during the visiting days. The rehabilitation requirement is explain to the family.
Family Orientation.
Family Counseling.
During the initial stage, a committee composed of parents and other family members welcome the new members into getting to know the existence of a support group.
FSG Family Bridging.
STAGE 2:
Ø At stage 2, initial orientations to be held regularly so as to familiarize the family with the aims and objective of forming the FSG.
Activities / events evolving the FSG
Elementary overview on the program modality, technique and approach.
The family will meet regularly and the session is to be facilitated by a staff. This will covers a period of 3 to 4 months.
Family Seminar.
Family Group Discussion.
STAGE 3:
Ø Regular workshop could be held during the 3rd stage that covers another period of 6 months. The workshop session are being held to orient the members the basic counseling skills, to discuss and also find solution to daily problems that they encountered during the interactive process.
Family Intervention Skills.
Role of codependency.
Family members should be helped to identify themselves and encourage to make changes.

CONCLUSION:
Ø IN CONCLUSION, IT IS ONLY APPROPRIATE TO PROVIDE A BRIEF UNDERSTANDING OF THE FAMILY INVOLVEMENT. WHEN A MEMBER OF THE FAMILY IS AN ADDICT OR EX – DRUG ADDICT. ALL FAMILY MEMBERS ARE AFFECTED IN VARIOUS TRAUMATIC REGRESSES.
Ø THE ACTIVE INVOLVEMENT OF PARENTS / SPOUSE IN ALL ASPECTS OF TREATMENT AND REHABILITATION PROGRAM IS ESSENTIAL FOR THE RECOVERING DRUG ADDICTS’ SUCCESSFUL TREATMENT.
Ø THIS WILL NO DOUBT CONTRIBUTE TOWARDS ACHIEVING A WHOLE PERSON RECOVERY. WE CAN BE PROUD TO BE PART RESPONSIBLE FOR THIS SUCCESS. IT WILL BE A TREMENDOUS BOOST NOT ONLY TO THE COMMUNITY, BUT ONE’S SELF ACCOMPLISHMENT.

**************************************************

Spirituality in substance abuse/dependence treatment

SPIRITUALITY IN SUBSTANCE ABUSE/DEPENDENCE TREATMENT

Abdullah Baniyameen
baniyameen@aol.com
August 12, 2009




OVERVIEW:

• Definitions of spirituality and religion.
• Why Spirituality is Important:

1. Relationship to Health.
2. Beliefs of Patients.
3. Beliefs of Medical Professionals.

• Spirituality’s Relationship to the Treatment of Substance Use Disorders.
• Research in AA and Spirituality.

DEFINITIONS:

• “Religio” – Humanity’s bond with a greater being.
• “Spiritus” – Breath or life.
• Religious thinking: “An intellectual endeavor out of the depths of reason.”

WHY SPIRITUALITY IS IMPORTANT?

• Involvement with spirituality / religion predicts improved quality of life and survival rates of patients with advanced malignancies.
• Association between religious commitment and lower blood pressure.
• Beliefs of our Clients.
• Beliefs of medical professionals.

BELIEVES OF OUR CLIENTS:

• 90% (or more) of Americans believe in God.
• 57% engage in daily prayer.
• 42% attended church in the last week.
• 80% believed that religious faith can aid in recovery from illness.
• 63% agreed that doctors should talk to them about spiritual issues.

- Mc Nichol, 1996

BELIEFS OF MEDICAL PROFESSIONALS:

• Most psychiatrists do not believe in God.
• Nurses and medical students in one survey ranked spirituality as a low consideration of patients treated on a dual diagnosis unit.
• However, the patients ranked spirituality and belief in God as most important to their recovery.

RELIGION & SPIRITUALITY IN SUBSTANCE ABUSE TREATMENT:

• “Religions have been far from silent on the use of psychoactive drugs.”
• Judeo – Christian sacraments involving wine.
• Native American, Polynesian and African religions have used hallucinogens and other substances to enhance spiritual transcendence.
• Judeo – Christian Bible denounces drunkenness.
• Islam strictly prohibits the use of alcohol and drugs.
• “… and spirituality has long been emphasized as an important factor in recovery from addiction.”
• Alcoholics Anonymous (AA) derived from a Christian Fellowship in 1935.
• 12 Steps.

FIRST III STEPS:

1. Admit powerlessness over alcohol.
2. Belief in a “power greater than ourselves”.
3. Turn will over to the care of God “as we understood Him”.

STEPS IV THROUGH VII:

1. Take a moral inventory.
2. Admit to God, to ourselves, and to another human being the exact nature of our wrongs.
3. Ready to have God remove all these defects of character.
4. Ask Him to remove our shortcomings.

STEPS VIII, IX & X:

1. Made a list of all persons harmed and became willing to make amends to them all.
2. Made direct amends wherever possible.
3. Ongoing personal inventory and promptly admitted when we were wrong.

FINAL II STEPS:

1. Through prayer and meditation improve our conscious contact with God, ‘as we understood Him’.
2. “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”.

RESEARCH INVOLVING SPIRITUALITY:

• Religious / Spiritual involvement predicts less use of and fewer problems with alcohol, tobacco and illicit drugs.
• Mechanisms are poorly understood:

1. Principles avoidance.
2. Social support for abstinence.
3. Involvement in activities those are incompatible with use.
4. Prosaically values.

RESEARCH INVOLVING ALCOHOLIC ANONYMOUS:

• Modest correlation found between improved drinking behavior and:

1. Having a sponsor.
2. Engaging in twelfth step work.
3. Leading a meeting.
4. Increasing participation compared to a prior involvement.

• Involvement with AA is associated with better outcomes after professional treatment.
• Project Match compared Twelve – Step Facilitation Therapy (TFT) with CBT and MET.
• TFT group did at least as well and did better on measures of complete abstinence.

FUTURE RESEARCH:

• Mechanisms unclear.
• Suggested:

1. Stress reduction.
2. Cognitive behavioral effect.
3. Affiliation.
4. Group therapy.

• Further research is necessary.

SUMMARY:

• Spirituality and religion have an important role in medicine, especially in the addiction field.
• Spirituality and religion play an important role in the lives and health of patients.
• Clinicians may have biases regarding spiritual issues.
• Current research findings.
• Further research is needed.

***********************************************************

Treatment methods for women addicted to drugs

TREATMENT METHODS FOR WOMEN ADDICTED TO DRUGS

Abdullah Baniyameen
baniyameen@aol.com
August 9, 2009

ADDICTION TO DRUGS IS A SERIOUS, CHRONIC, AND RELAPSING HEALTH PROBLEM FOR BOTH WOMEN AND MEN OF ALL AGES AND BACKGROUNDS. AMONG WOMEN, HOWEVER, DRUG ABUSE MAY PRESENT DIFFERENT CHALLENGES TO HEALTH, MAY PROGRESS DIFFERENTLY, AND MAY REQUIRE DIFFERENT TREATMENT APPROACHES.

UNDERSTANDING WOMEN WHO USE DRUGS:

It is possible for drug-dependent women, of any age, to overcome the illness of drug addiction. Those that have been most successful have had the help and support of significant others, family members, friends, treatment providers, and the community. Women of all races and socioeconomic status suffer from the serious illness of drug addiction. And women of all races, income groups, levels of education, and types of communities need treatment for drug addiction, as they do for any other problem affecting their physical or mental health.

Many women who use drugs have faced serious challenges to their well-being during their lives. For example, research indicates that up to 70 percent of drug abusing women report histories of physical and sexual abuse. Data also indicate that women are far more likely than men to report a parental history of alcohol and drug abuse. Often, women who use drugs have low self-esteem and little self-confidence and may feel powerless. In addition, minority women may face additional cultural and language barriers that can affect or hinder their treatment and recovery.
Many drug-using women do not seek treatment because they are afraid: They fear not being able to take care of or keep their children, they fear reprisal from their spouses or boyfriends, and they fear punishment from authorities in the community. Many women report that their drug-using male sex partners initiated them into drug abuse. In addition, research indicates that drug-dependent women have great difficulty abstaining from drugs, when the lifestyle of their male partner is one that supports drug use.

CONSEQUENCES OF DRUG USE FOR WOMEN:

Research suggests that women may become more quickly addicted than men to certain drugs, such as crack cocaine, even after casual or experimental use. Therefore, by the time a woman enters treatment, she may be severely addicted and consequently may require treatment that both identifies her specific needs and responds to them.

These needs will likely include addressing other serious health problems — sexually transmitted diseases (STDs) and mental health problems, for example.

More specifically, health risks associated with drug abuse in women are:

• Poor nutrition and below-average weight,
• Low self-esteem,
• Depression,
• Physical abuse,
• If pregnant, preterm labor or early delivery,
• Serious medical and infectious diseases (e.g., increased blood pressure and heart rate, STDs, HIV/AIDS).

AIDS is now the fourth leading cause of death among women of childbearing age in the United States. Substance abuse compounds the risk of AIDS for women, especially for women who are injecting drug users and who share drug paraphernalia, because HIV/AIDS often is transmitted through shared needles, and other shared items, such as syringes, cotton swabs, rinse water, and cookers. In addition, under the influence of illicit drugs and alcohol, women may engage in unprotected sex, which also increases their risk for contracting or transmitting HIV/AIDS.

From 1993 to 1994, the number of new AIDS cases among women decreased 17 percent. Still, as of January 1997, the Centers for Disease Control and Prevention had documented almost 85,500 cases of AIDS among adolescent and adult women in the United States.

About 62 percent were related either to the woman's own injecting drug use or to her having sex with an injecting drug user. About 37 percent were related to heterosexual contact, and almost half of these women acquired HIV/AIDS by having sex with an injecting drug user.

TREATMENT FOR WOMEN:

Research shows that women receive the most benefit from drug treatment programs that provide comprehensive services for meeting their basic needs, including access to the following:

• Food, clothing, and shelter,
• Transportation,
• Job counseling and training,
• Legal assistance,
• Literacy training and educational opportunities,
• Parenting training,
• Family therapy,
• Couples counseling,
• Medical care,
• Child care,
• Social services,
• Social support,
• Psychological assessment and mental health care,
• Assertiveness training,
• Family planning services.

Traditional drug treatment programs may not be appropriate for women because those programs may not provide these services. Research also indicates that, for women in particular, a continuing relationship with a treatment provider is an important factor throughout treatment. Any individual may experience lapses and relapses as expected steps of the treatment and recovery process; during these periods, women particularly need the support of the community and encouragement of those closest to them. After completing a drug treatment program, women also need services to assist them in sustaining their recovery and in rejoining the community.

EXTENT OF USE:

The National Household Survey on Drug Abuse (NHSDA)* provides yearly estimates of drug use prevalence among various demographic groups in the United States. Data are derived from a nationwide sample of household members aged 12 and older.

In 1996, 29.9 percent of U.S. women (females older than age 12) had used an illicit drug at least once in their lives-33.3 million out of 111.1 million women. More than 4.7 million women had used an illicit drug at least once in the month preceding the survey.

The survey showed 30.5 million women had used marijuana at least once in their lifetimes. About 603,000 women had used cocaine in the preceding month; 241,000 had used crack cocaine. About 547,000 women had used hallucinogens (including LSD and PCP) in the preceding month.

In 1996, 56,000 women used a needle to inject drugs, and 856,000 had done so at some point in their lives.

In 1996, nearly 1.2 million females aged 12 and older had taken prescription drugs (sedatives, tranquilizers, or analgesics) for a nonmedical purpose during the preceding month.
In 1996, 56,000 women used a needle to inject drugs, and 856,000 had done so at some point in their lives.

In the month preceding the survey, more than 26 million women had smoked cigarettes, and more than 48.5 million had consumed alcohol.

NHSDA is an annual survey conducted by the Substance Abuse and Mental Health Services Administration. Copies of the latest survey are available from the National Clearinghouse for Alcohol and Drug Information at 1-800-729-6686.

- From the National Institute on Drug Abuse
Current as of June 25, 2003

*************************************************