Initiatin therapy program for family empowerment

INITIATING THERAPY PROGRAM FOR FAMILY EMPOWERMENT

Abdullah Baniyameen
baniyameen@aol.com
June 24, 2009

Followed by a handbook on “Addiction Recovery Issues”
(Colombo Plan Drug Advisory Program)

TOPICS:

• COUNSELING,
• CHARACTERISTICS OF A GOOD COUNSELOR,
• FUNDAMENTAL RESPONSIBILITIES OF A COUNSELOR,
• ENHANCING GROWTH WITH GROUP THERAPY,
• BASIC TASKS FOR THE GROUP THERAPIST,
• QUALITIES OF AN EFFECTIVE GROUP THERAPIST,
• GUIDELINES FOR EFFECTIVE GROUPS,
• STAGES OF GROUP THERAPY PROCESS.

INITIATING THERAPY PROGRAM FOR FAMILY EMPOWERMENT:

The interconnected relationships within a family are widely recognized as crucial elements in drug addiction and its treatment. FAMILY THERAPY focuses on family change which includes parenting practices, family environment and dealing with codependency traits. The members are empowered to identify their own problems and determine the solutions to those problems. The essential components of family therapy Include educational sessions, counseling and group therapy.

THE BROAD GOALS OF FAMILY THERAPY ARE:

• To provide information about addiction and it’s effects on the family system.
• To provide a safe and acceptable environment for the family to discuss their problems.
• To help them to express their feelings of shame, guilt, fear and hurt.
• To assist them to grow out of their dysfunctional behavior.
• To facilitate the family to clarify their problems and set realistic goals.
• To aid them to improve their communication, so that they interact in a more constructive and helpful manner.
• To guide the family to provide a supportive environment for the recovery of the addict.

SUGGESTED COMPONENTS:

• REFLECTION ON THOUGHT FOR THE DAY – for example ‘ONE DAY AT A TIME’.
• RE-EDUCATIVE SESSIONS – Specific information can be provided about the symptoms of addiction, feelings experienced by family members, dealing with co – dependency traits, problems during recovery and improving quality of life.
• GROUP THERAPY – The family members are encouraged to share their feelings and the problems they face.
• INDIVIDUAL COUNSELING SESSIONS – Specific personal issues are handled. If the addict is married, marital counseling can also be provided.
• FAMILY SUPPORT GROUPS – Support groups play a significant role in reducing the family’s feelings of isolation and helplessness. They provide opportunities to share feelings / experiences and offer practical suggestions.

COUNSELING:

THE MOST PROFOUND IMPACT of addiction is basically shown on it’s effects in the members of the family. Parents, spouses and family members of drug abusers need to undergo treatment programs to be able to deal with issues and painful experiences.
THEY NEED PATIENT, but firm coaching and support to able to recover. Counseling is an integral part of the treatment program for addicts and their families. It is a helping relationship wherein the goal is to assist individuals in dealing with a variety of problematic situations.
COUNSELORS are required to evaluate each client as an individual with unique traits, strengths and weaknesses in determining how to meet client’s needs.
Each client will present unique characteristics and problems that will have to be approached with respect for the person’s own character and individuality. A good counselor will develop an approach that is flexible enough to accommodate the many kinds of clients who will be encountered.

CHARACTERISTICS OF A GOOD COUNSELOR:

• ACTIVE LISTENING involves intuitive perception, watching for cues, tone of voice, gesture, and posture and understanding the messages that the client is trying to convey, emphasis or avoid.
• GENUINENESS is presenting you in a straight forward and honest manner.
• EMPATHY is the understanding of another person’s emotional state. Having empathy does not mean that you share the pain but rather you are able to comprehend how the client feels and relate to his feelings from your own personal experiences.
• EMOTIONAL MATURITY means that the counselor should be able to manage his own personal issues and it should not interfere with that of his clients.
• NON – JUDGMENTAL ATTITUDE. The counselor should be able to deal with whatever issues his client would present without biases. He should be open and receptive to other’s point of view.
• PATIENCE AND FLEXIBILITY. The counselor should be able to adjust to the needs and capacities of clients.

FUNDAMENTAL RESPONSIBILITIES OF A COUNSELOR:

• PLACING THE CLIENT’S NEEDS. The knowledge of clients needs is the priority of the counselor. His need for success, control or praise may interfere with the therapeutic work, if those needs are foremost in counseling relationship. A BASIC RESPECT for the client as a person is fundamental to placing the client’s need first. This is important since most clients often have little respect for themselves, often seeing themselves unworthy of other’s respect, he may begin to act with self – respect.
• BEING YOURSELF. A counselor's tool is himself. His intelligence, talent, judgment, intuition and other personal qualities are his ‘equipment’. The counselor’s belief in him will help him act confidently and competently.
• GIVING EMOTIONAL SUPPORT. The emotional atmosphere of the client – counselor’s relationship should be safe. Expression of feelings must be encouraged for therapeutic gains. The counselor is responsible for helping the client recognize the difference between acknowledging the feeling and acting on it, particularly when such action is self – defeating.
• MAINTAINING A THERAPEUTIC ATTITUDE. The counselor must maintain an attitude that fosters the client’s continued involvement and effort in the counseling relationship. He must be able to motivate and convey a sense of hope to the client.

PROCESS:

• DEVELOPING A THERAPEUTIC RELATIONSHIP WITH CLIENT. The family is more likely to be resistant to enter into a counseling relationship. The physical and emotional pain coupled with the feelings of guilt and shame make them afraid in sharing their problems. THEY WONDER whether the counselor would understand or criticize them. During this initial stage, the discussion should focus on what the program is all about. The counselor should explain the counseling process, its goal and how it can be of help to the family. He should work towards building a trusting relationship and developing rapport with the family.

THE COUNSELOR SHOULD NOT ASK TOO MANY QUESTIONS. INSTEAD, THE FAMILY MEMBER IS ENCOURAGED TO TALK ABOUT NON – THREATENING OR NON – CONTROVERSIAL ISSUES LIKE HIS JOB, SIBLINGS OR CHILDREN AND OTHER GENERAL INFORMATION.

• EXPLORING PROBLEM AREAS. The counselor should assist the family identify and prioritize problems that need to be dealt with. When families enter into counseling, usually their focus is still in finding out solutions to help the addict. The counselor should help them understand and realize that they themselves have problems and issues that they have to deal with before they can help the addict.
• GOAL SETTING. The counselor should assist the family in setting goals that are specific, realistic and appropriate. Setting goals give them a clear sense of purpose and instill a sense of drive and enthusiasm to deal with the problems. MORE OVER, it helps in evaluating the progress they made. Families coming into treatment should be made to realize that their priority is their well – being. They need to be able to address their individual issues and problems instead of focusing on the addict.
• MAINTAINING CHANGE. The counselor involvement in the progress of the family is necessary to be able to sustain the latter’s effort in dealing with their problems. The changes need to be made if plans do not work well enough. The counselor needs to help the family stay on track and maintain focus on their goals. WHEN THE FAMILY FEELS that they are doing and are able to cope with certain events that used to be a problem area, they tend to stop going into the program. In this instance, the counselor should initiate and conduct follow – up visits and evaluate the family’s progress.
• TERMINATION. Termination is the conclusion of the process of counseling.
  When the counselor sees that the family has acquired skills to cope and deal with the demands of everyday life on their own, he may gradually end the counseling relationship.

ENHANCING GROWTH WITH GROUP THERAPY:

GROUP THERAPY has a special place in family therapy program.
Each member influences and is influenced by every other group member as well as the therapist.
This creates an intense therapeutic environment wherein family members can narrate experiences, express feelings and resolve issues.
THE PRESENCE of a trained therapist ensures that this process moves on smoothly in a non – threatening manner.
It would be appropriate to recognize the benefits, right at the outset.
Experiences of family members attending group therapy sessions have been presented in italics to understand how family members view the sessions.

• KNOWING THAT THEY ARE NOT ALONE GIVES A SENSE OF RELIEF. I entered the group session with a lot of reluctance. My problems were very different and I wondered how others would be able to help. True, our back grounds and life situations were different. Yet, the underlying thoughts, feelings and actions were so similar to mine. I kept saying, ‘It happened to me too!’ Knowing that I was not alone helped.
• VENTILATING PENT UP FEELINGS. Reservations about talking about addiction vanish as all the others in the group have also experienced the pain and can understand exactly how they feel. I found myself talking about things I had done. I felt lighter and better. I had not talked about all this to anybody because outsiders simply do not understand. But in the group, I felt that they did.
• INSIGHT INTO OWN ISSUES. Listening to others sharing helps to understand one’s own problem at a deeper level. I did not see myself as being codependent. Yet, when others talked about in the group, it helped me think. I remembered that I laughed a lot less during the past few months. MY FRIENDS noticing my tiredness had been enquiring if I was sick. I sometimes skipped church and gave excuses not to join the Christmas choir. I had been forcing myself to get to work. I had noted these changes in my husband but it was only in the group sessions that I recognized these in myself too.
• PROGRESS OF OTHERS INSTILLS HOPE AND OPTIMISM. I saw members who had more problems than me and yet had managed quite well. That was proof that life could be better if I put my mind to it. Some shared about how family therapy had helped reduce their fears and increase their confidence. Hearing them make plans for the future and move forward made me hopeful of my own recovery. I told myself, ‘If they can, I too can’.
• INTERNALIZING THE INFORMATION ABOUT ADDICTION RECOVERY. When I heard that relapses could happen, I was upset. ‘One day at a time’ and ‘Let go, let God’ slogans seemed too simple and childish. In a group, they discussed about how relapses can happen at any time and stressed that we could not prevent it. THEN I REASONED that it would be foolish to live in dread of something that was beyond my control. Instead I decided to get what I could of life. The slogans made sense now. This acceptance and the new way of thinking do not happen in a day. The group process helps members work through their issues gradually and plan for change.
• SHIFTING THE FOCUS FROM THE DRUG – ABUSER ONTO ONESELF. Every time I talked about him and his actions, the group members asked me what about you? How did you act? This helped me focus on the only thing I can change in the world – ME! As I attended more group sessions, I found myself talking lesser about what he did and should do and instead talked about what I could do!
• DEVELOPING PROBLEM SOLVING SKILLS. In groups, each member views the problem from a different angle based on their life experiences and generate range of options. The group weighs the pros and cons of the situation and help members come to a decision. I LIKED THIS APPROACH. Now, when I am faced with a problem, instead of making an impulsive move, I think like the group. I ask myself what options are available and what would suit me best. I understood that there was no single, right way of doing things. Life is all about options and doing things by thinking through it all.
• STRENGTHENING SELF – ESTEEM AND PERCEPTION OF SELF. Giving suggestions or messages of assurance to others puts them at the level of a help – giver which strengthens their self – esteem a great deal. There is a lot of empathy and caring that comes through from other members making them feel wanted and valued. Just having people who listened to me and valued my feedback and ideas made me feel good.
• FINE TUNING COMMUNICATION SKILLS. Meeting people, listening, sharing thoughts, expressing feelings, looking at issues from others point of view – everything happens in a group which helps members polish their rusted social skills. After months of isolating myself I had forgotten that I liked to socialize. It made me wants to get back to people, talk and enjoy myself.

BASIC TASKS FOR THE GROUP THERAPIST:

THE GROUP THERAPIST STRIVES:

1. To make members feel comfortable in the group setting.
2. To encourage sharing about themselves, their thoughts as well as their feelings.
3. To ensure active participation of all members in discussing issues and providing feedback.

• THE GROUP THERAPIST WORKS AT TWO LEVELS – the individual as well as the group level. The therapist is tuned to the individual’s needs and helps each make some progress on issues important to him. In group therapy, the therapist is only the catalyst who facilitates changes and the real change agent is the group itself. Thus, the therapist focuses on getting the group to discuss issues and deal with problems utilizing the resources within the group. Maintaining the group cohesiveness and getting everybody to participate is crucial to a good therapy session.
• HONEST SHARING of both positive as well as negative feelings is to be encouraged. Sharing makes members feel close to each other. Yet, this can also bring into the open differing points of view giving rise to disagreements and conflicts. MEMBERS MAY EXPRESS dissatisfaction about the program, resent or reject messages presented and argue vehemently. Issues like eating on time or taking care of your needs can be dismissed as selfish behavior while others may express doubts about whether they should offer support or divorce the drug abuser. EXPRESSING THESE NEGATIVE FEELINGS, doubts and disagreements should be encouraged. Stifling these discussions prevents the group from developing. The group therapist handles this delicate task of bringing conflicts into the open discussing diametrically opposite views and resolving it in a meaningful way.

QUALITIES OF AN EFFECTIVE GROUP THERAPIST:

• Sensitivity to recognize their anxiety, fears and hesitation coupled with the firmness to gently urge them to address issues that may be painful and threatening is a basic requisite.
• Adequate knowledge about addiction and family issues is crucial. A thorough understanding of the basic family dynamics, complexities involved and family recovery issues is very important.
• Skill training in counseling and handling group sessions is an important component. Reading literature, attending refresher training programs and regular evaluations by self as well as an experienced supervisor helps enhance skills.

GUIDELINES FOR EFFECTIVE GROUP:

• GROUP SIZE: Ideally between eight to twelve members. Having too many members or too few will reduce it’s effectiveness.
• DURATION: Sessions can be held for one to one and half hours. Family members need to attend at least ten group therapy sessions to initiate recovery.
• SETTING: An adequately lit, well ventilated room, free from distractions with comfortable chairs is needed.
• STRUCTURED TOPICS: The topic for discussion is decided by the therapist. The range of topics chosen should help family members to:
  1) Recognize the problems caused by addiction.
  2) Understand the impact of addiction in their own lives.
  3) Express negative feelings openly.
  4) Recognize the supportive role that they need to play for the drug abuser’s recovery.
  5) Identify areas of change and develop a recovery plan.
  6) Recognize the need to work on their own recovery on a long – term basis.

STEPS IN FACILITATING A GROUP THERAPY SESSION:

1. BRIEF INTRODUCTION OF THERAPIST AND MEMBERS.
2. RULES ARE EXPLAIN IN BRIEF:

a) Punctuality and regular attendance.
b) Restricting sharing to the stated topic.
c) Listening with eye contact.
d) Sharing honestly with focus feelings.
e) Talking about one self and not others.
f) Participate actively by providing feedback, seeking clarification and making suggestions with due respect to the other members.
g) Maintaining confidentiality.

3. PRESENTATION OF TOPIC FOR DISCUSSION WITH APPROPRIATE EXPLANATIONS.
4. SHARING AND DISCUSSION.
5. SUMMARIZING BY HIGHLIGHTING THE ISSUES DISCUSSED AND THE MESSAGES THEY NEED TO CARRY FROM THE SESSION.

STAGES OF GROUP THERAPY PROCESS:

1. PREPARATION FOR THE GROUP: The goals for group therapy, the duration, the rules and guide lines are to be explained to members prior to entering the group session. This reduces anxiety and increase participation.
2. FIRST PHASE: New members need encouragement to share and tend to look to the therapist for support and encouragement. A smile, a nod and eye contact helps them feel comfortable. Enquiries like, ‘Would you like to say something, what do you think about the issue under discussion’ etc., can be helpful.
3. SECOND PHASE: As the members feel comfortable, they start discussing real issues. Conflicts and disagreements come into the open. The therapist needs to help the group deal with these issues and keep the group going.
4. ACTION PHASE: The members settle down and view the situation in a balanced way. They now need to set goals and make plans to achieve them.
5. TERMINATION: When the members complete the required number of sessions, they leave the group. It helps to remind them to continue with counseling sessions, follow – up recovery groups and family support group meetings.

GROUP THERAPY SESSIONS CAN BE A PROFESSIONALLY CHALLENGING AND PERSONALLY SATISFYING EXPERIENCE. IN TERMS OF THE THERAPEUTIC VALUE, GROUP THERAPY IS BY FAR MORE VALUABLE THAN OTHER EFFORTS AS IT IS COST – EFFECTIVE AND INTENSIVE.

Followed by a handbook on “Addiction Recovery Issues”
(Colombo Plan Drug Advisory Program)

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How relapse occurs?

HOW RELAPSE OCCURS?

Abdullah Baniyameen
baniyameen@aol.com
June 24, 2009

WARNING SIGNS OF RELAPSE:

۩ Changes in ATTITUDE,
۩ Changes in THOUGHT,
۩ Changes in FEELINGS,
۩ Changes in BEHAVIOR.

1. Changes in ATTITUDE:

The recovering addict begins to be complacent, and stops his recovery program.

Indicators:

• Not caring about sobriety,
• Becoming too negative about life,
• Overconfidence,
• Tunnel vision,
• Impatience.
  

2. Changes in THOUGHT:

The recovering person gets back to his old thinking pattern.

Indicators:

• Thinking that he/she 'deserves drugs' because he/she has been sober for quite some time.
• Thinking that he/she can use substitute drugs like alcohol or marijuana.
• Thinking that the problem is cured since he/she had been abstaining for some time.
  

3. Changes in FEELINGS:

The recovering person begins to respond negatively in situations.

Indicators:

• Increased moodiness or depression,
• Strong feelings of angers and resentment,
• Increased feelings of boredom & loneliness.
  

4. Changes in BEHAVIOR:

Can be noticed by others through his/her behavioural responses. The person begins relating again to the set of people, places and activities which revolves around substance abuse.

Indicators:

• Visible signs of stress such as smoking more cigarettes.
• Talking repeatedly about the pleasures associated with drug use (war stories).
• Hanging out with drug taking friends.
• Skipping meetings or support group.

FACTORS LEADING TO RELAPSE:

• POOR COMMITMENT,
• HIGH RISK SITUATIONS,
• HIGH RISK EMOTIONAL STATES,
• INTERPERSONAL CONFLICTS,
• SOCIAL PRESSURES.
  

POOR COMMITMENT TO STOP USING DRUGS:

• Decided to stop drug use when confronted with negative consequences of drug use (illness, family problems, financial difficulties, loss of friends),
• After sometime, he/she begins to forget the negative effects caused by the drug and the pleasurable memories begins to occur.
  

HIGH RISK SITUATIONS:

• Situations or circumstances which the person previously used drugs. They are powerful reminders of past drug use, and act as cues for reinforcement of drug taking behaviour. (people, places, activities)
  

HIGH RISK EMOTIONAL STATES:

• A feeling that leads to the person's drug use in the past. (frustration, depression, rejection, sadness, loneliness, boredom, extreme happiness),
• These feelings can awaken the tendency for the person to use drug.
  

INTERPERSONAL CONFLICTS:

• Arguments and confrontations with others (family, friends, girlfriend/boyfriend, colleagues can trigger a relapse,
• These conflicts create stressful situations and fill the person with tension and negative feelings.
  

SOCIAL PRESSURES:

• Trying so hard to fit in a group. The need to belong and accepted by friends.
• Image projection – trying to be someone that they are not.
  

RELAPSE PREVENTION:

RELAPSE PREVENTION IS A BEHAVIOUR SELF CONTROL PROGRAM DESIGNED TO TRAIN INDIVIDUAL TO MAINTAIN CHANGES IN THEIR BEHAVIOUR. IT MUST BECOME A WAY OF LIFE AND BE INTEGRATED INTO EVERY ASPECT OF RECOVERY.

THE GOALS OF RELAPSE PREVENTION PROGRAM ARE:

• Developing new coping skills for handling high – risk situations,
• Identifying relapse warning signs,
• Making healthy lifestyle changes,
• Increase productive activities.
  

PHYSICAL RECOVERY:

• Taking care of health,
• Regular sleep,
• Recreational activities,
  

PSYCHOLOGICAL & BEHAVIORAL RECOVERY:

• Building self esteem,
• Taking up responsibilities and managing them,
• Cultivating values like honesty, sincerity etc.
  

SOCIAL RECOVERY:

• Spending time with family and positive friends,
• Developing positive network,
• Healthy relationship with opposite sex,
• Taking on specific role as a family member, community members, friend etc.
  

SPIRITUAL RECOVERY:

• Enhance moral and spiritual values.
  

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The Creed

THE MEANING OF CREED (DAYTOP PHILOSOPHY)

Abdullah Baniyameen

baniyameen@aol.com
June 24, 2009

THE DAYTOP PHILOSOPHY:

I AM HERE BECAUSE THERE IS NO REFUGE. FINALLY, FROM MYSELF. UNTIL I CONFRONT MYSELF IN THE EYES AND HEARTS OF OTHERS, I AM RUNNING. UNTIL I SUFFER THEM TO SHARE MY SECRETS, I HAVE NO SAFETY FROM THEM. AFRAID TO BE KNOWN, I CAN KNOW NEITHER MYSELF NOR ANY OTHER, I WILL BE ALONE. WHERE ELSE BUT IN OUR COMMON GROUND, CAN I FIND SUCH A MIRROR? HERE, TOGETHER, I CAN AT LAST APPEAR CLEARLY TO MYSELF NOT AS THE GIANT OF MY DREAMS NOR THE DWARF OF MY FEARS, BUT AS A PERSON, PART OF A WHOLE, WITH MY SHARE IN ITS PURPOSE. IN THIS GROUND, I CAN TAKE ROOT AND GROW, NOT ALONE ANYMORE AS IN DEATH, BUT ALIVE TO MYSELF AND TO OTHERS.
– Richard Beauvais 1965 –

WHO ARE WE?
A loser is a person who makes everything good in to something bad.

BECAUSE THERE IS NO REFUGE:
Refuge means to look for relief or shelter from our bad feelings from ourselves. We do this by getting high, which makes us think we feel good. When we think we feel good from drugs, we have found refuge or relief from feeling bad about ourselves. But getting high will not turn off our bad feelings forever and in the end, we must face them.

FINALLY:
This means in the end, after getting high so many times, we get used to it and it no longer takes away our bad feelings. Even though we are high we still feel our bad feelings about ourselves, that is why there is no refuge or relief from our bad feelings finally or in the end.

FROM MYSELF:
When we look to run away from our emotional pains we find they are inside us. We cannot get away from ourselves because we are the sources of our pain and we will go on making more pain for ourselves and for others until we change our behavior and begin to do things that will make us proud of ourselves.

UNTIL I CONFRONT MYSELF:
To confront means to look at something to find out what it really is. When a person confronts himself, he sees the truth about himself. When he does this, he might say things like, “I stole my mother’s money and even though she cried, I did it again because I have no courage.”

IN THE EYES AND HEARTS OF OTHERS:
When a person confronts himself truthfully while he is in front of other people and they see him crying because it hurts him to admit what he did and why he is ashamed, they will feel him and they will see themselves in him. Since every person in our house did almost the same things, they were also ready to take any chance in order to find refuge from their own bad feelings about themselves.

I AM RUNNING:
Only when a person finally confronts himself in this way does he stop running to find refuge from his bad feelings. He says, “I cannot confront myself because I am too ashamed or because it hurts me to much.” He is acting off his fears. This is cutting corners and all who try to run away from themselves in this or any self confrontation, this means that if you do not truthfully and completely change you will not be able to change no matter how hard you try.

UNTIL I SUFFER THEM TO SHARE MY SECRETS:
But when she does face the truth about herself and her brothers and sisters see her doing this, when they see how she cries because she feels her pain they will also cry. And when she shares her pain with them, she is suffering them and they cry for her the tears of acceptance.

I HAVE NO SAFETY FROM THEM:
When a person does not share his inner feelings and keeps them secret, he shows no proof that he is like everyone else and they cannot accept him. He will then be alone and this aloneness will make his pain stronger, as long as he is not accepted he cannot have relief or safety from his bad feelings about himself. However, when he does confront himself and sees other people accepting him, crying for him to be accepted by others like him who is also trying to change.

AFRAID TO BE KNOWN:
A person who allows her fears to control what she does is making stronger the behavior that made her fall in the past. Letting other people know about her weakness and inadequacy shows her trust and her belief in her environment and in doing this she will become worthy of the respect and admiration of others.

I CAN KNOW NEITHER MYSELF NOR ANY OTHER:
In order for one to work on himself and fail, one must believe things about himself that are not true, expect judgment from others and be taken advantage of by others. A person can make this true by acting off negative thoughts or ideas and will begin to work against him and others, remaining closed to the truth.

I WILL BE ALONE:
If a person does not really know you, it is almost impossible for them to be your friend. After all, how can these people comfort you if they do not really know what really hurts you? Therefore, without proof by self – confrontation that a person is like everyone else, no one can accept him and his or aloneness will cause even more pain than before.

WHERE ELSE BUT IN OUR COMMON GROUNDS:
What is commonly owned by all and belongs to one as much as the other. Either we hit bottom or we were headed that way. Since the reason for being here is the same for each one of us, it forms our common ground.

CAN I FIND SUCH A MIRROR?
You have found a person who is your mirror. If when he or she speaks, you find yourself saying, “That person sounds just like me.”

HERE:
We have already learned that here is a behavior learning school where losers can learn to change their behavior so that they can become winners. Since DAYTOP is the best behavior, changing school there is no other place like it. After all, where else can you find a school that is also our home?
TOGETHER:
After a person shows proof that he is like others he is accepted and he becomes a part of the whole group. After this is done, he is together with everyone.
I CAN AT LAST:
It is true that even though we always worked against ourselves and resisted change we secretly wanted to be good and respectable. Nevertheless, because we were controlled by both our hostility, which made us want to get back at others and by our fear of success, which made us, resist change. Most of us were never aware that we were secretly looking to stop doing bad. Now that we are on our way to change our past behavior, we are finally starting to grow up at last, after all our pain.
APPEAR CEARLY TO MYSELF:
When a person no longer believes false things about themselves, they no longer have to pretend that they are not scared when they are terrified. They no longer need their image to protect than because they can now handle the situations that in the past made them feel inadequate.
NOT AS THE GIANT OF MY DREAMS:
A person no longer has to create fantasies about themselves to feel good.
NOR THE DWARF OF MY FEARS:
A dwarf is a human being who is smaller than the rest. When a person acts off their fears they feel that way. When they grow, they are no longer controlled by their fears and they begin to feel equal.
BUT AS A PERSON:
A person is first equal. They feel equal because they can handle that once made them afraid. They feel equal because they worked for their equality by growing up through their great pains.
PART OF THE WHOLE:
A person is now an equal member of a group because they have worked for their position by growing consistent with their behavior. Good for now and for all the future.
WITH MY SHARE IN ITS PURPOSE:
My share because I worked for it with consistently good behavior, DAYTOP's purpose is to give people the knowledge of how to rely on themselves alone and no longer have to depend on others. Now he will no longer have to be jealous of those who are making it. Now he can be one of them.
IN THIS GROUND:
In this ground means in this situation or setting.
I CAN:
This is every person who is a part of ‘We’.
TAKE ROOT:
To take root is to commit yourself to stay grow and to pass our knowledge to help others become successful in life just like us.
AND GROW:
This mean to keep growing, always learning, always correcting our mistakes and always giving our knowledge to our younger brothers and sisters.
NOT ALONE ANYMORE:
Now that we have shown proof that we are just like everybody else, that we should believe we should be part of the whole because we learned it honestly, we no longer need to separate ourselves from others. We are no longer afraid to be together because we can now feel the acceptance of others.
AS IN DEATH:
Being alone in our pain is frightening and embarrassing in that it kills us a little bit each day.
BUT ALIVE TO MYSELF:
When a person who is a loser tries to do well, they turn into bad. However, when they learn DAYTOP’s teachings, they can do something good and it will remain good.
This is proof to them that they can make it and that they can rise above the indignities and embarrassment of being a loser. They are sure that they can really be happy and that when they do good things will happen. They are alive to themselves because they have what they have always wanted: SELF CONFIDENCE.
AND TO OTHERS:
When a person has self – confidence, others can see and feel it. Therefore, they are alive not only to themselves but also to all others who can see and feel their happiness. They are now a role model and they can give back to others.

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Relapse Prevention: Coming back from a relapse...

COMING BACK FROM A RELAPSE

Abdullah Baniyameen
baniyameen@aol.com
June 17, 2009

NOT EVERYONE WHO IS RECOVERING FROM AN ADDICTION RELAPSE, BUT THE POTENTIAL IS ALWAYS THERE.

DEFINING RELAPSE:

• The first definition of relapse is general and can apply to any illness:
• A relapse is falling back into a former state, or returning to an active phase of a disease after a partial recovery.
• The second definition is more specific to addictive illnesses:
• A relapse from an addictive illness is a return to attitudes, thoughts, feelings, emotions, and behaviors that lead back to addictive addiction.

HISTORY OF RELAPSE:

• Most people in recovery would be quite willing to admit that they sometimes get back into old behaviors patterns or old ways of thinking. This is often called “stinking thinking”. Unless this changes, it will usually lead back to using.
• People who are working a good recovery program become aware fairly quickly that they’ve derailed into these old patterns and know what to do to get back on track.
• Examine a relapse and the circumstances and events surrounding it can help understand what led to a return to using.
• In effect, each relapse has its own history.

IDENTIFYING RELAPSE FACTORS:

• There isn’t one simple or clear – cut answer to why people relapse?
• The reasons for relapse vary, depending on individual personalities and circumstances.
• There is seldom one reason for a relapse.
• Relapse is generally caused by a combination of factors.
• What are the “tools” that might have prevented them from using?

FACTORS THAT CAN LEAD TO RELAPSE:

• SOMETIMES PEOPLE SET THE STAGE FOR THEIR RELAPSE BECAUSE THEY DON’T GO TO ENOUGH SELF – HELP MEETINGS.
• OR THEY MAY ATTEND MEETINGS, BUT DON’T USE THEM EFFECTIVELY TO GET HELP.
• NOT ATTENDING RECOVERY MEETINGS.
  - Work! Work! Very Busy, Other commitments
• NOT USING THE TWELVE STEPS MEETING EFFECTIVELY.
  - In disclosure, not being open
• NOT HAVING A SPONSOR.
• NOT BEING HONEST.
  - Making excuses, rationalizing, deceiving.
• FEELING OMNIPOTENT: HAVING AN INFLATED EGO.
  - Feeling in control, unlimited ability to handling problems
  - Feeling different from others; “I’m not as bad as he is”.
  - Need always to be right; fear of making mistakes.
• NOT DEALING WITH ANGER, RESENTMENT, OR GUILT.
  - Holding anger inside or denying it exists.
  - Being unwilling to deal with destructive feelings.
• BEING COMPLACENT.
  - Forgetting about limitation.
  - Having a false sense of security.
• FEELING DEPRESSED AND NOT DOING ANYTHING ABOUT IT.
• FEELING SORRY.
  - Focusing on the negative.
  - Lack the sense of gratitude.
• BEING A PERFECTIONIST OR OVERWORKING.
  - Not allowing mistakes or becoming fatigued.
• BEING IMPATIENT.
  - Want results immediately.
  - Is only my way.
• USING TIME UNWISELY.
  - Leaving too much unstructured time.
• BEING CRITICAL AND JUDGMENTAL OF SELF AND OTHERS.
  - Unrealistic goals.
• ISOLATION.
• EXTERNALIZATION
  - Blaming others instead of taking responsibility.

TAKING STOCK:

• A. Start with the factor you identified as a problem leading to your relapse.
• B. Write examples of the ways this problem caused you difficulty that led it to become a trigger for your relapse.
• C. The key here is to be very specific in listing things you can do or changes you can make to prevent the relapse triggers from causing problems.

JOHN’S DIARY:

• Complacency.
• Meetings can really get boring.
• I began to think that I have arrested my addiction problems.
• I thought things were going well and that I had no problems.
• I thought that I could be with old buddies who were active as long as I don’t use.
• The old memories really weren’t that bad at all.
• Anger
• I always said I felt fine when I was really angry.
• I’d keep my anger inside until some small thing would happen and I’d explode, and felt guilty.
• I was afraid to let myself be angry, because I didn’t know what I might do.
• I always felt like under pressure which led me to a severe headaches.
• I’d yell at my kids when really I was mad at my spouse, boss.

MOVING FORWARD:

• Most recovering people learn that in order for their recovery to continue, they must constantly assess themselves. Part of this process include making changes both attitudinal and behaviors.
• An area that is critical for many recovering people is the necessity of attending a support group.
• Relapse's, almost without exception, indicates that failure to attend support group meetings preceded their using.

ACCEPTANCE OF ADDICTION:

• One reason for relapse is the failure to accept oneself as an addicted person. This often happens because people don’t want to be dependent thus refusing to look at their illness.
• Addiction exists whenever there is loss of control.
• Addiction exists whenever people experience increasingly serious problems in any major areas of life due to their use of an addictive substance or behavior.

MAKING CHANGES:

AN UN – CHANGED ADDICT IS ALWAYS AN ACTIVE ADDICT.

• Change is very much a part of living.
• It’s been said that the only unchanging thing in life is change.
• In general, addicted people tend to find it unusually difficult to accept an unpleasant reality. Perhaps that’s why they often look for “an easier, softer way” and thus gravitate towards addictive substances.

WELCOME TO RECOVERY:

• One of the unpleasant truths involved in relapse prevention is that you need to feel the pain your illness has caused you. Though it is uncomfortable.
• Why must one kept looking at the pain?
• Once forgotten it becomes easy to tell that the past addiction wasn’t that bad or one shoot can’t hurt me that much.
• Remembering the pain is one of the best relapse preventions available.

IMPROVING MENTAL, EMOTIONAL, SPIRITUAL & PHYSICAL HEALTH:

• Addiction is a mental, emotional, spiritual, and physical illness. Consequently, recovery needs to happen on all of those levels.

MENTAL AND EMOTIONAL HEALTH:

• I’ll ask someone for a hug today.
• I’ll apologize when I’m wrong. (amendments)
• I’ll share a positive feeling with a friend.
• I’ll praise someone.
• I’ll tell someone that I care for him or her.
• I’ll try to relax whenever I feel tense.
• I’ll let go of resentment just for today.
• I’ll practice some self-affirmation.
• I’ll practice saying no when I need to do so.

SPIRITUAL HEALTH:

• I’ll start and end my day with a prayer.
• I’ll read from one meditation book.
• I’ll tell the truth even if it hurts me.
• I’ll anonymously do something nice for someone.
• I’ll listen to some good music.

SELF-AFFIRMATIONS:

• Very often, recovering people are plagued by low self – esteem. While changing this can be a lifelong task, self affirmations can be helpful tools in changing bad feelings about ourselves.
• People practice affirming themselves in various ways as a means of improving mental and emotional health.

SELF-AFFIRMING STATEMENTS:

• I am loveable and caring.
• I am creative and innovative.
• I am unique, priceless and have a lot to offer.
• I trust myself to go at my own speed.
• I love myself as I am, I am enough.
• I am a radiant being filled with light and love.
• I am accepting of my limitations.

ASKING FOR HELP:

• This often seems to be a problem for relapse’s, so it deserves special attention.
• Frequently, relapse's not only have difficulty asking for help for themselves, but also get overly involve in helping others.
• We see ourselves as self – sufficient and able to handle things.

CONCLUSION:

• BEING IN RECOVERY IS NOT A GUARANTEED PERMANENT STATE AND IS ALWAYS SUBJECT TO CHANGE.
• REMEMBER THAT RELAPSE BEGINS AS A STATE OF MIND.
• CONSIDER THIS THOUGHT AS OF NOW, AT ANY GIVEN TIME ON ANY GIVEN DAY, YOUR ARE EITHER IN A RECOVERY MODE OR A RELAPSE MODE. SO MAKE IT A POINT TO CHECK FROM TIME TO TIME WHICH MODE ARE WE AT.

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What are triggers?

WHAT ARE TRIGGERS?

Abdullah Baniyameen
baniyameen@aol.com
June 7, 2009

• Thinking and talking about drugs craving actually stimulated drug hunger in some people. Many individuals do not want to talk about relapse, because they are scared that it might actually cause a relapse,
• Thinking about drugs, even dreaming about drugs is a natural part of recovery. Learning how to stop these drug thoughts from returning into drug cravings, however, prevents a person from returning to drug use,
• Without education about addiction, most addicts would relapse. However, by learning how relapse occurs, understanding how to prevent relapses, and learning the warning signs that lead to relapse, relapse can be prevented.

TYPES OF TRIGGERS:

• Whether realize it or not, most people have developed strong associations between their drug use and some event or situation,
• For instance, many people drink coffee, smoke a cigarette, and read the morning paper after breakfast. For these people, the coffee, cigarette, and the morning paper have become associated with each other,
• If these people tried to stop smoking cigarettes, they would have a strong urge to smoke every time they read the morning paper and a cup of coffee. The coffee and newspaper are the cues or reminders to smoke a cigarette. This cue or reminder is called trigger,
• Triggers are those of people, places, and things that have somehow become associated with a person’s drug use, and are often a combination of internal, external and sensory triggers.

INTERNAL TRIGGERS:

• An internal trigger is an emotional state that people experience before or during drug use.
• For instance, some people may feel very insecure sexually because they think they have to use before having sex in order to feel more comfortable. They always medicate their feeling of insecurity that feeling becomes a trigger to use.

EXTERNAL TRIGGERS:

• External triggers are the places where drugs are normally bought or used, certain locations in the city or specific bars and clubs, the people whom they are used, and even certain days and times, such as weekends

SENSORY TRIGGERS:

• Sensory triggers, related to the senses of sight, sound, taste, and touch, include certain types of lights seen on dance floor, certain styles of music or specific songs, the taste of drug, or the way that led you felt the numb or rush. For many powdered sugar or artificial are powerful triggers for heroin, cocaine.

HIDDEN TRIGGERS:

• Hidden triggers are those, which the brain associates with drug use, but of which the person is unaware. Some triggers may promote drug hunger even though the person is unaware what triggered it. Hidden triggers can be internal, external, or sensory triggers.

DEFUSING TRIGGERS:

Identifying Triggers:
A major goal of relapse prevention is to identify triggers. It is important to recognize that people are unaware of many triggers, even when the same triggers seem obvious to others. For this reason, feedback from other people can be valuable in the identification process.

Avoiding Triggers:
Once a person has identified certain high-risk situations, people, and other triggers it is important to avoid them. They are warning signs that are dangerous.

Interrupt Triggers:
Some triggers cannot be avoided. For some people, weekends, holidays, or nights can be triggers. Triggers can be interrupted by engaging in a healthy activity that can break the power of trigger. For instance, if Friday nights are high-risk times, healthy activities can be schedule, such as attending NA meeting, or just going to a movie with a friend. It is important that these activities be planned, and be with another recovering person.

IDENTIFYING TRIGGERS:

• A major goal of relapse prevention is to identify triggers. It is important to recognize that people are unaware of many triggers, even when the same triggers seem obvious to others. For this reason, feedback from other people can be valuable in the identification process.

HOW TRIGGERS WORK:

• Some people in this room may have used drugs for many years. Your triggers have also had many years to become strongly associated with the drug.
  
• After long periods of association, triggers become strong and powerful. When people fight them, they generally lose the fight and relapse. However, when people learn to interrupt the triggers, they can stop them from leading to relapse.

HOW TRIGGERS LEADS TO RELAPSE:

Step 1 (TRIGGER):
Because of the strong association between the trigger and drug, the trigger is automatic.

Step 2 (THOUGHT):
The trigger will prompt a person to think about drugs, even if just for a second.

Step 3 (CRAVING):
If the person continues to focus on using drugs, drugs cravings becomes more likely. At this point, physical reactions such as increased heartbeat and sweaty palms may occur.

Step 4 (USE):
After being overwhelmed by drug hunger, including physical reactions, it becomes easier to make the decision to use drugs

TRIGGER CHAIN:

Trigger:
Triggers are automatic and lead to think about using.

Thought:
Thinking is under your control. You decide whether to think excessively about using.

Craving:
If you think excessively about using, you will likely experience the physical symptoms of craving.

Use:
If you experience cravings without taking some healthy action, you are likely to use.

HOW TO STOP TRIGGER CHAIN:

TRIGGER => THOUGHT => CRAVING => USE

• Without realizing it, most people wait until the end of the trigger chain to stop drug use. For example, many people still have drug friends and paraphernalia. Being exposed to them will cause cravings. Once craving start, it is difficult to think of anything but using drugs.
  
• The trigger chain can be more easily interrupted at the beginning of the chain, especially at step one and step two.

INTERRUPTING THE TRIGGERS:

Avoid or leave the Trigger;
Once people become aware that a particular situation, person, or place is a trigger, that situation should be avoided whenever possible. If people suddenly realize that they are in a high-risk, trigger situation, they should leave immediately.

Change the Routine;
Some triggers such as payday and Friday nights are unavoidable. However, normal routines can be changed so that these triggers have less power. For unavoidable triggers, a change of routine could include meeting up with a sponsor and attending NA meeting. Scheduling healthy activities ahead of time, and with other people, are best. Involvement in healthy activities makes it harder to think about drugs.

DOING AND VIEWING:

Visualization:
Visualization techniques can be used when a person has drug thoughts.

Snapping:
A rubber band can be worn on the wrist, which can be snapped whenever someone has drug thoughts.

Relaxation:
Relaxation techniques can be used to decrease the physical signs of craving, as well as help to clear away drug thoughts.

INTERRUPTING THE TRIGGERS:

Activated Event:
Describe the situation?

Belief (Upsetting thoughts or belief):
What did you tell yourself about the situation?

Feelings:
Describe how you felt?

Action (Counter-challenge):
Describe what you did?

CONSIDER PROBLEM SOLVING APPROACH:

• Define the problem,
  
• Think of a possible solution,
  
• Choose the most workable solutions,
  
• Write a list of “to dos” to accomplish that solution, and schedule a time for each item on the list,
  
• Rehearse the solution in your mind.

GROUP DISCUSSION:

• What are some ways that you can identify your triggers?
  
• What are some of the strongest triggers for you?
  
• What are some of the ways you can do to avoid triggers?
  
• How can you interrupt triggers?

People:

• Co-workers,
• Relative,
• Homey.

Places:

• Specific Bars,
• Home Town.

Events:

• Concert,
• Parties,
• Visitors.

Things:

• Paraphernalia,
• Money.

Sensory:

• Sounds,
• Lighting,
• Music.

Times:

• Weekend,
• Holidays,
• After Work.

Feelings:

• Depress,
• Lonely,
• Euphoria.

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Treatment & counseling issues in re-entry & aftercare

TREATMENT AND COUNSELING ISSUES IN REENTRY AND AFTERCARE

Abdullah Baniyameen

baniyameen@aol.com

June 7, 2009

1. SEPARATION ISSUES:

• Dependency issue on the treatment environment,
• Attachment to people and place,
• Fear of failure.

2. DRUG CRAVING/URGES:

• Persistent even after months of sobriety,
• Triggered by people, places, and things or external and internal events in the recovering person’s life.

3. THE NEED FOR NEW SOCIAL NETWORK:

• Old social connections are often sources of risks for relapse,
• Learning to socialize in unfamiliar ways,
• The fear of being known as a recovering addict,
• Utilizing support groups, AA, NA, etc.

4. ADJUSTMENT TO DRUG-FREE ACTIVITIES AND NEW SOURCES OF SATISFACTION:

• Develop new hobbies or past times,
• Enjoying old forms of recreations e.g., movies, parties, etc., without using drugs,
• Learning a new set of social skills to make drug- free activities fun.

5. LEARNING HOW TO RESPOND SAFELY TO PAIN AND STRESS:

• Must learn to deal with everyday discomfort without the desire to find relief using psychoactive substances,
• Must recognize vulnerability to stress-pain reducing medications.

6. THE DESIRE FOR INTERPERSONAL INTIMACY:

• Initiating and learning how to sustain healthy relationships can take time,
• Old negative relationships often contribute to relapse and must be discarded,
• Any other meaningful past relationships are deeply damaged,
• Old associations between drugs and sex must be unlearned and new attitudes developed,
• Intimate relationship in early recovery stage can be distracting and stressful,
• Timing and maturity are critical factors if intimacy is to contribute rather than to sabotage recovery efforts,
• Learning new ways to cope with pain and manage stress effectively.

7. THE ACCESSIBILITY OF ALCOHOL, DRUGS, AND VARIOUS PRESSURES TO CONSUME IN OUR SOCIETY:

• Increasing the recovering addict’s feeling of self-efficacy to withstand temptation and be able to walk away from drugs,
• Learning how to respond appropriately, should a relapse occur to avoid a full-blown reactivation of drug use?

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What is Relapse?

WHAT IS RELAPSE?

Abdullah Baniyameen
baniyameen@aol.com
June 7, 2009

• Relapse is not an isolated event. Rather, it is a process of becoming unable to cope with life in sobriety. The process may lead to renewed alcohol or drug use, physical or emotional collapse, or suicide.
  
• Predictable and identifiable warning signs that begin long before a return to use mark the relapse process or collapse occurs.
  
• Relapse prevention therapy teaches people to recognize and manage these warning signs so that they can interrupt the progression early and return to the process of recovery.
  
• Studies of life-long patterns of recovery and relapse indicate that not all patients relapse.
  
• Approximately one third achieve permanent abstinence from their first serious attempt at recovery.
  
• Another third have a period of brief relapse episodes but eventually achieve long-term abstinence. An additional one third has chronic relapses that result in eventual death from chemical addiction.
  
• These statistics are consistent with the life-long recovery rates of any chronic lifestyle-related illness.
  
• About half of all relapse-prone people eventually achieve permanent abstinence. Many others lead healthier, more stable lives despite periodic relapse episodes.

CLASSIFICATION OF RECOVERY / RELAPSE:

• For the purpose of relapse prevention therapy, chemically dependent people can be categorized according to their recovery/relapse history. These categories are as follows:
  
• Recovery-Prone - Briefly / Chronically Relapse-Prone.
  
• These categories correspond with the outcome categories of continuous abstinence, brief relapse, and chronic relapse described above.
• Relapse-prone individuals can be further divided into three distinct subgroups.
  
• Transition patients fail to recognize or accept that they are suffering from chemical addiction in spite of problems from their use. This failure is usually due to the chemical disruption of the patient's ability to accurately perceive reality, or to mistaken beliefs.
  
• Un-stabilized relapse-prone patients have not been taught to identify the abstinence-based symptoms of PAW and addictive preoccupation.
  
• Treatment fails to provide these patients with the skills necessary to interrupt their disease progression and stop using alcohol and drugs. As a result, they are unable to adhere to a recovery program requiring abstinence, treatment, and lifestyle change.
  
• Stabilized relapse-prone patients recognize that they are chemically dependent, need to maintain abstinence to recover, and need to maintain an ongoing recovery program to stay abstinent. They usually attend Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or another 12-step program in addition to receiving ongoing professional treatment. They also make protracted efforts at psychological and physical rehabilitation and recommended lifestyle changes during abstinence. However, despite their efforts, these people develop symptoms of dysfunction that eventually lead them back to alcohol or drug use.

WHAT IS RELAPSE PREVENTION TREATMENT?

• Relapse prevention is a systematic method of teaching recovering patients to recognize and manage relapse warning signs.
  
• Relapse prevention becomes the primary focus for patients who are unable to maintain abstinence from alcohol or drugs despite primary treatment.
  
• Recovery is defined as abstinence plus a full return to bio/psycho/social functioning. As previously noted, relapse is defined as the process of becoming dysfunctional in recovery, which leads to a return to chemical use, physical or emotional collapse, or suicide.
  
• Relapse episodes are usually preceded by a series of observable warning signs.

PROGRESSION OF WARNING SIGNS:

• It is important to look at the dynamic interaction between the recovery and relapse processes. Recovery and relapse can be described as related processes that unfold in six stages:
  
• Abstaining from alcohol and other drugs,

• Separating from people, places, and things that promote the use of alcohol or drugs, and establishing a social network that supports recovery,

• Stopping self-defeating behaviors that prevent awareness of painful feelings and irrational thoughts,

• Learning how to manage feelings and emotions responsibly without resorting to compulsive behavior or the use of alcohol or drugs,

• Learning to change addictive thinking patterns that create painful feelings and self-defeating behaviors,

• Identifying and changing the mistaken core beliefs about oneself, others, and the world that promotes irrational thinking,

• When people who have had a stable recovery and have done well begin to relapse, they simply reverse this process. In other words, they:

• Have a mistaken belief that causes irrational thoughts,

• Begin to return to addictive thinking patterns that cause painful feelings,

• Engage in compulsive, self-defeating behaviors as a way to avoid the feelings,

• Seek out situations involving people who use alcohol and drugs,

• Find themselves in more pain, thinking less rationally, and behaving less responsibly,

• Find them in a situation in which drug or alcohol use seems like a logical escape from their pain, and they use alcohol or drugs.

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