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THEME 1 HELPING CLIENTS IDENTIFY HIGH-RISK RELAPSE FACTORS AND DEVELOP STRATEGIES TO DEAL WITH THEM

 High-risk factors are critical situations in which client used alcohol or drugs prior to treatment. The factors usually involve intra-personal & interpersonal situations 2
3  The need to recognize the risk of relapse & high-risk factors as well as develop 4 appropriate strategies to counter them are essential components of recovery

INTRAPERSONAL FACTORS (INTERNAL)

Negative emotional states (anger, anxiety, depression, frustrations, boredom)

Negative physical state Positive emotional states (celebration, intense excitement)
Testing one’s personal control (using “willpower” to limit consumption) Urges and temptations

HIGH-RISK FACTORS

ASSESSMENT STRATEGIES
1. Identify high-risk situations & coping problems through interview of client’s past lapses or relapse, relapse dreams or fantasies

2. Client in outpatient program who are unable to sustain abstinence can self-monitor by observing drinking or drug use situations, emotions & interpersonal factors associated with urges or substance use

3. Use of self-report questionnaires to assess highrisk factors or situations and inability to cope

GROUP EXERCISE
Break into Group Task:  Identify high-risk factors/situations & coping difficulties through discussions. Explore personal previous history of lapse / relapse, relapse dreams and fantasies  Large Group Process

Intervention Strategies
Once a client’s high-risk situations have been identified, 2 types of intervention strategies can be used to lessen the risk of relapse By being able to recognize those warning signals, the client may be able to take evasive action or avoid the highrisk situation

Intervention Strategies
1. Learning to recognize the warning signals associated with imminent danger , e.g. cues that the person is about to enter a high-risk situation

a. Apparently irrelevant decisions Warning signals

b. Lack of balanced lifestyle

c. Strong expectancies about drinking

Intervention Strategies
2. Evaluating

the clients existing motivation & ability to cope with specific High-risk situations & learning more effective coping skills
Refusing drinks Assertiveness in social Communication situations skills General Strategies e.g. anger management, behavioral refusal rehearsals

COPING SKILLS STRATEGIES

Cognitive strategies – reframing, coping imagery, positive self-talk, countering positive outcome expectancies, coping with abstinence violation effect

Lifestyle intervention

meditation

exercise

relaxation

Group Exercise
1
A client reports that he has been having the urge to drink, especially when he is experiencing negative or positive emotions, e.g. anger. Frustrations, excitement. Provide intervention using positive expectancies & eliminating myths effects

2
A client who has been drug free for several months had a lapse. He came for counseling feeling distressed & defeated. Proceed to conduct counseling using your knowledge of abstinence violation effect

Large Group Process

 Theme 2: Helping Clients Understand Relapse As A Process As Well As An Event