Case Study 1: Your client has sought help for alcohol misuse because they feel they can no longer cope with day-to-day life. They have been suffering from depression for several years and are on medication, however, believe that their antidepressants are no longer as effective as they used to be. Your client's partner has taken out an Apprehended Violence Order (AVO) against them because they lose control when they are drunk. Your client is unsure of what to do and is agitated about how this is affecting his life.
Case Study 2: A 33-year-old client with AOD issues has come to your service. This client uses cocaine to amp up their body, increasing their blood pressure, metabolism and reducing their ability to sleep. This client also drinks alcohol excessively which causes them to fluctuate between aggression and depression. The client's marriage broke up last year, and they are now unemployed. They seem to becoming increasingly confused and more tolerant of the substances they are addicted to.
According to the case studies answer the following tasks:
Building on your assessment with your clients as part of the simulation assessment assume that you are working as a Service Provider in a Mental Health organisation. Your client has returned to your service for a follow-up assessment, you will use this time to conduct a relapse planning session supporting clients with the following:
- Problem-solving
- Goal setting
- Coping
- Self-monitoring and management
- Recognising and managing cravings
- Cognitive restructuring
- Harm minimisation
Task 1 - Explore relapse prevention
Once you have greeted your client and they are ready to commence the session, you will need to:
1. Focus on engagement with your client. Build rapport again, find out what's happened in their lives since the last time you saw them, and give encouragement.
2. Substance use assessment- how much are they using now, how often, and what substance are they currently using
3. Check their Stage of Change - You may like to consider working with your client and listing the good and not-so-good things about their drug use. For the good - include everything they like about using drugs (keep in mind things like taste, the feelings you experience, and social reasons). Once you have listed the good things, list the not-so-good things - encourage the client to list things they have noticed that they don't like about their substance use, this may include health effects including withdrawal and increased tolerance, the negative ways drug use effects relationships with people, worries with the law and the cost.
4. Once you have listed the good and not-so-good things about substance use, you may like to ask the client to think about what will be good about cutting back or quitting their drug use. What will they be able to look forward to? This may include things such as, improved health, being able to save money, fewer fights with family, and how they may feel about themselves. Write these down next to the positive and negative aspects of use.
5. Talk about lapse and relapse with your client, explaining their differences and that they may experience both during their journey. Be sure to help your client understand that this is common and nothing to feel ashamed of.
6. Review the client's past attempts to slow down or give up substances. Find out what worked and what triggered the client to relapse. Use effective questioning and communication skills to assist with this.
7. In discussion with the client, identify the people who are involved in their relapse prevention process. This could be friends and family, other health professionals, people from support organizations, etc. You should discuss and identify the role these people may play on your client's relapse prevention.
Task 2 - Identify potential risks
Once you have considered what stage of change your client is in and reviewed their current substance use, you will need to:
1. Identify and discuss potential relapse triggers including environmental factors with the client - you could provide them with examples or factors to consider such as people, places, times, behaviors, feelings, and thoughts. You should discuss cravings with the client and consider when their cravings are at their strongest.
2. Identify and discuss circumstances that could cause potentially harmful behavior to the client and others - Consider motivational interviewing techniques with your client to help them recognize the good and not so good things about substance use and assist with identifying the harmful behaviors that are associated with using. This may be in relation to:
- overdose
- family violence
- driving under the influence of alcohol and other drugs blood-borne viruses
3. Undertake a risk assessment with the client to determine their current state - consider talking with them about any worries they may be experiencing in relation to harming themselves or others as well as worries regarding their substance use. You could ask them a few questions similar to the following:
- Have you ever thought about harming yourself or tried to harm yourself in the past?
- Have you been thinking about harming yourself recently?
- Have you ever hurt another person in the past?
- Have you been thinking about hurting another person? Any particular person?
- Are you feeling physically unwell, or have you stopped regular alcohol use suddenly?
· What is your current living situation like?
- Do you feel you have easy access to your chosen substance?
- Are there any people in your life right now that may not be supportive during your recovery?
Task 3 - Develop relapse prevention and management strategies
1. Look at what your client has identified as high-risk times for them in relation to their substance use, how they may react when under the influence of their substance, and if they have identified any potential risks that could result from their current situation (harmful behavior, living arrangements, friendships, etc). Based on this information you will be able to develop a list of strategies to deal with these high-risk times and situations.
2. Consider highlighting some useful strategies that can be used to help manage cravings and potential relapse triggers such as the 4 D's, urge surfing, relaxation, nominating a support person, ways to say no, lifestyle changes, etc. You might discuss self-help groups or retreat programs that are available.
3. Identify problem-solving skills with the client at this time - Effective problem-solving skills enhance a client's ability to manage day-to-day tasks and formulate long-term strategies for maintaining treatment goals. Effective problem-solving skills involve the client being able to recognize a problem and develop the best possible solution to that problem.
4. Ask the client to have input into what they feel might work for them based on their previous experience or know what they feel comfortable with.
5. Help your client understand their thought patterns and turn their negative thoughts into positive ones (cognitive restructuring). This is particularly helpful when understanding the difference between a lapse and a relapse.
6. Based on the information you have provided to your client and understanding their stage of change as well as their chosen substance, you will need to work with them to select the relapse prevention strategies that will work best for them. Remember your client knows what is best for them and should be able to make the ultimate decision with your guidance.
7. Work with the client to identify how they may apply relapse management strategies to certain situations. Discuss harm minimisation strategies in the instance a lapse occurs. Where relevant, consider practicing strategies with the client to ensure they are comfortable with the strategy. At this time, you may like to consider setting some goals with the client that will help them maintain change. Consider goals that are centered on engaging in recreational activities that the client is interested in. Keep to approximately 2 goals and no more than 3 steps for each.
8. Once the client has identified and begun to develop strategies to manage their cravings or urges to use, a treatment plan can be developed. The treatment plan outlines exactly which strategies to use in particular high-risk situations. You should ensure the treatment plan is accurate and reflects what you have discussed with the client. You can use the following information as a guide to develop your treatment plan:
- Contracting with the client to limit the extent of use.
- Contact the service worker as soon as possible after the lapse.
- Evaluating the situation and identifying the triggers that preceded the lapse.
- Reframing a relapse as a hiccup, a learning opportunity, or a temporary setback.
- Using problem-solving strategies previously learned.
- Using positive self-talk to prevent a lapse from becoming a relapse
- Utilising a previously negotiated support network; friends, family, doctor, and 24-Hour Alcohol and Drug Information Service (ADIS).
9. Providing simple written instructions for the client to follow when experiencing a trigger/craving
10. Inform the client that you are required to document the outcome of their session, the information discussed as well as their treatment plan in their file. You may explain to them that it is important to maintain these records for accurate progress tracking. You may explain to them where their files are stored and who has access to them.