8-21-14 longterm recovery skills webinar slides v2...aug 21, 2014 · 8/21/14 1 exploring...

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EXPLORING TECHNIQUES TO SUPPORT LONG-TERM ADDICTION RECOVERY

Presented by Dr. Gisela Berger Featuring Art Romero

August 21, 2014

Download the PowerPoint slides & access CE quiz here: www.naadac.org/exploringtechniquestosupportlong-termaddictionrecoveryforclientsandfamilies

A presenta*on by the NAADAC, the Associa*on for Addic*on Professionals

Misti Storie, MS, NCC

WEBINAR ORGANIZER

Director of Training & Professional Development

NAADAC, the Associa/on for Addic/on Professionals

USING GOTOWEBINAR

•  Control Panel

•  Asking Ques:ons

•  PowerPoint Slides

•  Polling Ques:ons

•  Audio (phone preferred)

www.naadac.org/exploring techniquestosupportlong-‐term addic/onrecoveryforclientsandfamilies

A presenta*on by NAADAC, the Associa*on for Addic*on Professionals

A COMPONENT OF THE RECOVERY TO PRACTICE (RTP) INITIATIVE

www.naadac.org/recovery

OBTAINING CE CREDIT

o  The educa/on delivered in this webinar is FREE to all professionals.

o  2 CEs are FREE to NAADAC members who aHend this webinar. Non-‐members of NAADAC receive 2 CEs for $25.

o  If you wish to receive CE credit, you MUST complete and pass the “CE Quiz” that is located at: (look for TITLE of webinar)

www.naadac.org/exploring techniquestosupportlongtermaddic/onrecoveryforclientsandfamilies

www.naadac.org/webinars

A CE cer/ficate will be emailed to you within 21 days of submiZng the quiz and payment (if applicable) – usually sooner.

o  Successfully passing the “CE Quiz” is the ONLY way to receive a CE cer*ficate.

Free to NAADAC Members!

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WEBINAR LEARNING OBJECTIVES

o  Describe the role of addic/on professionals in suppor/ng long-‐term recovery

o  Describe the difference between treatment planning and recovery planning

o  List 3 techniques for post-‐treatment support

o  Demonstrate skills necessary to assist clients and their families with recovery-‐focused reconstruc/on of iden/ty, character, rela/onships, and resiliency

Gisela Berger, PhD

WEBINAR PRESENTER

Director of Mental Health Services

Omni Family Medical Clinic

[email protected]

EVIDENCE-BASED APPROACHES TO

SUPPORT LONG-TERM RECOVERY

SCIENTIFICALLY BASED APPROACHES TO TREATMENT AND LONG-TERM RECOVERY

o  Cogni/ve–behavioral interven/ons

o  Community reinforcement

o  Mo/va/onal enhancement therapy

o  12-‐step facilita/on

o  Con/ngency management

o  Pharmacological therapies

o  Systems treatment

TREATMENT PLANNING VS. RECOVERY PLANNING

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TREATMENT PLANNING VS. RECOVERY PLANNING

There is a difference between:

o  Professionally directed, long-‐term treatment planning

o  Pa/ent directed long-‐term recovery planning

Recovery Planning IS NOT Treatment Planning

LANGUAGE MATTERS

o  “People" are not defined by their disease so should not be referred to that way

o  The way we speak reflects the way we think

o  Recovery terminology more hopeful than disease terminology

SAMHSA’S DEFINITION OF RECOVERY

“A process of change through which individuals improve their health and wellness, live a self-‐directed life, and strive to reach their full poten*al.

Four major dimensions that support a life in recovery:

o  Health: overcoming or managing one’s disease(s) as well as living in a physically and emo/onally healthy way;

o  Home: a stable and safe place to live;

o  Purpose: meaningful daily ac/vi/es, such as a job, school, volunteerism, family caretaking, or crea/ve endeavors, and the independence, income and resources to par/cipate in society; and

o  Community: rela/onships and social networks that provide support, friendship, love and hope.”

“Like other chronic diseases, addic/on involves cycles of relapse and remission. Without treatment or engagement in recovery ac/vi/es, addic/on is progressive and can result in disability or premature death.” -‐ American Society of Addic/on Medicine, 2012

RECOVERY PLANS ARE ESSENTIAL

RECOVERY PLANS ARE ESSENTIAL

PuPng a recovery plan in place is essen*al for long-‐term success.

“What is in my life today that will benefit my recovery, and what is in

my life today that may be a detriment to my recovery?"

DEFINITION OF RECOVERY

o  difference of ongoing care for people in recovery vs. other illnesses

o  different e/ologies/causes/forms of disease of addic/on

o  therefore different solu/ons to this disease

o  variables in recovery:

•  physical dependence to varying substances

•  family system

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DEFINITION OF RECOVERY

o  rates of recovery

o  shorter /me vs longer /me of recovery

o  specific difficul/es with recovery from heroin

o  automa/c thinking about not being able to use

REASON #1

The recovering individual is 100% responsible for their own recovery. Nobody else can do it for them.

WHY A RECOVERY PLAN IS NEEDED

REASON #2

New behaviors, aZtudes and skills require prac/ce


REASON #3

Old behaviors will quickly return unless the recovering individual has new behaviors to replace them


REASON #4

The individual in recovery is seZng a good example for their peers and for society


REASON #5

The disease will always be wai/ng for the recovering individual.


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RECOVERY VS. REHAB

There is a difference between:

o  Long-‐term recovery

o  Long-‐term rehab

AUDIENCE POLLING QUESTION

Do you have to be in recovery to help guide someone into long-term recovery?

SKILLS TO BUILD A RECOVERY PLAN


Help the client iden*fy their history of addic*on.

Purpose of describing the development of your addic/on:

o  to remind you why recovery is important

o  explain how you came to have an addic/on in a way that does not promote shame


Suggest wri/ng out the following as an introduc/on to the recovery and relapse preven/on plan:

o  addic/ons and mental health problems in the family of origin

o  problems in the home and development while you were growing up

o  /meline of coping strategies you used growing up (prior to addic/on)

o  how you related to others as you grew up/your role in your family

o  beginning and development of your addic/on

o  your 10 worst moments while ac/ng out

o  things you did to try to stop that didn’t work

o  non-‐judgmental summary paragraph about how your addic/on came to be

SECTION #1: BOTTOM LINE

o  ongoing commitment to a boHom line

o  state need for honesty with self and others

o  the recovering individual’s current boHom line: levels of behavior

o  mood altering behaviors/things the recovering individual needs to monitor or stop doing

HOW TO DEVELOP RECOVERY AND REPLASE PREVENTION PLANS

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SECTION #2: THE RECOVERING INDIVIDUAL’S ADDICTIVE SYSTEM

o  their triggers

o  ac/vi/es that nurture them

o  signs indica/ng when they’re “toxic” and poten/ally heading down the slippery slope toward relapse


SECTION #3: GETTING SUPPORT

o  ongoing commitment to 12-‐step mee/ngs

o  sponsorship (having one, being one) o  step work (set goals) o  support groups for other issues

o  emergency numbers list for help when star/ng to relapse or fully relapsed

o  mee/ng list so have plenty of op/ons


SECTION #4: PROFESSIONAL HELP

o  wounds from family-‐of-‐origin the recovering individual needs to address

o  effects of other traumas

o  managing current family of origin rela/onships and other important rela/onships

o  social and in/macy skills

o  emo/on-‐management skills


SECTION #5: ONGOING SELF CARE

o  vision for life, including 5 year goals

o  characteris/cs the recovering individual needs in their living situa/on

o  needs/goals for social ac/vi/es/friends

o  characteris/cs important in career & work

o  goals for medita/on & spirituality



o  recrea/on, hobbies, vaca/on

o  holidays, family /me

o  in addi/on to support groups: learning to beHer face obstacles and solve problems with the help of others

o  nutri/on, exercise, sleep



o  Physical considera/ons: abs/nence, exercise, and nutri/on:

o  Exercise and nutri/on play a bigger role than what most people think.

o  But, understand that these are issues dealing with the physical aspects of your recovery.

o  The general idea is one of health


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o  relaxa/on and self-‐care (e.g., medita/on, yoga, deep breathing exercises, etc.)

o  inspira/onal pictures, including family, to remind themselves of what they have gained in recovery

o  helping the recovering individual to manage their emo/onal state



o  control of emo/ons

o  socializing while in recovery

•  awareness of emo/onal state

•  not to directly manipulate emo/ons

o  chaos-‐makers and nega/ve-‐influencers can no longer be close friends



o  directly nudging nega/ve people out vs having them drik away on their own

o  friends reflect what person in recovery wants

o  ongoing quest for spiritual growth

o  higher educa/on

o  recovering person crea/ng own future vs living passively


SECTION #6: ROMANCE/SEXUALITY

o  personal sexual/rela/onship philosophy

o  who to date, how to date, and when to be sexual

o  characteris/cs important in primary rela/onship

o  statement about facing problems in primary rela/onship


SECTION #7: ONGOING RELAPSE PREVENTION

o  who will the recovering individual be accountable to, par/cularly if not aHending mee/ngs

o  budding signs: when to aHend more mee/ngs or re-‐enter therapy

o  when to review this plan: progress keeping it & making changes


SECTION #7: ONGOING RELAPSE PREVENTION

o  consequences: a list of what they will lose if they relapse

o  goals: a list of what the recovering individual wants to accomplish (6 months to 5 years)

o  daily inventory can raise awareness of mistakes, poten/al or already made. Can also be used to no/ce when sliding down the slippery slope toward relapse


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EXAMPLE RECOVERY PLAN 1)  I will aHend 3 AA mee/ngs

each week.

2)  I will call my sponsor once a week.

EXAMPLE RECOVERY PLAN

3)  I will aHend the akercare program from my treatment center each Tuesday.

4)  I will make 3 phone calls a week to recovery people.


5)  I will eat 3 meals a day.

6)  I will read my medita/on book on a daily basis.


7)  I will make my bed daily to remind myself that I am in recovery.

8)  I will exercise 3-‐4 /mes per week.


9)  I will spend 20 minutes a day quietly in medita/on.

10) I will read my akercare plan daily each morning to make sure I am following it.


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People in long term recovery (3 years +) note the following as their priorities-in order of importance:

o  Recovery from substance use

o  Employment

o  Achieve and enjoy improved, ‘normal’ produc/ve life

o  Family and social rela/onships

o  Physical health

o  Housing and living environment

o  Educa/on and training

o  Financial and material

o  Family reunifica/on

o  Emo/onal health and self-‐work

o  Give back, help others

o  Spirituality and religion

o  Legal issues (not even really men/oned, but was on the study’s list)

RECOVERY PRIORITIES

Alexandre B. Laudet, PhD and William White, MA; What are your priorities right now? Identifying service needs across recovery stages to inform service development, Journal of Substance Abuse Treatment. 2010 January ; 38(1): 51–59. doi:10.1016/j.jsat.2009.06.003.


Are you helping your clients develop recovery plans?


(CONT.)

SECTION #1: RED FLAG BEHAVIORS/THOUGHTS

These are destruc*ve and addic*ve, leading to preoccupa*on with the drug of choice and out of control behavior.

o  include behaviors where one instance of the behavior could cause dras/c consequences

o  include any behavior that “makes you crazy”

o  include what you will do if one of these behaviors/thoughts does occur

THE BOTTOM LINE

SECTION #2: CAUTION FLAG BEHAVIORS/THOUGHTS

These are behaviors/thoughts which are ques*onable or which signal that you are on dangerous ground.

o  Boundary Behaviors = behaviors that you cannot do, but which are not dras/c enough to reset your sobriety date if you do them.

o  Cau:on Behaviors = behaviors that you haven't decided to give up, but which should be monitored to make sure they don't get out of hand.

THE BOTTOM LINE

SECTION #3: GREEN FLAG BEHAVIORS/THOUGHTS

These behaviors/thoughts are healthy.

THE BOTTOM LINE

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THE NEXT STEP

Make a list of friends who don't use that they can go to for support and invite them to meet for coffee or go to a movie. Now is also the chance to spend time with family, participating in family activities and re-establishing bonds.

FRIENDS AND FAMILY

Suggest to eliminate everyone from the recovering individual’s life that is related to the addic/on: users, dealers or someone who encourages the recovering individual to use.

"100 meetings in 100 days"

AFTER-CARE MEETINGS

o  Whatever the program chosen, aHendance and par/cipa/on must be consistent for it to work.

o  Otherwise, the individual may experience feelings of shame and self-‐doubt.

IMPROVING HEALTH

Eat three balanced meals each day.

•  Makes the individual feel beHer and requires planning and discipline.

•  Discipline is at the heart of the en/re recovery plan.

Exercise briskly for ½ hour at least 3 *mes each week.

•  Will increase energy and enhance the detoxifica/on process

Bathe daily to feel and look their best.

•  Will increase confidence feel most comfortable

DAILY TASKS

Choose simple tasks to build their day around, giving it structure and meaning.

Tasks as simple as making the bed every morning or cleaning the kitchen at night can lead to a great feeling of accomplishment and lend a sense of purpose

during a /me in which days can seem long.

ENLISTING FAMILY

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ENLISTING FAMILY (BIOLOGICAL OR CREATED)

o  Advise, screen, and support con/nuing care recommenda/ons

o  Coordina/on and case management with all con/nuing care providers

Help the family to:


o  Re-‐integra/on planning including assis/ng in loca/ng twelve-‐step development and building a sober support network

o  Address concerns related to early recovery issues in order to cul/vate healthy living

Help the family to:


o  Assist in development and implementa/on of a relapse preven/on plan

o  Con/nue with psycho educa/onal work focusing on the disease of addic/on and recovery topics

Help the family to: Help the family to:


o  Promote family healing and long-‐term individual recovery

KEYS TO LONG-TERM RECOVERY


A solid support network.

Whether it comes from family, friends or those met during rehab, the individuals who enjoy the most success with their ongoing sobriety are those who have a strong network of support following treatment.

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Good physical health. Individuals who are in good shape, exercising and ea/ng right are much more inclined to stay the course and maintain their sobriety in the long term.


Strong rela:onships.

Individuals who are married or have a close-‐knit family unit tend to stay sober longer.

These are families that can get through the tough /mes caused by addic/on, and heal broken rela/onships with family counseling and improved communica/on.

THE BEGINNING OF LONG-TERM RECOVERY AND THE END OF EARLY

RECOVERY

When does long term recovery start and early recovery end?

THE BEGINNING OF LONG-TERM RECOVERY AND THE END OF EARLY RECOVERY

o  Early recovery is defined as learning how to live clean and sober.

o  Long-‐term recovery is defined as pushing yourself to grow as a person.

o  Of course, there is some overlap.

What Got You Clean And Sober Will Not Keep You Clean And Sober

COMMON MISCONCEPTION

o  Complacency is one of the biggest enemies for long-‐term recovery.

o  When recovering individuals start to coast, they are in trouble.

o  Start with holis/c health and with helping others.

MEETING ATTENDANCE IS NOT ENOUGH IN THE LONGRUN

o  12-‐step mee/ngs are a wonderful tool unless the recovering individual is using them as a crutch.

o  The trap is when people do not do enough outside of the mee/ngs to sustain their recovery.

o  In long-‐term recovery, recovering individuals will not be dependent on mee/ngs to keep them sober.

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Building a foundation in early recovery:

A NECESSARY FOUNDATION TO MOVE INTO LONG-TERM SOBRIETY

o  Massive commitment by the recovering individual to themselves, that they will not use drugs or alcohol no maHer what.

o  Taking massive ac/on by living in long-‐term treatment and following through with the program and the rules there.

o  Actually taking sugges/ons and doing what successful people said to do.

The recovering individual seeks to grow as a “whole” person and not neglect any aspect of health.

RELAPSE PREVENTION DONE RIGHT IS A HOLISTIC APPROACH

Educa/onal

Emo/onal

Spiritual Physical

Social

Eliminating bad habits is really important in long-term recovery.

LEAVING BAD HABITS BEHIND

“Clear away the bad to make way for the good.”

Crea/ng the discipline to remove bad habits in one’s life makes way for tremendous growth opportuni/es.

o  Getting started is hard.

o  It may be hard or even painful for the first few months.

OFTEN UNDERESTIMATED: EXERCISE AND ITS IMPACT ON RECOVERY

The benefits the recovering individual gets out of vigorous exercise are going to be equal to the effort that they put into it.

Part of the transition from early recovery to long-term recovery is about achieving balance.

ACHIEVING A BALANCED LIFESTYLE

o  early recovery is all about focus

o  long-‐term recovery is all about holis/c growth

HAVING FUN IN LONG-TERM RECOVERY

o  Their idea of what is “fun” is probably s/ll undergoing radical changes

o  Relearn how to appreciate the simple things in life

o  Happens naturally as a result of their growth experiences and interac/ons with others

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Recovering individuals have to help others in recovery.

INSURANCE AGAINST RELAPSE: HELPING OTHERS IN RECOVERY

ü  sponsor newcomers in recovery

ü  aHend 12 step mee/ngs and share experiences

ü  work in a local substance abuse facility ü  connect with people via a recovery website Each goal that one achieves becomes a platform to reach the

next milestone.

MAKING GOALS & ACHIEVING THEM

o  Early recovery is focused on goal-‐oriented progress.

o  Growth is cumula/ve.

o  Master one goal at a /me, and then move on.

FINDING PURPOSE & VISION IN RECOVERY

The recovering individual’s purpose and vision for long-‐term recovery will come to them over /me.

o  Do not force it.

o  Instead, follow the strategies for pursuing holis/c health and personal growth.

PUSHING RECOVERING INDIVIDUALS TO GROW IN THEIR RECOVERY

“What is the one thing I could change that would have the

biggest impact on my life right now?”

CONCLUDING THOUGHTS

CONCLUDING THOUGHTS – BOTTOM LINE

1.  No single treatment is appropriate for all 2.  Treatment needs to be readily available 3.  Effec/ve treatment aHends to the mul/ple needs of the individual 4.  Treatment plans must be assessed and modified con/nually to meet changing needs 5.  Remaining in treatment for an adequate period of /me is cri/cal for treatment effec/veness 6.  Counseling and other behavioral therapies are cri/cal components of effec/ve treatment 7.  Medica/ons are an important element of treatment for many pa/ents 8.  Co-‐exis/ng disorders should be treated in an integrated way 9.  Medical detox is only the first stage of treatment 10.  Treatment does not need to be voluntary to be effec/ve 11.  Possible drug use during treatment must be monitored con/nuously 12.  Treatment programs should assess for HIV/AIDS, Hepa//s B & C, Tuberculosis and other

infec/ous diseases and help clients modify at-‐risk behaviors 13.  Recovery can be a long-‐term process and frequently requires mul/ple episodes of treatment 14.  Remember Al-‐Anon as an op/on

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Have you experienced long-term recovery with yourself, family member, friend or

through a client?

STORY OF LONG-TERM RECOVERY

Art Romero

STORY OF LONG-TERM RECOVERY

[email protected]

THANK YOU!

ASKING QUESTIONS

Ask ques/ons through the Ques/ons Pane

OTHER RTP WEBINARS


Defining Addic*on Recovery •  Thursday, January 9, 2014 @ 3-‐4:30pm ET

What Does Science Say? Reviewing Recovery Research •  Wednesday, February 5, 2014 @ 3-‐5pm ET

The History of Recovery in the United States and the Addic*on Profession •  Thursday, March 6, 2013 @ 3-‐4:30pm ET

Defining Recovery-‐Oriented Systems of Care (ROSC) •  Thursday, April 3, 2014 @ 3-‐4:30pm ET

Understanding the Role of Peer Recovery Coaches in the Addic*on Profession •  Thursday, May 1, 2014 @ 3-‐4:30pm ET

Including Family and Community in the Recovery Process •  Thursday, May 29, 2014 @ 3-‐5pm ET

Collabora*ng with Other Professions, Professionals, and Communi*es •  Thursday, June 26, 2014 @ 3-‐4:30pm ET

Using Recovery-‐Oriented Principles in Addic*on Counseling Prac*ce •  Thursday, July 24, 2014 @ 3-‐5pm ET

Exploring Techniques to Support Long-‐Term Addic*on Recovery for Clients and Families •  Thursday, August 21, 2014 @ 3-‐5pm ET

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WEBINARS ON DEMAND

•  Medica:on Assisted Treatment •  Building Your Business with SAP/DOT •  SBIRT •  Billing and Claim Submission •  Ethics •  Co-‐occurring Disorders •  Test-‐Taking Strategies •  Conflict Resolu:on •  Clinical Supervision •  ASAM Placement Criteria •  DSM-‐5 Proposed Changes


CE credit s:ll available!


WWW.NAADAC.ORG

OBTAINING CE CREDIT

o  The educa/on delivered in this webinar is FREE to all professionals.

o  2 CEs are FREE to NAADAC members who aHend this webinar. Non-‐members of NAADAC receive 2 CEs for $25.

o  If you wish to receive CE credit, you MUST complete and pass the “CE Quiz” that is located at: (look for TITLE of webinar)

www.naadac.org/exploring techniquestosupportlongtermaddic/onrecoveryforclientsandfamilies


A CE cer/ficate will be emailed to you within 21 days of submiZng the quiz and payment (if applicable) – usually sooner.

o  Successfully passing the “CE Quiz” is the ONLY way to receive a CE cer*ficate.


Thank You for Par*cipa*ng!

www.naadac.org/recovery

NAADAC, The Associa*on for Addic*on Professionals 1001 N. Fairfax St. Suite 201 Alexandria, VA 22314 p 800.548.0497 f 800.377.1136

NAADACorg

Naadac

mis/@naadac.org

NAADAC

Dr. Gisela Berger: [email protected]

Art Romero: apon*[email protected]

8-21-14 longterm recovery skills webinar slides v2...aug 21, 2014 · 8/21/14 1 exploring...

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