Relapse PreventionRelapse Prevention
VA PrescottVA Prescott
Guy C. Lamunyon MSN, RN, CASGuy C. Lamunyon MSN, RN, CAS
(Cert...
Relapse PreventionRelapse Prevention
““Insanity:Insanity: doing the same thingdoing the same thing over and over againover...
AwardsAwards
HALL OF FAME – California Association of Alcohol andHALL OF FAME – California Association of Alcohol and
Drug...
Addiction Medicine SpecialistsAddiction Medicine Specialists
Joseph Zuska – Navy Alcohol Rehabilitation ProgramsJoseph Zus...
PsychiatristsPsychiatrists
Robert Gerner – Mood Disorders ResearchRobert Gerner – Mood Disorders Research
William Wirshing...
Confrontational StylesConfrontational Styles
and Outcomeand Outcome
STYLE OUTCOMESTYLE OUTCOME
HIGHHIGH WORSTWORST
MEDIUMM...
Project MATCH OutcomeProject MATCH Outcome
Compared Motivational EnhancementCompared Motivational Enhancement
Therapy (MET...
Relapse by AddictionRelapse by Addiction
Relapse by diseaseRelapse by disease
Gorski/CENAPS Model (1982)Gorski/CENAPS Model (1982)
Marlatt Relapse Prevention (1985)Marlatt Relapse Prevention (1985)
Professor of Psychology at theProfessor of Psychology a...
Marlatt Mindfulness BasedMarlatt Mindfulness Based
Relapse PreventionRelapse Prevention
Marlatt: Harm ReductionMarlatt: Harm Reduction
Relapse TheoryRelapse Theory
1. Relapse is part of the management of any1. Relapse is part of the management of any
chroni...
Critical indicators of effectiveCritical indicators of effective
relapse managementrelapse management
1. Frequency.   Occu...
The Phases and 37 WarningThe Phases and 37 Warning
Signs of RelapseSigns of Relapse
A Reliable & Valid Predictor of Alcoho...
The Phases and 37 WarningThe Phases and 37 Warning
Signs of RelapseSigns of Relapse
Phase1: The Return of DenialPhase1: Th...
The Phases and 37 WarningThe Phases and 37 Warning
Signs of RelapseSigns of Relapse
Phase2: Avoidance and DefensivePhase2:...
The Phases and 37 WarningThe Phases and 37 Warning
Signs of RelapseSigns of Relapse
Phase 3: Crisis Building.Phase 3: Cris...
The Phases and 37 WarningThe Phases and 37 Warning
Signs of RelapseSigns of Relapse
Phase 4: ImmobilizationPhase 4: Immobi...
The Phases and 37 WarningThe Phases and 37 Warning
Signs of RelapseSigns of Relapse
Phase 5: Confusion andPhase 5: Confusi...
The Phases and 37 WarningThe Phases and 37 Warning
Signs of RelapseSigns of Relapse
Phase 6: DepressionPhase 6: Depression...
The Phases and 37 WarningThe Phases and 37 Warning
Signs of RelapseSigns of Relapse
Phase 7: Behavioural Loss of Control.
...
The Phases and 37 WarningThe Phases and 37 Warning
Signs of RelapseSigns of Relapse
Phase 8: Recognition of Loss of contro...
The Phases and 37 WarningThe Phases and 37 Warning
Signs of RelapseSigns of Relapse
Phase 9: Option reductionPhase 9: Opti...
The Phases and 37 WarningThe Phases and 37 Warning
Signs of RelapseSigns of Relapse
Phase 10: Acute Relapse Episode.Phase ...
The Phases and 37 WarningThe Phases and 37 Warning
Signs of RelapseSigns of Relapse
37. Acute Relapse Episode.37. Acute Re...
Constructing a PersonalizedConstructing a Personalized
Warning Sign ListWarning Sign List
1. Check three to five warning s...
Constructing a PersonalizedConstructing a Personalized
Warning Sign ListWarning Sign List
5. Review the list every morning...
Relapse AssessmentRelapse Assessment
1.1. Begin with a period of solid sobrietyBegin with a period of solid sobriety
2.2. ...
Development Model ofDevelopment Model of
RecoveryRecovery
1.1. Tasks must be completed in orderTasks must be completed in ...
Development Model ofDevelopment Model of
RecoveryRecovery
Active Addiction:Active Addiction: During this stage substanceDu...
Development Model ofDevelopment Model of
RecoveryRecovery
Transition:Transition: During this stage patientsDuring this sta...
Development Model ofDevelopment Model of
RecoveryRecovery
Stabilization:Stabilization: During this stage patientsDuring th...
Development Model ofDevelopment Model of
RecoveryRecovery
Early Recovery:Early Recovery: During this stage patientsDuring ...
Development Model ofDevelopment Model of
RecoveryRecovery
Middle Recovery:Middle Recovery: During this stageDuring this st...
Development Model ofDevelopment Model of
RecoveryRecovery
Late Recovery:Late Recovery: During this stage patientsDuring th...
Development Model ofDevelopment Model of
RecoveryRecovery
Maintenance:Maintenance: During this stage patientsDuring this s...
Addicted Self versus Sober SelfAddicted Self versus Sober Self
Addicted Self versus Sober SelfAddicted Self versus Sober Self
ADDICTED SELF – mean, angry, lonely,ADDICTED SELF – mean, a...
Addicted Self versus Sober SelfAddicted Self versus Sober Self
SOBER SELF – is intelligent, warm, caring,SOBER SELF – is i...
Addicted Self versus Sober SelfAddicted Self versus Sober Self
Addicted Self versus Sober SelfAddicted Self versus Sober Self
““The goal of recovery is to put theThe goal of recovery is...
Coping with PAW/PAWSCoping with PAW/PAWS
1.1. Educate clients about PAW symptomsEducate clients about PAW symptoms
2.2. Id...
Coping with cravingsCoping with cravings
1.1. Stress ReductionStress Reduction
2.2. ExerciseExercise
3.3. Diversion (readi...
DOM Relapse Prevention ProgramDOM Relapse Prevention Program
Criteria:Criteria:
1. Four or more previous treatments1. Four...
DOM Relapse Prevention ProgramDOM Relapse Prevention Program
1. More restrictions – must have a safety1. More restrictions...
DOM Relapse Prevention ProgramDOM Relapse Prevention Program
DOM Relapse Prevention ProgramDOM Relapse Prevention Program
ASSIGNMENTS:ASSIGNMENTS:
1.1. Alcohol/Drug HistoryAlcohol/Dru...
RELAPSE PREVENTIONRELAPSE PREVENTION
PROGRAM OUTCOMEPROGRAM OUTCOME
IRREGULAR DISCHARGES - 2010IRREGULAR DISCHARGES - 2010...
RELAPSE PREVENTIONRELAPSE PREVENTION
PROGRAM OUTCOMEPROGRAM OUTCOME
IRREGULAR DISCHARGES - 2010IRREGULAR DISCHARGES - 2010...
RELAPSE PREVENTIONRELAPSE PREVENTION
PROGRAM OUTCOMEPROGRAM OUTCOME
IRREGULAR DISCHARGES - 2010IRREGULAR DISCHARGES - 2010...
SECOND CHANCE PROGRAMSECOND CHANCE PROGRAM
RELAPSE IN TREATMENTRELAPSE IN TREATMENT
N = 10N = 10
Irregular Discharge = 80 ...
SECOND CHANCE PROGRAMSECOND CHANCE PROGRAM
RELAPSE IN TREATMENTRELAPSE IN TREATMENT
New criteria:New criteria:
1.1. Relaps...
12 Step Resistance ? ? ?12 Step Resistance ? ? ?
(When the only tool you have is a hammer, everything(When the only tool y...
QUESTIONS ? ? ? ?QUESTIONS ? ? ? ?
Email: guy.lamunyon@va.govEmail: guy.lamunyon@va.gov
Google Profile: Guy LamunyonGoogle...
Relapse Prevention Inservice VA Prescott
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Relapse Prevention Inservice VA Prescott

  1. 1. Relapse PreventionRelapse Prevention VA PrescottVA Prescott Guy C. Lamunyon MSN, RN, CASGuy C. Lamunyon MSN, RN, CAS (Certified Addiction Specialist)(Certified Addiction Specialist) An evidence based practice forAn evidence based practice for substance abuse treatmentsubstance abuse treatment
  2. 2. Relapse PreventionRelapse Prevention ““Insanity:Insanity: doing the same thingdoing the same thing over and over againover and over again and expectingand expecting different results.” Albert Einsteindifferent results.” Albert Einstein ““The most predictable outcome from rehabilitation isThe most predictable outcome from rehabilitation is relapse.”relapse.” ““If you don’t understand relapse, you don’t understandIf you don’t understand relapse, you don’t understand addiction.”addiction.” Relapse is part of recovery for severely relapse proneRelapse is part of recovery for severely relapse prone individualsindividuals
  3. 3. AwardsAwards HALL OF FAME – California Association of Alcohol andHALL OF FAME – California Association of Alcohol and Drug Abuse Counselors (2002)Drug Abuse Counselors (2002) VA BEST PRACTICE – MHICM PROGRAMVA BEST PRACTICE – MHICM PROGRAM DEVELOPMENT (2003)DEVELOPMENT (2003) SECRETARYS AWARD – Advanced Practice Nursing – VASECRETARYS AWARD – Advanced Practice Nursing – VA Long Beach (2006)Long Beach (2006) VA BEST PRACTICE – OIF/OEF Outreach – VA HeadVA BEST PRACTICE – OIF/OEF Outreach – VA Head Nurse Conference Wash DC (2007)Nurse Conference Wash DC (2007)
  4. 4. Addiction Medicine SpecialistsAddiction Medicine Specialists Joseph Zuska – Navy Alcohol Rehabilitation ProgramsJoseph Zuska – Navy Alcohol Rehabilitation Programs Paul Ohligher – ARS, DOCTOR, ALCOHOLIC, ADDICTPaul Ohligher – ARS, DOCTOR, ALCOHOLIC, ADDICT chapter in the AA Big Bookchapter in the AA Big Book Max Schneider – CareManor and Educational VideosMax Schneider – CareManor and Educational Videos Joseph Pursch – treated Betty Ford - author and columnistJoseph Pursch – treated Betty Ford - author and columnist Walter Ling – Matrix Institute and researchWalter Ling – Matrix Institute and research
  5. 5. PsychiatristsPsychiatrists Robert Gerner – Mood Disorders ResearchRobert Gerner – Mood Disorders Research William Wirshing – Schizophrenia/MedicationWilliam Wirshing – Schizophrenia/Medication DevelopmentDevelopment Andrew Shaner – Dual Diagnosis ResearchAndrew Shaner – Dual Diagnosis Research Stephen Marder – Schizophrenia, MIRECC22Stephen Marder – Schizophrenia, MIRECC22
  6. 6. Confrontational StylesConfrontational Styles and Outcomeand Outcome STYLE OUTCOMESTYLE OUTCOME HIGHHIGH WORSTWORST MEDIUMMEDIUM IN BETWEENIN BETWEEN LOWLOW BESTBEST
  7. 7. Project MATCH OutcomeProject MATCH Outcome Compared Motivational EnhancementCompared Motivational Enhancement Therapy (MET), Cognitive BehavioralTherapy (MET), Cognitive Behavioral Therapy (CBT) and 12 Step FacilitationTherapy (CBT) and 12 Step Facilitation (TSF).(TSF). Twelve Step Facilitation was slightly but notTwelve Step Facilitation was slightly but not significantly more effective than MET andsignificantly more effective than MET and CBTCBT
  8. 8. Relapse by AddictionRelapse by Addiction
  9. 9. Relapse by diseaseRelapse by disease
  10. 10. Gorski/CENAPS Model (1982)Gorski/CENAPS Model (1982)
  11. 11. Marlatt Relapse Prevention (1985)Marlatt Relapse Prevention (1985) Professor of Psychology at theProfessor of Psychology at the University of WashingtonUniversity of Washington and Director of theand Director of the Addictive Behaviors Research CenterAddictive Behaviors Research Center
  12. 12. Marlatt Mindfulness BasedMarlatt Mindfulness Based Relapse PreventionRelapse Prevention
  13. 13. Marlatt: Harm ReductionMarlatt: Harm Reduction
  14. 14. Relapse TheoryRelapse Theory 1. Relapse is part of the management of any1. Relapse is part of the management of any chronic lifestyle related diseasechronic lifestyle related disease 2. It is unrealistic to expect a zero relapse rate as2. It is unrealistic to expect a zero relapse rate as an outcome standardan outcome standard 3. It is realistic to3. It is realistic to A. To reduce the relapse rateA. To reduce the relapse rate B.  Manage relapse episodes more efficientB.  Manage relapse episodes more efficient
  15. 15. Critical indicators of effectiveCritical indicators of effective relapse managementrelapse management 1. Frequency.   Occurring less often1. Frequency.   Occurring less often 2. Duration.  Getting shorter2. Duration.  Getting shorter 3. Severity.   Having fewer consequences3. Severity.   Having fewer consequences 4. Getting less expensive to manage4. Getting less expensive to manage
  16. 16. The Phases and 37 WarningThe Phases and 37 Warning Signs of RelapseSigns of Relapse A Reliable & Valid Predictor of Alcohol Relapses Miller, W. R., & Harris, R. J. (2000). A simple scale of Gorski’s warning signs for relapse. Journal of Studies on Alcohol, 61, 759-765.
  17. 17. The Phases and 37 WarningThe Phases and 37 Warning Signs of RelapseSigns of Relapse Phase1: The Return of DenialPhase1: The Return of Denial 1. Concern about Well Being1. Concern about Well Being 2. Denial of the Concern2. Denial of the Concern
  18. 18. The Phases and 37 WarningThe Phases and 37 Warning Signs of RelapseSigns of Relapse Phase2: Avoidance and DefensivePhase2: Avoidance and Defensive Behaviour.Behaviour. 3. Believing “I’ll never drink again”3. Believing “I’ll never drink again” 4. Worrying about Others Instead of Self4. Worrying about Others Instead of Self 5. Defensiveness.5. Defensiveness. 6. Compulsive Behaviour.6. Compulsive Behaviour. 7. Impulsive Behaviour.7. Impulsive Behaviour. 8. Tendencies towards Loneliness.8. Tendencies towards Loneliness.
  19. 19. The Phases and 37 WarningThe Phases and 37 Warning Signs of RelapseSigns of Relapse Phase 3: Crisis Building.Phase 3: Crisis Building. 9. Tunnel Vision9. Tunnel Vision 10. Minor Depression10. Minor Depression 11. Loss of Constructive Planning11. Loss of Constructive Planning 12. Plans Begin to Fail12. Plans Begin to Fail
  20. 20. The Phases and 37 WarningThe Phases and 37 Warning Signs of RelapseSigns of Relapse Phase 4: ImmobilizationPhase 4: Immobilization 13. Daydreaming and Wishful Thinking.13. Daydreaming and Wishful Thinking. 14. Feelings that nothing can be solved.14. Feelings that nothing can be solved. 15. Immature wish to be happy.15. Immature wish to be happy.
  21. 21. The Phases and 37 WarningThe Phases and 37 Warning Signs of RelapseSigns of Relapse Phase 5: Confusion andPhase 5: Confusion and Overreaction.Overreaction. 16. Periods of confusion.16. Periods of confusion. 17. Irritation with friends17. Irritation with friends 18. Easily Angered18. Easily Angered
  22. 22. The Phases and 37 WarningThe Phases and 37 Warning Signs of RelapseSigns of Relapse Phase 6: DepressionPhase 6: Depression 19. Irregular Eating Habits.19. Irregular Eating Habits. 20. Lack of desire to take action20. Lack of desire to take action 21. Irregular sleeping habits21. Irregular sleeping habits .. 22. Loss of daily structure.22. Loss of daily structure. 23. Periods of deep depression.23. Periods of deep depression.
  23. 23. The Phases and 37 WarningThe Phases and 37 Warning Signs of RelapseSigns of Relapse Phase 7: Behavioural Loss of Control. 24. Irregular attendance at AA and Treatment meetings 25. Development of an “I don’t care” attitude. 26. Open Rejection of Help. 27. Dissatisfaction with life. 28. Feelings of powerlessness and helplessness
  24. 24. The Phases and 37 WarningThe Phases and 37 Warning Signs of RelapseSigns of Relapse Phase 8: Recognition of Loss of controlPhase 8: Recognition of Loss of control 29. Self Pity.29. Self Pity. 30. Thoughts of social drinking.30. Thoughts of social drinking. 31. Conscious Lying.31. Conscious Lying. 32. Complete loss of self confidence.32. Complete loss of self confidence.
  25. 25. The Phases and 37 WarningThe Phases and 37 Warning Signs of RelapseSigns of Relapse Phase 9: Option reductionPhase 9: Option reduction 33. Unreasonable Resentment.33. Unreasonable Resentment. 34. Discontinuance of all treatment34. Discontinuance of all treatment and AAand AA 35. Overwhelming Loneliness,35. Overwhelming Loneliness, Frustration, Anger and Tension.Frustration, Anger and Tension.
  26. 26. The Phases and 37 WarningThe Phases and 37 Warning Signs of RelapseSigns of Relapse Phase 10: Acute Relapse Episode.Phase 10: Acute Relapse Episode. 36. Loss of behaviour control.36. Loss of behaviour control. 37. Acute Relapse Episode.37. Acute Relapse Episode.
  27. 27. The Phases and 37 WarningThe Phases and 37 Warning Signs of RelapseSigns of Relapse 37. Acute Relapse Episode.37. Acute Relapse Episode. A. Degeneration of all life areas.A. Degeneration of all life areas. B. Alcohol or drug Use.B. Alcohol or drug Use. C. Emotional Collapse.C. Emotional Collapse. D. Physical ExhaustionD. Physical Exhaustion E. Stress Related Illnesses.E. Stress Related Illnesses. F. Psychiatric Illness.F. Psychiatric Illness. G. Suicide.G. Suicide. H.H. Accident Proneness.Accident Proneness. I.I. Disruption of Social Structure.Disruption of Social Structure.
  28. 28. Constructing a PersonalizedConstructing a Personalized Warning Sign ListWarning Sign List 1. Check three to five warning signs from the list above that1. Check three to five warning signs from the list above that you find most interesting for you.you find most interesting for you. 2. In your own words, rewrite the summary title of the2. In your own words, rewrite the summary title of the warning sign that you have checked. The summary titlewarning sign that you have checked. The summary title is the word or short phrase at the beginning of eachis the word or short phrase at the beginning of each warning sign.warning sign. 3. Write a brief paragraph that describes in your own words3. Write a brief paragraph that describes in your own words each of the warning signs that you have selected.each of the warning signs that you have selected. 4. Read your warning signs (as you have written them) to4. Read your warning signs (as you have written them) to an addictions counsellor, your A.A. sponsor, or a friend,an addictions counsellor, your A.A. sponsor, or a friend, and ask for feedback. Rewrite the warning signs if theyand ask for feedback. Rewrite the warning signs if they are unable to understand clearly what you mean.are unable to understand clearly what you mean.
  29. 29. Constructing a PersonalizedConstructing a Personalized Warning Sign ListWarning Sign List 5. Review the list every morning and every5. Review the list every morning and every evening to remind yourself to look for theevening to remind yourself to look for the presence of these warning signs.presence of these warning signs. 6. Discuss the list with your friends and family and6. Discuss the list with your friends and family and ask them to tell you if they see any of theask them to tell you if they see any of the warning signs appearing in your life.warning signs appearing in your life. 7. If you notice a warning sign, evaluate your need7. If you notice a warning sign, evaluate your need to get help.to get help.
  30. 30. Relapse AssessmentRelapse Assessment 1.1. Begin with a period of solid sobrietyBegin with a period of solid sobriety 2.2. Review progression of relapse warningReview progression of relapse warning signssigns 3.3. Discuss the thoughts, feelings andDiscuss the thoughts, feelings and actions leading up to the first useactions leading up to the first use 4.4. Determine relapse dynamicsDetermine relapse dynamics 5.5. Educate client about their unique relapseEducate client about their unique relapse dynamicsdynamics
  31. 31. Development Model ofDevelopment Model of RecoveryRecovery 1.1. Tasks must be completed in orderTasks must be completed in order 2.2. Recovery task incompletion causesRecovery task incompletion causes “stuck points” in recovery“stuck points” in recovery 3.3. Stuck points in recovery may causeStuck points in recovery may cause relapserelapse 4.4. Completing recovery tasks out of orderCompleting recovery tasks out of order may cause relapsemay cause relapse
  32. 32. Development Model ofDevelopment Model of RecoveryRecovery Active Addiction:Active Addiction: During this stage substanceDuring this stage substance abusers are actively using alcohol and otherabusers are actively using alcohol and other drugs, receiving substantial perceived benefitsdrugs, receiving substantial perceived benefits from their use, experiencing few perceivedfrom their use, experiencing few perceived adverse consequences, and as a result see noadverse consequences, and as a result see no reason to seek treatmentreason to seek treatment Prochaska/DiClementeProchaska/DiClemente (Precontemplation):(Precontemplation):
  33. 33. Development Model ofDevelopment Model of RecoveryRecovery Transition:Transition: During this stage patientsDuring this stage patients recognize that they are experiencingrecognize that they are experiencing alcohol and drug related problems andalcohol and drug related problems and need to pursue abstinence as a life styleneed to pursue abstinence as a life style goal in order to resolve these problems.goal in order to resolve these problems. Prochaska/DiClemente:Prochaska/DiClemente: ContemplationContemplation
  34. 34. Development Model ofDevelopment Model of RecoveryRecovery Stabilization:Stabilization: During this stage patientsDuring this stage patients recover from acute and post acuterecover from acute and post acute withdrawal and stabilize their psychosocialwithdrawal and stabilize their psychosocial life crisis.life crisis. Prochaska/DiClemente:Prochaska/DiClemente: PreparationPreparation
  35. 35. Development Model ofDevelopment Model of RecoveryRecovery Early Recovery:Early Recovery: During this stage patientsDuring this stage patients identify and learn how to replace addictiveidentify and learn how to replace addictive thoughts, feelings, and behaviors with sobriety-thoughts, feelings, and behaviors with sobriety- centered thoughts, feelings, and behaviors.centered thoughts, feelings, and behaviors. THEME: SELF AND SOBRIETYTHEME: SELF AND SOBRIETY Prochaska/DiClemente: ActionProchaska/DiClemente: Action
  36. 36. Development Model ofDevelopment Model of RecoveryRecovery Middle Recovery:Middle Recovery: During this stageDuring this stage patients repair the life style damagedpatients repair the life style damaged caused by the addiction and develop acaused by the addiction and develop a balanced and healthy life style.balanced and healthy life style. THEME: SELF AND SOCIETYTHEME: SELF AND SOCIETY Prochaska/DiClemente: ActionProchaska/DiClemente: Action
  37. 37. Development Model ofDevelopment Model of RecoveryRecovery Late Recovery:Late Recovery: During this stage patientsDuring this stage patients resolve family of origin issues which impairresolve family of origin issues which impair the quality of recovery and act as long-the quality of recovery and act as long- term relapse triggers (PTSD here).term relapse triggers (PTSD here). THEME: SELF AND HISTORYTHEME: SELF AND HISTORY Prochaska/DiClemente: ActionProchaska/DiClemente: Action
  38. 38. Development Model ofDevelopment Model of RecoveryRecovery Maintenance:Maintenance: During this stage patientsDuring this stage patients continue a program of growth andcontinue a program of growth and development and maintain an activedevelopment and maintain an active recovery program to assure that they don'trecovery program to assure that they don't slip back into old addictive patterns.slip back into old addictive patterns. Prochaska/DiClemente:Prochaska/DiClemente: MaintenanceMaintenance
  39. 39. Addicted Self versus Sober SelfAddicted Self versus Sober Self
  40. 40. Addicted Self versus Sober SelfAddicted Self versus Sober Self ADDICTED SELF – mean, angry, lonely,ADDICTED SELF – mean, angry, lonely, greedy, hates for you to succeed, alwaysgreedy, hates for you to succeed, always wants the easy way out, is interested inwants the easy way out, is interested in short-term kicks regardless of the price, isshort-term kicks regardless of the price, is willing to kill you to get what it wants,willing to kill you to get what it wants, doesn’t care about anyone or anythingdoesn’t care about anyone or anything except getting more booze and drugs andexcept getting more booze and drugs and is angry when you get sober and try tois angry when you get sober and try to stay that way.stay that way.
  41. 41. Addicted Self versus Sober SelfAddicted Self versus Sober Self SOBER SELF – is intelligent, warm, caring,SOBER SELF – is intelligent, warm, caring, sober, in touch with higher power, can besober, in touch with higher power, can be strong at times, feels comfortable withstrong at times, feels comfortable with your faults and weaknesses, is able to askyour faults and weaknesses, is able to ask for help, is willing and able to help othersfor help, is willing and able to help others and gets involved with other peopleand gets involved with other people
  42. 42. Addicted Self versus Sober SelfAddicted Self versus Sober Self
  43. 43. Addicted Self versus Sober SelfAddicted Self versus Sober Self ““The goal of recovery is to put theThe goal of recovery is to put the sober self back in charge.”sober self back in charge.”
  44. 44. Coping with PAW/PAWSCoping with PAW/PAWS 1.1. Educate clients about PAW symptomsEducate clients about PAW symptoms 2.2. Identify PAW symptoms for clientsIdentify PAW symptoms for clients 3.3. Relate PAW symptoms to drugs ofRelate PAW symptoms to drugs of abuseabuse 4.4. Avoid stimulants and sedativesAvoid stimulants and sedatives 5.5. Stress reductionStress reduction 6.6. Encourage recoveryEncourage recovery
  45. 45. Coping with cravingsCoping with cravings 1.1. Stress ReductionStress Reduction 2.2. ExerciseExercise 3.3. Diversion (reading, television)Diversion (reading, television) 4.4. Sharing with others (peers, professionalSharing with others (peers, professional staffstaff 5.5. PrayerPrayer 6.6. One Day At A TimeOne Day At A Time
  46. 46. DOM Relapse Prevention ProgramDOM Relapse Prevention Program Criteria:Criteria: 1. Four or more previous treatments1. Four or more previous treatments oror 2. History of alcohol/drug use in treatment2. History of alcohol/drug use in treatment
  47. 47. DOM Relapse Prevention ProgramDOM Relapse Prevention Program 1. More restrictions – must have a safety1. More restrictions – must have a safety plan to leave the DOMplan to leave the DOM 2. Use of Relapse Prevention Therapy2. Use of Relapse Prevention Therapy
  48. 48. DOM Relapse Prevention ProgramDOM Relapse Prevention Program
  49. 49. DOM Relapse Prevention ProgramDOM Relapse Prevention Program ASSIGNMENTS:ASSIGNMENTS: 1.1. Alcohol/Drug HistoryAlcohol/Drug History 2.2. Relapse HistoryRelapse History 3.3. 37 Relapse Warning Signs Exercise37 Relapse Warning Signs Exercise 4.4. Relapse Prevention PlanRelapse Prevention Plan 5.5. Lapse/Relapse Intervention PlanLapse/Relapse Intervention Plan
  50. 50. RELAPSE PREVENTIONRELAPSE PREVENTION PROGRAM OUTCOMEPROGRAM OUTCOME IRREGULAR DISCHARGES - 2010IRREGULAR DISCHARGES - 2010 MONTH                ALL  DOM            RP TRACKMONTH                ALL  DOM            RP TRACK APR                        9                              6APR                        9                              6 MAY                       5                              5MAY                       5                              5
  51. 51. RELAPSE PREVENTIONRELAPSE PREVENTION PROGRAM OUTCOMEPROGRAM OUTCOME IRREGULAR DISCHARGES - 2010IRREGULAR DISCHARGES - 2010 MONTH                ALL  DOM            RP TRACKMONTH                ALL  DOM            RP TRACK JUN                        12                           0JUN                        12                           0 JUL                         11                           2JUL                         11                           2 AUG                       6                            1AUG                       6                            1 SEP                         10                           1SEP                         10                           1 OCT                        13                           1OCT                        13                           1
  52. 52. RELAPSE PREVENTIONRELAPSE PREVENTION PROGRAM OUTCOMEPROGRAM OUTCOME IRREGULAR DISCHARGES - 2010IRREGULAR DISCHARGES - 2010 MONTH                ALL  DOM            RP TRACKMONTH                ALL  DOM            RP TRACK NOV                      15                           9NOV                      15                           9 DEC                       14                          8DEC                       14                          8 IRREGULAR DISCHARGES – 2011IRREGULAR DISCHARGES – 2011 JAN 2011              12 EST                    9JAN 2011              12 EST                    9 FEB                      12 EST                    5FEB                      12 EST                    5 MAR                      12 EST                   5MAR                      12 EST                   5
  53. 53. SECOND CHANCE PROGRAMSECOND CHANCE PROGRAM RELAPSE IN TREATMENTRELAPSE IN TREATMENT N = 10N = 10 Irregular Discharge = 80 percentIrregular Discharge = 80 percent Regular Discharge = 20 percentRegular Discharge = 20 percent
  54. 54. SECOND CHANCE PROGRAMSECOND CHANCE PROGRAM RELAPSE IN TREATMENTRELAPSE IN TREATMENT New criteria:New criteria: 1.1. Relapse and ask for help may continueRelapse and ask for help may continue 2.2. Found in relapse by UDS, breath test orFound in relapse by UDS, breath test or clinical observations are dischargedclinical observations are discharged
  55. 55. 12 Step Resistance ? ? ?12 Step Resistance ? ? ? (When the only tool you have is a hammer, everything(When the only tool you have is a hammer, everything looks like a nail)looks like a nail) Suggest SMART RecoverySuggest SMART Recovery No stepsNo steps No higher powersNo higher powers No lifelong commitmentNo lifelong commitment Uses CBT/RET methodsUses CBT/RET methods Stop trying to shove square pegs in round holesStop trying to shove square pegs in round holes
  56. 56. QUESTIONS ? ? ? ?QUESTIONS ? ? ? ? Email: guy.lamunyon@va.govEmail: guy.lamunyon@va.gov Google Profile: Guy LamunyonGoogle Profile: Guy Lamunyon

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