The first step towards recovery is acknowledging that substance use has become a problem in the person’s life which is disrupting the quality of their life. This can result from impairment in school, work, social, recreational or other important areas of function. Once an individual recognizes the negative impact of a substance on their life, a wide range of treatment options is available Treatment options for addiction depend on several factors, including the type of addictive disorder, the length and severity of use, and its effects on the individual.  Common interventions might involve a combination of Inpatient and outpatient programs, Psychological counseling, Self-help groups, And medication

1. Management Plan for
Substance Abuse Disorder
Group Member
Samia Azeem
Saba Waheed
Saleha Javed
Ayesha Mehboob
Nazia Noureen

2. Treatment Plan:
⦿ The first step towards recovery is acknowledging that
substance use has become a problem in the person’s life which
is disrupting the quality of their life. This can result from
impairment in school, work, social, recreational or other
important areas of function.
⦿ Once an individual recognizes the negative impact of a
substance on their life, a wide range of treatment options is
available.

3. Conti..
⦿ Treatment options for addiction depend on several factors,
including the type of addictive disorder, the length and severity
of use, and its effects on the individual.
⦿ Common interventions might involve a combination of
⦿ Inpatient and outpatient programs,
⦿ Psychological counseling,
⦿ Self-help groups,
⦿ And medication.

4. Detoxification
⦿ Detoxification is normally the first step in treatment. This
involves clearing a substance from the body and limiting
withdrawal reactions.
⦿ In 80 percent of cases, a treatment clinic will use medications
to reduce withdrawal symptoms, according to the Substance
Abuse and Mental Health Services Administration
(SAMHSA).
⦿ If a person is addicted to more than one substance, they will
often need medications to reduce withdrawal symptoms for
each.

5. Counseling and behavioral therapies
⦿ Therapy might occur on a one-to-one, group, or
family basis depending on the needs of the individual.
It is usually intensive at the outset of treatment with
the number of sessions gradually reducing over time
as symptoms improve.
⦿ Counseling for addiction aims to help people change
behaviors and attitudes around using a substance, as
well as strengthening life skills and supporting other
treatments.

6. Different types of therapy include:
1- Cognitive-Behavioral Therapy, which helps people
recognize and change ways of thinking that have associations
with substance use.
2- Multi-Dimensional Family Therapy, designed to help
improve family function around an adolescent or teen with a
substance-related disorder
3- Motivational Interviewing, which maximizes an
individuals willingness to change and make adjustments to
behaviors motivational incentives that encourage abstinence
through positive reinforcement

7. Rehabilitation Programs
⦿ Longer-term treatment programs for substance-related
and addictive disorders can be highly effective and
typically focus on remaining drug-free and resuming
function within social, professional, and family
responsibilities.
⦿ Fully licensed residential facilities are available to
structure a 24-hour care program, provide a safe
housing environment, and supply any necessary
medical interventions or assistance.

8. A few types of facility can provide a therapeutic environment,
including:
Short-term residential treatment: This focuses on
detoxification and preparing an individual for a longer period
within a therapeutic community through intensive counseling.
Therapeutic communities: A person seeking long-term
treatment for severe forms of addictive disorder would live in a
residence for between 6 and 12 months with on-site staff and
others in recovery. The community and staff serve as key
factors in recovery from and changes in attitudes and behaviors
toward drug use.

9. Recovery housing: This provides a supervised,
short-term stay in housing to help people engage
with responsibilities and adapt to a new,
independent life without on-going substance use.
Recovery housing includes advice on handling
finances and finding work, as well as providing the
connection between a person during the final
stages of recovery and community support
services.

10. Advices :
⦿ 1- Trying
⦿ 2- Praying
⦿ 3- Good companion.
You have to bring changes in yourself to get rid off
drugs addiction. For this you can try further things to
avoid it.
• Focus on your today’s activity.
• Trying to avoid such substance and related activities

11. • Consider your family your first priority
• Good companion in your life must be_ that would
help you to get rid from this habits, advice you in
your life issues, you can share things with them
easily.

12. Grieving process
The normal process of reacting to a loss.
Emotional reactions of grief can include
anger, guilt, anxiety, sadness, and despair.
Physical reactions of grief can include
sleeping problems, changes in appetite,
physical problems, or illness.
Grieving includes the entire
emotional process of coping with a loss,
and it can last a long time

13. Conti..
⦿Grief is universal. At some point in everyone’s
life, there will be at least one encounter with
grief. It may be from the death of a loved one,
the loss of a job, the end of a relationship, or
any other change that alters life as you know
it.
⦿Grief is also very personal. It’s not very neat
or linear. It doesn’t follow any timelines or
schedules. You may cry, become angry,
withdraw, feel empty. None of these things
are unusual or wrong.

14. Grieving process and Alcohol
We are asking you to give up your
caretaking role, the role of enabler in the
disease of alcoholism. This will be a loss,
the death of a relationship, the loss of very
important role in your life and you will
experience a grief. Up to know you have
used a lot of energy, time and emotion in
caring for and worrying about the
alcoholic.

15. Conti…
We are asking you to give up this role , in
doing this you can pass through the
following stages of grief.

16. Stages of Grief
⦿In 1969, a Swiss-American psychiatrist
named Elizabeth Kübler-Ross wrote in her
book “On Death and Dying” that grief could
be divided into five stages. The five stages
of grief are:
⦿denial
⦿anger
⦿bargaining
⦿Depression
⦿Accepatance

17. Denial----it isn’t true
⦿Those who are emotionally involved with
an alcoholic deny that they cannot control
the situation. They deny there is a problem
often not to fear of betraying the alcoholic.

18. Examples
⦿Breakup or divorce: “They’re just upset.
This will be over tomorrow.”
⦿Job loss: “They were mistaken. They’ll call
tomorrow to say they need me.”
⦿Death of a loved one: “She’s not gone.
She’ll come around the corner any
second.”
⦿Terminal illness diagnosis: “This isn’t
happening to me. The results are wrong.”

19. Anger----I’m so mad
This stage asks “Why?”. The concerned
others become angry on the alcoholic, at
themselves, at life. They let the alcoholic
control them and become lost in their own
addiction---addiction to the alcoholic. They
are consumed with self pity.

20. Examples
⦿Breakup or divorce: “I hate him! He’ll regret
leaving me!”
⦿Job loss: “They’re terrible bosses. I hope
they fail.”
⦿Death of a loved one: “If she cared for
herself more, this wouldn’t have
happened.”
⦿Terminal illness diagnosis: “Where is God
in this? How dare God let this happen!”

21. Bargaining---Lets make a deal
The thought process can be this: “ I denied
it, and it didn’t go away, I raised the roof
and nothing happened, May be I can make
the deal…this is expressed by endless
offers that start with.. If you control your
drinking (stop or get help) we could take
that trip (enjoy more or live more like a
family).

22. Examples
⦿Breakup or divorce: “If only I had spent more
time with her, she would have stayed.”
⦿Job loss: “If only I worked more weekends,
they would have seen how valuable I am.”
⦿Death of a loved one: “If only I had called her
that night, she wouldn’t be gone.”
⦿Terminal illness diagnosis: “If only we had
gone to the doctor sooner, we could have
stopped this.”

23. Depression---there is nothing can
be done
When those around the alcoholic cannot
deny any longer, when anger does no
good, when bargaining proves futile, they
pass into depression. They have to learn
they are powerless to change anyone
other than self. This is the first step of AA
and A1 Anon program: “admitted we are
powerless over alcohol-that our lives had
become unmanageable”.

24. Examples
⦿Breakup or divorce: “Why go on at all?”
⦿Job loss: “I don’t know how to go forward
from here.”
⦿Death of a loved one: “What am I without
her?”
⦿Terminal illness diagnosis: “My whole life
comes to this terrible end.”

25. Acceptance---OK, that’s the way it
is, but I can change myself.
The end of caretaking role is the end of
important part of life, the death of a
relationship, a loss. Any time we give up a
role we are living in stress-we are grieving.
You have been living in a sick family system
and must willing to give up your role and
real with the addictive relationship.

26. Examples
⦿Breakup or divorce: “Ultimately, this was a
healthy choice for me.”
⦿Job loss: “I’ll be able to find a way forward
from here and can start a new path.”
⦿Death of a loved one: “I am so fortunate to
have had so many wonderful years with him,
and he will always be in my memories.”
⦿Terminal illness diagnosis: “I have the
opportunity to tie things up and make sure I
get to do what I want in these final weeks and
months.”

27. Profile of a caretaker
⦿ Caretaker have usually grown up being told by their
parents “don’t be selfish”. They go through life hiding
their own needs and turn all their attention to the needs
of others . They live in constant fear of being branded
as SELFISH.
⦿ Caretaker are usually lonely and emotionally
undernourished. They operate in an emotionally trade
deficit.
⦿ They give enormous amounts of compassion to others,
but will not accept emotional nurturing in return.
⦿ They have friends , but few intimate, nurturing
relationship.

28. Conti…
⦿Caretakers are afraid of their own anger as
well as the anger of others. They avoid
disagreements for peace at any cost. All
anger are directly inward where it can be
safely converted into depression.
⦿Caretaker are almost paralyzed when it
comes to asking for what they need
emotionally. After all, that would be selfish.

29. Cont…
When you give up the caretaking role you
will have more time to change yourself…
your recovery can begin.
Remember: Acceptance does not mean
that you have to like it..just accept it!.

30. BASIC TERMS
⦿Drugs: Drug is defined by WHO as “any
substance , which when taken into living
organism, may modify one or more of it’s
function”.
⦿Drug Abuse: Persistent or excessive use,
in consistent with or unrelated to
acceptable medical practice.
⦿Drug Misuse: Medical or lay use of drug,
for a disease state not considered to be
appropriate by the majority.

31. Cont…
⦿ Drug Overuse: Excessive medical or lay use of
drug, in terms of length of therapy or severity of
disorders in which there is accepted evidence of
the effect.
⦿ Drug dependence: Drug dependence occurs
when you need one or more drugs to function. The
American Psychiatric Association (APA) used to
distinguish between dependence and abuse.
Abuse was considered the mild or early phase of
inappropriate drug use that led to dependence.
People viewed dependence as a more severe
problem than abuse.

32. Cont…
⦿Physical dependence: It is the
physiological process by which the body
respond to certain drugs.
⦿Psychological dependence: A drug may
be taken because its effects make
stressful or anxiety-provoking situation
more bearable.

33. Conti…
⦿Tolerance: Tolerance is an adaptive state
characterized by a diminished response to
the same quantity of drug or requiring a
larger dose to produce the same dynamic
effect.
⦿Cross tolerance: In this, the individual not
only change his or her response to the
substance ingested, but he or she also
develops tolerance to related substance.

34. Conti…
⦿Reverse tolerance: It means that ingesting a
small amount of the substance may make
one or more sensitive to its effects on
subsequent occasion.
⦿Withdrawal: In withdrawal, a substance
specific syndrome follows reduction in intake
of a substance that was previously regularly
used by the individual to induce a
physiological state of intoxication.

35. Classification of Drugs
⦿Narcotics: Put people sleep and in similar
doses, relieve pain.
⦿Barbiturates: Calm people down and
relieve anxiety.
⦿Amphetamines and Cocaine: speed up
people reaction and counteract fatigue.
⦿Hallucinogens: Recreate some of the
symptoms of psychosis such as
hallucinations and diminished contact with
reality.

36. Conti….
⦿Marijuana: Have relaxing effects and
seem to heighten sensory perception.

37. 12 steps NA program
1.We admitted that we were powerless over our addiction ,that
our lives had become unmanageable
2.We came to believe that a power greater then ourselves
could restore us to sanirt
3.We made a decisions to turn our will and our lives over to
the care of God as we understood him .
4 . We made a searching and fearless moral inventory of
ourselves.

38. Conti..
⦿ 5 .
⦿ We admitted to God ,to ourselves ,and to another human being
the exact nature of our wrongs
⦿ 6 .
⦿ we were entirely ready to have God remove all these defects of
character
⦿ 7 .
⦿ We humbly asked him to remove our shortcomings

39. ⦿ 8 .
⦿ we made a list of all persons we had harmed and became
willing to make Amends to them all
⦿ 9
⦿ We made direct amends to such people wherever possible
,except when to do so would injure them or others
⦿ 10
⦿ We continued to take personal inventory and when we were
wrong promptly admitted

40. ⦿ 11
⦿ We sought through prayer and meditation to improve our
conscious contact with GOD. As we understood him praying
only for knowledge of his will for us and the power to carry
out that .
⦿ 12
⦿ Having a spiritual awakening as a result of these steps ,we tried
to care this message to addicts ,and to practice these principles
in all our affairs

41. RELAPSE
⦿ A person who's trying to stop using drugs can make
mistakes, feel bad, and start using again. This return
to drug use is called a relapse.
⦿ Relapse is common and normal and happens to a lot
of people recovering from drug addictions.
⦿ People will often have one or more relapses along the
way. It takes practice to learn how to live without
drugs.

42. Symptoms of relapse
⦿Emotional Relapse:
⦿ Emotional relapse is often the first stage of relapse, and it
occurs before someone in recovery even begins to consider
using again.
⦿ The individual usually starts to experience negative emotional
responses, such as anger, moodiness and anxious feelings.
⦿ They also may begin to experience erratic eating and sleeping
habits, and their desire for recovery often wanes due to a lack
of using their support systems

43. Mental Relapse
⦿ Mental relase is the second stage of the process.
⦿ This is often a time of internal struggle for a person in
recovery, as part of them wants to remain on the road
to long-term sobriety; however, that part of them is
embattled in a tug-of-war of sorts with another side
that wants to return to using.
⦿ There may always a part of a person that wants to use
again, which is why addiction is considered to be a
chronic condition.

44. ⦿As this phase of the relapse process progresses,
direct thoughts about using eventually arise,
and at this point, it’s very difficult to stop the
process. When someone dealing with addiction
decides they are going to use, it’ usually just a
matter of time until they do it

45. ⦿Denial
⦿Avoidance +defensiveness
⦿Immobilization
⦿Depression
⦿Behavioral loss of control
⦿Recognition loss of control
⦿Option reduction

46. SYMPTOMS OF RELAPSE
AYESHA MEHBOOB

47. DENIAL
Apprehension about
wellbeing where
Alcohol patients
reported an initial
sense of fear and
uncertainty.
Reactivation at this
stage tends to deny the
presence of Alcoholism
Denial Systems
reactivated in Patients
(apprehension, anxiety,
stress)
Mostly patients were
unaware while
experiencing

48. AVOIDANCE AND
DEFENSIVENESS
For someone struggling
with a substance abuse
problem, maintaining
sobriety is often an
everyday challenge.
Firstly, patients convinced
themselves and this is the
most important step
Imposing sobriety on
others
Sobriety main issue:
Patients focus on what
others were doing rather
than their own actions
Defensive power
increases in patients

49. Cont.
Compulsive
behavior: rigid and
repetitive behavior
Impulsive behavior:
tend towards stress
Patients prefer
loneliness and
avoidance
increased
Patients view their
life in isolated
parts, focus only on
one area
Depression begins
to appear
Life plans start
diminishing and at
the end they fail

50. IMMOBILIZATION
Idle
daydreaming
:
Concentratio
n diminished
and was
replaced
with fantasy
01
A feel of
“Nothing can
be solved”
developed
02
Immature
wishes to
stay happy
appears
03
Confusion
period
started
which results
in Irritation
with friends
04
Easily get
anger and it
increased
05

51. DEPRESSION
Irregular eating habits like Overeating, Junk foods
Loneliness increases, resulting in inability to concentrate
Irregular sleeping habits, Insomnia is common
Daily routine get totally disturbed
Depression becomes more severe and more frequent

52. BEHAVIORAL LOSS OF
CONTROL
Irregular attendance in the meetings with Alcoholics
Anonymous (AA)
“I don’t care” attitude developed
Patients cut them off from any help
Dissatisfaction with life begins
Feel of being helpless and powerless started

53. RECOGNITION LOSS OF
CONTROL
Patients
become
generous with
themselves
01
Thoughts of
social drinking
increases
02
Patients
consciously
start lying
03
Patients loose
complete self-
confidence
04

54. OPTION REDUCTION
Unusual anger, sometimes generalized and sometimes
focused
Patient discontinue all treatments like AA sessions
Patients get totally overwhelmed and think that there is no
chance except returning to drink, suicide or insanity
Frustration, Anger and Tension increases

55. Relapse SCALES
Relapse Prediction Scale
▪ Scale has 2 parts
1. Strength of urges is to determine how strong you think the
urges will be in certain situations.
2. Likelihood of urges is to determine the likelihood that you
will use in these situations.
▪ Scale is based on prediction
▪ 50 items scale
▪ 0-4 are the ranges 0 indicates none and 4 indicates very strong

56. Cravings beliefs questionnaire
▪ Scale items are 20
▪ It’s a rating scale
▪ Rating scale is based on “agree” or “disagree”
▪ Ranges start from 1-7

57. BELIEF ABOUT SUBSTANCE USE(BASU)
▪ Scale is based upon common belief about drug use
▪ Scale items are 20
▪ It’s a rating scale
▪ Rating scale is based on “agree” or “disagree”
▪ Ranges start from 1-7

58. Daily record of cravings
▪ Record for cravings are based on 5 columns
▪ First column is about date
▪ Second column is about situation
▪ Third column is about thought or feelings
▪ Fourth column is about degree of craving 0-100
▪ Fifth column is about rational responses or coping

59. Treatment goals
⦿ Goals are brief statements about what you want to change and
should be:
• It should be based on your problem list related to substance
abuse.
• Focusing on eliminating a behavior, focus on how to replace a
harmful behavior with a healthy one.

60. How the client can achieve the goals
▪ List of goals.
▪ In which goal you will need help.
▪ Divide these goals into long term and short term goals.
▪ Choose at least two goals for achieving.
▪ Prioritize the goals. First choose the goal which is more
important for you as a client.

64. DAILY JOURNALS
▪ Journaling is a type of expressive writing where you put
thoughts and feelings down on paper to help you to understand
and cope with these thoughts and emotions.
▪ It’s a record of your experiences and feelings relate to your
recovery process
▪ It can be used to record your recovery related struggles and
difficult emotions
▪ Decisions and actions are also part of this record.

65. Why journaling imp in addiction recovery
process
▪ Express Difficult Feeling
During the addiction recovery process, you will be
battling with some difficult emotions. Journal can serve as an
outlet to get any feeling or frustrations off your chest and onto
paper. It is beneficial for your recovery progresses.
▪ Celebrate Daily Progress
The addiction recovery process takes time but if the client
will be honest with yourself in your journal, you will be able to
track and celebrate progress from day to day and week to week.

66. ▪ Personal Accountability
Personal accountability is difficult duty in addiction
recovery process, specially during early stages. It can help the
client to develop a positive habit in place of a negative one.

67. BENEFITS OF JOURNALING
▪ Helping you prioritize problems, goals and responsibilities
▪ Tracking your symptoms and successes on regular basis
▪ Helping you better recognize, understand and deal with
trigegers
▪ Helping you to identify negative thoughts and habits and you
can replace them with positive.