As any therapist knows, the beginning of the year is when a lot of new clients show up, and when a lot of old clients decide to get serious about the work they’ve been doing. They seem to view the new year as a great time for a fresh start. This is especially true with addicts. Unfortunately, an addicted client’s enthusiasm for recovery can wane as quickly as our own resolutions to go to the gym every day, eat better, etc. The good news is there are things we can do, as therapists, that can help our clients make and sustain desired changes.
Set (or Reset) Goals
When I suggest setting/resetting goals as part of addiction-focused therapy, I’m talking about more than just the surface actions of goal setting, such as “I want to stop drinking.” What I’m talking about here is the deeper dive, looking at why a client’s goals matter. Why does the client want to quit drinking? What parts of the client’s life will improve as a direct result of meeting this goal? And which of those facets of life are most important as motivation for the client?
If it seems appropriate, you can assign this as a homework exercise, asking the client to list one to three very specific recovery-related goals for the upcoming year, with five to ten reasons why each of those goals is important. This work can then be discussed in therapy to provide clarity not only for the addict, but for you as a helping professional.
Create a Workable Action Plan
Addicted clients nearly always benefit from a written plan of action for achieving their goals. And I can’t stress the word “written” strongly enough. Make them write their action plan down. There’s something powerful about writing something down before reading it and discussing it in therapy (and maybe elsewhere). The act of writing a plan down gives it heft and credence that verbalization alone doesn’t create.
With my addicted clients, I usually suggest a three-tiered “traffic signals” plan, with red lights, yellow lights, and green lights. And yes, this is exactly what it sounds like. If a client’s goal is to stop drinking, red light behaviors would be things like drinking alcohol, buying alcohol, and hanging out in a bar. Yellow light behaviors could be things like going to a party where alcohol is freely available, feeling anxiety and not talking about it to a friend or in therapy, and skipping AA meetings or therapy sessions. Green light behaviors are positive actions the client can take instead of drinking. These can be immediate and concrete, like spending more time with the kids, painting the house, and taking up a hobby, or longer-term and less-defined, like going back to school, finding a more fulfilling job, and building a better marriage.
Once the client has created an action plan, the plan should be discussed in therapy, and perhaps with friends, family, and the client’s 12-step sponsor, with the client seeking feedback and amending his or her plan based on that feedback.
Identify Warning Signs for Slippage
This is an extension of the “yellow lights” portion of the action plan. I’m giving it separate attention here because these are certain issues that addicts don’t normally think about when creating an action plan. If you think it will be helpful, you can present your addicted client with the following list of slippery slope items to watch out for, discussing this list in therapy and identifying ways to combat these issues.
- Overconfidence: “This is going great. Maybe I’ve got this problem under control and I can relax a bit.”
- Denial: “I’ve had this under control for an entire week now, so obviously it’s not as big of a problem as I thought.”
- Minimization: “It’s not a big deal if I ‘give in’ just this once, for a few minutes.”
- Isolation: “I can handle this on my own. I don’t need therapy or any other support. I don’t need others to help me with this.”
- Blaming: “This really isn’t my fault. My parents neglected and abused me, and I behave this way because of them. They should be the ones in therapy, not me.”
- Devaluing Feedback: “My therapist and the people in my 12-step group don’t really understand what I’m going through, so I don’t need to take their advice.”
- Feeling Like a Victim: “If the world didn’t suck so much, I wouldn’t want to….”
- Rationalizing: “It’s OK for me to backslide a little when traveling for work or on vacation. My action plan doesn’t count when I’m in a different state.”
- Feeling Entitled: “I’ve worked really hard on my recovery, and I’ve been putting in extra hours at work, too, so I deserve a little treat.”
- Keeping Secrets: “What my therapist, family, and friends don’t know can’t hurt them.”
Identify Alternative Actions
This is an extension of the “green lights” portion of the action plan. Again, these possibilities can be discussed (and even practiced) in therapy as a way of familiarizing addicted clients with their healthy options.
- Gratitude: One of the best ways to combat anxiety, depression, stress, and other triggers toward addiction is to practice gratitude. In therapy, I often ask my addicted clients to, on a daily basis, list ten things they are grateful for. Some clients struggle with this initially. If so, I ask them to stick with it, knowing the task gets easier with practice. I also ask them to pay attention to how their thoughts and feelings change both in the moment and over time. Usually, they come to see that’s it’s impossible to be grateful and unhappy at the same time.
- HALT: HALT is an acronym for Hungry, Angry (or Anxious), Lonely, and Tired. Addicts can learn to HALT and check in with themselves to see what they’re feeling and experiencing at any given time. If they’re out of sorts, they can ask themselves, “When is the last time I had something to eat, did I get enough sleep last night, am I ticked off or worried about something, am I feeling lonely or isolated?” Usually, a sandwich, a nap, or a quick phone call to a friend or loved one will change the addict’s mood and decrease the odds of relapse.
- Bookending: Life is filled with temptations, and often these potential pitfalls can be seen well in advance. For instance, a client who wants to stop drinking may need to attend a work-related event with an open bar. If so, the client can call a supportive friend before the event to check in and to discuss a plan for staying sober (including leaving the event if necessary). After the event, the client can call that same friend to discuss what happened, the feelings that came up, and what the client might want to do differently in the future.
For the most part, keeping addicted clients on track and focused on their goals for change is the same at the beginning of the year as any other time of year. However, because addicts are often more motivated now as opposed to later, it may be useful to push them a bit harder than usual by asking them to examine their goals in greater detail, to create and commit to an action plan, and to look at and plan for potentially slippery situations. With this work, addicted clients have a much better chance of ultimately reaching their goals, though they are still likely to do so imperfectly.