Author: Melissa Killeen

[This is the third in a series of short posts about my interactions with recovery coaching clients. I want to share what happens during a recovery coaching engagement, the discussions that take place, what usually comes up for the client and how as a recovery coach I respond. In this post, I am still working with the client who relapsed.]

This month, a very well-known actor fatally overdosed on a “speedball,” a hazardous intravenous mix of cocaine and heroin or morphine, blended in and delivered from a single syringe. My client’s drugs of choice were speedballs, and so it was only natural when he talked about how he read absolutely everything about this actor, every newspaper article, listened to every radio broadcast and even bought People magazine to read about him.

This prompted a further discussion about “triggers.” As a result of this conversation my client began to understand and practice stimulus control. He realized (correctly) that as addicts we cannot change the “activating events,” cues or triggers that precede a relapse but we can change how we react to them. So, we don’t listen to the radio broadcast for the fifth time, or purchase People magazine. We click off the television in our mind as well as the TV in our living room and escape these triggers.

People, places and things—Some triggers we can avoid, like driving past that strip club, or hanging out at a neighborhood bar, drinking club soda.  We learn to accept the things that can’t be changed, like the death of this actor. They can cue you, but they don’t have to rule you.

I suggested that my client avoid the news altogether, for one month. No more CNN ceaselessly playing in the background. The morning paper left unread. A test, if you will, to see if this small attempt at stimulus control would work.

As a substitute for the news, I suggested he select a “”valued direction” to fill its void. As we all know, if you take something away, something else must take its place. Fortunately, my client loves cooking. Since coming home, he has taken on the responsibility of making dinner for his girlfriend and son. I suggested that he really get into cooking, to view it as an opportunity, in part, that would help him realize a goal of developing a balanced life with healthy indulgences and activities that can substitute for undesirable addictive behaviors. Now, along with turning off CNN, he is planning meals for the week, creating recipes and shopping daily for fresh organic ingredients. As it turns out, he is going beyond just dinner. As of late, he has begun each day packing his girlfriend’s lunch from the previous night’s leftovers.

[This is the second in a series of short posts about my interactions with recovery coaching clients. I want to share what happens during a recovery coaching engagement, the discussions that take place, what usually comes up for the client and how as a recovery coach I respond.]

In this post, I am still working with the gentleman who had relapsed. One of the consequences of his relapse is that he was discharged from his Intensive Outpatient Program (IOP). We spent time during one of the afternoon appointments I had with him using Google search to find another therapist, and an outpatient program he could attend.

Getting psychological help when needed is important. With many of my clients, their addiction is a symptom of an underlying mental health issue; this is often called a co-occurring symptom or disorder. Seeking and getting the necessary psychological help for this client, and medication for suspected psychiatric illnesses, was crucial. It is important that he learns better ways of coping with life events than drinking and drugging.

Treatment options for addiction are not limited to psychotherapy or support groups. In our research for a new psychiatrist, my client commented that he wanted to consider medication-assisted recovery options. I provided him printouts describing the many medications that are available for the recovering person. We reviewed these printouts and discussed what he thought about each medication, while further discussing the perception of medication-assisted recovery as a positive sign. People in this client’s 12-step meetings consider taking medication to assist in recovery another form of addiction. We talked further about this prevailing 12-step-group attitude and I made it clear that it was never a mark of failure or inadequacy to take medication as prescribed and needed. I assumed the role of an educator, pointing out the possible side effects and interactions, asking him to keep in mind that it is important for him to complete a full psychiatric and medical evaluation before considering these medications. He expressed a willingness to look at medications like Disulfiram (Antabuse®), Naltrexone (ReVia®), or Acamprosate (Campral®).

As a result of our investigations into finding a new psychiatrist and doctor, my client scheduled two appointments the following week to interview prospective doctors. Both physicians use medication-assisted therapy as part of their treatment plan. And my client scheduled at the end of the month an evaluation for a new outpatient program, as well.

Over the next few months I would like to share with you a series of short posts about my interactions with recovery coaching clients. I would like to share what happens during a recovery coaching engagement, the discussions that take place, what usually comes up for the client and how as a recovery coach I respond.

In previous blog posts, I have described working with a client who has relapsed. That the severity of the consequences of his relapse far exceeded any expectations he might have had really hit him hard. His girlfriend left him. He was discharged from his Intensive Outpatient Program. His Employee Assistance professional reported the relapse to his employer. And his mother will not answer his phone calls. He was sure that I would leave him, as well.

This is the time a client most needs a recovery coach to hold out their hand as that client slowly climbs out of the hole. Portia Nelson describes this process in her book, There’s a Hole in My Sidewalk: The Romance of Self-Discovery.

“I walk down the street.
There is a deep hole in the sidewalk.
I fall in.
I am lost . . . I am helpless.
It isn’t my fault.
It takes forever to find a way out.

I walk down the same street.
There is a deep hole in the sidewalk.
I pretend I don’t see it.
I fall in again.
I can’t believe I am in the same place.
But, it isn’t my fault.
It still takes me a long time to get out.

I walk down the same street.
There is a deep hole in the sidewalk.
I see it is there.
I still fall in. It’s a habit.
My eyes are open.
I know where I am.
It is my fault. I get out immediately.

I walk down the same street.
There is a deep hole in the sidewalk.
I walk around it, looking at the hole.

Today, I walk down another street.”

I give this poem to my clients, if and, when they relapse and on each occasion of any future relapses. One of my clients received from me fifteen copies of this poem! Sometimes, often, a recovery coach has to sit back and watch their clients fall into that hole, until those clients decide to walk down another street.