Category: Recovery Coaching

[This is the fourth 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.]

As discussed in my last few posts, I am working with a gentleman who relapsed some two months ago. At our last meeting, he and I discussed Medication Assisted Therapy (MAT). My client is considering using a specific medicine to aid him in his recovery. Appropriately, he mentioned this to his 12-step sponsor, and not surprisingly, the sponsor expressed his objection to MAT. The sponsor was adamant that my client not use drugs of any kind as a crutch for getting and staying clean. “No matter what, don’t pick up,” his sponsor warned, along with a litany of other 12-step slogans.

My client is affected by drugs, alcohol and a variety of processes or behavioral addictions. At the risk of discrediting any of the 12-step programs because of one person’s opinion, the following describes the impact that opinion had on my client.

In our meeting, he began to rant, spewing out the negative thoughts and feelings any addict holds against recovery, against 12-step programs, and for giving into his addiction. Giving up was number one on his list of negative talk. Even though there are statistics that show 12-step programs are credited for approximately 10% of the addict population getting clean, I could not allow my client to go down that path of giving up. Not with so little clean time under his belt. So what did I do?

Listened. I just listened. I could hear (and see) the emotional distress he was feeling. I knew this was no place for advice giving. And if I wanted to hear what he really had to say, I had to be quiet. I had to resist the voice in my head that was compiling good statistics on recovery. The general comments I could make to persuade him to feel and believe otherwise were best left unsaid. I had to block out all distractions, like his son upstairs playing Hip Hop music, and really concentrate on what he was telling me.

I chose to find greater value in observing this client, how he was sitting, leaning forward or pushing back into his chair, even the way in which his hands were waving about or hitting the armrest. You can glean a lot of information from tone, delivery, and body language.

I wanted him to know I was listening to him. So I leaned forward, maintained eye contact, and when I agreed, I nodded in the affirmative. When I disagreed, well, I remained still. As a coach, I often use my personal recovery experience to help my clients. But not this day, even though I had suffered a similar incident, it was not about me.

Eventually, at what seemed an appropriate moment, I spoke up. Using motivational interviewing techniques, I repeated some of the points my client had heatedly made. When unsure, I said, “Let me see if I have this right,” or words to that effect, and I would paraphrase a statement he had made. I asked open-ended questions beginning with the interrogatives, what, where, how, and when, and did not use the word why.

To the untrained ear, it was fifty minutes of listening to a high-volume tirade. But to me, much became apparent. He was frustrated with the slowness of his recovery. And tired of battling with his personal demons. He feared losing everything — his sobriety, his job, his girlfriend — as well as the calm provided by his drug of choice. He felt he couldn’t win. (Not winning for my client was never an option, coming from a high-pressured, always competitive family). He was convinced he’d run out of options. At least, he said, “when using he didn’t worry about winning, losing or anything else, for that matter.”

When his emotional fire had cooled, he popped the tab on a Diet Coke, took a good pull from it and said, “You know, no one listens to me. Thanks for listening to me.” Seeing the gratitude on his face was all I needed. The process of working out his feelings and expressing his thoughts was what he needed from his coach that day.

Lesson learned.

[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.