Tag: substance use

This is a generic, sample treatment plan for SUD (substance use disorder). It includes a suggested reading list as well as the National Institute on Drug Abuse’s principles of effective substance use treatment.

Treatment Plan for SUD

• Goals
• Objectives
• Interventions
• Recommended Reading

CLIENT GOALS

Increase knowledge about addiction and treatment: Individuals should have a basic understanding of addiction, including the signs, symptoms, and the underlying factors associated with developing a SUD. Individuals should be introduced to multiple treatment approaches. (There is no “one-size-fits-all.”)

Develop coping and emotional regulation skills: Individuals should learn how to cope with stress, difficult emotions, and cravings without using substances.

Improve social support and develop effective interpersonal skills: Individuals should develop a strong support network of people who care about them and can help them in their recovery as well as learn how to communicate effectively.

Relapse prevention: Individuals should develop a written plan for how they will maintain their sobriety. Components of a strong relapse prevention plan include the following:  

1. Identify triggers and warning signs: One of the first steps in relapse prevention is identifying triggers. Triggers can be internal (i.e., difficult emotions, thoughts about using, etc.) or external (i.e., people, places, events, circumstances, etc.) Warning signs are behavioral changes or changes in mood or thinking that may indicate the person is in “relapse mode.” Common warning signs include isolation, not attending 12-step meetings, sleeping too much or too little, irritability, etc. (Hint: The individual should consider asking significant others, close friends, or family members for help with identifying their warning signs.)
2. Develop a coping plan: Once the individual is aware of their triggers and warning signs, they can develop a plan for how they will manage them. This plan might include things like calling a friend, going to a meeting, or taking a walk. The plan should be individualized; things that work for one person may not work for other. The plan should also include coping or distraction techniques for cravings. (Consider this worksheet for tracking urges to use.)
3. Identify and avoid high-risk situations: If certain situations are likely to trigger the individual, it is best to avoid them if possible. This might mean not going to certain places or not hanging out with certain people. The individual should consider setting boundaries with loved ones who trigger them. If a situation is unavoidable, they may want to bring their sponsor or trusted person with them.
4. MAT (medication-assisted treatment): A psychiatrist or other licensed provider can prescribe medications such as naltrexone or buprenorphine to reduce cravings. (For locating a practitioner who specializes in MAT, see Buprenorphine Treatment Practitioner Locator | SAMHSA.)
5. Mental health treatment: If the individual has a mental health diagnosis, it’s important to take mental health medications as prescribed and attend all scheduled psychiatric appointments. It’s also important to understand how co-occurring disorders interact with substance use.
6. Stay connected to a support network: It is important to stay connected to a support system, such as a therapist, 12-step (or similar) group (e.g., Alcoholics Anonymous, NA, SMART Recovery, Celebrate Recovery, Women for Sobriety, etc.), peer support, or friends and family who are supportive of recovery goals. A recovery network can help the individual to stay on track.
7. Practice self-care: Self-care and wellness practices are important for everyone, but especially so for individuals in recovery. It’s crucial to get enough rest, eat healthy foods, drink plenty of water, attend to physical illness, and exercise regularly (at a minimum). Nutrition in recovery is especially important for heavy drinkers; the individual should consider seeing a nutritionist if they have a history of alcoholism.
8. Find hobbies or leisure activities to pursue: A strong recovery program is balanced and includes enjoyable activities. The individual should plan leisure activities or explore new hobbies and engage in them on a regular basis.
9. Explore spirituality: Many individuals find that spiritual practices such as attending church, seeking guidance from a spiritual leader or shaman, forest “bathing,” etc. enhance their recovery program.  
10. Have patience: Relapse prevention can be a lifelong process. There may be times when slip ups happen. This does not take away from the time the individual maintained their sobriety. The important thing is to get back on track and not give up.

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CLIENT OBJECTIVES

• Client will abstain from or reduce the use of mood-altering substances.
• Client will identify the consequences of their addiction.
• Client will identify their triggers, high-risk situations, and warning signs.
• Client will develop a plan for coping with cravings and triggers.
• Client will identify, challenge, and replace destructive thought patterns with positive, reality-based self-talk.
• Client will attend 12-step meetings (or other support groups) regularly. (For online support groups, see The 7 Best Online Sober Clubs.)
• Client will develop a support system of people and organizations that are supportive of their recovery.
• Client will find a job or start school.
• Client will maintain a healthy and balanced lifestyle that includes pleasant activities and self-care.
• Client will manage their finances.
• Client will resolve any legal issues.
• Client will maintain healthy relationships with supportive family and friends.
• Client will develop a written relapse prevention plan.

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THERAPIST INTERVENTIONS

Assess for the following:

• Suicide risk
• Cognitive deficits (either as a result of long-term use and/or overdoses or pre-existing conditions that may impair individual’s insight)
• Co-occurring disorders
• Pregnancy
• Trauma – If severe, individual would benefit from evidence-based trauma treatments, such as CBT, EMDR, CPT (cognitive processing therapy), or TF-CBT
• Conditions that lead to “self-medicating” (e.g., insomnia, chronic pain)
• Recent events (divorce, death of a loved one, etc.) or circumstances (poverty, disability, etc.) that may directly influence substance use
• Family of origin problems – Especially in younger individuals, family therapy should be considered as part of the treatment plan
• Safety concerns – Screen for domestic violence, unsafe living environment (e.g., staying at a homeless shelter), at high-risk for overdose, etc.
• Stage of change – Consider harm reduction for individuals who are not ready to commit to sobriety (e.g., Narcan, fentanyl strips, etc.) (For an evidence-based guide on enhancing motivation for change, see TIP 35: Enhancing Motivation for Change in Substance Abuse Treatment | SAMHSA.)

Evidence-based therapeutic approaches:

• Motivational interviewing
• Motivational enhancement therapy
• Mindfulness-based therapies
• CBT
• DBT
• MAT (refer to)
• Behavioral therapy
• Family or couples therapy
• Trauma therapy (EMDR, CPT, Seeking Safety, etc.)
• Experiential therapies
• Contingency management

Therapeutic interventionS:

• Complete a thorough biopsychosocial assessment.
• Assess for severity of addiction and for the need for medical detox services; refer as needed. (Consider using the ASAM criteria.)
• Refer client to a medical provider for a physical/wellness exam and STI testing (as needed).
• Refer client to a psychiatrist for an evaluation and medication management, including MAT, (as needed).
• Individualize treatment (or refer to a specialist) for co-occurring disorders.
• Assess the severity of impairment in the individual’s different life areas to guide a collaborative treatment plan.
• Link client to community resources for deficits in education, employment and/or finances and for legal help (as needed/appropriate).  
• Explore how past events or circumstances (as appropriate) may have impacted the individual’s addiction.
• Provide client with education on addiction (risk factors, signs and symptoms, addiction science, long-term and permanent consequences, complications, etc.)
• Provide client with education on various treatment options and approaches (i.e., harm reduction, abstinence, moderation, etc.)
• Assist client in identifying their risk factors, triggers, high-risk situations, and warning signs.
• Help client to identify consequences and benefits of use.
• Help client to identify coping skills.
• Assist client with the development of a crisis plan (including things they can do, people they can contact, hotlines, etc.)
• Teach assertiveness, anger management, and distress tolerance skills.
• Teach mindfulness practices, grounding techniques, and self-soothing activities.
• Recommend local 12-step and/or support groups.
• Educate client on the benefits of peer support and link client to a peer recovery center or a peer recovery support specialist.
• Assess for case management needs (e.g., transportation, childcare, etc. that may impact client’s ability to attend outside meetings), and link client to appropriate resources.
• Assist client in identifying supportive persons in their life and maintaining a strong support network.
• Help client to identify activities they find meaningful and/or pleasurable.
• Explore spirituality with individual.
• Teach problem-solving and decision-making skills. (For additional problem-solving worksheets, see 10 Best Problem-Solving Therapy Worksheets & Activities (positivepsychology.com).
• Explore the role of shame and guilt in addiction.
• Explore values and motivation for recovery.
• Teach self-compassion and explore self-care practices. (For more on self-compassion, see Homeworks and Handouts for Clients (actwithcompassion.com).)
• Explore making amends (including “living amends”), forgiveness, and self-forgiveness.
• Assess for self-esteem problems and assign strengths-based homework or review client’s accomplishments and strengths in sessions.
• Utilize CBT techniques for irrational thought patterns that impact client’s ability to stay sober.
• Teach and role play refusal skills.
• Teach conflict resolution skills.
• Challenge and develop discrepancy with clients in the later stages of change.
• Consider implementing a reward system for attending therapy appointments; this works well with individuals who misuse stimulants. (See Counselor’s Treatment Manual for more on stimulant use treatment.)
• Assist client in developing a written relapse prevention plan. (Consider this free workbook from Between Sessions.)
• Assign homework to support the individual’s goals.
• Use bibliotherapy for addiction recovery. (See suggested reading list below.)
• If client relapses, revisit the relapse prevention plan, problem-solve, and amend as needed.

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SUGGESTED READING FOR SUBSTANCE USE AND RELATED DISORDERS

Disclaimer: This section contains affiliate links. As an Amazon Associate, I earn from qualifying purchases.

Addiction and Change: How Addictions Develop and Addicted People Recover by Carlo C. DiClemente

The Addiction Recovery Skills Workbook: Changing Addictive Behaviors Using CBT, Mindfulness, and Motivational Interviewing Techniques by Suzette Glasner-Edwards, PhD

Adult Children of Alcoholics by Dr. Janet G. Woititz 

The Anxiety and Phobia Workbook by Edmund J. Bourne, PhD

Attached: The New Science of Adult Attachment and How It Can Help You Find – and Keep – Love by Amir Levine

Becoming Aware: A 21-Day Mindfulness Program for Reducing Anxiety and Cultivating Calm by Dr. Daniel Siegel, MD

Beyond Addiction: How Science and Kindness Help People Change by Jeffrey Foote

Beyond the Influence: Understanding and Defeating Alcoholism by Katherine Ketcham

The Big Book of Alcoholics Anonymous by Anonymous

The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk, MD

Boundaries: When to Say Yes, How to Say No to Take Control of Your Life by Henry Cloud

Braving the Wilderness: The Quest for True Belonging and the Courage to Stand Alone by Brené Brown

The Cognitive Behavioral Workbook for Anger: A Step-by-Step Program for Success by William J. Knaus, EdD

The Cognitive Behavioral Workbook for Anxiety: A Step-By-Step Program by William J. Knaus, EdD

The Cognitive Behavioral Workbook for Depression: A Step-by-Step Program by William J. Knaus, EdD

The Complete Family Guide to Addiction: Everything You Need to Know Now to Help Your Loved One and Yourself by Thomas F. Harrison

The Complex PTSD Workbook: A Mind-Body Approach to Regaining Emotional Control and Becoming Whole by Arielle Schwartz, PhD

The Dance of Anger: A Woman’s Guide to Changing the Patterns of Intimate Relationships by Harriet Lerner

The Dance of Intimacy: A Woman’s Guide to Courageous Acts of Change in Key Relationships by Harriet Lerner

The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance by Matthew McKay, PhD

Feeling Great: The Revolutionary New Treatment for Depression and Anxiety by David D. Burns, MD

Flourish: A Visionary New Understanding of Happiness and Wellbeing by Martin E. P. Seligman

The Four Agreements: A Practical Guide to Personal Freedom (A Toltec Wisdom Book) by Don Miguel Ruiz

Get Out of Your Own Way: Overcoming Self-Defeating Behavior by Mark Goulston

The Happiness Advantage: How a Positive Brain Fuels Success in Work and Life by Shawn Achor

The Happiness Trap: How to Stop Struggling and Start Living by Russ Harris

In the Realm of Hungry Ghosts: Close Encounters with Addiction by Gabor Maté, MD

It Will Never Happen to Me: Growing Up with Addiction as Youngsters, Adolescents, and Adults by Claudia Black, PhD

A Mindfulness-Based Stress Reduction Workbook by Bob Stahl, PhD

The Mindfulness Workbook for Addiction: A Guide to Coping with the Grief, Stress, and Anger That Trigger Addictive Behaviors by Rebecca E. Williams, PhD

Narcotics Anonymous Basic Text by Anonymous

The Power of Habit: Why We Do What We Do in Life and Business by Charles Duhigg

The PTSD Workbook: Simple, Effective Techniques for Overcoming Traumatic Stress Symptoms by Mary Beth Williams, PhD, LCSW, CTS

Radical Acceptance: Embracing Your Life with the Heart of a Buddha by Tara Brach

Refuge Recovery: A Buddhist Path to Recovering from Addiction by Noah Levine

Self-Compassion: The Proven Power of Being Kind to Yourself by Dr. Kristin Neff

The Self-Esteem Workbook by Glenn R. Schiraldi, PhD

The Sober Survival Guide: How to Free Yourself from Alcohol Forever – Quit Alcohol & Start Living! by Simon Chapple

The Subtle Art of Not Giving a F*ck: A Counterintuitive Approach to Living a Good Life by Mark Manson

Twelve Steps and Twelve Traditions by Anonymous

Under the Influence: A Life-Saving Guide to the Myths and Realities of Alcoholism by James Robert Milam

The Upward Spiral: Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time by Alex Korb, PhD

The Wellness Workbook: How to Achieve Enduring Health and Vitality by John W. Travis

A Woman’s Addiction Workbook: Your Guide to In-Depth Healing by Lisa M. Najavits

You Are a Badass: How to Stop Doubting Your Greatness and Start Living an Awesome Life by Jen Sincero

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NIDA’S PRINCIPLES OF EFFECTIVE TREATMENT

1. Addiction is a complex but treatable disease that affects brain function and behavior. Drugs of abuse alter the brain’s structure and function, resulting in changes that persist long after drug use has ceased.
2. No single treatment is appropriate for everyone. Treatment varies depending on the type of drug and the characteristics of the patients.
3. Treatment needs to be readily available. Because drug-addicted individuals may be uncertain about entering treatment, taking advantage of available services the moment people are ready for treatment is critical.
4. Effective treatment attends to multiple needs of the individual, not just his or her drug abuse. To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems. It is also important that treatment be appropriate to the individual’s age, gender, ethnicity, and culture.
5. Remaining in treatment for an adequate period of time is critical. The appropriate duration for an individual depends on the type and degree of the patient’s problems and needs. Research indicates that most addicted individuals need at least 3 months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment.
6. Behavioral therapies—including individual, family, or group counseling—are the most commonly used forms of drug abuse treatment.
7. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
8. An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs. A patient may require varying combinations of services and treatment components during the course of treatment and recovery.
9. Many drug-addicted individuals also have other mental disorders. Because drug abuse and addiction—both of which are mental disorders—often co-occur with other mental illnesses, patients presenting with one condition should be assessed for the other(s).
10. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse.
11. Treatment does not need to be voluntary to be effective.
12. Drug use during treatment must be monitored continuously, as lapses during treatment do occur. Knowing their drug use is being monitored can be a powerful incentive for patients and can help them withstand urges to use drugs. Monitoring also provides an early indication of a return to drug use, signaling a possible need to adjust an individual’s treatment plan to better meet his or her needs.
13. Treatment programs should test patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk-reduction counseling, linking patients to treatment if necessary.

Source: Principles of Drug Addiction: A Research-Based Guide (Third Edition) (nih.gov)

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