Managing unhealthy relationships
Condensed version
Advised Leah to anticipate situations where she will feel pressure to use and to prepare for them in advance. Prompted her to consider sources of both direct and indirect pressure. Modeled ways of declining offers to use. Offered alternatives such saying she has an important appointment in the morning or is taking medications that can’t be combined with drugs or alcohol. If there is a social gathering she needs to attend where she feels he may be tempted to use, suggested she take a trusted support person along. Role-played to help her practice declining offers. Helped her identify situations that should be avoided altogether. Emphasized the importance of making new friends to take the place of ones she may need to leave behind.
Full version
Session 1: Engaged Leah in a discussion about unhealthy relationships. Informed her that one of the biggest factors contributing to relapse on drugs and alcohol is peer pressure. This may involve other people directly offering her substances or just urging her to party. Pressure can also be indirect and may involve situations where people are using without directly asking her to use. Explained that by thinking ahead and identifying the pressures she is likely to experience, she can come up with strategies to avoid giving in and practice using them. Instructed Leah to spend the next week identifying situations where she feels she is most likely to give in to drug or alcohol use. Explained that in future sessions, we would brainstorm ways of handling those situations when encounters them.
Session 2: Last week I directed Leah to identify situations where she felt she was most likely to give in to drug or alcohol use, and decide in advance what she will do if she encounters them. Today I offered suggestions for ways of handling those situations. If anyone asks, she should be up-front about her desire not to use. If necessary, she can tell the person she is in recovery and would appreciate it if they don’t offer her drugs or alcohol again. Or she can say she is taking medication and isn’t allowed to drink or use anything while on it. If there is an upcoming event where she knows she may feel pressure to use – but it’s an event she doesn’t want to miss – she could take a support person with her, such as a friend in recovery, a sponsor, or a family member who knows about her recovery. If she is feeling an increasing pressure to use or thinks she may be tempted to use, she should get out of the situation as quickly as possible.
Session 3: Helped Leah practice and internalize skills she learned in prior sessions. Asked her to imagine that one of her friends has offered her drugs or alcohol, then brainstormed with her to come up with at least three strategies she could use to help her refuse their offer. Leah came up with four ideas: "Tell them I have to go get tested tomorrow and let them imagine what that means", "Tell them I could lose my housing", "Say I have something important to do first thing in the morning", and "Just look them in the eye and tell them I’m trying hard to stay clean". Discussed how refusing this offer would affect her physically and emotionally, and the coping skills she would use to manage those feelings.
Session 4: Reviewed suggestions for handling high-risk situations we talked about last week. Asked Leah to recall three of the high-risk situations she identified after our first meeting, then role‐played encountering these situations with her. Encouraged her to try using the ideas she came up with in our last session. Provided feedback and offered suggestions for improvement. Praised her for successfully engaging in each role‐play scenario and for demonstrating effective ways of refusing offers to use. Emphasized the importance of emotional support and encouraged Leah to look for opportunities to make new friends to take the place of ones she may need to leave behind in order to keep moving forward in her recovery.