Practice Demonstration - Substance Abuse Counseling

Summary

This video script centers on substance abuse counseling, particularly during the active treatment phase. It emphasizes the importance of cognitive behavioral counseling and skills training to help clients manage thoughts, emotions, and behaviors leading to substance use. The clinician guides clients in developing coping strategies, such as alternative activities to substance use for mood and energy enhancement. The dialogue also touches on managing external cues like people and places associated with substance use, and the challenges of maintaining abstinence. The clinician supports the client in identifying triggers and practicing refusal skills, highlighting the collaborative effort in recovery.

Takeaways

• 🌟 Substance abuse counseling during the active treatment stage focuses on identifying and addressing the client's unique triggers and consequences related to substance use.
• 🧠 Cognitive behavioral counseling and skills training are central to helping clients change thoughts, emotions, and behaviors that lead to substance use.
• 🔄 Counselors aim to assist clients in coping with cravings and developing new behaviors that can replace substance use without the negative consequences.
• 🚫 The process involves teaching coping skills such as managing urges, developing alternative behaviors, and recognizing the negative impacts of substance use.
• 💡 Clinicians use techniques like balancing the recognition of positive and negative consequences to help clients make more informed decisions about substance use.
• 🏋️‍♂️ Physical activities like walking and listening to music are suggested as alternatives to substance use for mood elevation and energy boost.
• 🎵 The combination of exercise and music is highlighted as an effective strategy for managing cravings and improving mood without substances.
• 🏢 Identifying and managing external cues, such as people, places, and activities, is crucial in preventing relapse and supporting recovery.
• 🗣️ Practicing refusal skills and building confidence in saying no to substance offers are important aspects of counseling for substance use disorder.
• 🔍 The script emphasizes the importance of identifying personal triggers and developing individualized coping strategies to avoid substance use.
• 🌱 Engaging in meaningful activities like gardening can provide a sense of accomplishment and peace, serving as a positive alternative to substance use.

Q & A

What is the primary focus of substance abuse counseling during the active treatment stage?

The primary focus is on the client's unique cues that lead to substance use and the consequences resulting from substance use, as identified in the contextual assessment.

What are the main tasks in substance abuse counseling?

The main tasks include cognitive behavioral counseling and skills training, helping clients cope with and change thoughts, emotions, behaviors, and cravings that lead to substance use.

How does the counseling process aim to change a client's thoughts and emotions related to substance use?

Counseling aims to change thoughts and emotions by helping clients recognize the negative consequences of substance use and by finding alternative behaviors that can provide the perceived positive effects without actual substance use.

What is an example of a coping skill that might be taught to a client during substance abuse counseling?

Examples include teaching clients social skills, leisure skills, or work skills, and helping them find alternative activities that can provide energy and mood elevation without substance use.

How does the clinician in the script help Mark cope with caffeine cravings?

The clinician helps Mark by first understanding what draws him to caffeine, then by creating new thoughts that emphasize the negative consequences of caffeine use, and finally by suggesting alternative behaviors like walking and listening to music.

What is the significance of identifying external cues to substance use?

Identifying external cues is significant because it helps clients recognize situations, people, places, and activities that trigger substance use, enabling them to avoid or cope with these triggers more effectively.

How does the clinician work with the client to manage external cues to substance use?

The clinician helps the client by identifying specific people, places, activities, and things that cue substance use and then practicing ways to cope or avoid these cues.

Why is it important for the client to have a list of alternative activities to cope with cravings?

Having a list of alternative activities is important because it provides the client with immediate, short-term strategies to distract from cravings and helps them get through the peak of the craving without resorting to substance use.

How does the clinician address the client's difficulty in saying no to certain individuals?

The clinician addresses this by identifying specific individuals who make it hard for the client to say no and then role-playing scenarios to practice refusal skills and build confidence.

What role do cognitive and behavioral strategies play in helping clients avoid relapse?

Cognitive strategies help clients change their thought patterns leading to substance use, while behavioral strategies provide them with practical coping mechanisms to avoid high-risk situations or respond effectively when in them.

How does the clinician support the client in finding work and building new leisure activities?

The clinician supports the client by discussing the client's work history and interests, suggesting ways to update their resume, and encouraging the exploration of new activities that can replace substance use, such as gardening.

Outlines

00:00

💡 Substance Abuse Counseling Techniques

This paragraph introduces the focus of the video on substance abuse counseling during the active treatment stage. It emphasizes the importance of identifying unique cues and consequences related to substance use, as uncovered in the contextual assessment. The main tasks of counseling include cognitive behavioral counseling and skills training, aiming to help clients change thoughts, emotions, behaviors, and cravings associated with substance use. The video demonstrates techniques such as creating new thoughts and behaviors that highlight the negative consequences of substance use and finding alternative behaviors for achieving the perceived positive effects without actual substance use. The example of managing caffeine cravings is discussed, where the client is guided to recognize both the positive and negative outcomes of caffeine use and to explore alternative activities like walking and listening to music to achieve similar effects.

05:02

🏋️‍♂️ Alternatives to Cravings and Identifying Triggers

The second paragraph delves into the exploration of alternative activities to manage cravings without resorting to substance use. It discusses the benefits of exercise and music in elevating mood and energy levels, contrasting them with the anxiety-inducing effects of caffeine. The client identifies additional strategies such as visiting the mall, watching movies, and reading at the library. The conversation also touches on the concept of cravings as waves that can be managed by enduring the peak and using distractions or alternative activities. The importance of having a readily available list of these alternatives is emphasized, as well as setting a stop date for substance use. Furthermore, the paragraph addresses the management of external cues to substance use, such as people, places, activities, and things, with a focus on developing strategies to cope with these triggers.

10:05

🗣️ Practicing Refusal Skills and Coping with Peer Pressure

This paragraph focuses on role-playing and practicing refusal skills as part of the treatment plan. It highlights the difficulty the client faces in saying no to certain individuals who are associated with substance use. The clinician helps the client identify these individuals and the triggers they present, such as showing money or drugs. Through a simulated interaction, the client practices refusing an offer to use cocaine. The session emphasizes the importance of recognizing and managing these high-risk situations and the feelings of pressure and fear they induce. The client acknowledges the challenge but also the progress made in reducing substance use.

15:07

🌱 Gardening as Therapy and Overcoming Work-Related Triggers

The fourth paragraph explores the therapeutic benefits of gardening as an alternative to substance use. It discusses the client's fear of returning to work due to past negative experiences and the pressure that led to substance use as a coping mechanism. The clinician supports the client in identifying work interests and skills, while also addressing the fear and triggers associated with previous work environments. The conversation highlights the client's realization of the need for support and the importance of recognizing warning signs of potential relapse. The client expresses a desire to work and the peace of mind they experience through gardening, which contrasts with the stress of their previous job.

20:07

🌼 The Importance of Support Networks and Avoiding Triggers

The final paragraph emphasizes the role of support networks and the importance of avoiding triggers in maintaining sobriety. It discusses the client's decision to avoid a job that could be a trigger for substance use, opting instead for supportive group meetings and other non-triggering activities. The client acknowledges the difficulty of attending certain groups that may trigger cravings but recognizes the importance of seeking support from friends or hotlines. The conversation also touches on the client's engagement in meaningful activities like gardening, which bring a sense of peace and accomplishment without the need for substance use. The clinician reinforces the client's progress and the ongoing work needed to manage triggers and maintain a substance-free lifestyle.

Keywords

💡Substance Abuse Counseling

Substance abuse counseling refers to the process of assisting individuals who are struggling with addiction to substances. In the video, this counseling focuses on helping clients identify triggers and consequences related to substance use, and developing coping strategies to manage these. It is central to the video's theme, as it outlines the methods used to help clients navigate through their addiction treatment.

💡Active Treatment Stage

The active treatment stage is a phase in substance abuse treatment where the individual is actively engaged in therapies and interventions aimed at overcoming their addiction. The video script discusses this stage, emphasizing the importance of counseling to change thoughts, emotions, and behaviors that lead to substance use.

💡Cognitive Behavioral Counseling

Cognitive behavioral counseling is a therapeutic approach that focuses on identifying and changing negative thought patterns and behaviors. In the context of the video, it is one of the main tasks in substance abuse counseling, aimed at helping clients cope with thoughts and cravings that lead to substance use.

💡Skills Training

Skills training in the video refers to teaching clients new behaviors and coping mechanisms to deal with triggers and cravings. It is a crucial part of substance abuse counseling, where the clinician works with the client to develop alternative behaviors that can be used instead of substance use.

💡Cravings

Cravings are strong desires to use a substance and are a common challenge for individuals in recovery. The video discusses how clinicians help clients manage cravings through techniques like recognizing negative consequences and finding alternative behaviors, as illustrated in the conversation with Mark about managing caffeine cravings.

💡Coping Skills

Coping skills are strategies used to manage stress, negative emotions, or challenging situations without resorting to substance use. The video highlights the importance of teaching clients such skills, like exercise and music, to help them deal with cravings and maintain sobriety.

💡External Cues

External cues are environmental factors that can trigger the desire to use substances. The video script describes how clinicians help clients identify these cues, such as certain people, places, or activities, and develop strategies to cope with them or avoid them altogether.

💡Relapse Prevention

Relapse prevention is a set of strategies to prevent an individual from returning to substance use after a period of abstinence. The video emphasizes the role of counseling in teaching clients to recognize triggers and develop plans to avoid or cope with high-risk situations without resorting to substance use.

💡Contextual Assessment

A contextual assessment is a comprehensive evaluation of a client's situation, including their environment, relationships, and personal history, to understand the factors contributing to their substance use. The video mentions this assessment as a basis for identifying unique cues and consequences that are later addressed in counseling.

💡Alternative Behaviors

Alternative behaviors are new actions or activities that clients can engage in to achieve the same effects they sought from substance use without actually using substances. The video provides examples of such behaviors, like walking and listening to music, which Mark uses to manage his caffeine cravings.

💡Self-Efficacy

Self-efficacy refers to an individual's belief in their ability to succeed in specific situations or accomplish a task. In the video, the clinician works on increasing the client's self-efficacy by helping them build confidence in saying no to substance use and managing triggers.

Highlights

The video focuses on substance abuse counseling during the active treatment stage, emphasizing the client's unique cues and consequences.

Cognitive behavioral counseling and skills training are key tasks in addressing substance abuse.

Counseling aims to help clients cope with thoughts, emotions, behaviors, and cravings associated with substance use.

The clinician assists the client in changing thoughts and emotions that lead to substance use.

Behavioral coaching is used to teach clients new behaviors to replace substance use.

Coping skills, social skills, leisure skills, and work skills may be taught to clients.

A clinician helps a client manage caffeine cravings by developing alternative behaviors.

The client identifies the urge to use caffeine for energy and mood elevation rather than as a wake-up tool.

Clinicians design craving management plans that include reminders of adverse consequences and alternative behaviors.

The client is encouraged to balance positive associations of caffeine with negative consequences.

Alternative activities to caffeine use are explored, such as walking and listening to music.

Exercise and music are identified as effective coping strategies for avoiding caffeine cravings.

The client lists additional activities like window shopping and watching movies as alternatives to caffeine.

Drinking water is suggested as an alternative to caffeinated drinks.

Cravings are likened to ocean waves, with a peak that can be managed by enduring the peak period.

An index card with a list of alternative activities is recommended for the client to carry for immediate reference.

Clinicians help clients identify and manage external cues to substance use, such as people, places, and activities.

The client discusses difficulty saying no to certain individuals who are associated with substance use.

Role-playing is used to practice the client's ability to say no to诱惑s from known drug users.

The client recognizes the importance of avoiding high-risk situations and finding healthy coping strategies.

The clinician and client discuss the client's past work experiences and potential new job opportunities.

Gardening is highlighted as a peaceful and rewarding activity that helps the client avoid substance use.

The client expresses fear and reluctance to return to work due to past negative experiences and triggers.

The clinician supports the client in identifying warning signs of potential relapse and planning for how to handle them.

The importance of social support and engaging in non-triggering activities is emphasized.

Transcripts

- [Narrator] In this video, we will focus on substance

abuse counseling during the active treatment stage.

This type of counseling focuses

on the client's unique cues that lead to substance use,

and consequences that result from substance use

that you identified in the contextual assessment.

Cognitive behavioral counseling and skills training

are the main tasks in substance abuse counseling.

Specifically, you will want to help your client

cope with and change thoughts that lead to substance use,

unpleasant emotions that lead to substance use,

behaviors that lead to substance use,

and craving, or feelings that lead to substance use.

You may accomplish these goals

by counseling to change thoughts and emotions,

and by training and coaching your client

to change his behavior.

You may teach him coping skills,

social skills, leisure skills,

or help him get a job and teach him work skills.

In the following sequence, the clinician

is helping a client cope with thoughts and craving

that lead to substance use.

He uses two techniques:

First, he helps the client create new thoughts and behaviors

that emphasize the negative consequences of substance use.

Second, the clinician helps the client

come up with new behaviors that he can use

to get the perceived positive affect of substances

without actually using substances.

- One thing we might consider, Mark,

that would give you more control,

would be to work on

skills at managing craving,

- Skills at managing craving. - for caffeine.

In other words, as you started to feel

the urge to use caffeine,

developing alternative behaviors

to drinking caffeine.

- I don't know how to do that.

- Well, let's start with understanding it.

Okay? - Mm-Hmm.

- When you get up in the morning,

what draws you to a cup of coffee?

- Energy boost, and the mood elevation

that I seem to be seeking

instead of just thinking of coffee

as being a wake-me-up tool,

I'm really looking for a high out of it.

- Well, Mark, the types of plans

that we usually design for craving

include those components of reminding yourself

of the adverse consequences, as well as,

typically, finding an alternative behavior

that can be successful for you.

So for example, if you start to

want to have a cup of coffee,

and you're,

kind of thinking about it,

"Oh, I'll feel energy, I'll feel,

"my mood will get lifted."

You're thinking about those positive things.

One step is to balance that with

a recognition of the negative consequences.

"Well, I'll feel more anxious.

"I don't really like feeling anxious,

"that's an uncomfortable feeling."

So playing back for yourself

a balance of the,

sort of anticipated positives

with a balance of the anticipated negatives.

That the association with the drug becomes

less rosy, and more accurate,

more accurately reflecting some of the pain

that it causes you.

- Mm-Hmm.

- The other thing will be

to have some specific alternatives.

So that, for example, you're looking to lift your mood,

and boost your energy with caffeine.

Let's find alternative activities

that you can do that will achieve those same things

without the price that caffeine creates for you.

Can you think of any examples?

Are there any other things that help you

to lift your mood and boost your energy?

(Mark coughs)

- Well, basically,

when I walk,

and especially when I'm walking

and listening to my radio,

personal radio like a Walkman.

That seems to give me more energy

than I would if I was sitting around

smoking cigarettes and drinking coffee.

And it also lifts my spirits,

because I love music quite a bit,

and I enjoy walking and

since I don't have a car,

I do quite a bit of walking and,

- Excellent.

- I enjoy different things like going to the mall,

and even if it's just for window shopping,

and taking in a movie or something.

- So you've identified several different

effective coping strategies for avoiding a cup of coffee,

if you're craving caffeine.

And I'll separate the first two,

because I think they're important.

Exercise and music both are helpful,

and when you combine them,

it's even more helpful it sounds like.

But exercise is something that most people

find lifts mood and improves energy level,

because you increase the circulation

of blood to your brain and your whole body,

and it helps to energize you.

So getting up and taking a walk

rather than going to a cup of coffee

will achieve the same things.

Exercise though, actually helps to reduce anxiety,

rather than increase it.

So you can have the benefits of

the energy lift, the mood lift,

without paying the price of suffering

the anxiety down the line,

and being constructive for your body,

being healthy for your body.

- Right.

- Adding the music to it improves the good mood,

because you enjoy the music.

You also mentioned a couple other strategies,

which may not be as immediately available

every time of the day,

but watching a movie, or doing some window shopping,

which involves getting yourself further,

getting yourself to the mall,

and getting yourself to a movie theater,

or whatever, watching a movie on TV.

As you think about those,

any others that you would add to that list?

- Well--

- Other things you could do that would--

- Yeah, I enjoy going to the library

and reading the various magazines that they have,

you know like Time Magazine or Newsweek and newspapers.

- And you know, another thing that we didn't mention,

that might want to go on the list of behaviors,

is something that's fairly close to,

like for example, caffeine you normally take

by drinking something.

So you could drink a glass of water, you know?

An alternative that gives you, you know,

still the opportunity to drink something

without it being caffeine containing.

- Mm-Hmm.

- Mark, you and I have talked before

about the fact that cravings tend to come

in what are described as waves,

sort of like the waves in the ocean,

where they come, they have a peak,

and then they crash, and then they sort of diminish.

Okay? - Right.

- And typically when a person has a craving,

most of the job is getting through

a limited period of time where that craving has its peak.

And if you can get through five or 10 minutes,

even distracting yourself with something else,

the craving tends to diminish, if you don't feed it.

If you do feed it, then it gets stronger

and stronger, all right?

And so a lot of what you're doing

is buying time for five and 10 minutes,

and you've identified several things,

a couple of which are more immediately

available, short-term strategies,

and a couple of which are more involved.

And one of the problems with cravings

is that it's often difficult to think

in the middle of a craving, right?

Because the powerful urge to use.

- Right.

- And so what we typically do

is advise people to get an index card,

write down you know,

their list of alternative activities,

and we can do that together,

where we'll write down, take a walk,

listen to music, go to the library,

you know, go window shopping,

take in a movie, okay?

So you've got a list of things available to you

as alternatives, okay? - Mm-Hmm.

- And you've got those in your pocket,

and you carry it with you all the time in the beginning

until you get to a point where it's real solid.

So what we should do then is define a stop date.

Do you feel ready to do that now?

- Yeah.

- Or do you want to give yourself a couple of days?

What are you thinking?

- No, I'll feel less anxious

by not drinking caffeine.

I'll have more positive energy in the end

that doesn't fluctuate up and down.

- [Narrator] Clinicians can also help clients

identify and manage external cues to use substances,

such as people, places, activities and things.

People that cue substance use can be friends who use,

drug dealers, or others that

remind a client of substance use.

Places that cue substance use can include

bars, hangouts, friends' houses,

or other places where substances are being used,

or have been used by the client in the past.

Activities that cue substance use

can include any activity that was associated

with drug use in the past.

Many clients will have given up all other activities,

and will need to learn new leisure activities

to enjoy without substances.

Things that cue substance use can include

drug paraphernalia, money, and the substance itself.

In the next sequence, you will see

a clinician helping a client

identify external cues that lead to

intense craving and cocaine use.

She helps him identify and practice ways to cope.

- Are you comfortable with your ability to say no to people?

- Yeah, sometimes.

- Yeah.

- Sometimes, yeah. - Yeah.

When are the times when it's easier to say no?

- Depends who it is I run into.

- Okay.

- Yeah, yeah.

- And when is it more difficult to say no?

- I can say no to porn, I can say no to alcohol.

- Okay.

- And all that.

- Right.

So if the right person came along,

- Yeah.

- that was really hard to say no to,

and that person had cocaine in his pocket,

that sound like it would be really hard

for you to say no.

- Yeah, sometimes Bill Heath helps me out.

- Okay.

- Say no, you know.

- Yeah.

Right.

- A few people care about me there.

- Yeah.

So maybe something that we could work on

in your treatment plan is working on

how to increase your confidence around saying no to,

maybe we could identify the people

that it's really hard for you to say no to.

- Yeah, some of them come here, you know.

- Well, I know, I know.

That's what makes it difficult.

- Some of 'em come here. - Is some of 'em do come here,

and you see 'em every day.

- Yeah, see them every day.

- So that's a trigger every day.

- Yeah, yeah.

- So maybe we could work on identifying who they are,

and then maybe we could practice you saying no to them.

- Right.

- You know, in kind of of way

so that you feel more confident

when you actually see them,

and they have the cocaine in their hand.

- Yeah.

- So, first of all, let's just list the people

that you see the most often

that you find it the most difficult to say no to.

- Yeah.

- Can you tell me who they are?

- Bob. - Bob?

- Bob. - Anybody else that you see?

- Daryl. - Daryl?

- Yeah. - Anybody else?

- Uh, Keith.

- Keith? - Yeah.

- Anyone else?

- No. - Okay, so Bob, Daryl

and Keith are the three people that you find it the hardest

to say no to. - Yeah, right, yeah.

- Okay, let's just talk for a minute

about what makes it difficult to say no to them,

when it's real easy for you to say no to me,

and it's real easy for you to say no to Dr. Burnett,

and it's real easy for you to say no to Richie,

and it's real easy for you to say no to Bill.

Okay, so there's four of us that I know

you've done a really good job saying no to.

- Right, yeah. - Okay.

So what is it about these three guys

that makes it difficult for you?

- They show me sometimes, they get me going.

They show me the money.

- They show you the money. - They show me the bag.

- They show you the bag. - They show me the bag.

- They get you going.

- Yeah, they get me going.

- Okay. - Yeah.

- Are there other things they do to get you going?

- Uh, no I get sweaty palms when I want to use.

- Okay.

- My hands turn sweaty and everything, you know?

- Do they challenge you in some way?

Do they threaten you at all?

- Sometimes, yeah.

- Yeah?

What kinds of things would they say to threaten you?

- Like Jenemi, you don't need Jenemi,

you don't need that and all that stuff.

- Okay.

- Sometimes they swear at ya,

or they walk away and give you the finger.

- Yep. - Yeah.

- And somehow that

works in your mind as a way,

that makes you want to use.

- Yeah, right.

- as opposed to making you feel like,

wow, they're not respecting what I'm doing.

- Right, yeah. - They wanna--

- They're really not my friends, you know.

They're just there.

- Right, right.

- Yeah.

- And these are three guys you've used with

for a long period of time.

- Yeah, long period of time.

- So you have a lot of history with them.

- Yeah.

- So not only are they showing you the money,

and they're showing you the cocaine,

just seeing them is a trigger,

because of all the times you used.

- Yeah, just seeing them is a trigger, yeah.

- And these are three people that get their meds here,

that you see almost on a daily basis.

- Yeah, yeah.

- Let's try to pretend that I'm Daryl.

- Yeah, yeah.

- And I'm gonna come up to you,

and I've got money in my pocket,

and I've got the cocaine.

I would say, "Hey Mark, I haven't seen you in awhile."

- Yeah.

- "Look what I've got today."

- Wow.

- "Come on with me. - No, I'm gonna--

- "You don't need to be there, come on."

- I'm gonna go back to Jenemi and talk to somebody.

- "Oh come on, you've been there lots of times.

"They're not gonna tell you anything

"you haven't already heard." - No--

- Come on, I got this really good stuff.

- Yeah, I gotta do urine samples.

If I do cocaine, it's gonna come back

in the urine, you know?

- "Well, we can get you some urine from somebody.

"You know, you can have tests."

- (laughs) No, no thanks.

- "I've got John with me, and I've got Keith with me.

"You know, we're gonna go hang out in the park."

- No, that's all right.

- "It's a great day today."

- That's fine, no, no thanks.

- Okay, all right, stop.

- Walk away from it.

- All right, how did you feel when I was doing that to you?

Because your face has gotten red.

- Pressure, yeah.

- You face has gotten red.

- Yeah.

- Pressure, you know?

- You're starting to move a little bit more in your chair.

It was really hard, wasn't it?

- It was hard, yeah, yeah.

- But you were able to do that.

- [Narrator] Next you'll see a segment

of a counseling session where the Clinician

is helping the client deal with triggers

to use cocaine without actually using.

Notice that she talks directly

about what the client's triggers are,

and she works collaboratively with the client

to find ways to either avoid the high risk situation,

or once in the situation, to cope with it without using.

Notice also how frequently she reinforces

the client's attempts to avoid using,

but then she also encourages the client

to work harder at finding healthy coping strategies.

She focuses mostly on behavioral strategies,

but she alludes to using cognitive strategies as well.

- Talking about how far you've come.

Last year you were using

- Every day, all day. - every day, all day.

- Whenever I get a chance.

- And now, you've really reduced your use.

- Yep.

- It's sporadic, but we know what things trigger it.

And one of the things is gonna be

getting your check, getting your money in your hand.

Another is trying to talk to people

about some of the things that you need from them.

And you go two ways.

You either run to your bed and hide from everybody,

or you go out and use.

- Yeah, so I guess I started early this time,

running to the bed, huh? (laughs)

- [Clinician] What other things can you try?

What other supports have you started to build?

- I was trying, I asked you about

finding some work for me to do.

- Mm-Hmm. - And, um,

- Finding me some work to do,

try to keep me busy, but,

I don't know.

It's scary to do that because

I don't know if I can handle that.

I want to handle it, but I,

everything's scary, 'cause it's new.

- But you've worked really successfully in the past.

And I think that working would be

something that would make you feel better,

and not feel like you're taking from other people.

- I don't feel like I'm taking from other people.

I've worked all my life, so I figure

what's given to me is owed to me.

It was came out my pocket when I was working,

so, 'cause I've always worked.

- I agree, and I think that that's really important.

It's important for all of us to work,

and we can work with the earn team

to try and help you identify what interests you,

set up your resume.

You've got some wonderful work experience,

and I know that you have a lot of interests.

Gardening is one of them.

You've done secretarial work.

There are skills that you have.

You have a lot of people skills.

- I also have another skill,

working in a factory.

I do have it, I do have it in my head.

Just the only thing is, is if I, it's scary to get back,

because I know what took me out of there.

- What took you out of there?

- Well, what I'm, taking me away from the working scene.

It was too much pressure for me.

It got to be nasty on the job,

and I didn't know how to handle it,

so I just grabbed my things and left work one day.

It happens, something pops in my brain.

Back, things that happened to me in the past

on my job just pops in my brain,

and then I'm not able to, I wouldn't be able to come

and say, I'd be too late by the time I get to you.

- I don't think this is easy.

I think you've been working really hard for a long time.

And there's little steps that you have to take,

and you have to set your plan.

There's gonna be slips, there's gonna be triggers,

and I think our work is to be always talking about

what you can do when those triggers appear.

- Okay. - Okay?

We know some of the warning signs.

- I know, I walk out,

and then I disappear.

- But I think you know the warning signs

before the walking out even happens.

- Yeah, now I know the warning signs.

- Mm-Hmm.

- Working with you, yeah, I learned a whole lot,

a whole, whole lot.

Yeah, a whole lot.

But it's a big fear to go back there,

but I have to do it, and I'm gonna try and do it.

I believe if I do that, then I wouldn't even slip anymore.

I really do.

That's why I said I need help again.

- Yeah, I think that--

- But the, yeah.

- There are slips.

And there may be slips in the future.

We're still gonna keep working together,

even when there's slips,

to keep you from relapsing,

to going back to where you were a year ago.

- Yeah.

- How are things at home right now?

- It's okay.

I guess I'm sleeping away them, too. (laughs)

I just, I just sleep when I'm not here with you,

or working in the garden, that's what I'm doing.

I tried working, I told you, for a friend of mine,

but I realize I'm not no man,

and I shouldn't have to be out there

pulling on trees and stuff like that.

So I asked her if I could do work in the house,

and don't pay me,

don't pay me once.

- You don't want to be paid in cocaine.

- I need a job where I can see progress like--

- I think what concerns me is you're going back

to a place where, that's a trigger, it is a trigger.

That job is a trigger, because they've always

paid you in drugs instead of money.

- Yeah.

- And I'm not sure why you keep

setting yourself up to go back there.

- I sure didn't, I sure didn't wake up

or nothing to make sure I went back.

I could have, I got the phone number.

- You could have gone back there yesterday, you mean?

- Yeah.

- And that's why you stayed in bed.

- Yeah, and so,

but that's not fair to me either, you know?

- No, I think there's probably a different way

of handling avoiding that trigger.

- Oh I'm tired of running to the bed, too.

- Mm-Hmm.

Well yesterday was Wednesday,

- Yeah, I coulda came here. - and what were you,

what was, what group do you go to on Wednesday?

- My drug NA group. - Yeah.

I didn't go there, I mean, it's a good group,

but I kind of, if you ask me, it triggers me.

The group I go to on Friday does not trigger me.

- But yesterday, I mean, I think that that's important

that you didn't go to that job yesterday,

because you did recognize that

that would be a trigger for you.

- [Client] Yeah.

- But I think it would have been better,

even if you came to the group,

even if it's difficult for you.

It would have been better coming to the group.

It would have been better going to a friend.

Who could you have called?

- What, you mean to make me go to the group?

- [Clinician] Or to get some support

so you didn't have to stay in bed.

- The warm line, yeah.

- [Clinician] Or Ray?

- Yeah, I coulda went down and talked with her.

- [Clinician] Mm-hmm.

You have friends, you have other things

that you can do besides just go to bed.

- Yeah, there are other things,

but the easiest thing is just to lay down.

But you're right, I do have other places to go.

- I think the most important thing is that you didn't use,

and you recognized that going to work yesterday

would have been a trigger.

I think that was important.

But I think there is other things you can do.

- And there's work out there to be done for nothing.

And it also brings beauty.

It's like artwork working in her garden.

So I like to do that.

And there's nobody really knocking me down

for what I'm doing, and I make my own creation.

- [Clinician] Mm-hmm.

- So I like that.

- [Clinician] I think that's important.

- That's why, I always say, that's her Mother's Day present,

for me to have that fixed.

- [Clinician] To work her garden for her.

- Yeah, to work her garden.

Yep. - Yeah, I think that

you're giving her something, but it's something for you too,

because it makes you. - Yeah, there's peace of mind.

It makes me feel real peaceful,

and it, I don't even feel like using afterwards.

I don't even feel like saying,

"Hey lady, how much you're gonna give me?"

I don't, you know, for working in the yard.

That's for nothing, so,

as you can see, the expression on my face

has changed because--

- 'Cause it's peaceful.

- It's peaceful.

- Mm-Hmm. - Yep.

- Yep.

- So, but back to the drug part again.

I have to keep going back to that, you know?

- Mm-Hmm.

- Because,

- Because why?

- Because I know I can do it.

I think I can really do it,

but it's gonna be hard.

It's gonna be real hard.

- It has been hard work.

You have to keep remembering what you were--

- It's just really--

- doing a year ago, or even six months ago.