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COMPLICATIONS FACED
DURING TREATMENT
Marc Dixon- Seager
Dip Couns, NCAC, ADAP
THE ART OF COMPLIANCE (Minimize treatment involvement) Addicts present themselves as finished treatment
before they have begun
O Participation is verbal and not behavioural
O Talk about the importance of expressing feelings but don’t
express feelings
O Usually gush with praise and mouth superficial slogans
using statements such as “the program is wonderful, their
counsellor is wonderful, they have seen the light”
O This form of compliance is to escape from the treatment
experience
The Miracle Cure
COMPLIANCE INVISABLE CLIENT
O Escape the treatment experience by seeking invisibility
within the treatment environment
O Stick to the rules and meet the minimal expectations
set for them but initiate nothing related to their own
treatment
O Create an Illusion of involvement whilst remaining
emotionally detached
O Quite and emotionally isolated from the environment
O This withdrawal from treatment is simply to but time
before returning to their addictive career
COMPLIANCE THE INSTANT COUNSELLOR
O Spend most of their time focusing on the problems of others
(externalize their process)
O Usually quite supportive and insightful and offer good advice
which they are unable to personalize or apply themselves
O Their preoccupation with others allows them to escape from
the pain and consequences of their behaviour and own
addiction
COMPLIANCE
THE PROFFESSIONAL ADDICT
O Spent more time in treatment than
actively in addiction
O Use treatment programs as a shelter
or alternative lifestyle
O Highly knowledgeable of recovery
principles and concepts
O Their expertize at doing treatment is
to escape treatment
“All tied up and no where to go”
O “Never interrupt with the enemy (addict)
when they are about to make a mistake”
O Laissez Faire (Management Style)
DRUG SEEKING BEHAVIOUR OR SEEKING MEDICAL ATTENTION &
SURGERY O An addict is put through the initial crisis of
treatment when their drug relationship is
severed through detoxification
O High level of manipulative behaviours to
sustain the drug relationship
O Fearing the loss of their drug exaggerates
their drug consumption (Medical
practitioners becomes their dealers)
O Broad knowledge of medication closely
related to their substance of choice and
prone to self diagnose
PRECONTEMPLATION (STAGE) NOT READY TO CONSIDER BEING
DIFFERENT
O Addict does not recognize the problem or are in denial of the problem
O Addict does not hold themselves personally responsible for their behaviour
O Precontemplation becomes more complicated when the addict has created and been supported in the way he/she has been behaving and living. (Created a support system for their addiction)
O Addict has been protected or rescued from the consequences of their addiction
PRECONTEMPLATION TO CONTEMPLATION
O During this transition the addict is still highly volatile due
to the measure of ambivalence (Conflicted emotions)
O Objective in counselling is to getting the addict to
contemplate how life might be if he/she would change.
O Getting the addict to focus on the reasons and pros for
changing and the cons for staying the way they are.
O Secure a buy into treatment and get the addict to the
place of making preparation to change and then put it
into direct action
INCENTIVES O That which we gain to easily we esteem to lightly (Hold no value
in things)-Addiction rooted in self- esteem issues and
insecurities
O Reward comes through ‘earning’ or ‘deserving’
O The harder a recovery process is to acquire the less easy to give
it away (Hold value)
O During treatment the addict must not sense that they are being
incentivised to be in treatment or to complete treatment
O One needs to be cautious of sending gifts or packages during
treatment or hint at rewarding the addict for their behaviour and
addiction to substances
O Exploit/abuse/expect/feel entitled/lazy/don’t understand the
value of money/ don’t budget/don’t save /don’t manage
money/have no consideration for others (Instant gratification)
VISITS DURING TREATMENT
O Initial visit (After the successful completion of the first step)-Process of relinquishment
O The obvious change on a physical level often supports the addict in having the leverage to manipulate and convince family members to support the abortion of treatment
O Alternate options of treatment and continuum of therapy or convince the family that they have learnt their lesson
O The addict usually starts seeding the set up over the phone prior to the visit taking place
VISIT OFF SITE O Associations (Cue-induced cravings)
O Simple exposure to these cues automatically
trigger cravings which can lead to lapse in
behaviour during the visit or post visit or in
some cases relapsing on the substances
O Home environments, neighbourhoods, friends,
shopping centres, public toilets, petrol
stations
CRAVING CYCLES
O Predetermined (RHT) Predetermined visit to the Boma
O N/A rooms reward addicts once they have achieved certain
mild stones along their journey in recovery (1,30,60,90,6
months,9 months, 1 year, 18 months)
O N/A found that their members during these periods were
falling along the way side and not attending the meetings
as a result of relapsing
O The cravings during these periods do not present in the
physical form of wanting to use the substance. The addict
is adamant and sincere in not wanting to use but adamant
to abort treatment immediately
O This subconscious craving manifests emotionally and
usually presents in high levels of frustration , irritation,
anger, intolerance
O Strong defining characteristic of a subconscious craving is
excuse making
O Should the addict abort treatment or abscond during these
volatile phases relapse is inevitable
O Its during these phases that the families, support
structures, counsellors need to have a united front (Draw
the line and maintain the line)
SELF-WILL (CONTROL)
O Where no guidance is the people fall but in a multitude of counsel there is safety.
O Hope deferred makes the heart sick.
O Self-Will-Run-Riot Worksheet (I know better)
O Belief systems
O Attempting to dictate pace of program
O Visits/ Discharge dates
O Unsettling
O Shut off and close-minded to objective input
DISTRACTIONS
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DISTRACTIONS O Proverbs “often in life there are two roads set before
us both seem right one leads to death” (deceived)
O Preoccupation with concerns outside the centre or
beyond the addicts control
O Familiarity
O Fraternisation (Found my soul mate – God sent)
O Masking with spirituality
O Doing a good thing that is not the right thing which is
therefore the wrong thing (overly commited to helping
others)
SPLITTING BEHAVIOUR (All or Nothing thinking) O Splitting is an emotional and defensive dynamic.
Individuals that split are usually high conflict people because they increase conflicts around themselves instead of resolving them.
O Addicts causing rifts between family members by engaging in behaviours that turn family members against each other and in the context of treatment attempting to turn counsellors against each other or to align family members against counsellors often with the intent of achieving a desired outcome.
O Splitting is a predictable destructive dynamic
O Open communication line with all family
members with each other and with all
counselling staff and care givers
O Avoid getting intensely “emotionally hooked”
O Do not close off from each other and from
one another
O Need to define and set boundaries about
behaviour that you will tolerate and
behaviour that is unacceptable
EXPECTATIONS (Train the addict to face an unfair world) O Expectations are premeditated resentments
which are premeditated relapses
O What we expect out of life and what we get
out of life are often 2 different things
O A major role player in addicts resenting is
because of their unmet expectations which
often gives addicts the perfect excuse to use
RESERVATIONS
O Time (Rome wasn’t built in a day) – ICU of
recovery
O Relationships
O Romantic involvement
O Alcohol
O Cultural activities
O Presentation of self
