Relapse Prevention Plan Paper

Running head: RELAPSE PREVENTION PLAN 1

Relapse Prevention Plan

Old Dominion University

Introduction to Substance Abuse

RELAPSE PREVENTION PLAN 2

Relapse Prevention Plan

Description of the problem

Julie is a 40-year-old white female living in Prescott Valley, Arizona. Her drug of

choice was alcohol, a depressant or sedative hypnotic. She admits to having an “alcohol

problem,” in the past stating she consumed up to 20 drinks a day. Julie states she would drink

beer or wine but liquor is what she drank the most; vodka, rum, and schnapps. She ingested

the alcohol through mixed drinks but also drank it straight. Client states her use was

persistent over the past five years.

Two years ago she lost her job for showing up drunk and being unreliable. She

receives government assistance for disability and child support but states spending nearly all

of her money on alcohol over her past substance abuse. Before entering rehab, the client

states she had recently sold her possessions to make money to pay rent, but had not paid the

rent and was facing eviction. Julie is divorced and has two children whom she has legal

custody over, but live with her mother and father. She lives with her boyfriend who she also

describes as someone having an “alcohol problem.”

Signs and Symptoms of Abuse

Julie presented with symptoms of alcohol addition as evidenced by daily morning,

afternoon, and evening use. Other signs include unemployment (or the inability to sustain a

job), memory blackouts, and strained relationships with her children, sisters, and parents.

Client relayed she often woke up remembering nothing after nights of binge drinking. Julie

expressed her concerns of sexual assault in the past during her “blackouts,” but cannot recall

if it was real or not.

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The amount of consumption could be up to 20 drinks a day and had effected Julies

physical state. She sometimes became comatose and had trouble with basic motor

coordination. Client states while drinking in the past she could not walk and would crawl on

the floor. Julie becomes annoyed when her sisters criticize her drinking or express their

concern. Often, Julie’s speech was slurred and staggering and she could not hold

conversations or focus. She has a history of attempting suicide in the past and recently sold

her possessions though she states she does not have thoughts or feelings of self harm at this

time.

Referrals

1. Julie will participate in Alcoholics Anonymous meetings 3-5 x weekly; she will

provide weekly attendance sheets to verify attendance.

2. Recommend psychiatric counseling and medication evaluation for her depression.

3. Refer client to health clinic for a full physical.

4. Advise for individual counseling to address current life challenges. 1-2 x every two

weeks.

5. Visit with a career counselor or job placement programs to discuss employment

opportunities.

6. Attend parenting education classes.

Risk/Protective Factors

Currently the client denies any family history of addiction but states her individual

use has been “a problem,” for the last 5 years though she she is currently sober. Basic needs

of food and shelter are being met, though she faced eviction, client states she is now using

income to pay her rent. Client admits to suicide attempt in the past trying to suffocate herself

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with a shower curtain but states she has not since and there is no visual evidence of bruising,

scarring, or cutting.

Though client denies other suicidal thoughts or feelings, she believes she deserves

some form of punishment for her drinking. Denied she has chosen drinking over her children

but is sad she does not have a relationship with them and wishes she did stating, “I shouldn’t

have been drinking, I shouldn’t have been out, I should have been with my kids so this is

what I get.” Client’s daughter and son are protective factors that could possibly help support

her recovery as she shared they were her, “reason to get well.” Client’s children described

her as “good person, sociable, a joy to be around, gorgeous.” They also stated the client

carries, “guilt, anger, depression.” Impressions are client and children would like to develop

a meaningful relationship.

This is the client’s first attempt at sobriety in the past 5 years. Client has never

attended an AA meeting or any other support group besides the current rehab facility. She

states having a history of overeating. Client expresses that when her marriage fell apart, her

husbands absence made her feel “disappointed,” and at 30 when they divorced she felt

“betrayed.” Client began overeating after the divorce to cope with her issues; her heaviest

weight was approximately 300 pounds.

At 33 she had gastric bypass surgery, and lost all of her weight. She felt “better

physically,” it made her feel “more attractive.” Six months after the surgery she started

“going out” and drinking. A year after the surgery she began drinking every night and her

kids went to live with her parents. Client describes her children leaving to live with their

grandmother as the, “worst,” she has felt. Her mother states she never dealt with “all that

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pain.” Her mother refers to her divorce, lack of acceptance from her father, stressed

relationship with her children, and job loss.

Client took part in risky behaviors offering sexual favors for alcohol. Julie describes

waking up passed out in different men’s beds unsure if she has been sexually active with

them or not. She also states she thinks she’s been forced to have sex under the influence of

alcohol but cannot really recall since she was abusing alcohol during those times. Risky

behaviors also included driving under the influence in the past. Client extents that her social

circle consists of other alcoholics. Given clients sexual and surgical history accompanied

with possible harm from long term drinking, medical attention should be sought a referral

was made and patient was educated on both concerns and resources available.

Family support is provided by her two sisters and her mother. Clients mother may

decrease recovery as there perceives to be possible co-dependency. As her mother claims,

“Julie relies on me to take care of her.” Relationship with mother could potentially be

enabling as client also feels her past drinking was accepted by her mother stating, “My mom

is really there for me with my drinking, she really tries to understand and listen.”

Her sisters are angry with her but are there to support her, they state they “love her and want

her to get better.” Client has some degree of denial but claims she, “Really screwed myself

up,” and feels she “hate myself for it,” expressing feelings of guilt for her past behaviors.

Barriers to Treatment

1. Unstable housing – Client currently has stable housing but faced eviction in past for

non-payment. Having to pay for the rent alone could cause additional financial stress

while client is learning to live sober and practice new coping methods. Living with

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boyfriend whom she describes as, “having an alcohol problem,” would put client at

greater risk to relapse, especially being around old behaviors and possibly alcohol.

2. Enabling family/friends – Julies group of friends all drink, if they are not hanging out

at the bar, they are drinking at the house with one another. Besides her immediate

family, Julie’s entire social circle puts her at high-risk for relapse. Mother is

supportive but also poses as a barrier to treatment as Julie describes her mother as

“understanding,” of her disease.

3. Ongoing stressors- Distant relationship with her father and children are a constant

stressor. Being the oldest child, she felt her father put a lot of pressure on her. He was

distant and she says she felt “insecure,” because of the neglect and emotional abuse

she experienced in childhood. Low-self esteem and feelings of being worthless

consistently add to clients stress on daily basis.

4. Dating relationships – As stated above, client describes boyfriend as having a,

“drinking problem.” Client admits to sleeping with other men while in relationship

and to offering sexual favors to men for alcohol in past, sometimes with boyfriend

present.

5. Untreated mental health issues- Client appears to have emotional and social problems

from childhood and adulthood that have not been addressed resulting in possible

depression. Client tends to feel anxiety when family or friends address her with their

concerns for her health.

Plan for Discharge/Relapse Prevention

1. Continue community based support group, (Alcoholics Anonymous meetings 3-5 x

weekly).

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2. Remain in mental health treatment.

3. Continue parenting classes to help develop parent-child relationship with children.

4. Continue family counseling to address childhood issues with father and self worth

along with family counseling for her and children.

5. Return to treatment if needed.

Progress

Before treatment client presented with dependence on alcohol ingesting up to 20

drinks of liquor per day for the past 5 years. Her alcohol consumption negatively impacted

her physical and emotional state. Client had slurred speech and lack of focus while

conversing. Client is now detoxed and has been sober for the past 30 days. Her physical

appearance is much neater, she looks clean and no longer disheveled. Her speech is clear and

her memory and focus seem to be more organized.

Client faced eviction as a result of spending her government income on her addiction.

In the past client experienced job loss but is now employed working 3-4 times per week.

Client states seeing nutritionist after being referred from the doctor who ran her physical as

precautions for her post-gastric bypass surgery. Client has taken responsibility and uses

coping strategies learned in counseling to deal with stress related issues versus over eating or

drinking.

Negative thinking patterns have diminished that generate fearful or worrisome

emotions by: taking the time to identify the dominant emotion (i.e. hurt, anger, sadness), then

identify the cause(s) for this emotion and document episodes in a journal. Include a list of

possible consequences of lashing out including the physical and emotional effects, and

follow up with the benefits of being emotionally aware and refraining from abusing

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substances. Client states attending group support meetings (attendance sheet attached) no less

than 3 times weekly.

Julie states ability to identify common triggers and come up with two techniques or

plans of action to intercept irrational behaviors and practice them when problematic

situations occur. Client no longer dates boyfriend stating she is concentrating on herself, her

children, and sobriety and spends time with supportive family members. She avoids bars and

old friends homes where she used to drink stating she, “doesn’t feel confident” in attending.

Ability to problem solve has made significant progress as a result of her disease acceptance.