Editor’s note: This is the second in a series of five (formerly three) articles that concentrate on what’s working in the trenches for frontline counselors.

Psychosocial tools include lifestyle planning and monitoring, individual therapy, group therapy, peer support, and family treatment (Coombs, 2001, xii). The purpose of this article is to introduce six psychosocial recovery tools that have been proven effective in assisting addicted clients. Although, as with any recovery tool, the addictions counselor must first establish a baseline assessment to determine client need(s).

Blueprint for Life/Work Designs
The Blueprint for Life/Work Designs is the product of 10 years of research and development involving thousands of career practitioners and educators across the United States. The program is sponsored by the National Career Development Guidelines, through a partnership with the U.S. Government and America’s Career Resource Network (http://www.acrna.net/), National Life/Work Centre, Canada Career Information Partnership, and Human Resources Development Canada.

Used by addictions counselors, career counselors, community services workers, educators, human resource specialists, and social workers, the Blueprint for Life/Work Designs provides an incremental strategy for acquiring critical skills that focus first on core life skills to prepare the person for reintegration into the workforce. Progressing through three developmental steps, the client develops critical core competencies to enhance effective living, including developing a rewarding career.

Personal Management: (1) Build and maintain a positive self-image; (2) Interact positively and effectively with others; (3) Change and grow throughout one’s life.

Learning and Work Exploration: (4) Participate in life-long learning, supportive of life/work goals; (5) Locate and effectively use life/work information; (6) Understand the relationship between work and society/economy.

Life/Work Building: (7) Secure/create and maintain work; (8) Make life/work enhancing decisions; (9) Maintain balanced life and work roles; (10) Understand the changing nature of life/work roles; (11) Understand, engage, and manage one’s own life/work building process.
This entire model can be found online for your review and use. It is an exceptional resource for addiction counselors: http://www.blueprint4life.ca/.

Individual therapy (Internal Locus of Control)
One major advantage of individual therapy is its ability to adapt and focus on the unique needs of the person’s situations. Zweben (2001) purports that individual therapy enhances the quality of recovery through behavior and lifestyle change based on the client’s motivation level. Clients with addictive disorders often perceive the environment controlling them, leaving them feeling powerless. Internal Locus of Control taught in a one-on-one environment has proven to be an effective clinical tool in helping clients see the insight of choice. Internal Locus of Control is a personality construct, in which the client’s perceptions of personal control are determined internally by ones own choices not external circumstances. Choice theory provides counselors a user-friendly model for teaching Internal Locus of Control to their clients.

Choice theory, created by William Glasser, MD, uses metaphors that a client can easily relate to — such as a car to illustrate total behavior (the connection of actions, thinking, feeling, and physiology) — from which the client learns why he does what he does (Glasser, 1998, 2000). This theory teaches clients how to demystify the whys of human behavior and can open the door for accepting responsibility for self and actions. Choice theory purports that the environment only provides information and the client ultimately chooses how he will respond. In the field of addictive disorder, this power-of-choice construct can make the difference between recovery and re-lapse. Teaching the client choice theory can be an effective first step to owning this power.

Glasser’s work is making a major impact in the fields of mental health, education, addictions, business, and justice, and is recognized in most modern counseling books that discuss counseling theory. For more information on choice theory, visit: http://www.wglasser.com/.

Group therapy (anger-management training)
“Group therapy provides an almost ideal forum for addressing core features of the addictive disorder: the person’s inability to see and accept the reality that is plain to others, the lack of internal ‘radar’ needed to motivate and guide adaptive responses to the environment, the tendency to disown personal responsibility and focus instead on external solutions, and the overwhelming feelings of failure, guilt, and toxic shame that perpetuate the addictive cycle” (Washton, 2001, p. 240).

Group therapy is a powerful process for the development of a specific psychosocial theme, such as anger. Profes-sionals who work in the addictions field commonly come across people who need to learn how to manage their anger. Research is very clear that anger hijacks clear thought. Clients in recovery need their best thinking to be successful. Optimally, group therapy is most effective when conducted by a professional with a strong background not only in the various kinds of addictive disorders represented in the group, but also in anger management.
Individuals on the road to recovery commonly report that anger is one of the most challenging emotions to overcome. An important aspect of anger management is teaching cognitive thinking strategies to the client. Research points out that anger-management problems tend to be related to thinking errors (Lochman, White, & Wayland, 1991). Group therapy provides an opportunity for each participant to learn to take control of anger from a variety of sources: peer group participants, the leader, and course handouts. For example, leaders who teach participants cognitive-relaxation techniques can assist each participant individually and within the group dynamic to significantly reduce anger (Holloway, 2003). Regardless of the composition of the group, and whether it addresses guilt, anger, or relationships, a synergistic overlap of learning helps participants in group therapy to develop an awareness and quality of life through an understanding of the experiences of others.

For more information on anger management programs and group therapy with addicts, refer to: Kassinove, H., Tafrate, R. C. (2002). Anger management: the complete guidebook for practitioners. Atascadero, CA: Impact, http://www.growthgroups.com/anger-info.htm/ and Elder, I. R. (1990). Conducting group therapy with addicts. Brandenton, FL: Human Services Institute.

Peer-support programs
Peer support, essential to addiction recovery, is available in several programmatic formats. Alcoholics Anonymous, started in 1935 by “Dr. Bob” and Bill Wilson, is the largest and most successful recovery program in the world today (Kurtz, 2000). Over the last 67 years, AA, aligned with the disease model, continues to help millions achieve sobriety by creating a non-judgmental treatment environment. Miller reports that 80 percent achieve abstinence for one year with attendance at AA and an outpatient or inpatient treatment program (Miller, 2001). The AA format, which draws on the respect and understanding gained in dialoguing with others who can relate because they share similar experiences and addictions, has been used to help addicted individuals with a variety of substances and addictive disorders (sex, gambling, etc).

Six peer-support programs are:

1. Alcoholics Anonymous (AA) and other 12-step programs (e.g., Cocaine Anonymous, Debtors Anonymous, Narcotics Anonymous). This is spiritual program based in the twelve steps and traditions that outlines a protocol for recovery. For more information, see: http://www.alcoholics-anonymous.org/ and Alcoholics Anonymous (2001) (4th ed.). New York, NY: World Services Inc.

The following five alternative peer-support programs are relatively new:

2. Moderation Program — Unlike AA, this program is not for serious alcoholics. Audrey Kishline founded this program as an alternative to the twelve steps, because there are very few programs that specifically address the needs of beginning stage problem drinkers who are not yet alcohol dependent. For more information, visit: http://www.moderation.org/.

3. Women for Sobriety — Like AA, this program encourages living ‘one day at time’ and abstention. Women For Sobriety is both an organization and a self-help
program for women alcoholics. Jean Kirkpatrick, PhD, developed this program that has been recognized as the first national self-help program for women alcoholics. In 1975 the name of New Life was changed to “Women For Sobriety, Inc.” and the program incorporated the Thirteen Statements of Acceptance of the “New Life” Program. For more information, visit: http://www.womenforsobriety.org/body.html

4. Rational Recovery — Unlike AA, Rational Recovery does not promote the disease model. This program was founded by Jack and Louis Trimpey as an alternative for the twelve-step spiritual-based program. The goal of this program is teaching people how to achieve self-recovery. In addition, this program promotes the philosophy that the ultimate authority for all personal issues is the person. For more information visit: http://www.rational.org/.

5. SMART Recovery® — Founder Dr. Simon Budman designed this program to help people find a meaningful life and a desire not to drink. SMART Recovery® has established four main goals: (1) enhance and maintain motivation to abstain; (2) cope with urges; (3) manage thoughts, feelings, and behaviors; (4) Balance momentary and enduring satisfactions. SMART Recovery® offers groups, publications, and an Internet e-mail list discussion group to help people learn how to achieve: motivation and lifestyle balance, as well as overcome urges and solve problems. For further information, visit: http://www.smartrecovery.org/.

6. Humanistic Alternative Twelve Steps — A twelve-step program minus associations with “God,” to include those who dislike a spiritual component. Religious underpinnings were replaced with Skin-ner’s twelve behavioral steps. For more information, visit: www3.sympatco.ca/gdavidson/VariousVersions.htm.

For more information on peer recovery programs, visit: http://www.alcoholism.about.com/.

Monitoring treatment plans using journaling
Addictive disorder treatments often are challenged with incidents of relapse that extinguish progress. What causes the addict to relapse? There are many theories as to why a person relapses. For example, recovery can be disrupted when a client stops their daily health recovery behaviors that make up the personal treatment plan. These might include attending AA meetings, healthy eating, and daily reading. Relapse often complicates recovery because of the emotions it breeds: shame, guilt, anger, frustration, and self-defeating thinking. In this example, one can infer that when a client sticks to the daily health recovery behaviors, the risk of relapse is reduced.

Keeping a daily journal provides the person with an interactive strategy to track and monitor personal progress. Through daily journaling, the client has a medium to process daily stress, separate facts from opinions and realign goals. Journaling also helps the person slow down, allowing the client to put the day into perspective and think through and solve daily challenges. “Using expressive writing reduces intrusive and avoidant thoughts about negative events and improves working memory” (Carpenter, 2001, 68).

To increase the benefit of journaling, the counselor can determine each client’s brain dominance and match the journal to the brain type. Brain dominance research suggests left-brained people often like journals that have structured measures and rigor (Howatt, 2001), where right-brained people respond better to less structure, similar to a traditional daily diary (Howatt, 2000). Regardless of the journal, for the process to be of value the client must be motivated and willing to journal. One final important consideration before recommending any journaling program is to ensure that the client is screened for functional literacy. For more information refer to: Neubauer, J. R. and Adams, K. (2000). Complete Idiot’s Guide to Journaling. New York: New York: Macmillan USA.

Family strengthening — A cornerstone for recovery
Addicted clients whose families participate in treatment have better outcomes than those treated alone. Treating clients as isolated entities is, as one observer noted, like taking the addicted client out of a dirty puddle, cleaning him up, and then tossing back into the puddle (Coombs, 1997, p 197).

Family input is advantageous in gaining an accurate picture of the client’s addictive disorder. And involving a client’s family in the treatment process, especially spouses, can both enhance recovery and reduce relapse rates. Family education and counseling strategies that address issues of codependency and co-addiction, pathologies that reinforce addiction and undermine recovery, routinely include: multifamily group sessions, individual family therapy, couple therapy, and week-long family programs. These approaches use a variety of family strengthening techniques, such as psychodrama and family sculpturing, both powerful clinical tools that involve all family members in discussing and acting out dysfunctional family roles and behaviors. For example, Wegscheider (1981) defines four prominent roles in the alcoholic family: (1) the family hero; (2) the scapegoat; (3) the lost child; and (4) the mascot.

Family-oriented self-help programs such as Al-Anon (www.alanon.alateen.org) and Adult Children of Alcoholics (www.adultchildren.org) have a long history of making a significant therapeutic impact on addictive behaviors. For an excellent review of family assessment measures and family strengthening tools that can enhance recovery, see Schmidt and Brown (2001). In addition, visit the Strengthen American Families Web Site: http://www.strengtheningfamilies.org/.

Conclusion
Rich in content and opportunity, these recovery tools can have powerful therapeutic influences on the whole spectrum of client addictions. The clinical success of each treatment option obviously rests in the hands of the addict and the relationship with the treatment counselor.

William A. Howatt, PhD, EdD, ICADC, a Post-doctoral Fellow at the UCLA School of Medicine, serves on the faculty at Nova Scotia Community College and is Co-editor (with Robert H. Coombs) of the Wiley Book Series on Treating Addictions. He can be reached via e-mail at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

Robert H. Coombs, PhD, CAS, Professor of Biobehavioral Sciences at the UCLA School of Medicine, has published 18 books, 180 other works, and is Editor, Section on Substance Use among Health Professionals for Substance Use and Misuse.

References
Carpenter, S. (2001 September). A new reason for keeping a diary. Washington, DC: APA Monitor On Psycho-logy, pp. 68-70.
Coombs, R. H. (1997). Drug-impaired professionals, Boston, MA: Harvard University Press
Coombs, R. H. (Ed.). (2001). Addiction recovery tools. Thousand Oaks, CA: Sage Publications, Inc.
Glasser, W. (1998). Choice theory: a new psychology of personal freedom. New York, NY: HarperCollins.
Glasser, W. (2000). Reality therapy in action. New York, NY: HarperCollins.
Holloway, J. D. (2003). Advances in anger management. Monitor On Psychology, March, Vol. 34, No. 3.
Howatt, W. A. (2000). Journal 51 (Left -Brain Journal). Kentville, NS: A Way With Words.
Howatt, W. A. (2001). Journal 31 (Right -Brain Journal). Kentville, NS: A Way With Words.
Kurtz, L.F. (2001). Peer Support: Key to Maintaining Recovery. In Coombs, R. H. (Ed.), Addiction recovery tools (pp.257-271). Thousand Oaks, CA: Sage Publications, Inc.
Lochman, J.E., White, K.J. & Wayland, K.K. (1991). Cognitive-behavioral assessment and treatment with aggressive children. In P.C. Kendall (Ed.), Child & adolescent therapy: Cognitive-behavioral procedures (pp. 25-66). New York: Guilford Press.
Miller, N. S. (2001). Disease orientation: Taking away blame and shame. In Coombs, R. H. (Ed.). Addiction recovery tools (pp.99-110). Thousand Oaks, CA: Sage Publications.
Schmidt, J & Brown, S. (2001), Family treatment: Stage-appropriate psychotherapy for the addicted family,” In Coombs, R. H. (Ed.). Addiction recovery tools, (pp. 273-290). Thousand Oaks, CA: Sage Publications.
Washton, A.M. (2001). Group Therapy: A Clinician’s Guide to Doing What Works. In Coombs, R. H. (Ed.), Addiction recovery tools (pp.239-255). Thousand Oaks, CA: Sage Publications, Inc.
Wegscheider, S. (1981). Another chance: Hope and help for the alcoholic family. Palo Alto, CA: Science & Behavior Books.
Zweben, J. E. (1995). Integrating psychotherapy and 12-step approaches. In Washton, A. M. (Ed.), Psychotherapy and substance abuse: A practitioner’s handbook (pp. 124-140). New York: Guilford.

This article is published in Counselor,The Magazine for Addiction Professionals, August 2003, v.4, n.4, pp. 58-61.

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