How to live a drug free life: Ways to support clients after addiction treatment
NLP can help your clients maintain sobriety
Relapse is often a problem for individuals who have experienced a substance abuse or process addiction. It is said that 70 to 90% of individuals who complete a traditional recovery program will relapse within a year. The rate for individuals going through detox only is higher. (Check out my post on how to treat a client who has relapsed here).
However, I believe these statistics can be lower when resources are provided to support the individual after the treatment program ends: Specifically, strategies based on Neurolinguistic Programming (NLP) can lead to better long-term outcomes for people seeking counseling post-rehab.
Neurolinguistic Programming (NLP) for a drug-free life
As you may recall, NLP targets how people:
- communicate externally and internally
- process, store, and recall information
- alter their communication to achieve the results and goals they want – in this case, overcoming an addiction
Practitioners like myself believe that human beings have an extraordinary capacity for flexibility. There is nothing that happens mentally or spiritually we cannot learn to handle. The focus of Neurolinguistic Programming in addiction recovery is on how an individual formulates the thoughts and beliefs that help effect and maintain change.
The Stages of Change Model: Post-Addiction Treatment
In terms of Prochaska’s and DiClemente Stages of Change Model, the client who has completed traditional rehab has moved from the Action Stage to the Maintenance Stage. In the Maintenance Stage, s/he has learned to avoid or overcome obstacles which could cause a return to old behaviors. Through practice, the client has:
- attained a greater level of confidence
- integrated new behaviors into his lifestyle
- decreased her risk of relapse
Maintaining change requires different skills than those first acquired. A person can successfully stop drinking during a treatment program, but may have no resources to cope with the interpersonal conflicts which caused the need to use. Therefore, my goal is to provide the client with resources using Neurolinguistic Programming strategies.
How to use NLP strategies for addiction recovery
I begin by introducing the 10 Presuppositions. NLP Presuppositions are the foundation of the approach I use. The following presuppositions can be extremely helpful when working with people in addiction recovery:
1. Have respect for the other person’s model of the world – Each person is unique and experiences the world in varying ways.
2. The map is not the territory – People respond to their ‘map’ of reality, not to reality itself.
3. Mind and body form a linked system – Your mental attitude affects your body and your health which, in turn, affects how you behave.
4. If what you are doing isn’t working, do something else – Flexibility is the key to success.
5. Choice is better than no choice – Having options can provide more opportunities for achieving results.
6. We are always communicating – Even when silent, we are communicating. Non-verbal communication accounts for a large proportion of a message.
7. The meaning of your communication is the response you get – While your intention may be clear to you, it is the other person’s interpretation and response that reflects your effectiveness.
8. There is no failure, only feedback – What seemed like failure can be thought of as success that just stopped too soon.
9. Behind every behavior there is a positive intention – When we understand other people have a positive intention in what they say and do (however annoying and negative it may seem), it can be easier to stop getting angry and to start moving forward.
10. Anything can be accomplished if the task is broken down into small enough steps.
Pre-suppositions provide a unique foundation for working with a client. As you can see, strategies based on these pre-suppositions are quite different than strategies based on the traditional medical model or the A.A. model.
How to assess a client’s desired outcome using NLP
We’ll first review the assessment process used in NLP and how it can be useful for people who have completed an addiction treatment program. Then, we will review three strategies for assessing a client’s desired outcomes.
STEP#1: Assessment Process
After building rapport with a client, I conduct the following exercises to determine how best to proceed.
- Outcome Specification – Oftentimes, clients are unclear about what they want. This nine-question exercise provides a summary of client goals and dedication.
- Logical Levels – Exploring the levels helps a counselor understand what makes a client “tick,” and pinpoints why change is not occurring. Knowing exactly where a block is located determines where to intervene most effectively.
- Positive Intent – When the intention of a behavior is understood, other alternatives can be considered.
Three Strategies for Sustaining New Behavior
Given that we now have a clear picture of the presenting issue and a path to proceed, I will introduce strategies for sustaining new behaviors.
After the counselor understands the problem and the blocks involved, it is time to teach the client strategies for sustaining new behaviors. We will review The Swish Pattern, The New Behavior Generator, and Anchoring.
STRATEGY # 1: Swish Pattern
The Swish Pattern allows an individual to replace a negative image with a more positive, motivating one. The process is as follows:
- Name the unwanted behavior or habit.
- Identify a cue image to use when the unwanted behavior occurs.
- Recall a desired, more compelling self-image than the image triggering the unwanted behavior.
- Check to see if any part of the mind objects to adopting the new image.
- Remember the problem behavior cue image and locate a small dark picture of a desired compelling, new, self-image in the corner of the mind.
- Swish by rapidly decreasing and darkening the cue image and simultaneously making the desired self-image larger and brighter.
- Test the swish by thinking of the cue image and notice what happens. If the swish is effective, the desired self-image will replace the old one, resulting in a change of state and a loss of desire for the problem behavior.
STRATEGY #2: New Behavior Generator
This strategy helps a client recognize additional behavioral choices. The steps are as follows:
- Identify a “stuck state.”
- Consider the stuck state from a dissociated view point. Considering the stuck state involves seeing the “self” at a distance as if a neutral
- observer watching a movie.
- From the dissociated state, identify several choices that can be taken.
- Check “ecology” with each alternative by asking, “What would happen if you incorporate this behavior into your situation?”
- Encourage the person to step into each image with each alternative.
- Future pace using the following steps:
……………….-Think of possible future situations that may trigger the old behavior.
……………….-Imagine stepping into each situation. Have the client see, hear, feel, smell and/or taste the experience.
……………….-Notice whether the change holds and whether the response is acceptable.
STRATEGY #3: Anchors
Certain stimuli trigger specific physiological and emotional states or behaviors; in other words, an automatic reaction. Anchors often happen unintentionally. A song can evoke memories of an old friend. Anchors can also be created intentionally. For example, an anchor can be created by pinching one’s ear while feeling confident and then pinching the ear to recall the feeling of confidence as needed.
Hypothetical Client Wishing to Remain Alcohol-free
In the hypothetical case below, I use the three strategies in a coordinated approach with the client.
Julie is a 34-year-old woman whose husband, Jon, died 3 years ago. Jon was jogging in the neighborhood when a woman under the influence of prescription drugs lost control of her car and hit Jon – killing him instantly. Since his death, Julie has been drinking more and more heavily.
Recently, she was cited for public drunkenness and because she has three young children, Child Protective Services (CPS) became involved. Fear that the children will be placed in foster care was so strong that she agreed to attend a 30-day in-patient program.
Julie has had no alcohol since successfully completing the treatment program; yet, she is concerned about relapse. For this reason, she makes an appointment with me to learn strategies for maintaining an alcohol-free lifestyle and keeping her children with her. Based on the Stages of Change Model, Julie is in the Maintenance Stage. She has been abstinent for four months, and feels healthier, happier, and more in control of her life.
After building rapport with Julie, I conducted The Outcome Specifications exercise. The questions and her responses are below.
1. What do you want?
………Julie: I want to manage my feelings in healthy ways.
2. How will you know when you have reached the goal?
………Julie: I will no longer have a glass of wine when I feel depressed or overwhelmed.
3. Why is your goal relevant and/or irrelevant?
……….Julie: I have been killing myself with alcohol, spending too much money on wine, and jeopardizing my children for the past three years – it is time for a change.
4. What stops you from pursuing the goal wholeheartedly?
………..Julie: Sometimes, the pain of Jon’s death and the weight of raising three children on my own is too much. The alcohol provides relief for a short time.
5. What personal resources can you use to help achieve this goal?
…………Julie: I am strong. I love my children. I will do whatever it takes to keep them with me.
6. What additional resources will you need to achieve your goal?
…………Julie: I need strategies for managing my feelings and fears other than drinking.
7. How would the goal affect important people in your life or is there any risk associated with achieving this goal?
…………Julie: My children need me. There is a pending CPS case and I don’t want to lose them. There is no risk. I owe it to myself and my children to succeed. Besides I want Jon to be proud of me.
8. What daily actions will you take to achieve your goal, and what is the first step?
…………Julie: I want to learn new skills for managing my emotions and, then, to use them daily. The FIRST STEP was to make this appointment with you.
9. Given everything you have considered to this point, is achieving the goal worth it?
In reviewing the Logical Levels, the questions and Julie’s responses were as follows.
1. Environment Level – refers to what is around the person when the behavior occurs.
……..Julie: I drink when I am alone or with friends, when something reminds me of Jon, and when I feel overwhelmed with the responsibility of raising three young children by myself.
2. Behavior Level – refers to what the person does.
………Julie: I drink – mostly wine.
3. Capability Level – refers to what a person can do.
……..Julie: I manage well until memories and fears return and then I fall apart.
4. Belief Level – refers to what a person thinks he or she can or should do.
……..Julie: I should be able to manage without alcohol. Sometimes, I doubt whether I can raise the children by myself. I don’t want to live without Jon and yet I must for them.
5. Identity Level – refers to what a person thinks of him or herself.
……..Julie: I was a strong woman and loving mother; I would like to be that person again.
One option was to intervene at the Environment Level. I could teach Julie to stay away from places and people who trigger the desire to drink. However, I know intervening at a higher level affects the lower levels; so, I chose to focus on the Identity Level. At the Identity Level, Julie thinks “I was a strong woman and loving mother.” If her thinking were, “I am a strong woman and loving mother,” she might see her options differently.
Julie identified the positive intent of her drinking as easing the pain of losing her husband and reducing the fear of raising three small children on her own.
My initial goal was to motivate Julie to change, to identify new possibilities, and to provide more effective ways of managing her feelings. To this end, I employed the Swish Pattern, the New Behavior Generator, and Anchoring. In using The Swish Pattern, I guided Julie to replace a negative image with a more positive, motivating one. Her responses were as follows:
– The unwanted behavior or habit
……..Julie: excessive drinking when depressed or overwhelmed
– The cue image, or reminder
………Julie: a glass of wine
– A desired, more compelling self-image
………..Julie: a picture of my three children
– Regarding the ecology check, the picture of her children was a strong motivation.
– I instructed Julie to “swish” by remembering the problem behavior cue image (a glass of wine) and locating a small dark picture of the desired compelling self-image in the corner of her mind (the picture of her children).
– I then encouraged Julie to swish by rapidly decreasing and darkening the cue image and simultaneously making the desired self-image larger and brighter.
– I had her test the swish by thinking of the cue image for the problem state and noticing what happened. We went through the process several times before she easily replaced the cue image with the new image.
Now that Julie had a motivating image, the second strategy I used was the New Behavior Generator. This strategy allows a person to gain access to additional behavioral choices. The steps and Julie’s responses are as follows:
1. I asked Julie to identify the “stuck state.”
………Julie: My stuck state is drinking wine when I feel depressed or overwhelmed.
2. I asked Julie to consider the stuck state from a dissociated view point. This involved her viewing herself at a distance as if she were a neutral observer watching a movie.
3. From the dissociated state, she identified several options other than having a glass of wine.
………..Julie: I could go for a walk, call a friend, go to a counselor, take my children on a play date, or join a fitness club.
4. I checked ecology with each alternative by asking “What would happen if you incorporate this behavior into your situation?” For example,
……..a. Would a switch to walking be satisfying and deter your desire to have a glass of wine when you feel overwhelmed?
……..b. If the emotional pain were intense, would talking to a counselor help?
……..c. If a television show triggered painful memories, could taking the kids on a play date make a difference?
5. I encouraged Julie to step into each image and use each alternative.
………….a. Walking won’t work because I can still think.
………….b. A counselor would be helpful. Could we continue working together?
………….c. I want to be more involved with the kids.
………….d. I like the idea of joining a club, but not yet.
………….e. If the friend wouldn’t allow me to feel sorry for myself that might work.
……..Julie: I would like to start out with the first three options.
6. Finally, I asked Julie to Future Pace by using the following steps:
- Think of possible situations that might trigger your drinking such as watching certain television programs, an anniversary, or seeing a friend of Jon’s.
- Imagine stepping into each situation – see, hear, feel, smell and/or taste the experience. For example, picture playing with your kids, instead of reaching for a drink when you see an old friend of Jon’s.
- Notice whether the change holds and whether you respond the way you want.
Another intervention is to encourage Julie to think of a time when she had fun playing with her children and anchor it by grasping her left wrist with her right hand. When she next feels an urge to drink, she can grasp her wrist and replace the negative image with the positive one. This can be practiced several times until the anchor is strong enough to be effective.
Using NLP to help clients achieve sobriety
In this article, we discussed NLP presuppositions, assessed a client by conducting the Outcome Specification, examined Logical levels, and identified the positive intent of the behavior. Then, we explored strategies for motivating Julie to change, for generating new behaviors, and for anchoring a supportive image.
These are my first steps in working with Julie. However, additional NLP tools will be used including core transformations and psychological attachments.
Do you have questions about the use of NLP in addiction recovery? Please leave your questions in the comments section below. We do our best to respond to all questions personally and promptly.