Introduce rationale for behavioural self-monitoring
Elicit concerns about high-risk situations and triggers for using
Introduce link between triggers, thoughts about using and urges to use
Use urge diary
Introduce rationale for behavioural self-monitoringThe first step in learning to manage daily life without speed is to first identify those situations in which the client is most likely to use/experience the urge to use. Explain that keeping tabs on speed use over time helps to make conscious the apparent 'automatic' nature of a habit or behaviour related to dependence. Self-monitoring assists a client to see patterns of behaviour previously unidentified. Identifying patterns allows clients to more easily identify high-risk situations and triggers for using, and provides an opportunity for people to practise a range of strategies to reduce the likelihood of using.
Elicit concerns about high-risk situations and triggers for usingExplain that an important first step in quitting or cutting down speed use is to become aware of the circumstances that tempt the client to use. These circumstances are called 'triggers'. Triggers can be external or environmental such as bumping into friends who use or being exposed to the drug itself. Internal triggers can include mood states such as feeling depressed or even excited and physical states such as feeling tired and run down. Triggers are very personal and should be identified in detail.
Go through the triggers the client thinks lead to his/her use of speed. Elicit the client's concerns about high-risk situations for using speed and discuss circumstances surrounding these.
Introduce link between triggers, thoughts about using and urges to useIntroduce the link between the personal triggers identified and explain how these triggers promote thoughts (cognitions) about using and often lead to an increase in urges to use. This pattern is often seen in relapse and should be uncovered for each person so a management plan can be developed. Use the following rationale for the client:
"In working out how to better manage your speed use, we first need to find out which situations are most likely to lead you to use and what you are thinking and feeling in those situations. What we want to learn is what kinds of things are triggering or maintaining your urges to use. Then, we can try to develop other ways you can deal with these 'high-risk' situations without using speed. An important first step in managing these trigger situations and urges to use is to monitor those times of the day and night when they occur. Quite often, this whole process happens so quickly we don't even realise what has happened – it's almost like we've gone into automatic pilot and are suddenly having a speed craving. But a whole series of thoughts and reactions take place between the trigger situation and our urge to use speed. So, in becoming aware of this process, we put ourselves in a better position of being able to cope."
Use urge diarySet the client the homework task of monitoring themselves over the next week and writing down the situations in which he/she feels the urge to use and the feelings associated with those situations. The following is an example that could be used: Top of page
Exercise 2: The urge diary
- Where were you?
- Who were you with?
- Did any significant events happen?
- What were you thinking?
- What were you feeling?
- What did you actually do?
SummariseToward the end of the commitment process, offer a broad summary. Include a repetition of the issues of concern, the client's self-motivational statements, the client's plans for change, and the perceived consequences of changing and not changing. Ask:
"Do I have it right?"
"What have I missed?"
Record any additional information that is offered.