Discuss Valuing Self-Reflection

The counselor reminds the client that acting without thinking it through is common. People develop automatic processes that allow important tasks to be completed, but in treatment the client is encouraged to be aware of activities and choices. During the early phases of learning something new and essential to one’s survival or emotional health and well-being, such as stopping substance use, the client needs to be aware of his or her choices and decisions. This increases the likelihood that each choice moves the person toward his or her goals.

The counselor stimulates the client’s ability to be aware of his or her thoughts and choices:

C: Think about every choice you make, no matter how seemingly irrelevant it is to using marijuana. By thinking ahead about each option you have and where each choice may lead, you can anticipate dangers that may lie along certain paths.

By paying more attention to the decisionmaking process, you’ll have a greater chance to interrupt the chain of decisions that could lead to a relapse. It’s easier to stop the process early, before you wind up in a high-risk situation, than later, when you’re in a situation that’s hard to handle because you’re exposed to triggers.

When you pay attention to your decisionmaking process, you can recognize certain thoughts that can lead to risky decisions, such as the thought George had to call home. Thoughts like you have to go to a party, have to see a certain person you used marijuana with, or have to drive by a particular place often occur at the beginning of a seemingly irrelevant decision and should be treated as a warning or red flag. Other red flag thoughts often start “It doesn’t matter whether I…” or “I can handle…”.

Discuss the Role of Consciousness in Decisionmaking

The counselor encourages the client to plan coping approaches:

C: When faced with a decision, you should choose a low-risk option, one that will help you avoid a risky situation. However, if you select a high-risk option, you must plan to protect yourself. By becoming aware of seemingly irrelevant decisions, you can take action to avoid high-risk situations. It is easier to avoid a high-risk situation than it is to resist temptation once you’re in it.

Introduce Topic Exercises

The counselor introduces several exercises pertinent to this session:

C: Think about your most recent marijuana use. Follow the decisionmaking chain. What was the starting point (e.g., exposure to a trigger, certain thoughts)? Can you recognize the points where you chose to make a risky decision?

Have you made plans for this weekend? If no, why not? Is this a seemingly irrelevant decision? Sometimes not making any plans means planning to use. What plans can you make for this weekend to avoid a risky situation?

Here are other examples of situations involving seemingly irrelevant decisions that can be setups for a relapse. Which ones apply to you? What is a low-risk option for each?

Whether to keep marijuana in the house

Whether to offer a ride home to a friend you used to smoke with

Whether to tell a friend you’ve quit using.

In the following dialog the counselor inquires about potential seemingly irrelevant decisions:

C: You’ve gone several weeks without smoking. That’s quite an accomplishment.

Doug (D): Yeah, I never thought I could go that long.

C: What caught your attention during our talk about seemingly irrelevant decisions?

D: I put a secret stash in the garage several months ago. Sometimes I forget it’s there, but I guess I want a way out if things get too tough.

C: You seem concerned about it.

D: Yeah, that idea that not making plans may mean planning to smoke hit me right between the eyes. As long as I keep pot around, I guess I’m planning to smoke it sooner or later.

C: What are you thinking about now that you know that?

Terminate Treatment

If this is the final treatment session with this client, the counselor discusses termination issues (see pages 18 and 131).