Help Client Identify Specific Behavior Change Strategies

The counselor discusses specific coping strategies to handle vulnerabilities to slipping. The counselor gives the client Learning New Coping Strategies (form 1A) and A Guide to Quitting Marijuana (form 1B). If time permits, the counselor reviews these forms with the client, highlighting sections that seem particularly relevant to the client. The counselor explains that many concepts touched on in the forms are discussed in detail in later sessions and the client should bring the forms to the next session (session 2).

Because managing one’s stress level is important, particularly in the early weeks and months of treatment, the counselor advises the client about HALT:

• Don’t let yourself become too Hungry.

• Don’t let yourself become too Angry.

• Don’t let yourself become too Lonely.

• Don’t let yourself become too Tired.

The counselor asks the client to think about people, situations (e.g., certain times of day, days of the week, places, moods), and thoughts that can increase vulnerability to slipping. Some of these were mentioned on the Self-Efficacy Questionnaire (form AS7). For example, a client may describe plans to spend time with a smoking buddy. A client may face significant life changes (e.g., job or relationship changes, illness in the family or of a close friend) likely to produce stress that could place the client at risk for slipping. The counselor and client identify and discuss coping strategies for each situation.

The counselor helps the client identify people from whom he or she can seek and get support. The counselor encourages the client to consider several options rather than only one or two and to think creatively. With the counselor, the client can practice making requests and can benefit from the counselor’s modeling and feedback. Practicing interactions during treatment sessions can lessen the anxiety the client may have about asserting himself or herself with friends and family:

M: I’ll be going away for a few days, and I have concerns that no one will be watching me.

C: What concerns do you have?

M: I’ll be at a meeting with several people who smoke. For years we’ve gone out and partied after the meetings. I don’t know what I’ll do.

C: You just identified a high-risk situation.

M: Yeah. What should I tell them? I thought about saying I had a cold, but that’s lying.

C: You would prefer to tell them the truth. What are your concerns about that?

M: I guess I’m afraid they would think I’m judging them. I really like these people.

C: That is a difficult situation for you. Maybe if you and I rehearsed a couple of different ways to tell them, it would make it easier for you. Would you be willing to try that?

M: Sure, what should we do?

C: Why don’t I play the role of one of your colleagues on this trip, and you try different ways you might handle it. Ready?