Session 4 Protocol
The counselor welcomes the client and provides an overview of the session. In this session, the counselor draws on information from previous sessions to increase the client’s understanding about use patterns.
Explore the Development of Addictive Patterns
The counselor asks the client to look closely at his or her behavior, environment, and beliefs to identify addictive patterns:
Counselor (C): We think of repeated marijuana use as learned behavior. When people start to use marijuana a lot, they learn that it changes the way they feel. For example, some people use it like a tranquilizer to help them cope with stressful situations. Some use it when they feel blue. Others expect it to enhance positive feelings. Some think it makes them more confident. And some use it to avoid thinking about troublesome things. How does that fit with your experience? [Waits for answer.]
C: After a while, things in the environment can trigger use, sometimes without your even realizing it. The environment can trigger cravings. Things in the environment that can trigger use include seeing or smelling marijuana, being around people who are smoking, or being in stressful situations. During the assessment session, we talked about the connection you’ve noticed between getting paid on Fridays and buying pot. Are there other connections like that for you?
C: People often develop beliefs about marijuana and their using. These are ideas or “automatic thoughts” you’ve come to believe about you and your marijuana use. I’ve heard you say things in previous sessions like, “I can’t be creative or work effectively without it,” “I can’t take the way I feel when I’ve tried to quit,” “I need to change, but it’s not worth the effort.” What other beliefs do you have about you and marijuana?
C: Marijuana can change the way a person feels, acts, and thinks. To help you avoid or cope with the situations in which you smoke and to help you find things you can do instead of smoking, let’s start by working on understanding your behavior. Does this make sense to you?
Assess High-Risk Situations
The counselor explains that marijuana use behavior is learned over time. The client’s understanding of his or her use patterns can help the client change those patterns. Understanding high-risk situations can help the client avoid or cope with those situations:
C: If using marijuana changes the way a person acts, thinks, and feels, it’s helpful to begin by identifying use patterns and habits. Once your patterns are identified, you may find it easier to change your behavior. You can find ways to cope with your high-risk situations without using. Change involves learning specific skills and strategies. Once you know about the situations and problems that contribute to your using marijuana, you can look for other ways to handle those situations. What do you think about that?
The counselor focuses on the client’s behaviors and high-risk situations:
C: In what situations do you use marijuana (e.g., places, people, activities, specific times, days)?
C: What are your triggers for using (e.g., when you’re in a social situation, when you’ve had a tense day, when you’re faced with a difficult problem, when you want to feel relaxed)?
C: Can you describe a recent situation when you used (e.g., a relapse story)?
C: Can you remember your thoughts and feelings at the time you used (e.g., tense, bored, depressed, stressed, overwhelmed, angry)?
C: What were the consequences of using?
The counselor asks the client about marijuana use behavior using motivational interviewing techniques (e.g., reflection, expressing empathy) while finding out important information about the client’s use environment:
C: In what situations do you find yourself smoking?
Doug (D): When things get hectic at home. Between my wife and my son, it seems as if everyone is out to get me. When I smoke, I can cope with them.
C: Smoking helps you cope with stress at home. Are there other situations when you smoke?
D: Not right now. When I go home, I should be able to relax, but with all the nagging, I end up smoking to escape.
C: You want your home to be peaceful, but conflicts over your smoking push you to smoke.
D: Yeah; sounds crazy, doesn’t it?
C: Your situation is difficult. Things you identify that lead you to smoke are called triggers. You’ve said that conflicts at home trigger you to smoke. What are your thoughts and feelings during times of conflict at your house, right before you light up?
D: I’m thinking that if everyone would get off my back, I might be able to quit smoking. But they don’t, and it’s the only way I know how to relax.
C: You find yourself in a bind. Let’s use the Marijuana Use Self-Awareness Record [presents form 4A] to list the things we’re talking about. You said smoking marijuana helps you relax. What else does it do for you?
D: It helps me sleep. When I don’t get high, it’s hard getting to sleep. I used to enjoy the high a lot more than I do now. I keep smoking, but I don’t even get that high anymore.
C: Sounds as if you’re listing the negative parts of smoking. Are there others?
Together the counselor and client fill out the Marijuana Use Self-Awareness Record (form 4A).