Topic 5: An All-Purpose Coping Plan
Tasks for Topic 5
- Anticipating future high-risk situations
- Developing a personal, generic coping plan
Despite patients' best efforts, a variety of unforeseen circumstances may arise that result in high-risk situations. These often have to do with major, negative stressful events or crises, such as the death or sickness of a loved one, learning one is HIV positive, losing a job, the loss of an important relationship, and so on. However, positive events can also lead to high-risk situations. These could include receiving a large amount of money or starting a new intimate relationship. Since such events may occur anytime, during as well as after treatment, patients are encouraged to develop an emergency coping plan which they can refer to and use should such crises occur.
The goals of this session are to -
- Anticipate future high-risk situations.
- Develop a personal, generic coping plan.
Anticipate High-Risk Situations
Therapists should point out that although patients will find it helpful to recognize, avoid, and cope with high-risk situations, life is unpredictable, and not all high-risk situations can be anticipated. Crises, negative stressors, and even positive events can result in high-risk situations.
Therapists should ask patients to think of three or four major stressors that might arise over the next few months, as well as what their reactions might be. Then ask them to anticipate anything that might happen to shake their commitment to abstinence. For each of these situations or circumstances, therapists and patients should develop concrete coping plans.
Develop a Coping Plan
When patients are most stressed, they may feel vulnerable and be more likely to return to old, familiar coping strategies than use the healthier but less familiar strategies they have practiced during sessions. It is important to try to develop a generic, "foolproof" coping strategy that can be used in the event of any major crisis. This should include, at minimum, the following.
- A set of emergency phone numbers of supportive others who can be relied on
- Recall of negative consequences of returning to use
- A set of positive thoughts that can be substituted for high-risk cocaine thoughts
- A set of reliable distracters
- A list of safe places where the patient can ride out the crisis with few cues or temptations to use (e.g., a parent's or friend's house)
The practice exercise for this session includes anticipating some crises and responses and developing the all-purpose coping plan (exhibit 9). Remind patients that treatment will end soon, and they will be using these skills on their own.