A classic practice in addiction counseling

Disclaimer: Nothing in this document should be taken or held as clinical instruction, clinical supervision, or advisory concerning patient care.

There’s a classic practice in addiction counseling that I’ve seen implemented for decades but have never seen written up in the clinical-applied literature, practice guidelines, research studies, or anywhere else I can think of.

Here it is: educate the person with chronic, severe, and complex addiction illness, during the active treatment phase of their care, on the value of doing each of these each day:

• Read in the literature from their chosen support pathway.
• Talk with someone who has what they want.
• Do some kind of behavioral activity that develops a spiritual connection or spiritual capacity.
• Check yourself at the end of the evening (how you did during your day) and set a plan for tomorrow.

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As I consider those, the following things come to mind:

Reading gets outside input, and the content gets in through the intellect/cognition. And it can be done privately.

Talking with someone gets outside input, but it’s also a transactional back-and-forth method. The material gets in through human transaction and mirroring.

Practicing the types of behaviors that develop spiritual connection helps to “strike while the iron’s cold” That’s a whole different kind of practice from trying these behaviors for the very first time on our worst day. These behaviors can be done privately and some versions can be done in real time. Sometimes this is experienced as dumping something and getting relief, and at other times it’s experienced as gaining something quite particular.

Reviewing the day and setting a plan for tomorrow sets up improved self-awareness over time. Eventually, the circular model of this activity (review, revise, do; review, revise, do; and so on) gets internalized and people start adjusting in the moment rather than adjusting for tomorrow very late in the day today.

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Having grown up for my first 19 years simultaneously in a long-term residential (Therapeutic Community) program and an outpatient Methadone Maintenance program, I have seen first-hand the giant impact of doing these 4 things on a single day. And an even bigger impact from doing them daily for weeks, months, or even longer.

One thing I’ve always liked about these 4 things is that they’re independent of any chosen pathway of personal improvement. And by nature they’re super-adaptable.

Another thing I’ve always thought was super important about these is that taken together they’re a self-efficacy building way of driving one’s own personal improvement. Doing these for just one day is far less daunting than imagining doing well every day from now until you’re 90 years old. And such a daily regimen really imparts the basic idea and method of “Illness Self-Management”.

Why something like this (that’s so practical, behavioral, individualizable by the person served, and so foundational) has not been written up in the professional literature (to the best of my knowledge) I’ll never understand.

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Acknowledgement: Thanks to Kristin White for her comments on a previous version of this manuscript