Therapeutic Interventions

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1. Administer to the client psychological instruments designed to objectively assess ADD and substance abuse (e.g., Conners' Adult ADHD Rating Scales [CAARS]); give the client feedback regarding the results of the assessment.

2. Arrange for psychological testing to rule out emotional factors or learning disabilities as the basis for the client's maladaptive behavior; give feedback to the client and his/her family regarding psychological testing results.

3. List the ways that using addictive behavior to cope with the symptoms of ADD and the feelings that result from it leads to power-lessness and unmanageability.

4. Probe the feelings the client had when trying to deal with the failure to learn due to symptoms of

4. List the ways that using addiction to cope with symptoms of ADD and the feelings that result from it leads to power-lessness and unmanageability.

5. Verbalize the interpersonal difficulties caused or exacerbated by symptoms of ADD and substance abuse. (6, 7)

6. List the negative messages given to oneself in a learning situation and replace each with an encouraging, affirming message. (8, 9)

7. Identify specific instances when the negative emotions associated with failure to learn were a trigger for addiction, and verbalize constructive coping mechanisms to use in future learning situations. (10, 11)

ADD, and discuss how chemical abuse was used to avoid uncomfortable feelings.

5. Using a12-step Step One exercise, help the client to correlate ADD and addiction with powerlessnes and unmanageability.

6. Probe the client's relationship problems caused or exacerbated by ADD and addiction.

7. Confront statements in which the client blames others for his/her impulsive behaviors and fails to accept responsibility for the consequences of his/her actions.

8. Assist the client in identifying distorted, negative self-talk with positive self-talk in a learning situation.

9. Train the client to replace negative expectations and disparaging self-talk with positive self-talk in a learning situation.

10. Review specific instances of the client's failure to learn and the negative emotions associated with the experience; note if these emotions triggered addictive behavior as an escape.

11. Role play and model constructive alternative coping behaviors (e.g., cognitive focusing, deep breathing, make lists, reduce distractions, shorten learning sessions, repeat instructions verbally) to deal with difficult and frustrating learning situations.

8. List how working a program of recovery can assist in eliminating the negative effects of ADD and addiction. (12, 13)

9. Comply with a physician's evaluation to determine if psychopharmacological intervention is warranted; then take any medications as directed. (14, 15)

10. Implement remedial procedures for learning disabilities that add to frustration. (16)

11. Keep lists of all scheduled activities and obligations and mark off each item as it is completed. (17)

12. List techniques that can be used to reduce the negative effects of ADD. (18)

12. Help the client to see how working a program of recovery can aid in reducing the negative influences of ADD and addiction (e.g., going to meetings, talking regularly with a sponsor, and enjoying recreation with a new recovery peer group).

13. Help the client to understand the AA concept of a higher power and teach the client the ways a higher power can assist him/her in recovery (e.g., turn problems over to God, practice regular prayer, and meditation).

14. Refer the client to a physician to determine if psychopharmacolog-ical intervention is warranted, and to order medications as indicated, titrate medications, and observe for side effects.

15. Direct the staff to administer medications as ordered by the physician and to monitor for side effects and effectiveness.

16. Refer the client to a special educator who will design remedial procedures for any learning disabilities that may be present in addition to ADD.

17. Assist the client in developing calendars and lists to carry that detail activities and obligations.

18. Help the client to develop a list of the things he/she can do to reduce the negative effects of ADD (e.g., reduce extraneous stimulation, make lists and reminders, take medication, utilize relaxation techniques, talk to someone, go to AA/NA meetings, engage in physical exercise).

13. Create and utilize a learning environment that is free enough of extraneous stimulation that productive learning can take place. (19)

14. Implement coping skills when experiencing ADD symptoms or craving for addiction.

15. Family members verbalize what each person can do to assist the client in recovery. (24, 25)

19. Help the client develop a quiet place that is free of extraneous stimulation, where he/she can concentrate and learn.

20. Teach the client relapse prevention techniques of going to meetings, talking to someone, calling a sponsor, utilizing relaxation skills, engaging in physical exercise, and turning worries over to a higher power.

21. Using relaxation techniques (e.g., progressive relaxation, guided imagery, biofeedback), teach the client how to relax; assign him/her to relax twice a day for 10 to 20 minutes.

22. Encourage the client to implement relaxation skills as a coping and focusing mechanism when feeling tense and frustrated by a learning situation or when tempted to relapse into addictive behavior.

23. Help the client develop an exercise program, increasing the exercise until he/she is exercising at a training heart rate at least three times a week for at least 20 minutes; encourage exercise as a means of reducing the level of stress and frustration or when tempted to relapse into addictive behavior.

24. In a family session, teach the family members the connection between ADD and addiction, going over what each family member can do to assist the client in recovery (e.g., go to Alanon meetings, reinforce positive coping skills, keep expectations realistic, go to ADHD support group).

16. Complete a re-administration of objective tests of ADD as a means of assessing treatment outcome. (26)

17. Complete a survey to assess the degree of satisfaction with treatment. (27)

25. Provide the family members with information about ADHD (e.g., You Mean I'm Not Lazy, Stupid, or Crazy? by Kelly and Ramundo).

26. Assess the outcome of treatment by re-administering to the client objective tests of ADD; evaluate the results and provide feedback to the client.

27. Administer a survey to assess the client's degree of satisfaction with treatment.

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