Therapeutic Interventions

1. Using a 12-step recovery program's Step One exercise, help the client to understand how impul-sivity and addictive behavior led to powerlessness and unmanage-ability.

2. Review the client's behavior pattern to assist him/her in clearly identifying, without minimization, denial, or projection of blame, his/her pattern of impulsivity.

3. Administer to the client psychological instruments designed to objectively assess impulsivity (e.g., Barratt Impulsiveness Scale [BIS], Conners' Adult ADHD Rating Scales [CARRS]); give the client feedback regarding the results of the assessment.

4. Discuss how impulsivity and addiction meet the 12-step recovery program's criteria for insanity. (4)

5. Identify the negative consequences that are caused by impulsivity. (5, 6, 7)

6. Verbally identify several times when impulsive action led to addictive behavior and subsequent negative consequences. (8)

7. Increase the frequency of reviewing behavioral decisions with a trusted friend or family member for feedback regarding consequences before the decision is enacted. (9, 10)

Verbalize the biopsychosocial elements that cause or exacerbate impulsivity and addictive behavior. (11)

4. Using a 12-step recovery program's Step Two exercise, help the client to see that doing the same things over and over again and expecting different results meets the 12-step recovery program's definition of insanity.

5. Assist client in making connections between his/her impulsivity and the negative consequences for himself/herself and others resulting from it.

6. Assign the client to write a list of negative consequences that occurred because of impulsivity.

7. Help the client to see how dangerous it is to act impulsively (e.g., you don't have time to think, you can't plan effectively).

8. Explore times when the client acted too quickly on impulses, resulting in addictive behavior.

9. Conduct a session with spouse, significant other, sponsor, or family member and client to develop a contract for the client to receive feedback prior to his/her engaging in impulsive acts.

10. Review the client's implementation of reviewing with significant others decisions to act before engaging in impulsive actions; reinforce success and redirect for failure.

11. Probe the client's biopsychosocial history and help the client to see the contributing factors to his/her impulsivity and addictive behavior (e.g., family models of impulsiv-

Comply with a physician's evaluation regarding the necessity for psychopharmacological intervention. (12)

Take all medications as prescribed and report as to effectiveness and side effects. (13, 14)

Identify the thoughts that trigger impulsive behavior, and then replace each thought with a thought that is more accurate. (15, 16)

List the inappropriate behaviors that are displayed when feeling anxious and uncomfortable, and replace each behavior with an action that is positive and adaptive. (2, 17)

ity or addictive behavior, anxiety that energizes impulsivity, failure to learn delay of gratification in childhood).

12. Refer the client to a physician to examine him/her, order medications as indicated, titrate medications, and monitor for side effects and effectiveness.

13. Direct the staff to administer the medications as ordered by the physician.

14. Monitor the client's psychotropic medication for effectiveness as well as side effects.

15. Help the client to uncover dysfunctional thoughts that lead to impulsivity; assist him/her in replacing each dysfunctional thought with a thought that is more accurate, positive, self-enhancing and adaptive.

16. Help the client to develop a list of positive, accurate, self-enhancing thoughts to read to himself/herself each day, particularly when feeling upset, anxious, or uncomfortable.

2. Review the client's behavior pattern to assist him/her in clearly identifying, without minimization, denial, or projection of blame, his/her pattern of impulsivity.

17. Probe the client's anxious, impulsive behaviors, and then use modeling, role-playing, and behavior rehearsal to teach him/her new behaviors that are positive and adaptive (e.g., talking to someone about the problem, taking a time out, calling the sponsor, going to a meeting, exercising, relaxing).

13. Implement relaxation procedure when feeling upset or uncomfortable. (18)

14. Practice stopping, looking, listening, thinking, and planning before acting. (19, 20)

15. Verbalize an understanding of a 12-step recovery program's Step Three regarding the role of a higher power, and how this step can be used in recovery from impulsivity and addiction. (21, 22)

16. Relate how each wrong behavior identified in a 12-step recovery program's Step Four exercise can be related to im-pulsivity and addiction. (23, 24)

18. Teach the client relaxation techniques (e.g., progressive relaxation, self-hypnosis, biofeedback); assign him/her to relax whenever he/she feels uncomfortable.

19. Using modeling, role-playing and behavior rehearsal, show the client how to use "stop, look, listen, think, and plan before acting" in various current situations.

20. Review the client's use of "stop, look, listen, think, and plan" in day-to-day living, and identify the positive consequences.

21. Teach the client about the 12-step recovery program's concept of a higher power, and discuss how he/she can use a higher power effectively in recovery (e.g., practice stopping and asking a higher power for strength and direction, practice daily prayer and meditation).

22. Using a 12-step recovery program's Step Three exercise, teach the client how to turn his/her will and life over to the care of a higher power.

23. Using a 12-step recovery program's Step Four exercise, assign the client to write an autobiography of the exact nature of his/her wrongs, and relate these wrongs to impulsivity and addictive behavior.

24. Assist the client in acknowledging the relationship between the wrongful behavior identified in a Step Four exercise and his/her im-pulsivity and addictive behavior.

17. Develop and write a continuing care program that includes the recovery group meetings and any further therapy that is necessary for recovery. (25)

18. Family members verbalize a connection between impulsivity and addictive behavior.

19. Complete a re-administration of objective tests of impulsivity as a means of assessing treatment outcome. (29)

20. Complete a survey to assess the degree of satisfaction with treatment. (30)

25. Help the client to develop an aftercare plan that includes regular recovery groups, getting a sponsor, and any further therapy necessary to recover from impul-sivity and addiction.

26. Encourage the client to share with family members the journey through impulsivity, addiction, and recovery.

27. Discuss with family members the connection between impulsive behavior and addictive behavior.

28. In a family session, review what each member can do to assist the client in recovery.

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

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

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