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Drug Avoidance Skills
Rationale
When initiating drug-refusal training, therapists
begin by explaining why this will be important to the patients.
"Drug refusal training can be very important in
helping you achieve a substantial period of abstinence and for
maintaining that abstinence. We are going to practice ways to refuse
cocaine or to refuse to go to places where cocaine is available. The
ability to effectively say no in these situations will help you feel in
control when faced with situations that are tempting and to which you
may previously have said yes automatically."
"Our experience is that patients usually
underestimate the difficulties encountered when trying to refuse or
avoid cocaine. You may feel that you will have no problem saying no, or
that no one will ask you if they know you are trying to quit. However,
previous patients have found that, if they do not prepare themselves to
deal with these situations, good intentions do not always lead to
effective refusal. What we and our patients have found to be helpful is
to plan and repeatedly practice using specific refusal skills for
handling high-risk situations that may arise."
"We have developed a training protocol that is
designed to teach or remind you of some effective ways to say no when
opportunities arise. An important component of this training is for you
to be creative in anticipating many of the situations that may come up
in the following months. We have developed some examples that we feel
are typical of what many cocaine abusers face, but each person has a
unique set of circumstances. This training will benefit you most if you
include situations relevant to your life so that we can rehearse how to
handle them."
Refusing Cocaine and Other Drugs
Therapists then initiate a discussion and provide
information concerning how patients can learn to effectively refuse
cocaine. Some important concepts and instructions are presented as
follows.
"Remember that those persons who offer you cocaine or
alcohol are not thinking of your best interests. They may be your
friends, but once you have decided to quit, it is important for you to
consider anyone who asks you to use cocaine or go party as a pusher.
They must be discouraged - politely, if possible, but firmly."
"Saying no is the first and most important part of
your refusal response. There are different ways of saying no that are
appropriate in different situations. Different people say no in
different ways. It is important to feel comfortable, which means that
you have to develop your own style. When working to develop your style,
it is important to keep a few goals in mind.
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Components of Effective Refusal
"When creating your own refusal style, a few basic
components of your refusal responses will increase the likelihood that
they will be effective.
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No should be the first thing you say.
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Tell the person offering you drugs or asking you to
go out not to ask you now or in the future if you want to do cocaine.
Saying things like 'maybe later,' 'I have to get home,' or 'I'm on
medication' just make it likely that they will ask again.
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Body language is important.
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Offer an alternative if you want to do something
else with that person. Make sure that it is incompatible with cocaine
use (taking your children for a walk or to the park, going to work
out).
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Change the subject to a new topic of conversation.
Change the subject to a new topic of conversation.
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Practice Refusal Skills
Next, therapists help patients begin to develop
personal refusal styles. Basic examples of saying no are provided.
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No, thank you.
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No, thank you, but I'll have some coffee or
something to eat.
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No, I'm not using anymore; it is causing me too
many problems.
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No, I've got a cocaine problem, so I'm not using
anymore.
Therapists then help patients construct at least
three typical scenes in which patients have had or may have difficulty
refusing cocaine. Examples of such situations are friends stopping by
with cocaine, friends calling on the telephone, running into friends
while shopping, special occasions, parties, or leaving work. The
situations that they choose should be very specific. That is, they
should include specific people, specific times of day, and so forth.
Therapists and patients then role-play two or three
of these situations. Before starting, therapists remind patients of the
components of effective refusal and the goals for the situation. A list
of these components is provided for the patient to refer to before and
during refusal practice attempts
(exhibit 16).
For each situation, therapists first have the
patients function as themselves, with the therapist acting as the person
offering cocaine. After each trial, constructive feedback is given.
Therapists continuously refer to the components and goals of effective
refusal when giving feedback. Examples or alternatives are given as
needed. Problems with some of the patients' tactics are pointed out if
they seem ineffective. Following the feedback, the role-play is
repeated. When patients experience a lot of trouble, therapists reverse
roles with them and model an effective response.
Second, therapists have patients act as the person
offering drugs, and the therapists act as the patient. The same
procedures are followed. Therapists initiate a discussion of how it
feels to be in the different roles: What is hard? What is easy? What
feels comfortable? What does not?
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Patients may have difficulty with some components.
Teaching the components one or two at a time may be a useful method for
helping them develop effective refusal skills. Therapists should model
the components that they have difficulty with by using role reversal.
Homework
Therapists should remind patients that the most
important thing in developing effective refusal skills is practice.
Weekly practice goals are set. For example, two high-risk situations can
be identified, and patients can practice these scenes each day between
sessions. If the patients have partners to practice with, this can be
scheduled either during or outside of the session. If patients do not
have anyone to practice with, they can either practice aloud in front of
a mirror or write down a refusal scenario with responses and bring it to
the next session for practice.
In addition, therapists should ask patients to
identify situations during the next week in which they may be confronted
by a pusher. These situations should be rehearsed in session, and
therapists should contract with patients to practice this refusal scene
daily and to refuse in that real-life situation.
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