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LOCATION: Home > Tools > Drug Avoidance Skill > Page 5

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.

• Your primary goal is to refuse or turn down cocaine.

• Your secondary goals might be to -

  • Reinforce your commitment to not use.

  • Feel good about yourself for doing it."

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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.

• No should be the first thing you say.

• 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.

• Body language is important.

  • Making good eye contact is important; look directly at the person when you answer.

  • Your expression and tone should clearly indicate that you are serious.

• 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).

• 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.

• No, thank you.

• No, thank you, but I'll have some coffee or something to eat.

• No, I'm not using anymore; it is causing me too many problems.

• 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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