Step 5: Skill Building

During the first 10-week skill building phase, a program member is attending weekly individual counseling, seeing the provider on a weekly or biweekly basis for refills, and attending a weekly, 90 minute Skill Building Group session (maximum 12 members). The Skill Building sessions contain more didactic material than subsequent home group sessions, but with plenty of input from participants. Subjects include:

  1. Exploring values
  2. Defusing from the addiction
  3. Exploring and setting goals.
  4. Value based avoidance
  5. Building recovery skills, part 1
  6. Building recovery skills, part 2
  7. Motivation
  8. ”Re-mindfulness”
  9. Quality of life: Value based living
  10. Relationships

When patients first enter the recovery program they are like deer in a car headlights. They are confused, desperate, grasping for help, and in dire need of assistance. As they stabilize on their initial dose of buprenorphine, people often enter a honeymoon period lasting a few weeks, in which they feel tremendous relief that they no longer need to search for their next hit. They will be grateful, compliant, and happy.

Beware if they want to stop and rest here. Many will be homeless, penniless and jobless, and all will have left a wreckage of traumatized families and destroyed relationships in the wake of their addiction. There is much work to be done.

Beware, too, if they want to fix everything at once. Mending social and life problems cannot be done overnight. People will need help prioritizing, taking a sequence of small steps rather than one huge one. Maslow’s hierarchy of needs will come in handy. Housing, employment and safety come first. Then repairing relationships. People quickly learn that it is best to lose all one’s old friends for a time, change cell phone numbers, erase old dealer’s names and numbers, and stop going to old haunts which contain the triggers to use. There will be issues and dilemmas along the way. As the drama lessens, amends will be made, regrets expressed, bonds reforged.