MODULE 7
SOCIAL/RECREATIONAL
COUNSELING

	

Table Of Contents

TABLE OF CONTENTS…………………………………………………………...………………	II
MODULE 7: SOCIAL/RECREATIONAL COUNSELING…………………………………………..	1

CHECK-IN…………………………………..……………………………………………………………….………….	1
SET THE AGENDA ……………………………………………………………………………………………………..	2
DISCUSS THE SELF-MEDICATION TRAP……..………… …………………………………………………………	2
DISCUSS THE POSITIVE CYCLE OF CHANGE...........................................................................................................	3
Troubleshooting……… ……………………………………………………………………………………………	4
ELICIT OTHER REASONS TO ENHANCE LEISURE SKILL………………………………………………….…….	4
Changes in use leave some void…………………………………………………………………………………...	5
Free time can be risky for some people……………………………………………………………………………..5
Quitting may feel like a sacrifice……….……………………………………………………………………………	5
Being unhappy is a risk for starting again…………………………………………………………………………	5
SUMMARIZE RATIONALE…………………………………..………………………………………………………..	5
DISCUSS REWARD, PLEASURE, AND HAPPINESS ……………………………………………………………….	6
Discuss Immediate Reward/Relief…………………………………………………………………………………	6
		Discuss Pleasure…………………… ……………………………………………………………………………….	6
Discuss Happiness………………………………………………………………………………………………….	6
Narrow focus……….………………………………………………………………………………………………..	6
Discuss skill decay and interrupted learning………………………………………………………………………	7
IDENTIFY SOURCES OF REWARD, RELIEF, AND PLEASURE…………………………………………………..	7
Troubleshooting…………………………………………………………………………………………………….	8
	DISCUSS GOAL SETTING….…………… …………………………………………………………………………….8
DISCUSS STRATEGY OF SAMPLING ACTIVITIES………… …………………………………………………….	9
	ASK FOR COMMITMENT TO GOAL….…………… ……………………………………………………………….	9
COMPLETE AGENCY SPECIFIC TASKS…………..………… …………………………………………………….	9
SUMMARIZE SESSION.........................................................................................................................................…......	9
PREVIEW NEXT SESSION …………………………………………………………………………………………….	10
DISCUSS HOME ASSIGNMENT ……………………………………………………………………………………....10
END SESSION……………….…………………………………………………………………………………………..	10

APPENDIX A: SESSION MATERIALS………………………….. …………………………………..11

SELF-MEDICATION TRAP…….………………… ……………….…………………………......................................	12
FINDING REWARD, PLEASURE, AND HAPPINESS...…………………………………………………………...…	13
PLANNING TO FEEL GOOD….………………… ……………….…………………………......................................	14
MODULE 7 SESSION CHECKLIST……………….………………………………………………………………...…	15

Social/Recreational Counseling

The primary objectives of this module are to 1) build motivation for making some changes in social and recreational activities, 2) enhance clients’ engagement in social and recreational activities, and 3) encourage ongoing planning and development of skills for maintaining pleasure, relief and reward.

=====╣Module Outline╠===========================================

Target Discussion Points

	Check-in
	Set the agenda
	Discuss the “self-medication trap”
	Discuss the “positive cycle of change”
	Elicit other reasons to enhance leisure skills
	Summarize rationale
	Discuss reward, pleasure, and happiness
	Identify sources of reward pleasure, and happiness
	Discuss goal setting 
	Ask for commitment to goal
	Complete agency specific tasks
	Summarize session
	Preview next session
	Review home assignment
	End session

Check-in
The therapist should conduct a brief check-in to assess how the client has been doing.
Time for discussion of client’s thoughts, questions, or concerns about the session material from the previous week may be taken as needed.

“Welcome back. It’s good to see you again.  How have you been doing since our last session?”

“Do you have any questions or thoughts about what we worked on last time we met?”

Set the Agenda
The therapist should set the agenda for the session goals including: 1) discuss pleasure and reward as a coping skill, 2) review client’s current means for achieving reward and pleasure, and 3) consider additional means for finding reward and pleasure.

“One of the topics we talked about when you were deciding what you wanted to work on was increasing reward, pleasure, and happiness.  Today we will begin working in this area.  We can review what you have been doing for pleasure up to now, and begin to think about what you can add to your routine to bring you more reward, pleasure, and happiness.  How does that sound?

Discuss the self-medication trap
For many clients the relationship between mood symptoms and substance use can be powerful and bi-directional.  Substance use may be an effective (but temporary) means

Using 
Substances

Feeling Unhappy

	
Clients rely on to medicate or numb their
negative mood states.  An over-reliance on
substances to cope with the negative mood
states may in turn exacerbate those mood
states. Some clients may be caught in a 
cycle of using to escape the negative mood 
states that using has caused or worsened.
This treatment module is intended to 
interrupt this cycle of using substances to 
feel better an then feeling worse because of 
using.

For those who have a substance use disorder that is secondary to a mood disorder, negative  mood states may improve with the elimination of substance use and enhancement of social and recreational skills, but will persist to a greater degree than for individuals with a mood disorder secondary to a substance use disorder.  For these clients, enhancing social and recreational skills may be particularly important as they typically rely on substance use as a coping strategy at the exclusion of more adaptive coping.

Begin the discussion with the client the Self-Medication Trap Handout (Appendix A).

“One life area that is particularly important for us to consider is your happiness and well being in everyday life.  We often find that people who have been drinking for some time are drinking in part because they are unhappy, but are unhappy I part because they are drinking.”

“What do you make of this?”

“Is this something you see happening sometimes in your life?”

Discuss the positive cycle of change

Discuss the client’s thoughts and reactions to the model and then move to consider how the client could interrupt the cycle.  The goal of this discussion is to enhance client motivation for working enhancing on social and recreational skills.  Clients should recognize that not using and finding healthy ways to achieve happiness are both important in recovery.

“You can imagine that this cycle will go on and on for some people, sometimes getting much worse over time.  I am wondering, how do you think you could interrupt this cycle?”

The key to interrupting circular problems is to work on both components at the same time.  Not using substance may lessen some acute negative mood states but the client will continue to experience some negative mood and will not have substance use as an available coping strategy.  Making changes in social and recreational efforts will help to increase reward and pleasure, but continuing to use substances will detract from the 

Positive Feelings

Benefits of healthy behavior and maintain negative mood.  Working on both the substance use and the social and recreational skills may help the client to make progress in both areas.

Introducing healthy behavior (not using and developing alternative rewards) often helps 

Healthy Behaviors

people to feel better about themselves, more hopeful about the future, and it generally has a 
positive effect on mood.  Helping clients to see
this relationship may help to give them a better sense of choice and control over unpleasant mood states.  Using Self-Medication Trap Handout, discuss clients’ thoughts about taking some control through work on this module.

“When people begin to invest some time and energy into living their lives differently, the first thing they usually notice is that they feel better about themselves.  Taking even small steps or making a little progress with something can feel good.  Have you ever had an experience like that?

If the client can reflect on an experience like this try to elicit the observation that healthy behavior is self-reinforcing.

“People are more likely to make healthy choices when they are happy, and they are more likely to be happy when they make healthy choices.  My hope is that we can get you into a cycle like this by working on both the drinking and your ability to find pleasure in daily life.”

Troubleshooting
Some clients may use substances primarily for reasons related to pleasure, reward, and social custom (positive reinforcement).  These clients may not identify with the notion of self-medication (negative reinforcement) and may deny that substance use has resulted in any significant negative mood states.  Offering an alternative rationale for these clients may help to engage the client in thinking about how this module will be helpful.

“So it sounds like your drinking is not so much because you are unhappy; for you drinking is more about creating some good times than trying to cope with some bad times.  If you have success in reaching this goal of changing your drinking, you may find that not having alcohol to create a good time or make some good times better leaves you feeling less satisfied in your life.  Our goal here is that we can work together to keep that from happening.  Working on finding more pleasure and reward in daily life may help you to avoid the feeling that not drinking is a sacrifice.”

Elicit other reasons to enhance leisure skills
One of the most important objectives in this module is helping the client develop a strong belief that working on social and recreational skills can have a direct impact on substance use.  Consistent with the spirit of Motivational Interviewing (MI), having the client articulate the reasons for change would be the most desirable strategy for enhancing the client’s motivation to work on social and recreational skills.

“We have talked about some reasons why our work today could be helpful to you.   I’m wondering if you have other ideas about how this will help you to reach your goal.”

“What are some other benefits to working on increasing pleasure in your life through finding alternative ways to reward yourself?”

As the client identifies reasons for the importance of social and recreational skills, reflect and affirm as appropriate.  Pay particular attention to language that favors change and be sure to use this change talk in reflections.

“This is something you seem pretty excited about, you really want to learn how to feel food without having to drink.”

Use follow-up questions as needed to elicit multiple reasons for enhancing social and recreational skills.

“So drinking has been a reward for you at the end of the day, without it you feel like you are missing something… it feels like a sacrifice.  You are hoping that you will find some other ways to get that reward that you deserve.  What are some other ways of enhancing reward and pleasure that might help you to quit drinking?”

Clients’ reasons for enhancing social and recreational skills may be varied, but some of the common points to support the rationale for this module should be reviewed in a more directive manner if the client does not identify them.

Changes in use leave some void

“Drinking has been a part of life for a while.  You devote some time to drinking on a daily basis and it does serve some purpose the moment that you use it.  If you stopped drinking, you might find yourself with some unexpected free time, a bit of a gap in your schedule that you may not be sure what to do with.  One of the goals of this module is to help you think about what to do with that time that will give you greater reward, pleasure and happiness in your life.”

Free time can be risky for some people

“You mentioned that sometimes you drink just because of feeling like boredom and loneliness.  Giving up drinking and having extra free time may give you more time to feel bored or lonely.  Filling up this time with things that really help you feel happy and connected to others may make it less likely that you would find yourself going back to drinking because of these feelings.”

Quitting may feel like a sacrifice

“Even though you want to quit using marijuana, there are some things about marijuana that you still enjoy.  If you just quit using marijuana and don’t find other pleasurable ways to spend your time, you may feel as though quitting was a big sacrifice.  Finding ways to spend your time that gives you some genuine pleasure and reward might keep you from feeling this way.”

Being unhappy is a risk for starting again

“If you quit and you feel miserable, theirs is not much pleasure in it, you may have a hard time staying away from cocaine in the long-run.”

Summarize rationale
Provide a transitional summary of the preceding discussion before moving on to the action phase of this module.

“Everybody could probably find some ways to increase reward and pleasure in life… we all want to be happy.  It’s clear to me that you see some other benefits to doing this work; it will help you to achieve and maintain your goals of not drinking.  You see the trap of drinking because you are depressed and feeling depressed because of your drinking.  It sounds like you are ready to work on your drinking and on finding ways to feel less depressed.”

Discuss reward, pleasure, and happiness
For clients who use substances as a primary source of pleasure and reward, ideas about other means to find pleasure and reward may be spare.  Substance use may begin as a quick and effective means for achieving reward and pleasure.  Over time, clients may stop using non-substance strategies and stop learning new skills for maintaining pleasure and reward.  Both the decay of existing leisure skills and the interruption of learning new leisure skills may leave clients with no idea of how to have fun without substances.  Using the Finding Reward, Pleasure and Happiness Handout, (Appendix A), discuss the three categories of behaviors.

Discuss Immediate Reward/Relief

“I have a worksheet that may help us to get started thinking about how to increase rewards and pleasure in your life.  You can see I’ve broken this down into three general categories.  On the bottom laryer are the things that people do to find immediate reward or relief on a daily basis.  These things give us a moment of pleasure or relief from some negative mood.  These are the kinds of things you can do when you need to and don’t require a lot of planning or other people.  This is an especially important if drinking has become your primary to get some relief or pleasure.”

Discuss Pleasure

“On the second layer are the things that people do for pleasure on an ongoing basis.  These are things more like the hobbies, interests that keep your attention for a while and become part of your routine.   Something you look forward to may provide you with pleasure.  These things may take time to get started, but provide a regular stream of satisfaction once you’ve worked them into your regular routine.”

Discuss Happiness

“On this third layer are the big picture things that may be hard to change quickly, and sometimes they really can’t be fully changed.  Working on these life areas is important in the long run.  When people talk about long-term goals in sobriety, it is usually some of these things they are thinking about working on.”

Narrow focus

“Of all three layers, I think the two that may be most important to work on right now are the first two; immediate reward and relief, and also regular pleasure and enjoyment.  Finding immediate pleasure in the moment, or relief from unpleasant feelings in the moment are really important skills.  Having interests or ongoing activities that you look forward to may help to keep you feeling rewarded and engaged in your life.”

Discuss skill decay and interrupted learning

“You may have noticed how drinking has crowded out some of the things you used to do in these two lists.  It is common for alcohol to overpower these other ways to find reward and pleasure, and after a while, people almost forget what used to keep them feeling happy in life.”

“Sometimes people also stop changing and learning new ways to achieve pleasure and reward.  When you started drinking your life was probably much different, you were probably much different, and the things that seemed fun and interesting to you then have probably changed.  Sometimes alcohol can become such a regular fall-back to finding reward and pleasure that people stop finding new ways to do it.”

Identify sources of reward, relief, and pleasure
As the client is reviewing the Finding Reward, Pleasure and Happiness Handout a discussion may begin naturally about what the client is currently doing, what they may have done in the past, and what they would like to do.  Try to keep a mental checklist of these items for this next task.  The primary goal of this section is to help the client identify sources of reward and pleasure that the client is genuinely interested in pursuing.  Using the Planning to Feel Good Worksheet (Appendix A), begin the process of identifying potential sources for reward and pleasure.

“I would like to help you think about how you can find more ways to feel reward, relief and pleasure in your daily life.  Going back to how we started this session, I really believe that helping you to feel happy and engaged when you are not drinking will make it easier for you to stick with the change, and it will certainly be a lot more fun.  You can see that I have three lists on this sheet.”

“I am doing this right now - This includes anything from these first two layers, or anything not on this list that you do to bring you a moment of pleasure, relief, and reward.  Something that you can do that just makes you feel good or is a moment of escape from everyday worries.”

“I used to do this, I want to try again – You may have had some other ways to take care of yourself in the past that you have stopped using for whatever reason.  Some may not make any sense now given changes in your life or in you.  Some, however, may be things that you might really enjoy if you found a way back to doing it.”

“I have never done this, I would like to try it out – These are things that you may have thought about doing at some point in your life and never had the chance.  People find pleasure in all sorts of fun ways, finding something that keeps you looking forward to the next time you can do it may mean trying out some new things.”

As you work with the client to identify possible sources of reward, relief, and pleasure, have the client take responsibility for completing the worksheet.  It is important that clients identify activities that are personally relevant and interesting to them.  Providing explicit suggestions about what clients might try (e.g., “How about learning to paint?”) may result in a discussion in which the therapist say “try this” and the client says “no thanks.”  To avoid this trap, give the client the responsibility of coming up with their own ideas about what would be good for them to try.  Guide the discussion with evocative questions rather than explicit suggestions about how the client can make changes in leisure skills.

“What was your life like before drinking was routine in you daily life?”
“Tell me about the things you used to enjoy in life that didn’t involve cocaine?”
“Have you ever wanted to try something fun and never followed through with it?”
“Are there some things you do now that feel good in the moment?”

Troubleshooting
Some clients may have a particularly hard time identifying activities that will provide reward, relief, and pleasure.  In this circumstance it may be better to suggest that client work on this worksheet over the next week than to have the therapist assume a more directive role in helping the client identify specific activities.  Affirm the client for the work they have done and ask if the client would like to take some time to work through the exercise.  Encourage the client to talk to others in this support system to help the client identify pleasurable activities.

“You have some great ideas already…it’s not an easy task to do.  I wonder if it would be helpful to you to take some time between now and our next meeting to work on some ideas?”

“Sometimes it is helpful for people to look around at other people… try to figure out what people do to take care of themselves when they feel badly or are looking for some fun.  Sometimes getting a friend or family member involved can be helpful also; someone who knows you well or has known you for a long time may help you think this through.  These are simply suggestions, however you do it is up to you.”

Discuss goal setting
Once the client seems to be stuck in generating any additional activities and it appears that they have a good initial list to work from, transition to setting a goal for trying out new activities each week.  Affirm the work the client has completed and try to elicit some commitment form the client to pursue the goal of trying at least one new activity each week.

“You have put together a great list of things to do for fun.  You may have some more ideas to add to these lists, I encourage you to keep adding and revising as you figure out what you can do to keep yourself feeling good.  You have some ideas about how to have fun, the next task is figuring out what works and what doesn’t.  How could you go about doing this?”

Having the client generate their own strategy for exploration and practice of social and recreational skills is more desirable than having the therapist suggest a strategy.  A more directive approach can be used as needed.

“I would like to ask you to consider setting a goal for yourself of trying out at least one new thing each week?”

Discuss strategy of sampling activities
Finding activities that provide reward, relief and pleasure may take some time, experimentation, and practice.  Encourage clients to try something out, evaluate the effects, and make a decision whether to continue or to move on to the next activity.

“After trying something new out, ask yourself, how was that?  Did I get the pleasure or relief I was looking for?  If you didn’t, maybe you can toss that activity out and try something different?  If you keep doing this, eventually you are going to build up a core list of things you can do that feel good, give you pleasure and leave you feeling satisfied in your daily life.”

“Sometimes an activity won’t bring pleasure the first time you do it because it takes some investment before you start getting the reward.  Like exercise… if you haven’t exercised in a long time, the first time out may be a challenge.  If you try something and you think it has potential to turn into a rewarding activity, keep at it for a while until you are sure one way or the other.”

Ask for commitment to goal

“How are you feeling about this?”
“Do you have an idea about where you want to begin?”
“What do you think would be good to try over the coming week?”

Complete agency specific tasks
Complete any agency specific paperwork with the client as needed.

Summarize session
The therapist should provide a closing summary of the session highlighting major accomplishments made during the session, reviewing any commitments the client has made to try out new strategies, and recognizing the client’s efforts.

“I would like to wrap-up for today and tell you about what is to come in our next session.  We have covered a lot of ground today and I appreciate the time and effort you have put in to this with me.  You can see how your drinking and your happiness have been connected in the past, and you seem eager to make some changes in both areas.  You have put together a great list of things to try and I look forward to hearing about what you have tried the next time we meet.”

Preview next session

“In our next session, we can talk more about how you can increase reward, relief and pleasure in your daily life.  It may also be good to consider some of the long-term goals for happiness if you would lie to.  I will leave that up to you to decide… I think it’s most important to talk now about things that you have more control over and that will help you achieve and maintain your goal of not drinking.  We can spend as much time as you want in the next session working on developing your plan for finding more pleasure and reward in daily life.  We may decide to move on to another topic if that is what you want.  We can figure that out when we meet next.  Either way, I think it would be good if we talked about how your plan is working out for at least a few minutes each time we meet.  You have a great start toward getting some good things going, I think that talking about it for a little time each week will help you to keep the plan moving forward.  How does that sound to you?”

Discuss home assignment
The therapist may assign home exercises as needed to continue to work on the skills and concepts within the current module, or to prepare the client for material that will be covered in the next session.

“So in the next week, your plan is to try out X and Y (or to come up with some things to try if the client has not yet done this).  Great, I look forward to hearing how these things worked out for you.”

End session

“I think we have made some good progress today; you have some great ideas about how you can begin changing your life right now.  Do you have any other questions, concerns, or thoughts before we end today?”

Examples
Read a paper, magazine or book
Exercise
Solve a puzzle
Write a letter
Make some cookies
Watch a movie
Play with a pet
Talk on the phone
Take a nap
Listen to music
Go out to eat
Watch people
Take a shower
Surf the web
Go swimming
Watch sports
Cook a nice meal
Listen to talk radio
Rollerblade
Look at the stars
Drink a cup of coffee
Play a video game
Go shopping
Roast marshmallows over a fire
Take a bubble bath
Clean and organize something

Examples
Going fishing
Growing a garden
Building something 
Drawing/painting/sculpting/writing
Playing league sports
Meeting friend for a regular event
Learning how to fix things
Joining a club
Visiting with friends or family
Playing an instrument
Taking a class
Playing board games or card games
Writing a story, poem or journal
Meditating
Volunteering for a personal cause
Going camping/hiking
Getting a massage
Going to a museum
Seeing a concert or play
Dancing
Joining a gym

3. Long-term happiness 
These life circumstances contribute to your sense of happiness and feeling contentment in your life. This category is mostly life circumstances and larger life goals.

Examples
My relationships with others
My spiritual growth
My occupation
My housing
My long-term goals
My self-esteem
My education
My appearance
My physical health
My finances

2. Regular pleasure and enjoyment
These activities give you a sense of pleasure and enjoyment on a regular basis. It may be a hobby, interest, social group, or other type of activity. These activities may take some planning and effort to start and maintain. 

1. Immediate Reward
These activities bring feelings of reward and relief in the moment. They are things you can easily do that may not need much planning or help from others. 

Finding Reward, Pleasure, Happiness

I have never done this
I would like to try it out

I used to do this
I want to try it again

I am doing this 
right now

Planning to Feel Good

Module 7 Session Checklist
Social/Recreational Counseling

PREPARATIONS	•		
  Session checklist		
  Agency-specific paperwork		
  Self-Medication Trap handout		
  Positive Cycle of Change handout	  	
  Finding Reward, Pleasure, & Happiness handout		
  Planning to Feel Good worksheet		
GETTING STARTED		
  Check-in 		
  Set the agenda		
DISCUSSING OF SELF-MEDICATION TRAP		
  Discuss progressive negative cycle		
  Discuss cycle of positive behavior		
ELICITING OTHER REASONS TO ENHANCE LEISURE SKILLS		
  Changes in use leaves voids		
  Free time can be risky		
  Quitting may feel like a sacrifice		
  Unhappiness increases risk for using		
  Summarize rationale		
DISCUSSION OF REWARD, PLEASURE & HAPPINESS		
  Review Reward, Pleasure and Happiness categories		
  Narrow focus		
  Skill delay & interrupted learning		
IDENTIFYING SOURCES OF REWARD, RELIEF & PLEASURE		
  Doing this right now		
  Will try this again		
  Try something new		
DISCUSSION OF GOAL SETTING		
  Plan for coming week		
  Sample activities		
  Ask for commitment to goal		
COMPLETING AGENCY SPECIFIC TAKS		

WRAP UP		
  Summarize session		
  Preview next session		
  Assign home exercises