curiositech/modern-drug-rehab-computer

Modern Drug Rehab Computer

Comprehensive recovery guidance system for individuals navigating addiction treatment and early recovery.

DECISION POINTS

Craving/Urge Response Matrix

INTENSITY LEVEL → ACTION PATH

1-3 (Mild):
├── Apply HALT check (hungry/angry/lonely/tired)
├── Use 5-4-3-2-1 grounding
├── Continue current activity
└── Note trigger in journal

4-6 (Moderate):
├── Stop current activity immediately
├── Contact accountability person (text/call)
├── Apply TIP skills (temperature/exercise/breathing)
├── Remove yourself from triggering environment
└── If persists >30 min → escalate to 7-10 response

7-10 (Severe):
├── Emergency contact (sponsor/counselor/crisis line)
├── Go to safe location immediately
├── Consider emergency meeting attendance
├── If thoughts of using are specific → crisis intervention
└── DO NOT isolate - stay with safe person

SPECIAL CONDITIONS:
├── At family event → buddy system + exit strategy
├── In treatment setting → immediate staff notification
├── Post-detox (first 30 days) → lower threshold for escalation
└── PAWS symptoms → medical consultation if persistent

Treatment Modality Selection

PATIENT PROFILE → RECOMMENDED APPROACH

Trauma History + Addiction:
├── Primary: EMDR or trauma-informed CBT
├── Secondary: DBT for emotional regulation
├── MAT if opioid/alcohol involved
└── Avoid exposure therapy until stabilized

High Emotional Dysregulation:
├── Primary: DBT (distress tolerance focus)
├── Secondary: Mindfulness-based interventions
├── Consider psychiatric evaluation
└── Structure over insight-based therapy initially

Motivation Ambivalence:
├── Primary: Motivational Interviewing
├── Avoid confrontational approaches
├── Focus on discrepancy between values/behavior
└── Let patient argue for change

Opioid Use Disorder:
├── MAT evaluation within 24-48 hours
├── Buprenorphine if mild-moderate withdrawal
├── Methadone if severe dependency/failed bup
├── Vivitrol only after 7-14 days clean
└── Combine with psychosocial treatment always

Crisis Intervention Thresholds

PRESENTATION → IMMEDIATE ACTION

Active suicidal ideation with plan:
├── 988 crisis line or 911
├── Do not leave person alone
├── Remove means if accessible
└── Transport to emergency room

Active withdrawal symptoms:
├── Medical evaluation within 4 hours
├── Alcohol withdrawal → ER (seizure risk)
├── Opioid withdrawal → comfort measures + MAT consult
└── Benzo withdrawal → medical supervision required

Relapse with medical complications:
├── Overdose risk assessment
├── Tolerance may be reduced
├── 911 if unconscious/slow breathing
└── Medical clearance before treatment re-entry

Family crisis/domestic violence:
├── Safety planning immediate priority
├── Remove from unsafe environment
├── Connect with domestic violence resources
└── Treatment secondary to safety

FAILURE MODES

1. White-Knuckling (Willpower Dependency)

Detection: Patient relies solely on determination, avoids tools/support, says "I should be stronger" Symptoms: Increasing irritability, isolation, "I don't need meetings/medication" Fix: Reframe recovery as skill-building, not character test. Introduce concrete coping tools. Address shame around needing help.

2. Program Shopping (Perpetual Seeking)

Detection: Frequently changing programs, blaming failures on "wrong approach," never completing treatment Symptoms: "This program doesn't work for me," constant research into new methods Fix: Commit to one evidence-based approach for 90+ days. Address underlying perfectionism/control issues.

3. Dry Drunk Syndrome (Abstinence Without Recovery)

Detection: Stopped using but mood, relationships, and functioning remain poor; increased irritability, depression Symptoms: "I'm miserable sober," relationship conflicts, emotional instability despite abstinence Fix: Focus on underlying mental health, trauma work, relationship skills. Recovery is more than not using.

4. All-or-Nothing Relapse Response (Relapse = Failure)

Detection: After any slip, patient abandons all recovery efforts, "I've blown it completely" Symptoms: Binge after minor slip, quitting treatment post-relapse, shame spiraling Fix: Normalize slips as part of learning process. Immediate re-engagement strategy. Harm reduction mindset.

5. Medication Stigma Trap (MAT Avoidance)

Detection: Refusing MAT due to "not being really sober," pressure from others, shame about medication Symptoms: Multiple failed attempts without MAT, listening to anti-MAT voices in recovery community Fix: Education on brain disease model, connecting with MAT-positive peers, addressing internalized stigma.

WORKED EXAMPLES

Example 1: Early Recovery Craving Episode

Scenario: Day 45 in IOP, patient Sarah texts at 7 PM: "Having massive craving. Just drove past my dealer's street. Don't know what to do."

Expert Response Process:

1. Immediate triage: Assess current location/safety - still in car near dealer?
2. Intensity assessment: Rate 1-10 → Sarah says "8"
3. Apply 7-10 protocol:
   • Direct her to drive to safe location (coffee shop, meeting)
   • Stay on phone/text until she's there
   • Have her call sponsor while driving
4. HALT check: Hasn't eaten since noon (hungry), angry about job rejection today
5. Physical intervention: Order food, use ice cubes for TIP skills
6. Follow-up plan: Stay at coffee shop 1 hour, attend 8:30 meeting
7. Next day processing: Discuss trigger sequence in therapy

Novice mistake: Would focus on "willpower" or shame about the craving Expert insight: Cravings are neurobiological - treat with behavioral interventions, not moral judgment

Example 2: Family Visit During Treatment

Scenario: Jake, 30 days residential, family visiting this weekend. Parents historically critical, triggering shame and previous relapses.

Expert Preparation Strategy:

1. Pre-visit planning: Role-play difficult conversations in therapy
2. Boundary setting: Communicate visit structure to family beforehand
3. Exit strategy: Clear plan for shortened visit if needed
4. Support activation: Sponsor on standby, group members aware
5. Emotional preparation: Process family trauma in therapy sessions
6. During visit:
   • Structured activities (avoid unstructured time)
   • Check-ins with staff every 2 hours
   • Use bathroom breaks for grounding exercises
7. Post-visit debrief: Process emotions in next therapy session

Novice approach: "Just get through it" without preparation Expert insight: Family visits are high-risk periods requiring active management

Example 3: PAWS vs. Depression Treatment Choice

Scenario: Month 3 recovery, persistent depression, fatigue, anhedonia. Question: Start antidepressant or wait for PAWS to resolve?

Expert Decision Tree:

1. Timeline assessment: When did symptoms start? Pre-use, during use, or post-cessation?
2. Severity evaluation: Functional impairment level? Suicidal ideation?
3. Previous episodes: History of depression independent of substance use?
4. Substance of choice: Alcohol/depressants more likely PAWS, stimulants may mask depression
5. Decision matrix:
   • If symptoms pre-date substance use + functional impairment → medication trial
   • If closely tied to cessation + mild-moderate severity → wait 6 months with close monitoring
   • If suicidal ideation present → immediate psychiatric evaluation
   • If mixed picture → 3-month intensive therapy trial first

Novice error: Assuming all post-cessation depression is PAWS Expert nuance: Distinguish between neurochemical rebalancing and underlying mood disorders

QUALITY GATES

Recovery Support Mastery Checklist:

• [ ] Can demonstrate 3+ coping skills under stress without prompting
• [ ] Has identified specific personal triggers and corresponding response plans
• [ ] Maintains regular contact with recovery support network (weekly minimum)
• [ ] Can explain their medication regimen and when to contact medical team
• [ ] Has completed crisis contact list and shared with family/friends
• [ ] Demonstrates understanding of HALT principles and applies them consistently
• [ ] Can articulate the difference between slip and relapse with recovery plan for each
• [ ] Has established consistent daily structure including sleep/meal times
• [ ] Shows evidence of processing trauma/underlying issues in therapy
• [ ] Can identify warning signs of mental health deterioration and help-seeking steps

NOT-FOR BOUNDARIES

DO NOT use this skill for:

• Prescribing or adjusting medications → defer to medical team
• Crisis intervention with active suicidal ideation → use crisis-intervention-specialist
• Active overdose situations → call 911 immediately
• Family therapy facilitation → refer to family-systems-therapist
• Trauma processing → use trauma-therapy-specialist
• Legal advice regarding treatment or addiction-related charges → legal professional
• Employment/disability determinations → vocational counselor
• Child custody issues related to addiction → family law attorney

Refer to other skills:

• Daily relapse prevention → sober-addict-protector
• Deep psychological work → jungian-psychologist
• Communication with partners → partner-text-coach
• Emotional regulation → hrv-alexithymia-expert