Contributor: Yvette McBride Thomas

1. What happens if a patient has no progress for a long time? 
Sometimes when a patient goes along time with no progress it can be one or a combination of several things: 1) The patient has become comfortable with the progress made up to that point and could possibly be afraid to move on; 2) sometimes patients sabotage their own progress because they are not use to having any success in their lives; 3) the relationship with the counselor may be the only positive relationship in their lives and they don’t want it to end. This list is not limited; it will be up to the counselor to help the client discover why they are not progressing further. This is where the stages of change will be very helpful and ASAM dimension 4. Treatment acceptance/resistance (Process of change). It is sometimes helpful to walk the client through each stage and help them discover where they are in their recovery and why they are stuck. Being stuck is a setup for relapse and if the client is unaware of their relapse triggers they may return to using and sometimes they will relapse to stay in treatment.

2. Will treatment be stopped?
Treatment usually will not be stopped until all avenues have been explored. Using the ASAM guidelines will help identify the possible challenges facing the client. They may not know what the challenge may be or if they do they do not know how to put it into words. If the client is really resistant to treatment and is not ready to make the necessary change or do the required work they will discontinue treatment on their own.

ASAM Dimension 4. Treatment acceptance/resistance/stages of changes:

a. Denial
b. Surrender and compliance
c. Process of recovery
d. Treatment issues
e. 12-step philosopy
f. Attitudes in recovery and addiction
g. Patient in need of information on treatment and program tools

3. Or would treatment be changed to something else?
The treatment goals can change based on the new information discovered. This may also be an opportunity to introduce the client to a new person via referral and explain to the client that based on the treatment changes it maybe beyond your scope of expertise (except when the client states that there has been some physical/sexual abuse) You can also suggest that the client attend a 12step support meeting for a specific area (i.e. ACOA or Coda)