New Program At FSB: Living In Balance

The Living in Balance program, sometimes referred to as the LIB program, is a comprehensive and practical guide for conducting group and individual treatment sessions for persons who have a substance use disorder, with sessions dedicated to serve clients who also have a co-occurring mental health disorder. Living in Balance can be used as the core treatment or as an adjunct treatment strategy, depending on the clinical setting, level of care, and type of program.  Danya International, Inc., developed the Living in Balance program and published the program with Hazelden Publishing in 2003 as one of the top programs for the treatment of substance use disorders. In 2015, Living in Balance was updated for DSM-5 compliance, and sessions were added to cover rising topics such as chronic pain and opioids, chronic disease management, older adults in recovery, and medication-assisted treatment for substance use disorders.

We here at Family Service Bureau of Newark are excited to begin to implement LIB as Gateway to Freedom’s new Substance Abuse Program curriculum in both the Intensive Outpatient Program (IOP) and Outpatient Program (OP): The evidence-based Living in Balance Collection draws from cognitive-behavioral, experiential, and Twelve Step approaches. Living in Balance is a comprehensive recovery program that incorporates a biopsychosocial approach to strengthening neglected areas of an addict’s life. Sessions can be easily customized for specific client populations or treatment tracks. Living in Balance views a severe substance use disorder, or addiction, as a “chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences” (National Institute on Drug Abuse 2007).

Addiction is viewed as a biopsychosocial process in which various biopsychosocial factors act as risk or protective factors, thereby increasing or decreasing the likelihood of the onset, maintenance, or relapse of addiction and substance use behaviors (Institute of Medicine 1996). As a result, Living In Balance is likewise biopsychosocial in nature. The Living in Balance program centers on sets of interactive client worksheets that teach, engage, and motivate clients in therapy sessions with a counselor. Each session is devised to be simple for counselors to facilitate, with easy-to-use materials and contain optional relaxation, role-play, or visualization exercises. The Core Program is made up of 12 unique sessions to help clients address life issues that are central to achieving successful recovery. Sessions 1-12 comprise the core of the program and address basic issues commonly faced by clients in early recovery. Session topics are: Definitions, Terms, and Self-Assessment; Alcohol and Other Drug Education; Triggers, Cravings, and Avoiding Relapse; Planning for Sobriety; Alcohol and Tobacco; Spirituality; Sex, Alcohol, and Other Drugs; Stress and Emotional Well-Being; Skills for Reducing Stress; Negative Emotions; Anger and Communication; and Relapse Prevention Basics.

Recovery Management sessions includes the following: Introduction to Self-Help Groups; the Twelve Steps;  Sexually Transmitted Diseases; Focus on AIDS; Nutrition and Exercise; Physical Wellness; Problem Solving; Attitudes and Beliefs; Human Needs and Social Relationships; Family Matters; You and Your Parents; Child Development and Parenting Skills; Educational and Vocational Goals; Money Management; Insurance and Consumer Credit; Sexual Abuse; Compulsive Sexual Behavior; Addiction and Loss; Grief: Responding to Loss; Spirituality and Personality; Advanced Relapse Prevention; Medication-Assisted Treatment and Twelve Step Recovery; Chronic Pain and Opioids; Chronic Diseases; and Older Adults.

Also being used in the IOP and OP groups are 10 Living in Balance with Co-occurring Disorders sessions that integrate a client’s mental health disorder into their addiction treatment program and help to bring their life into balance. These sessions are facilitated by one of our Mental Health Clinicians whom are actively pursuing their licensure as a Licensed Clinical Alcohol and Drug Counselor (LCADC). Also included with the Core Program is an audio CD of relaxation and visualization exercises and this unique component is an ideal tool to begin each session. Co-occurring Disorders Sessions focuses on co-occurring disorders topics, including treatment, phases of dual recovery, self-help groups, medication use, relapse prevention, and more. It includes a facilitator guide and 10 client sessions with associated printable client worksheets.

The Co-occurring Disorders Sessions include the following: Effects of Substance Use on Mental Health; What Are Co-occurring Disorders?;  Comprehensive Treatment and Medications for Substance Use Disorders; Phases of Dual Recovery; Twelve Steps for Co-occurring Disorders; Mutual Self-Help Groups and Co-occurring Disorders; Important Issues about Mental Health Medications; Relapse Prevention I: Building a Recovery Support System; Relapse Prevention II: Making the Best Decisions; and Seeking Help for Co-occurring Disorders.

The Relaxation and Guided Imagery Audio features soothing narration and music to help clients release tension, breathe deeply, and relax fully. Management of stress and positive ways to handle stressors are an integral part of the recovery process and this is recognized by the focus put teaching clients healthier ways to deal with the everyday stress they are now facing without the use of alcohol and/or drugs which can often be a daunting task when told that the coping mechanism which may have worked for a participant for the majority of their lives is no longer a viable option and that they must now face these uncomfortable feelings and emotions without medicating them.

Living In Balance is a clinically-validated program and this curriculum is listed on the National Registry of Evidence-based Programs and Practices (NREPP). To effectively address biopsychosocial factors, Living in Balance rests on a foundation of evidence-based addiction treatment approaches. These include motivational enhancement therapy, cognitive-behavioral therapy, and others. Living in Balance incorporates key conceptual elements of motivational enhancement therapy and the stages of change model. Through the use of written exercises (such as thought-provoking fill-in-the-blank questions, multiple-choice exercises, and group discussion launchers), Living in Balance seeks to enhance the motivation of clients to move from one stage of change to the next (for example, from precontemplation to contemplation).

Through written and group exercises, Living in Balance supports client efficacy by helping clients to recognize their inherent wisdom and ability to solve problems effectively. Throughout the program, Living in Balance conveys to clients that they have the ability to learn, process information, and carry out treatment plans. Living in Balance exercises and didactic educational sections provide opportunities to point out discrepancies between goals and behaviors and between perceived benefits and consequences of substance use. By pointing out such discrepancies, Living in Balance helps to enhance clients’ motivation and determination. Central to Living in Balance are cognitive-behavioral therapy elements including functional analysis and skills training and at numerous points in the program, clients are guided through functional analyses in which they identify their thoughts, feelings, and circumstances before and after substance use. Through such exercises, clients and counselors can assess high-risk situations and promote insights into the reasons why clients use drugs. Later, they can identify situations in which clients are having problems coping.

Living in Balance also emphasizes skills training through numerous written and group exercises, role-play exercises, relapse prevention sessions, and homework assignments. Through these exercises, clients are taught craving coping skills (describing cravings, identifying triggers, and coping with cravings), refusal skills, assertiveness skills, interpersonal skills, decision-making skills, and problem-solving skills. Through these cognitive-behavioral techniques, clients learn important interpersonal skills and strategies to help them expand their social support networks and build enduring, drug-free relationships.

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