Alfred is a 50-year-old man who had been sober for 12 years before having a severe motorcycle accident this past year. He rear-ended a car when it stopped abruptly on the freeway without warning or cause (the brake lights did not work on the car and the driver was intoxicated). Asa  result, he was hospitalized for a month and had to have numerous surgeries for broken bones (pelvis, arm, leg). The pain was reportedly incredible, and he took the opiates prescribed to him for pain management in his recovery. He is comfortable with having taken the drugs for the few months he felt he needed them to cope and worked closely with his AA sponsor on the intake of the medication. Now he is coming to you for counseling because he has heard that you are knowledgeable about addiction and he believes you can help him. The problem he presents to you is that he has had strong urges to use alcohol and drugs to cope with the residual, chronic pain he has from the accident and to cope psychologically with the limits it has placed on him: he lost his job as a factory worker and is on permanent disability. He says he has trouble sleeping at night and finds, much to his embarrassment, that he tears up easily when he is upset (he did not have these problems before the accident).

1. How would you make an assessment of his pain management?

2. What techniques might you use as a part of the assessment process?

3. What exercises would you use to help him learn about his reaction to pain?

4. What would be the components of a relapse-prevention plan you would develop with him?

5. How might you collaborate with and educate people in his recovery circle about his pain management struggles?