condom, how could you deal with it so that you could have safer sex?

How would you deal with a situation where you insisted on having safer sex and your

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partner got angry?

A major risk during outpatient treatment is the involvement of the client in sexual networks and

sexual mixing. Many clients in treatment may select sexual partners from similar networks

(recovery programs, 12-Step meetings, and so on). These partners might include persons who

have used syringes, traded sex for drugs or money, been victims of trauma, or been incarcerated.

All of these populations may have higher rates of HIV infection, making transmission more

likely, and clients should be counseled about these risks.

Drop-in centers

Drop-in centers are an excellent way to engage homeless people in treatment. These centers offer

a needed service for substance-abusing individuals who are homeless. As individuals start

dropping in, they begin to interact with staff and form trusting relationships, which builds a

necessary foundation for beginning treatment. The use of maintenance strategies characterizes

treatment in drop-in centers. At this phase, service providers must work to prevent relapse and

bring together the gains achieved during inpatient and outpatient treatment. During this time,

clients may have learned to adjust their new behavior to the environment in which they live, and

the behavior has perhaps become habitual.

Also during this time, many clients relapse and may return to earlier treatment levels and

milestones. As discussed elsewhere, there are many factors leading to client relapse. Situations

such as breaking off relationships, starting new ones, severe temptation, or lack of environmental

support may contribute to relapse. In addition, the client can easily choose not to try again due to

the negative feelings associated with relapse such as shame, embarrassment, guilt, failure, regret,

anger, or denial.

Service providers may work with clients so that they can realize that their past successes indicate

better chances of success in the future. They should underscore the fact that clients have learned

new ways of coping with old behaviors and have developed supportive relationships. Service

providers may find the use of reinforcement management a helpful strategy that can be facilitated

in either individual or group level modes. Reinforcement management helps clients develop

internal and external reinforcers and rewards that increase the chance of new behaviors

continuing.

Workers can also reassure clients that relapse encounters are part of an ongoing process. Helping

clients determine what caused the slip can be useful in helping them develop strategies to avoid

lapses in the future. Workers can also work with clients to help them learn more about

themselves, their environment, and their addiction and risky behaviors.

Questions similar to the following can help determine if clients need better or more

reinforcement management:

Do you feel good about your new behavior?

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