Playing It Through

Playing it through, sometimes referred to as playing the tape through, is a recovery capital skill aimed at helping patients respond to cravings by visualizing the long-term consequences of use. This relapse prevention technique interrupts the trigger and directs thought away from current thoughts and emotions toward conscientious consideration. Playing it through allows patients to run a cost-benefit analysis on the impact of their decision, disrupt their brain's default neural pathway towards use, and reinforce the fact that what they are feeling at present will pass.

This lesson is designed to maximize patient engagement and talk time. The focus tasks, small-group sizes, collaborative objectives, and individual work assignments are included strategically to meet this purpose. The timing, number of sessions, and room makeup may be adjusted according to need. 

Session Objective: 

By the end of this session, participants will be able to explain what impact the decision to use would have on their life in the immediate, near, and long-term future.

Delivery Time: 60 Minutes

Materials: Notebook paper, writing materials, clipboards (if no desks/tables are available), calculators, Play It Through Flow Map PDF (2 copies per participant),  Play It Through Practice Cards PDF (1 copy; 2 copies for larger groups) 

Set-up: 

1. If possible, set chairs and desks in a semicircle. If no desks are available, distribute clipboards so participants have a sturdy, portable means of taking notes and completing tasks.
2. If a whiteboard or projector is available, write the session objective.
3. Print all associated materials, and cut the Play It Through Practice Cards  so they are ready for use.

Procedure: 

1. Session Objective – Read the session objective aloud.

2. Introduction (10 minutes) The session begins with a series of questions designed to build interest and create buy-in.

Q1 - If you could be born knowing one thing you know now, what would it be? Perhaps it would be to invest in Apple/Amazon, avoid a person/place/thing, or be more considerate to a friend/coworker/family member. This hypothetical question builds interest and gets patients thinking.

Give participants a moment to consider before asking a few volunteers to share their responses.

Q2 - What would be the value in knowing how something would turn out before it happened? The responses will likely relate to making correct choices, and it should pose little trouble to guide answers in that direction.

Have participants discuss possible responses with the person seated next to them. After the discussion concludes, have the group share what they found and board appropriate responses.

While it is true that no one can catch a glimpse into the future, humans are capable of making remarkably accurate predictions in many of life's avenues if they recognize patterns and critically analyze data; just look at some of the world's wealthiest investors. If we can identify patterns in our own life, we can make probable predictions about how certain events will turn out.

Q3. Think back to a time when you planned to use only once but continued (wedding/sporting event/celebration/visit to old friend’s house/etc.). Is this something that has happened more than once? The answer is likely yes, which is important because we want to establish that any thoughts that suggest this next time will go differently and go against an established pattern.

Have participants turn to a partner and have an honest assessment of their prior use patterns.

The following questions are not meant for discussion but can be delivered quickly before transitioning to the next section; this will plant the seed for the narrative activity that follows later in the session:

Q4. Of these past experiences, which led to the most severe negative consequence?

Q5. Could it have been worse? Due to the sometimes progressive nature of SUD, future use could well indeed lead to increasingly negative consequences.

3. Calculate the Costs (10 Minutes) - Urges to use are entirely normal, and people who succeed in their recovery do so because they don't make snap decisions; they stop, analyze the potential outcomes, and make informed decisions.

To get the most accurate prediction of how an extended relapse could look, we should first gather some data. Instruct participants to think about how much they would spend on average on their substance of choice in one week when deep in addiction.

As the group considers their responses, distribute the Play it Through Flow Map PDF and a calculator to each group member. Guide them to the bottom left of the document. Here is where they calculate the cost of use over time solving for 1 week, 1 month, 1 year, and 5 years. While there may be some resistance to the calculation, especially for 1 or 5 years, the fact that SUD has likely been progressive in their lives makes this cost a possible reality.

After participants complete the first two calculations, have them continue through the sheet to complete the data as accurately as possible. If the cost of a scenario isn't known, use approximation.

Once complete, direct the group to the last box, other considerations, on the bottom right of the document. Health, employment, and freedom should be considered when determining possible repercussions. 

4. Play It Through Narrative (10 Minutes) - Each participant will now consider all their data as they complete parts 2 and 3 of the Play It Through Flow Map. Once participants have completed their summaries, they should spend the rest of this section trying to commit it to memory. A simple retrieval practice activity would be to use the summary section as a flash card. Begin by reading each sentence, remove the note support, and recall the sentence. Continue for the rest of the sentences and repeat to aid in the consolidation into long-term memory.

5. Speed Recall (15 Minutes) - This activity contains trigger-to-use scenarios and other situations to promote interleaving. When a participant faces a trigger scenario, they should respond to the situation by verbalizing their relapse narrative, using their summary as reference only if necessary, as the goal is to know the response so well it becomes automatic. Remember to alternate or randomize the card distribution so that participants get intervaled practice of their use response.

The room set-up for this activity is quite important. Ideally, you want to have patents facing each other similarly to how speed dating would look. In front of each chair, place Play it Through Practice Cards, facing down; these should be shuffled so that trigger to use cards and other scenarios will be practiced intermittently. Participants will rotate through stations clockwise, partnering with a new group member and reading or receiving a unique practice situation until the group has completed a rotation.

Each group member should have paper, a clipboard, and a writing tool. Decide which row of chairs will read first. The opposite side will respond. During the response, the one who initially provided the scenario will take notes on the response (these notes will be used for the following group discussion). This should last for about 1 minute before the roles are reversed. After another minute, have participants put their cards face down where they found them, stand up, and rotate clockwise.   While 1 minute may seem rushed, the goal here is to promote automated responses and maximize practice. This activity can last much longer if time permits, and, as an additional activity extension, group members can create their own scenarios.

6. Group Discussion (15 minutes) –  Using the notes taken from the speed recall activity, have participants share their feedback on other members' responses. What did they think went well? Are there pieces of advice they can offer for areas of improvement? This is likely to be an engaging discussion/debate, so it may be useful to manage talk-time with a ball throw or talking stick to ensure everyone has their voice heard. 

Conclude the session with a final hypothetical question to end on a positive note and water the seed already planted that the responses participants give are achievable outcomes:  If you had (insert the amount in the total cost box on the Play It Through Flow Map), what is the most positive way you could think to use those funds? The great news is, that outcome is entirely possible.

7. Home Practice: Repeat the relapse narrative five times daily and anytime an urge to use arises. Practice playing it through with other decisions not related to use throughout the week and arrive at the following session ready to discuss the situations and impact of using the skill.