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Opioid antagonism complicates perioperative analgesia. The MAC, with client authorization, facilitates communication to develop a pain plan (regional techniques, non-opioid multimodal strategies, timing of antagonist relative to surgery, and if opioids are required, how to manage safely). Include relapse-prevention steps: supports, monitoring, and postoperative follow-up. Doing nothing (A) risks inadequate pain control and relapse. Canceling surgery (C) is rarely appropriate. Alcohol (D) is unsafe. Clear coordination respects autonomy, maintains safety, and aligns medical and recovery needs. Document discussions and ensure the client understands the plan and emergency contacts.

Boredom is a potent relapse trigger. Behavioral activation replaces empty time with valued, reinforcing activities (exercise class, creative work, volunteering, peer meetings), scheduled specifically during the client’s high-risk windows. Weekly review and reinforcement (including CM where appropriate) strengthens adherence. Willpower (A) lacks structure. Reading (C) does not deliver competing reinforcement. Reducing sessions (D) may remove accountability. The MAC ties activities to values, uses implementation intentions (“If it’s 7pm, then I start the 20-minute guitar practice”), and tracks mood/cravings pre/post to show effect. Over time, building a meaningful routine increases natural rewards, reducing reliance on substances as the default source of pleasure or relief.

Accurate triage requires clarifying temporal and severity markers of alcohol withdrawal. The Master Addiction Counselor obtains the precise last-drink time, documents previous complicated withdrawal (seizures or delirium tremens), and quantifies current physiologic symptoms with a validated tool (e.g., CIWA-Ar) to guide level-of-care decisions. Weekend binge patterns often produce “Monday withdrawal,” and autonomic signs (tachycardia, tremor, diaphoresis) may escalate without monitored care. Preference questions (A) are irrelevant. Readiness (C) matters but should not preempt safety assessment. Personality testing (D) does not inform acute risk. A complete assessment also screens for co-ingestants (benzodiazepines), medical comorbidities, pregnancy, and social supports, and includes brief education about warning signs that necessitate urgent medical attention. Documentation should reflect objective findings and the safety plan (e.g., referral for medically supervised withdrawal when indicated). Once stabilized, the counselor can return to motivational work and relapse-prevention planning, but the immediate priority is preventing complications through proper recognition and rapid medical collaboration.

Measurement-based care converts pattern data into micro-interventions. When lapses follow late shifts and missed meals, the plan should address physiological depletion and cue-rich windows. A structured routine—portable meal or protein snack, water, 10-minute decompression (walk/breathing), and a pre-committed call/text to a support—interrupts the high-risk chain. Psychoeducation (A) without behavior change has limited impact. Morning meditation (C) may help baseline regulation but won’t cover the evening risk window. Monthly sessions (D) reduce support during an active risk pattern. The MAC also rehearses refusal scripts for post-shift invitations, sets if-then prompts (“If I clock out after 9pm, then I text Sam and start my snack before leaving”), and considers contingency management for verified adherence. Weekly review of heavy-use days and craving intensity gauges effect; iterate by adjusting timing or adding alternate routes home to avoid alcohol cues. This targeted, time-anchored plan aligns with stepped care and strengthens self-efficacy.