**V. Relapse Prevention Group**

##### 

##### Introduction

***Goals of Relapse Prevention Group***

-   Allow clients to interact with other people in recovery.

-   Alert clients to the pitfalls of recovery and precursors of relapse.

-   Give clients the strategies and tools to use in sustaining their
    recovery.

-   Allow group members to benefit from the long-term sobriety
    experience of the recovering co-leader.

-   Allow the counselor to witness the personal interactions of clients.

-   Allow clients to benefit from participating in a long-term group
    experience.

###### Session Format and Counseling Approach

*New Member Introductions*

Each 90-minute Relapse Prevention (RP) group meeting begins with new
members introducing themselves and giving a brief description of their
substance use history. This description should not be detailed or
graphic, nor should it be a litany of "war stories." New members provide
basic information such as type of substances used and their reasons for
entering treatment. Clients who ramble or provide unnecessary substance
use details should be prompted gently to finish their introduction.

*Topic Presentation and Discussion*

Following the introductions and during the first 15 minutes of the
session, the counselor presents a specific topic in a casual, didactic
manner. The counselor then opens up the topic for discussion by the
group for 45 minutes. Over the first hour of the meeting, the counselor
ensures that all the important aspects of the topic are covered and that
premature digressions from the main topic are avoided. Clients with
concerns or questions unrelated to the topic can be assured that the
final 30 minutes of the group meeting will be devoted to issues that
individual clients are struggling with. The counselor wraps up the
discussion period with a reiteration of the session topic and the
important issues relevant to it.

*Open Discussion*

During the last 30 minutes of each group session, the counselor asks
clients whether they have had any recent problems or whether they wish
to bring up any matters. Individual clients, particularly those who have
been having problems or those who have not participated in the group
session, should be encouraged to participate. General questions that
usually evoke a response include the following:

-   How are things going?

-   Are there any new developments with the problem you brought up last
    time?

-   Have you had any cravings?

-   If so, how did you handle them?

-   How are you planning to stay abstinent this week?

###### End of Session

The counselor ties up loose ends, summarizes the discussion, and
acknowledges any unresolved issues. Discussion of these issues can be
carried over to the next meeting. The counselor can ask clients who
during the session mentioned cravings or who appear troubled, angry, or
depressed to stay afterward to talk briefly and to schedule them for
individual sessions as soon as possible. All sessions should end on a
positive note and with a reminder that what is said in group *stays* in
group and a commitment by clients to attend the next RP group meeting.

##### *Special Considerations*

Clients who are quiet and uncommunicative may be concealing issues that
should be elicited and discussed.

The group provides an opportunity for clients to solicit input from and
give encouragement to other group members. The counselor should ask for
comments from all clients on the issue being discussed, especially if
particular group members have coped with the issue. For example, clients
who have moved beyond the protracted abstinence period could be asked to
describe how they handled problems they encountered during that time.
The counselor should not, however, relinquish control of the group or
promote directionless crosstalk about how each person feels about what
the others have said. The counselor must maintain the group's focus and
direction and be ready to redirect discussions that are moving into
redundancy, irrelevance, inappropriateness, or volatility.

The recovering co-leader can be a positive role model, reinforce
suggestions, and share advice from experiences. Rather than lecture or
talk down to the group, the recovering co-leader should speak in the
first person about his or her experiences. The recovering co-leader may
be effective in instances where clients are resistant to the counselor's
input. In such cases, the co-leader's discussion of what worked for him
or her may be offered in a "for what it's worth" manner, with the aim of
providing a strategy that worked for one person and the encouragement
that comes with knowing that others have succeeded.

####### Balancing Group Cohesion With Excessive Interdependence

Along with 12-Step or other mutual-help meetings, the RP group is the
most consistent element of Matrix treatment. Each of the initial 16
weeks of treatment features an RP group meeting on Monday and Friday.
The frequency and intensity of these group meetings foster
interdependence among clients. The resulting bonding and cohesion can
support and motivate clients and help sustain treatment involvement.
However, balancing clients' responsibility to their fellow group members
with the need to take charge of their own recovery can be tricky. The
counselor needs to ensure that clients gain support and encouragement
from the group without developing exclusive dependence on the group for
their abstinence and recovery. Each client should view recovery as a
personal achievement that has been supported and encouraged by other
group members. If several group members experience relapse, the
independence of each client's personal recovery can help prevent relapse
contagion, in which relapse seems to spread from member to member of a
group like an infectious disease.

The camaraderie and cohesion of an RP group are extremely valuable to
the treatment process. However, clients should be cautioned against
treatment program romances and outside involvement with other group
members (e.g., entering into a business relationship). When they start
treatment, clients must sign an agreement to avoid intense relationships
outside group. The counselor should remind clients of this agreement and
discuss with them the rationale for prohibiting intense personal
involvement between group members. If two clients are becoming
inappropriately involved, the counselor should meet with them briefly
after group to remind them that such relationships are discouraged and
to discuss appropriate ways that the clients can handle the situation.

In the first few months of recovery, the main forums for social support
in the context of the Matrix method are the RP group and outside
spiritual and mutual-help support groups. Clients should be encouraged
to find a long-term support system through their involvement in these
groups. By attending meetings and socializing with 12-Step members,
recovering clients will be able to find a sponsor to help guide their
recovery as well as make recovering friends with whom to pursue
substance-free activities. To build a vital support system that will
help them avoid relapse, clients in early recovery need to expand their
network of support beyond the people they meet in treatment to include
people with longer term abstinence.

####### Handling Troublesome Client Behaviors

At times, the counselor may need to intervene assertively in response to
specific types of client behavior in the group. This intervention may
consist of quieting a client, limiting a client's involvement in the
group, or removing a client from the group. Below are some strategies
for handling troublesome client behaviors.

**Behavior:** Occupying too much session time with an issue that has
been addressed.

**Intervention:** Politely suggest that it is time to allow others to
discuss their issues and move on.

**Behavior:** Arguing in favor of behavior that is counter to recovery
(e.g., using, dropping out of group, using self-control instead of
avoiding triggers) after receiving repeated feedback.

**Intervention:** Point out the futility of these sorts of approaches in
light of the realities of addiction and the experience of others. If the
client continues along the same lines, ask him or her to listen and not
to speak for the remainder of the group; this client's concerns should
be discussed individually after the group meeting.

**Behavior:** Making threatening, insulting, or personally directed
remarks; behaving in a manner obviously indicative of intoxication.

**Intervention:** Take the client out of the group, and let the
recovering co-leader lead the group. Have a brief individual session
with the difficult client, or have another counselor intervene. Be sure
that the client has calmed down before leaving him or her. Arrange for
transportation home, if the client cannot drive or get home safely.

**Behavior:** Having a general lack of commitment to treatment, as
evidenced by poor attendance, resistance to treatment intervention,
disruptive behavior, or repeated relapses.

**Intervention:** Reassess and adjust the treatment plan in an
individual or conjoint session with the uncommitted client. If the
client agrees not to show up intoxicated or engage in inappropriate
behavior, he or she can be allowed to attend the meeting but should be
asked to listen and not to speak. The client should be given some
discussion time at the end of this session, contingent on appropriate
behavior.

####### Addressing Drug Dreams During Recovery

It is not unusual for clients in recovery to have frequent and intense
dreams about substance use. The counselor should reassure clients that
these dreams---which can be frightening---are a normal part of recovery.
Stimulant use interferes with normal sleep patterns; when people stop
using substances, vivid dreams are part of the brain's recovery process.
Intense dreams of substance use can produce feelings that persist into
the waking day and can act as triggers for use. Clients who have
detailed dreams about using should be alert to the added risk of relapse
during the ensuing day. The counselor should encourage clients to
express their concerns about drug dreams during the open discussion
period of RP sessions. However, clients should be discouraged from
describing their dreams of using in detail because they may act as
triggers for other clients. If, during a group session, a client
mentions having dreamed about using substances, the counselor should
have clients look at handout RP 33---Drug Dreams During Recovery and go
over it with them. The handout discusses how drug dreams affect early
(0--6 weeks), middle (7--16 weeks), and late (17--24 weeks) recovery and
provides some suggestions to help clients address the issue of drug
dreams. This handout also can be used to supplement RP sessions that
focus on triggers and cravings (e.g., sessions 3, 9, 11, 13, 16, 18, and
21).

*Rational Brain Versus Addicted Brain*

The RP group session descriptions use the metaphorical struggle between
a client's *rational brain* and *addicted brain* as a way to talk about
recovery. The terms rational brain and addicted brain do not correspond
to physiological regions of the brain, but they give clients a way to
conceptualize the struggle between the desire to stay committed to
recovery and the desire to begin using stimulants again.

*Adapting Client Handouts*

Client handouts are written in simpler language than the session
descriptions for counselors. The client materials should be
understandable for someone with an eighth grade reading level. Difficult
words (e.g., *abstinence, justification*) are occasionally used.
Counselors should be prepared to help clients who struggle with the
material. Counselors should be aware that handouts will need to be
adapted for clients with reading difficulties.

***Session Descriptions***

The following sections provide structured guidance to the counselor for
organizing and conducting the RP group sessions. Figure V-1 provides an
overview of the RP sessions.

+--------+----------------+--------------------------------------------+
| ###    |                |                                            |
| #####  |                |                                            |
| Figure |                |                                            |
|  V-1.  |                |                                            |
| Relaps |                |                                            |
| e Prev |                |                                            |
| ention |                |                                            |
|  Sessi |                |                                            |
| ons Ov |                |                                            |
| erview |                |                                            |
+========+================+============================================+
| **S    | ##### Topic    | ##### Content                              |
| ession |                |                                            |
| Nu     |                |                                            |
| mber** |                |                                            |
+--------+----------------+--------------------------------------------+
| 1      | Alcohol        | Clients learn how alcohol can jeopardize   |
|        |                | recovery. Clients discuss and plan for     |
|        |                | situations in which they are likely to     |
|        |                | drink.                                     |
+--------+----------------+--------------------------------------------+
| 2      | Boredom        | Clients learn that boredom in recovery is  |
|        |                | to be expected and will diminish over      |
|        |                | time. Clients discuss activities to help   |
|        |                | alleviate boredom.                         |
+--------+----------------+--------------------------------------------+
| 3      | Avoiding       | Clients learn about relapse drift and      |
|        | Relapse Drift  | discuss things that anchor their recovery. |
+--------+----------------+--------------------------------------------+
| 4      | Work and       | Clients learn how their work life affects  |
|        | Recovery       | their recovery and explore ways to balance |
|        |                | work and recovery.                         |
+--------+----------------+--------------------------------------------+
| 5      | Guilt and      | Clients learn to distinguish between guilt |
|        | Shame          | and shame and discuss ways to cope with    |
|        |                | each.                                      |
+--------+----------------+--------------------------------------------+
| 6      | Staying Busy   | Clients learn that idle time can be a      |
|        |                | trigger and discuss how scheduling         |
|        |                | activities can help them avoid relapse.    |
+--------+----------------+--------------------------------------------+
| 7      | Motivation for | Clients learn that the same motivation     |
|        | Recovery       | that brought them to treatment may not     |
|        |                | sustain them. Clients discuss new          |
|        |                | motivations and strategies for staying     |
|        |                | abstinent.                                 |
+--------+----------------+--------------------------------------------+
| 8      | Truthfulness   | Clients learn that although truthfulness   |
|        |                | is not always easy, it is integral to      |
|        |                | successful recovery. Clients discuss the   |
|        |                | consequences and benefits of always        |
|        |                | telling the truth.                         |
+--------+----------------+--------------------------------------------+
| 9      | Total          | Clients learn that substance use of any    |
|        | Abstinence     | kind will cloud their decisionmaking and   |
|        |                | endanger recovery. Clients discuss changes |
|        |                | they must make to eliminate all substance  |
|        |                | use.                                       |
+--------+----------------+--------------------------------------------+
| 10     | Sex and        | Clients learn that impulsive sex can be a  |
|        | Recovery       | form of dependence and can lead to         |
|        |                | relapse. Clients discuss the ways that     |
|        |                | stable relationships can contribute to     |
|        |                | recovery.                                  |
+--------+----------------+--------------------------------------------+
| 11     | Anticipating   | Clients learn to recognize the warning     |
|        | and Preventing | signs of relapse and explore strategies    |
|        | Relapse        | for avoiding relapse.                      |
+--------+----------------+--------------------------------------------+
| 12     | Trust          | Clients learn the necessity of restoring   |
|        |                | lost trust and discuss ways to cope with   |
|        |                | being suspected of continued substance     |
|        |                | abuse.                                     |
+--------+----------------+--------------------------------------------+
| 13     | Be Smart, Not  | Clients learn that recovery is not a test  |
|        | Strong         | of will but of commitment and smart        |
|        |                | planning. Clients discuss the efficacy of  |
|        |                | their approach to recovery.                |
+--------+----------------+--------------------------------------------+
| 14     | Defining       | Clients explore the difference between     |
|        | Spirituality   | spirituality and religion and discuss ways |
|        |                | that spiritual beliefs can support         |
|        |                | recovery.                                  |
+--------+----------------+--------------------------------------------+
| 15     | Managing Life; | Clients identify aspects of their life     |
|        | Managing Money | that have been neglected and explore ways  |
|        |                | to manage their lives responsibly.         |
+--------+----------------+--------------------------------------------+
| 16     | Relapse        | Clients learn about relapse justification. |
|        | Justification  | Clients discuss justifications to which    |
|        | I              | they are susceptible and formulate plans   |
|        |                | to counter them.                           |
+--------+----------------+--------------------------------------------+
| 17     | Taking Care of | Clients learn the importance of            |
|        | Yourself       | self-esteem to recovery and explore        |
|        |                | aspects of their lives that require        |
|        |                | change.                                    |
+--------+----------------+--------------------------------------------+
| 18     | Emotional      | Clients learn that emotions can act as     |
|        | Triggers       | triggers and discuss tools that will help  |
|        |                | them avoid dangerous emotions.             |
+--------+----------------+--------------------------------------------+
| 19     | Illness        | Clients learn that becoming ill can be a   |
|        |                | trigger and discuss ways to keep their     |
|        |                | recovery on track when they are sick.      |
+--------+----------------+--------------------------------------------+
| 20     | Recognizing    | Clients learn the threat that stress poses |
|        | Stress         | to recovery. Clients discuss how to        |
|        |                | identify and cope with stressful           |
|        |                | situations.                                |
+--------+----------------+--------------------------------------------+
| 21     | Relapse        | Clients learn that moving closer to        |
|        | Justification  | relapse (e.g., to test the strength of     |
|        | II             | their recovery) is dangerous. Clients      |
|        |                | explore strategies to resist relapse       |
|        |                | justifications.                            |
+--------+----------------+--------------------------------------------+
| 22     | Reducing       | Clients are reminded that stress can       |
|        | Stress         | endanger their recovery and discuss        |
|        |                | strategies to reduce stress.               |
+--------+----------------+--------------------------------------------+
| 23     | Managing Anger | Clients learn that anger can be a trigger. |
|        |                | Clients discuss ways to recognize and      |
|        |                | address a buildup of anger.                |
+--------+----------------+--------------------------------------------+
| 24     | Acceptance     | Clients learn that accepting their         |
|        |                | substance use disorder is not a sign of    |
|        |                | weakness. Clients explore strengths to     |
|        |                | rely on.                                   |
+--------+----------------+--------------------------------------------+
| 25     | Making New     | Clients learn that abstinent friends can   |
|        | Friends        | support their recovery. Clients discuss    |
|        |                | people who can serve as supportive friends |
|        |                | and how to meet them.                      |
+--------+----------------+--------------------------------------------+
| 26     | Repairing      | Clients learn the importance of making     |
|        | Relationships  | amends and discuss how to address people   |
|        |                | who refuse to forgive them.                |
+--------+----------------+--------------------------------------------+
| 27     | Serenity       | Clients learn to distinguish between       |
|        | Prayer         | things that can be changed and those that  |
|        |                | cannot. Clients discuss things in their    |
|        |                | lives that they will change.               |
+--------+----------------+--------------------------------------------+
| 28     | Compulsive     | Clients learn what compulsive behaviors    |
|        | Behaviors      | are and how they can endanger recovery.    |
|        |                | Clients discuss ways to recognize and      |
|        |                | eliminate compulsive behaviors.            |
+--------+----------------+--------------------------------------------+
| 29     | Coping With    | Clients learn to recognize their emotional |
|        | Feelings and   | responses, especially signs of depression. |
|        | Depression     | Clients explore strategies for coping with |
|        |                | depression.                                |
+--------+----------------+--------------------------------------------+
| 30     | 12-Step and    | Clients learn how 12-Step and mutual-help  |
|        | Mutual-Help    | programs support recovery. Clients explore |
|        | Programs       | the variety of 12-Step and mutual-help     |
|        |                | programs available.                        |
+--------+----------------+--------------------------------------------+
| 31     | Looking        | Clients learn that boredom can be a        |
|        | Forward;       | relapse trigger. Clients discuss ways to   |
|        | Managing       | break the monotony of recovery.            |
|        | Downtime       |                                            |
+--------+----------------+--------------------------------------------+
| 32     | One Day at a   | Clients learn to avoid feeling overwhelmed |
|        | Time           | by the past and explore strategies for     |
|        |                | focusing on the present.                   |
+--------+----------------+--------------------------------------------+
| El     | Client Status  | Clients learn that establishing a regular  |
| ective | Review         | pattern of self-review will help support   |
| S      |                | recovery. Clients discuss areas in which   |
| ession |                | they need to improve.                      |
| A      |                |                                            |
+--------+----------------+--------------------------------------------+
| El     | Holidays and   | Clients learn that holidays pose risks for |
| ective | Recovery       | recovery and discuss ways to alleviate the |
| S      |                | added stress that comes with holidays.     |
| ession |                |                                            |
| B      |                |                                            |
+--------+----------------+--------------------------------------------+
| El     | Recreational   | Clients learn how new hobbies and pursuits |
| ective | Activities     | can help support recovery. Clients discuss |
| S      |                | old hobbies they would like to pick up     |
| ession |                | again or new pursuits they wish to try.    |
| C      |                |                                            |
+--------+----------------+--------------------------------------------+

Following the presentation of the 32 RP sessions are descriptions of 3
elective sessions that can be used as substitute sessions whenever the
counselor deems appropriate. For example, Elective Session B addresses
the difficulties clients may face around major holidays, such as
Christmas or the Fourth of July. The counselor may wish to substitute
this session for 1 of the 32 regular sessions if a holiday is
approaching. The handouts indicated in all the RP session descriptions
are provided after the session descriptions for the counselor's use and
are duplicated in the *Client's Handbook.*

# **Session 1: Alcohol**

## *Goals of Session*

-   Help clients understand that alcohol is a substance whose use can
    jeopardize recovery.

-   Help clients identify the situations in which they are most likely
    to drink.

-   Help clients plan for those situations so they can remain abstinent.

### *Handout*

-   RP 1---Alcohol

### *Presentation of Topic (15 minutes)*

1.  *Understanding the Effects of Alcohol on the Brain*

Because alcohol affects the rational, reasoning part of the brain,
people who are drinking are especially ill equipped to evaluate the
detriments of drinking and the benefits of quitting. Drinking also
lessens people's inhibitions and makes them feel less self-conscious,
more sociable, and more sexual. Some clients will have to address the
fact that they have used alcohol to make themselves feel comfortable in
social situations. Some clients may have to address the fact that
sexuality is linked with alcohol for them. Clients who are accustomed to
consuming alcohol in social or sexual situations may find that, for a
time, these activities are uncomfortable without alcohol.

2.  *Being Alert for External and Internal Triggers for Drinking*

> Alcohol consumption is a significant and pervasive part of U.S.
> culture. Clients who are trying to stop using alcohol face a difficult
> struggle. External triggers bombard clients; consumption of alcohol is
> assumed to be the norm, especially at social functions and
> celebrations. It is hard for clients to go through a typical day
> without coming across many reminders---both cultural and personal---of
> alcohol. Advertisements, movies, and TV shows link drinking with being
> happy, popular, and successful. Clients encounter colleagues, friends,
> and family members with whom they used to drink and pass by bars or
> liquor stores that they used to frequent.
>
> Internal triggers also pose problems for clients. Depression, anxiety,
> and loneliness are all characteristic of recovery. These emotional
> states also are cues to drink for many people. Facing the emotional
> fallout from quitting other substances, clients feel justified in
> turning to alcohol to "relieve" their mental state. It is difficult
> for clients to realize that alcohol may be responsible for their
> depression or other emotional problems.

## *Preparing for Situations Involving Alcohol* 

Drinking often accompanies certain activities: wine with dinner, a beer
at the game, a drink after work. Alcohol also is integral to
celebrations such as parties and weddings. For some clients, alcohol
seems to be an inextricable part of these activities; they cannot
conceive of enjoying certain activities without drinking. Not drinking
may mean that clients feel left out of the fun, less cool. It is
important for clients to know that they will have these feelings and to
prepare for them. Clients should be encouraged to think about ways of
celebrating that do not involve alcohol. If they know that being around
others who are drinking will make them feel left out, clients should
avoid such situations until their recovery is well underway.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 1---Alcohol.

-   Ask clients who already have covered the material to recall the
    discussion of triggers from Early Recovery Skills (sessions 2 and 3)
    and share what they learned about external and internal triggers
    with the group. The recovering co-leader can share his or her
    experiences with triggers.

-   Ask clients to discuss what people, places, situations, and mental
    and emotional states act as triggers for them.

-   Survey clients' success at stopping drinking. How many have tried?
    How many have succeeded?

-   Ask clients to recall a time when they saw that someone else's
    judgment was affected by drinking. What does this tell them about
    their ability to make smart decisions about recovery while they
    still are drinking?

-   Encourage clients to discuss ways they have become dependent on
    alcohol in social situations. (Note: Although it is important for
    clients to discuss their experiences, the counselor should ensure
    that clients do not detour into elaborate descriptions of substance
    use that could act as triggers.)

-   Ask clients how they can prepare themselves for situations in which
    they formerly used alcohol.

-   Urge clients to think about situations to avoid if they are to
    remain abstinent.

-   Ask clients what changes they can make in their celebrations with
    family and friends to remain abstinent.

The counselor should end this portion of the group session by reassuring
clients that everyone who stops drinking must work through the same
difficulties. The longer clients are abstinent, the easier it will be
for them to manage these difficult situations.

## *Open Discussion (30 minutes)*

Although it is important for clients to be able to speak about what is
on their minds, the counselor should make sure that the session's topic
has been explored completely.

#### ***Homework***

To prepare for abstinence, instruct clients to use their journal or
pages 6 and 7 of their *Client's Treatment Companion* to solidify their
plans*.* Ask clients to write down situations that pose the greatest
threat to their sobriety and, for each situation, detail three
alternatives to help them avoid drinking.

# **Session 2: Boredom**

## *Goals of Session*

-   Help clients understand that boredom poses a risk to their recovery.

-   Help clients understand that the situation will improve with time.

-   Help clients identify new activities and techniques that will help
    them through their boredom.

### *Handout*

-   RP 2---Boredom

### *Presentation of Topic (15 minutes)*

1.  *Understanding the Risk Boredom Poses*

Boredom is a precursor to relapse. For many clients, boredom is a
trigger: when they were bored, they would use. Unless clients take some
action, the boredom---and the relapse risk that accompanies it---will
not dissipate. To have a successful recovery, clients must continue to
make progress. Standing still can mean losing ground. Clients need to
take action to combat the inertia that boredom represents.

2.  *Understanding the Reasons for Boredom*

> Some of the boredom clients feel can be attributed to the shift from a
> substance-using to a substance-free lifestyle. When contrasted with
> the emotional highs and lows of substance use, an abstinent life can
> seem dull. The brain still is adjusting to the lack of substances.
> While the brain heals, clients may feel listless or bored. The period
> from 2 to 4 months into recovery (known as the Wall) is often
> characterized by emotional flatness and boredom. Finally, the
> structure clients must impose to have a successful recovery may not
> offer them the short-term emotional rewards of a substance-using
> lifestyle.
>
> It is important for clients to know that, as their body and mind
> adjust to recovery, boredom will become less of an issue.

## *Addressing Boredom*

There are several ways clients can reduce feelings of boredom. The
skills clients learn in the Early Recovery Skills group can be put to
use. For example, scheduling every hour of every day helps clients
identify unplanned sections of time that can be used to explore
interesting activities. Starting new hobbies or picking up interests
that were abandoned while clients were using is a good way to defeat
boredom. Some clients schedule something that they can look forward to:
a long weekend, a visit with family, a concert, a movie. It also may
help clients to discuss their feelings of boredom with a spouse, loved
one, or trusted friend. Starting new friendships with substance-free
people met through 12-Step or mutual-help groups also can help alleviate
clients' boredom. (The counselor should remind clients that intense
personal involvements---including romantic or sexual
relationships---among group members are discouraged.)

The danger of boredom during recovery is that it encourages clients just
to float along. Before they know it, clients can drift from abstinence
into relapse. The most important thing clients can do is take an active
role in their recovery. Engaging in some kind of process and working
toward a goal---taking up a hobby, planning a vacation, starting a
friendship---also help clients move toward their recovery goals.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 2---Boredom.

-   Ask clients whether they are having trouble with boredom. When did
    they first notice it?

-   Ask what actions clients have taken to counter boredom.

-   Ask the recovering co-leader to share his or her experiences with
    boredom.

-   Ask clients to list new activities they have tried or might try to
    help them during recovery. How have these activities affected or
    will they affect their recovery?

-   Survey the clients to learn how many are scheduling activities. Ask
    them to share how scheduling has helped them.

-   Ask clients what kinds of activities they can plan and anticipate to
    help them counter boredom.

-   Remind clients that although structure is important to recovery,
    sometimes boredom results from too *much* routine. People who are
    stuck in a boring rut can be heading toward relapse. Boredom can
    indicate that clients are not challenging themselves enough in their
    daily lives. Encourage clients to try new things that will advance
    their personal growth and bolster their recovery.

-   Ask the recovering co-leader to share with clients the activities
    and techniques that helped him or her defeat boredom.

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

Have clients keep a record of their emotional states, staying vigilant
for signs of boredom.

# **Session 3: Avoiding Relapse Drift**

## *Goals of Session*

-   Help clients understand the process of relapse drift.

-   Help clients identify things in their lives that are anchoring their
    recovery.

-   Help clients identify things that must be avoided because they
    threaten to send clients into relapse drift.

### *Handouts*

-   RP 3A---Avoiding Relapse Drift

-   RP 3B---Mooring Lines Recovery Chart

### *Presentation of Topic (15 minutes)*

1.  *Understanding How Relapse Drift Can Lead to Relapse*

> In the group session on boredom (RP session 2) clients learned that
> boredom can be a sign that they are not taking an active role in their
> recovery, that they are just going with the flow. Relapse drift is the
> process by which people slide from abstinence to relapse without even
> realizing what is happening. A useful comparison is that of sailors
> who anchor a boat before going to sleep below decks. If the anchor is
> not properly set, the boat will drift away during the night; the
> sailors wake up to find they are in unfamiliar waters, far from their
> safe anchorage.
>
> Although relapse may feel like a sudden occurrence---an unforeseeable
> disruption of recovery---often it is the result of a gradual movement
> away from abstinence that is so subtle clients can explain it away or
> deny responsibility for it. Relapse rarely occurs without warning
> signs. Clients need to remain vigilant for signs of relapse. (In Early
> Recovery Skills session 7, these early warnings of relapse were
> referred to as addictive behaviors.)

2.  *Understanding the Importance of Mooring Lines*

People who are successful in recovery find ways to remain abstinent.
Pursuing certain activities or avoiding certain people and situations
becomes essential to maintaining recovery. Identifying these
recovery-supporting behaviors and checking to make sure they are in
place also are essential to maintaining abstinence. These
recovery-supporting behaviors are the "mooring lines" of people in
recovery. They keep clients anchored in recovery and alert them to the
first signs of relapse drift. Clients need to examine their recovery
process and identify their mooring lines. Doing so allows them to list
and monitor the things that are anchoring their recovery.

## *Monitoring Mooring Lines*

To monitor their mooring lines, clients need to identify them and list
them as specifically as possible. Merely listing "Exercise" is not as
helpful to the client as listing "Ride bike for at least 30 minutes, 4
times a week." Likewise, listing a friend as a mooring line is not as
helpful as writing "Talk on the phone with Louisa once a week." Clients
should avoid listing attitudes or things that are not quantifiable as
mooring lines. Although a feeling of optimism may help clients stay
abstinent, it is not easy to monitor. The goal is to have clients make a
list of activities or behaviors whose presence or absence they can note.
Detailed, concrete listings give clients better indications of whether
their mooring lines are secure.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to read handout RP3---Avoiding Relapse
Drift and complete handout RP3B---Mooring Lines Recovery Chart before
the discussion begins. Clients should not be forced to comply if they
find it difficult or uncomfortable to complete the handout in the group.
The handout is primarily a tool for discussion. The counselor steers
clients away from reading their responses and encourages them to
converse about the issues the handout raises. The counselor ensures that
all clients have an opportunity to participate.

-   Go over handout RP 3A---Avoiding Relapse Drift. Cover any aspects of
    the topic that were not addressed in the didactic portion of the
    session.

-   Go over handout RP 3B---Mooring Lines Recovery Chart. Give clients 5
    to 10 minutes to complete this chart.

-   Ask clients to share the activities, behaviors, and people they
    identified as mooring lines.

-   Have clients explain how one of their mooring lines helps keep them
    abstinent and secure in their recovery.

-   Ask the recovering co-leader to share his or her experience with
    mooring lines. Have they stayed the same over time? Or has the
    co-leader added new mooring lines as recovery has progressed?

-   Ask clients to share the activities, behaviors, and people they must
    avoid if their recovery is to remain anchored.

-   Ask clients how often they will check their mooring lines. It is
    recommended that they check them at least weekly.

-   Review with clients the steps they can take if they realize that
    more than two of their mooring lines are missing and they are
    drifting toward relapse.

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

Instruct clients to check their mooring lines once before the next RP
session.

# **Session 4: Work and Recovery**

## *Goals of Session*

-   Help clients understand how their work life affects their recovery.

-   Help clients examine possible solutions to problems that work poses
    to their recovery.

### *Handout*

-   RP 4---Work and Recovery

### *Presentation of Topic (15 minutes)*

1.  *Understanding Conflicts Between Work and Recovery*

> Recovery takes a total commitment from clients, yet few people can
> afford to ignore their jobs or stop job-hunting and focus solely on
> their recovery. As a result, many clients experience conflicts between
> employment issues and recovery. Some conflicts may be difficult to
> resolve; it is important to acknowledge conflicts that exist and work
> toward solutions.

2.  *Finding Balance Between Work and Recovery*

Although the four work situations on the handout RP 4---Work and
Recovery are very different, some general principles can help clients
address them. Because treatment must coexist with work, clients may have
to find ways to cut back on their work commitments to incorporate all
the activities and demands of recovery. Finding this balance may require
employees to request that their work schedules be adjusted.

Clients who are in jobs that contributed to their substance use problem
(e.g., where other people use substances or where the client is paid in
cash) face a dilemma. Clients may feel that it is better to quit such a
job, yet major change or upheaval is not recommended during the first 6
months to a year of recovery. Unemployment may seem preferable if the
job poses risks to relapse. However, without the structure of and income
from work, clients may have difficulties committing to recovery.

Although it is unpaid, recovery is work in a real sense. And recovery
may be more important to clients' happiness and success than their
paying work. Clients should be encouraged to devote as much time and
effort as they can to their recovery.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to read the handout before the discussion
begins. The handout is primarily a tool for discussion. The counselor
encourages clients to converse about the issues the handout raises. The
counselor ensures that all clients have an opportunity to participate.

-   Go over handout RP 4---Work and Recovery.

-   Ask clients to share which of the work situations best fits them.
    Are there other situations that are not listed on the sheet that
    apply?

-   Ask what compromises and changes clients have made to find time for
    recovery.

-   Ask the recovering co-leader to share his or her experience with
    balancing work and recovery. Has striking that balance gotten easier
    as recovery has progressed?

-   Allow clients to debate the pros and cons of leaving a job that is
    obstructing recovery.

-   Ask clients whether they have worked with their bosses or their
    company's employee assistance program to make it easier to commit to
    treatment activities.

-   Ask whether there are clients in the group who opted for intensive
    outpatient treatment over inpatient treatment because of the demands
    of their jobs.

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

Ask clients to examine their commitment to recovery and come up with two
new strategies for effectively balancing work and recovery.

# **Session 5: Guilt and Shame**

Note: This topic should not be used when there is a client attending his
or her first RP group session. If there is a client new to the group,
the counselor should choose a different topic for the session so that a
new member is introduced to the group with a less daunting subject.

## *Goals of Session*

-   Help clients understand the difference between guilt and shame.

-   Help clients learn strategies for coping with guilt and shame.

### *Handout*

-   RP 5---Guilt and Shame

### *Presentation of Topic (15 minutes)*

1.  *Differentiating Guilt From Shame*

> Guilt refers to feeling bad about things one has done or failed to do.
> For example, one might feel guilty for cheating on a spouse or for
> neglecting to keep promises to a child. Shame goes beyond a response
> to a specific action or behavior. Shame means feeling bad about who
> one is---a belief that one is defective or unworthy.
>
> Feelings of guilt and shame are often part of people's responses to
> substance abuse. But it is important for clients to distinguish
> between the two. Guilt can be a useful reaction in recovery,
> indicating to clients that they have done something that goes against
> their value system. Guilt can motivate clients to seek forgiveness and
> make amends for the pain and trouble they have caused others. However,
> if clients are convinced they are bad people, they may feel unworthy
> of recovery and feel that they have a license to use substances. Shame
> can be an impediment to abstinence.

2.  *Addressing Feelings of Guilt and Shame*

Both guilt and shame can erode a client's self-esteem and
self-confidence. Focusing on negative feelings can cause clients to turn
to substance use to alter their mood or to escape. Clients should be
reminded that their substance abuse is not related to their being bad or
weak. To stay abstinent, clients need to be smart and work hard, and
part of being smart and working hard is understanding their feelings.
What things do they feel guilty about? What has contributed to their
feelings of shame? Clients may need time to work through feelings of
guilt and shame. Clients need to give themselves time to feel better
about themselves and their behaviors. Talking about feelings of guilt
and shame also may help clients, as can making amends.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 5---Guilt and Shame.

-   Ask clients to list the things that they feel guilty for doing and
    for neglecting to do.

-   Remind clients that it is all right to have made mistakes; they
    cannot change the things they did in the past. Ask whether they are
    able to forgive themselves for past mistakes.

-   Have clients discuss the difference between moving past guilt by
    forgiving themselves and simply letting themselves off the hook.

-   Ask the recovering co-leader to share his or her experience of
    overcoming guilt. How did the co-leader balance the need to take
    responsibility for past actions with the need to forgive those
    actions?

-   Have clients discuss how they can get over feelings of guilt and
    shame. What positive behaviors can they engage in that will aid this
    process?

-   Ask clients who are attending 12-Step or mutual-help meetings
    whether guilt and shame have been discussed in meetings. Ask how
    these discussions have been helpful.

-   Ask the recovering co-leader to discuss how mutual-help fellowship
    has helped him or her cope with guilt and shame.

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

Encourage clients to think about people from whom they may need to ask
forgiveness. How will they approach these people? What can they do to
put things right with the people they have hurt?

# **Session 6: Staying Busy**

## *Goals of Session*

-   Help clients understand the importance of scheduling activities.

-   Help clients understand how idle time can be a trigger to use.

-   Help clients learn and share strategies for scheduling and staying
    busy.

### *Handout*

-   RP 6---Staying Busy

### *Presentation of Topic (15 minutes)*

1.  *Understanding the Importance of Scheduling and Structure to
    Recovery*

Most clients in this session already will have been introduced to the
practice of scheduling in the Early Recovery Skills group (Early
Recovery Skills session 1). However, the structure that scheduling
provides is so important to recovery that the principle should be
reviewed here. Clients are reminded that many people who abuse
substances organize their days around procuring, using, and recovering
from the substances. Without these activities to structure their time,
many people with a substance use disorder feel a void or sense of loss.
Finding new activities and new ways to occupy their time and replace
that sense of loss is a major component of recovery for clients. It is
important for clients to write down their schedules. Schedules that
exist only in one's head are too easy to revise or abandon. When clients
are making their schedules, special attention should be paid to weekends
and other times clients feel they are particularly vulnerable to
substance use.

2.  *Understanding How Free Time Can Act as a Trigger*

Because using was a habitual activity for clients, their minds gravitate
back to thoughts of using if they have nothing to do and nowhere to go.
Then, the thought--craving--use process begins, and clients are on their
way to relapse. Being alone also can be a trigger for clients. Before
they entered treatment, many probably isolated themselves from friends
and loved ones when they used. For this reason, it is important not just
that clients schedule substance-free activities but that these
activities involve other people who are living a substance-free life
(e.g., people clients meet at mutual-help meetings) or are committed to
the clients' recovery (e.g., family members and friends).

3.  *Incorporating New Activities and New People*

Even clients who are committed to recovery can miss aspects of a
substance-using lifestyle. Scheduling activities and staying busy are
ways to keep clients engaged in their new lives without substance use.
Some clients are interested sufficiently by picking up old hobbies or
activities; others need the increased interest that is generated by new
activities and new acquaintances. Although the focus of their lives must
be recovery, clients are encouraged to think of recovery as a time to
try something they have put off: volunteering, taking up a new sport,
learning to play a musical instrument.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 6---Staying Busy.

-   Ask clients to think about how unfilled time and an unoccupied mind
    can act as triggers.

-   Ask whether clients have felt tempted to use when they had too much
    free time on their hands. How did they respond?

-   Ask the recovering co-leader to share his or her strategies for
    staying busy to keep recovery on track.

-   Ask clients whether they always used in groups or tended to use
    alone. Discuss the dangers of being alone for those who tend to
    isolate themselves.

-   Ask clients what activities have helped them stay busy and stay
    abstinent since they stopped using.

-   Solicit suggestions from clients for hobbies or activities they
    would like to try that they feel will help them stay abstinent.

-   Ask clients whether they have made new friends through mutual-help
    meetings. What activities have they pursued outside meetings?

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

Instruct clients to make a wish list of activities they would like to
pursue. The lists could include activities that they learned about from
other clients in the group.

# **Session 7: Motivation for Recovery**

## *Goals of Session*

-   Help clients understand that the motivation that brought them into
    treatment may change as they progress in treatment.

-   Help clients recognize new motivations and strategies for staying
    abstinent.

-   Help clients identify benefits from recovery.

### *Handout*

-   RP 7---Motivation for Recovery

### *Presentation of Topic (15 minutes)*

1.  *Understanding That Reasons for Staying in Treatment Evolve Over
    Time*

Clients know that they must remain steadfast in recovery. This knowledge
may lead some to believe that their motivation for remaining abstinent
must always be the same. It does not matter what brings clients into
treatment in the first place. What is important is what motivates
clients to stay abstinent each day. The counselor might remind clients
that, although staying abstinent is a lifelong goal, they can achieve it
only hour by hour and day by day. Clients may find that their reasons
for staying abstinent change over time. Some clients may realize this
for the first time as a result of handout RP 7 and the ensuing
discussion.

2.  *Using New Strategies as Motivations Evolve*

Clients may enter treatment because they are afraid of what will happen
if they do not stop using substances. Clients may find that if they
focus on staying abstinent, their initial motivation for not using drugs
and alcohol will evolve into a personal, internal desire to maintain
their new lives.

3.  *Remaining Abstinent Long Enough To See the Benefits of Recovery*

When clients have been abstinent long enough to experience the benefits
that abstinence brings, the desire to see those benefits persist becomes
a powerful motivator for clients to stay in recovery. Clients are able
to address problems with family, friends, and employment that resulted
from substance abuse. In place of feeling the shame and having the
self-defeating attitude that characterize many people who abuse
substances, clients now can take pride in their abstinence and their new
lives.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 7---Motivation for Recovery.

-   Ask clients what assumptions they made about the various motivations
    for starting treatment listed on RP 7---Motivation for Recovery.
    Which motivations *seem* the strongest?

-   Ask clients to discuss the reasons that brought them to treatment.

-   Ask whether the same things are motivating them today that motivated
    them when they started treatment.

-   Ask what motivates clients to stay in treatment and be abstinent
    now.

-   Ask the recovering co-leader to discuss how his or her motivations
    evolved from the start of treatment.

-   Ask clients whether they feel that they are running out of reasons
    for staying in treatment.

-   Ask the group to suggest reasons for staying abstinent and in
    treatment.

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

Ask clients to add to the list of current motivations they made during
this session. Instruct them to identify three more reasons for them to
stay in treatment.

# **Session 8: Truthfulness**

## *Goals of Session*

-   Help clients understand that substance dependence and truthfulness
    are irreconcilable states.

-   Help clients acknowledge that truthfulness will not always be easy.

-   Help clients understand that continued truthfulness is integral to
    successful recovery.

### *Handout*

-   RP 8---Truthfulness

### *Presentation of Topic (15 minutes)*

1.  *Understanding That Substance Dependence Is Based in Unreality and
    Recovery Is Based in Truth*

Substance dependence represents an escape from the realities of life, a
flight from responsibility, and a denial of consequences. Maintaining a
substance-abusing lifestyle requires people to lie and make excuses
continually. Entering recovery represents the first step toward
acknowledging the truth of substance dependence. To be successful,
recovery must continue to be grounded in truth. This means not just that
clients acknowledge that they have a substance use problem but also that
they make a commitment to behave truthfully with the people in their
lives.

2.  *Understanding the Difficulties Posed by Truthfulness*

Often it is hard for clients to be honest with themselves about their
substance abuse. Having taken the step to enter treatment and be
truthful with themselves, they now face the more daunting task of being
honest with those around them. Being honest with friends and loved ones
can be harrowing. Clients risk driving away friends and alienating
family members when they give an honest account of their actions while
they were using. Clients may be embarrassed to admit their actions.
Loved ones may be offended by clients' blunt approach to truth telling.

The RP group is a good place for clients to get used to telling the
truth. Other group members may take offense, but that, too, provides
good practice for addressing the responses of family members and
friends.

3.  *Understanding That Recovery Cannot Be Successful Without
    Truthfulness*

If clients choose to be in treatment without being totally truthful,
they have not committed fully to recovery. It is as if by continuing to
deceive and be less than truthful, these clients are holding back,
refusing to become involved fully in their recovery.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 8---Truthfulness.

-   Ask clients to make an honest assessment of the ways they were
    dishonest when they were using. Encourage them to look beyond
    obvious lies and discuss ways in which they misled people or let
    them believe something that was not true.

-   Discuss the limits of truth telling. What types of things should
    clients be sure they are always honest about? Are there situations
    in which it is all right *not* to be completely honest?

-   Ask clients to think about the consequences of telling the truth to
    friends and family members. Does the prospect of doing so upset
    them?

-   Ask the recovering co-leader to discuss his or her experiences of
    telling the truth to friends and family members.

-   Ask whether clients are experiencing difficulty telling the truth in
    group.

-   Ask what problems clients have encountered. What positive
    experiences have come from being honest?

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

# 

# Encourage clients to speak truthfully about their substance abuse with a friend or family member before the next RP group meeting. 

# **Session 9: Total Abstinence**

## *Goals of Session*

-   Help clients understand that they need to stop using alcohol and
    *all* mood-altering drugs.

-   Help clients understand that continued substance use will cloud
    their decisionmaking and endanger recovery.

### *Handout*

-   RP 9---Total Abstinence

### *Presentation of Topic (15 minutes)*

1.  *Understanding the Connection Between Alcohol and Other Substance
    Use and Relapse to Stimulants*

Substance abuse clouds judgment and throws lives out of balance. People
and things that had been priorities before a person became substance
dependent---family, friends, work---often get ignored as substance abuse
takes precedence. To put their lives back into balance and to reorient
their priorities, clients need to be able to think and act clearly.
Stopping stimulant use is an important part of this process. But
continued use of marijuana, another drug, or alcohol can jeopardize this
process.

Clients may not think these other substances pose a problem. Some may
even argue that occasional use of alcohol or marijuana helps them cope
with the stress of stopping stimulant use. Clients need to be convinced
that any substance use will interfere with their brain's ability to heal
and their mind's ability to reason clearly. Any substance use interferes
with recovery. However, the counselor makes it clear that clients should
continue to take prescribed medications required to treat chronic
physical or mental disorders.

2.  *Understanding That It Is Not Possible To Learn How To Cope Without
    Stimulants if Clients Turn to Alcohol or Marijuana or Other
    Substances To Escape*

The counselor reminds clients that they signed an agreement not to use
any substances when they began treatment. Even if clients have not used
stimulants during treatment, use of alcohol or other mood-altering
substances is a way of avoiding a full commitment to recovery. By
continuing to use substances, clients are hedging their bets, using
alcohol or marijuana as an escape hatch in the event that recovery is
too hard. Clients lessen their chances of successful recovery for
stimulant dependence if they continue to use alcohol and other
substances, even once in a while. Alcohol use makes relapse to stimulant
use eight times more likely; marijuana use makes relapse three times
more likely (Rawson et al. 1995).

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to read the handout before the discussion
begins. The handout is primarily a tool for discussion. The counselor
encourages clients to converse about the issues the handout raises. The
counselor ensures that all clients have an opportunity to participate.

-   Go over handout RP 9---Total Abstinence.

-   Ask clients to share their responses to the "no substance use"
    agreement they signed on admittance to treatment.

-   Ask whether clients find themselves coming up with justifications
    for drinking or getting high. What are these justifications?

-   Ask whether some clients have come to appreciate the logic of
    ceasing all substance use. What changed their minds?

-   Ask the recovering co-leader to discuss his or her experiences with
    the "no substance use" policy.

-   Ask clients to think about what changes they have made or will have
    to make in their lives to eliminate use of alcohol and marijuana
    (e.g., get rid of all the alcohol in the house, ask family members
    or housemates not to bring home pot, advise loved ones that they
    have stopped drinking and getting high).

-   Ask clients who have stopped all substance use to share with the
    group reasons why total abstinence is a good idea.

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

# 

# Instruct clients to list the steps they will take to begin totally abstinent recovery. Ask clients who are already in compliance with the "no substance use" agreement to list reasons they will maintain total abstinence. Clients can use their journals or pages 8 and 9 of their *Client's Treatment Companion*. 

# **Session 10: Sex and Recovery**

Note: This topic should not be used when there is a client attending his
or her first RP group session. If there is a client new to the group,
the counselor should choose a different topic for the session so that a
new member is introduced to the group with a less sensitive and intimate
subject.

## *Goals of Session*

-   Help clients understand distinctions between intimate sex and
    impulsive sex.

-   Help clients understand that impulsive sex can be a form of
    dependence and can lead to relapse.

-   Help clients appreciate the importance of stable relationships.

### *Handout*

-   RP 10---Sex and Recovery

### *Presentation of Topic (15 minutes)*

1.  *Understanding What Distinguishes Intimate Sex From Impulsive Sex*

The counselor should anticipate that this topic will be met with some
nervous laughter and joking from clients. This response may be
unavoidable. However, the counselor and recovering co-leader need to
take a serious approach to the topic and maintain a serious atmosphere
during discussion.

The distinction between intimate and impulsive sex depends on the
relationship with the sexual partner. Intimate sex is a caring act that
takes place in the context of a relationship. It is an extension of the
feelings that two people have for each other. Impulsive sex is a selfish
act in which the sexual partner is being used to achieve a type of high.
The feelings of the partner are irrelevant. Impulsive, selfish sex need
not even involve another person; excessive masturbation is a form of
impulsive sex.

Counselors should ensure that all clients understand that they run the
risk of contracting HIV/AIDS and other sexually transmitted diseases if
they engage in impulsive and unprotected sex.

2.  *Understanding How Impulsive Sex Can Act as a Trigger for Substance
    Use*

For some clients, impulsive sex was linked with substance use before
they came into treatment. They usually would have sex when they were
using. Other clients may turn to impulsive sex to achieve a kind of high
after they have stopped using substances. In both cases, impulsive sex
is a trigger for substance use and can lead to relapse. Clients even can
become dependent on impulsive sex just as they were dependent on
substances.

3.  *Understanding How Intimacy and Stable Relationships Can Support
    Recovery*

> Many components of a stable relationship also are important to a
> successful recovery. Clients who have relationships characterized by
> trust, honesty, and support should find it easier to participate fully
> in recovery activities, support others in group sessions, and be
> truthful about their lives. A stable relationship that includes
> intimate sex can help support recovery.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 10---Sex and Recovery.

-   As the discussion begins, be sure to keep the group focused on the
    importance of these issues to recovery.

-   Ensure that clients understand the difference between impulsive sex
    and intimate sex.

-   If clients are not in a relationship, help them determine whether
    they need a period of celibacy to support their recovery. For some
    clients, sex and stimulant use are so intertwined that any feelings
    of arousal can act as a trigger. With abstinence from substances,
    the connection between arousal and stimulant use will diminish.

-   Ask clients to discuss the connection between impulsive sex and
    substance use in their lives.

-   Ask clients to discuss rewarding, caring relationships they have had
    or currently have.

-   Ask what features of these relationships help support clients'
    recovery.

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

# 

# Have clients list specific ways they can make their current relationship more caring, supportive, and intimate. If clients are not in a relationship, ask them to focus on ways to improve their next relationship. 

# **Session 11: Anticipating and Preventing Relapse**

## *Goals of Session*

-   Help clients understand what relapse is and how it develops.

-   Help clients recognize the warning signs of relapse.

-   Help clients develop strategies for avoiding relapse.

### *Handout*

-   RP 11---Anticipating and Preventing Relapse

### *Presentation of Topic (15 minutes)*

1.  *Understanding That Staying Abstinent Is Different From Deciding To
    Stop Using Substances*

The decision to stop using substances and enter treatment is important.
But having decided once to stop using, clients must now decide every day
not to *start* using again. Now that they have stopped using and are in
treatment, clients need to be vigilant about signs of relapse. Using is
familiar and comfortable behavior; clients' bodies and minds will want
to return to using. So clients must anticipate and prevent relapse.

2.  *Learning To Recognize Emotional Buildup and Addictive Behaviors*

Being on guard for relapse means that clients are attuned to their
physical and emotional well-being. Persistent, nagging emotions (e.g.,
boredom, anxiety, irritability, depression) or physical symptoms (e.g.,
insomnia, headaches) often can serve as triggers in the relapse process.
Likewise, clients may find themselves engaging in the behaviors that
used to accompany their substance abuse (e.g., lying, stealing, acting
compulsively). These addictive behaviors are like an alarm bell; they
tell clients that a relapse is on the way unless the clients take
action.

3.  *Enacting a Plan To Avoid Relapse*

Clients need to plan in advance how they will intervene when they are at
risk of relapse. Different interventions work for different clients.
Common actions that help are talking with a trusted friend or family
member, going to a mutual-help meeting, talking to a counselor,
exercising, or doing something to move out of a rut, such as taking a
day off from work. Clients should think about what will work for them
and be prepared to put their plan into action at the first sign of a
relapse.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 11---Anticipating and Preventing Relapse.

-   Make sure clients understand what relapse is and appreciate the
    importance of relapse prevention.

-   Ask clients to describe the activities that they engaged in when
    they were using. These are addictive behaviors. Have these behaviors
    crept back into their lives?

-   Ask the recovering co-leader to give examples of addictive behavior
    from his or her experience.

-   Emotional buildup may be a difficult concept for clients to grasp.
    Ask the recovering co-leader to describe how emotions can build up
    and lead to relapse.

-   The concept of addictive thinking will be addressed further in two
    sessions on relapse justification. For now, have clients discuss
    justifications for engaging in behaviors that could lead to relapse.

-   Ask clients what indications of an impending relapse they will look
    out for.

-   Ask clients to share their plans for avoiding relapse. Encourage
    them to be specific about their plans.

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

# 

# Ask clients what they are doing on a regular basis to avoid relapse. Have clients record the steps they are taking to avoid triggers and stop thoughts of using. 

# **Session 12: Trust**

## *Goals of Session*

-   Help clients understand the role that trust plays in their
    relationships.

-   Help clients understand the necessity of restoring lost trust.

-   Help clients cope with suspicions of continued substance abuse.

### *Handout*

-   RP 12---Trust

### *Presentation of Topic (15 minutes)*

1.  *Understanding the Damage That Substance Abuse Does to Trusting
    Relationships*

People who use substances often find themselves concealing their
behavior from those they care about with deceit and lies. If the
substance abuse comes to light, the people who have been lied to often
have a hard time trusting the person who has been deceiving them. Once
trust has been violated, it is not easy to win back. Trust that has been
earned over years can be demolished with a single act. And it may take a
long time to convince people that the person who destroyed their trust
is worthy of being trusted again.

2.  *Restoring Trust in Relationships*

The only way for clients to rebuild trusting relationships with those
they have wronged is by staying abstinent and making amends for the harm
they have done. The process of restoring the trust is more laborious
than the blow that brought it down. Clients cannot expect their friends
and family members to believe that they will remain abstinent. Clients
have to provide evidence that they can be trusted again.

3.  *Coping With Suspicions of Continued Substance Use*

Earning back people's trust can be a frustrating process. Clients may
feel that they have been abstinent long enough for their loved ones to
trust them again. However, clients must understand that restoring trust
does not happen on the clients' schedule. Rebuilding a trusting
relationship may take time, even if both parties are committed to the
process. Clients should be prepared to cope with the frustration that
comes from being suspected of using even though they have not done so.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 12---Trust.

-   Ask clients to discuss relationships that they have damaged by
    losing the trust of others.

-   Ask clients whether they can work to rebuild these relationships.

-   Ask clients to put themselves in the shoes of someone whose trust
    they violated. Encourage them to empathize with that person. How
    might it feel for clients to have their trust taken from them?

-   Ask the recovering co-leader to discuss a relationship that was
    damaged by substance abuse and how he or she is working to restore
    the other person's trust.

-   Ask clients to discuss how they will respond if their loved ones are
    suspicious of them even though clients have stopped using and are
    doing their best to repair damaged relationships.

-   Ask clients what they can do, in addition to staying abstinent, to
    earn back the trust of those they care about.

-   Ask clients how they will respond if some relationships are severely
    damaged, if it seems that the lost trust cannot be restored.

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

# 

# Have clients list three positive ways in which they can respond to a loved one who refuses to trust them even though the clients have remained abstinent. 

# **Session 13: Be Smart, Not Strong**

## *Goals of Session*

-   Help clients understand that recovery is not mainly a test of will,
    but of commitment and smart planning.

-   Help clients understand the importance of avoiding triggers and
    relapse situations.

-   Help clients assess the efficacy of their approach to recovery.

### *Handout*

-   RP 13---Be Smart, Not Strong

### *Presentation of Topic (15 minutes)*

1.  *Understanding That Substance Dependence Is Stronger Than the
    Individual*

When people become dependent on a substance, chemical processes are at
work on a biological level that cause cravings. Clients cannot conquer
these cravings merely by an assertion of will anymore than they can
concentrate and make feelings of hunger disappear. With longer
abstinence, cravings will fade. The physical processes that clients set
in motion when they became dependent on stimulants are stronger than
their willpower. Most people who come into treatment have tried very
hard on their own not to use. But quitting is not just a matter of
deciding not to use and then gritting one's teeth. It requires clients
to be smart and make plans to remain abstinent.

2.  *Understanding the Importance of Avoiding Triggers to Abuse and
    Likely Abuse Situations*

No matter how strong clients' desire to remain abstinent, wanting to be
abstinent is not enough by itself. People who are able to stop using and
stay abstinent do so by being smart. Clients need to use the relapse
prevention skills they learn in these sessions and in Early Recovery
Skills sessions to ensure that they are avoiding triggers and relapse
situations. Clients should take a hard, honest look at the people,
emotions, and situations that are linked to their substance abuse, make
a list of these triggers, and then make a commitment to avoid them.
Likewise, clients should analyze situations for their risk potential. If
a group of friends always winds up at a bar, clients need to avoid that
group of friends. If substances are prevalent at a certain club, clients
need to avoid that club.

3.  *Assessing How Well Prepared Clients Are To Avoid Relapse*

Clients need to have an accurate idea of how smart their approach to
recovery is. Avoiding triggers and relapse situations is not all there
is to recovery. But doing these things helps support the complete
lifestyle change necessary for a solid recovery. The more skills clients
have at their disposal to help them avoid triggers and prevent relapse,
the stronger their recovery will be. The techniques clients learn in
Early Recovery Skills sessions should be thought of as tools to use to
stay abstinent. For recovery to be successful, clients need to have as
many tools in their toolboxes as possible.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 13---Be Smart, Not Strong.

-   Ask clients whether the statements at the top of the handout sound
    familiar.

-   Ask clients to discuss the difference between being strong and being
    smart, in the context of recovery.

-   Ask the recovering co-leader to discuss his or her experience with
    trying to be strong and being smart.

-   Have clients calculate their Recovery IQ.

-   Review the various techniques listed on the chart. Do clients
    understand the importance of all these techniques?

-   Ask clients what they can do to work on the techniques they
    currently are not practicing.

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

# 

# Have clients choose 1 of the 11 relapse prevention techniques for which they rated themselves fair or poor and describe how they will work to improve that rating. Clients can write in their journals or on pages 10 and 11 of their *Client's Treatment Companion.* 

# **Session 14: Defining Spirituality**

Note: Clients may have passionately held beliefs about religion and
spirituality. This session is not designed to change clients' ideas
about religion. The goal is to provide clients a constructive way to
approach 12-Step meetings and recovery that is not explicitly religious.
Because the material is potentially contentious, the counselor may want
to take a few moments at the start of this session to remind clients to
be respectful of one another.

## 

## *Goals of Session*

-   Help clients understand the difference between religion and
    spirituality.

-   Help clients explore their beliefs so they can understand better
    what will bring them happiness.

-   Help clients see that success in recovery can be bolstered by
    spiritual beliefs.

### *Handout*

-   RP 14---Defining Spirituality

### *Presentation of Topic (15 minutes)*

1.  *Understanding That Spirituality Is About Inner Strength and Peace,
    Not Necessarily About Belief in God*

Spirituality has been shown to be an important component in recovery. It
occupies a prominent place in 12-Step and mutual-help programs. It
should be expected that some clients will have objections to this part
of the recovery process. Some may feel that spirituality equates with
belief in the Christian God and excludes people of other faiths. Some
may feel that it is a sign of weakness to look for help outside
themselves. Some may feel that their struggle with substance abuse is
physical and cannot be aided by appealing to God. These clients should
be reassured that spirituality is not the same as organized religion and
does not always involve belief in God. Likewise, including spirituality
as an aspect of recovery is not a sign of weakness. Clients'
spirituality should be seen as a source of strength that they may not be
using.

2.  *Assessing What Spirituality Means for Individual Clients*

Many people are more concerned with the physical aspects of their lives
than with the spiritual aspects. During recovery, clients should examine
the quality of their spiritual lives. Spirituality can be a source of
strength, but clients first must understand what spirituality means to
them and how it affects their lives. The goal is for clients to find a
source they can draw on for inner strength and peace---a quiet
satisfaction---that supplants their desire to abuse substances.

3.  *Linking Spirituality With 12-Step or Mutual-Help Groups*

Along with fellowship, spirituality is the foundation of 12-Step and
mutual-help programs. Clients who are closed off to the spiritual
aspects of recovery have a hard time benefiting from these recovery
groups. Twelve-Step programs invoke a higher power and often close with
the Serenity Prayer. Clients who are uncomfortable with a strictly
religious meaning of the prayer can think of these elements in the
broadest terms: higher power can refer to the inner source of strength
provided by spirituality, and the Serenity Prayer can be thought of as a
wise saying about achieving inner peace rather than as a supplication to
God.

Twelve-Step and mutual-help groups are not the only means to incorporate
spirituality into one's life. The counselor should be familiar with
other supportive options that may be better suited to clients, depending
on their values, religion, or culture.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 14---Defining Spirituality.

-   Have clients discuss the four definitions of spirituality provided
    plus additional definitions that clients may suggest. It is
    important for clients to understand that spirituality may include
    one or more of the definitions listed on the handout. In other
    words, clients should not be led to believe that the first response
    listed is wrong.

-   Ask the recovering co-leader to share what spirituality means to him
    or her. How has spirituality played a part in the co-leader's
    recovery?

-   Encourage clients to be honest and detailed in their responses to
    the four questions on the handout. The questions are personal, but
    all clients in the group can benefit from listening to one another's
    honest appraisals of the spiritual aspects of their lives.

-   Clients who use spirituality to help themselves achieve inner peace
    and support their recovery should be encouraged to share their
    experiences. What has helped these clients? Meditation? Reading
    certain writers or philosophers? Keeping a journal?

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

# 

# Encourage clients to attend a 12-Step, mutual-help, or spiritually oriented meeting before the next RP session. Have them focus on the spiritual aspects of the meeting that they can apply to their recovery. 

# **Session 15: Managing Life; Managing Money**

## *Goals of Session*

-   Help clients identify important, practical areas in their lives that
    they have been neglecting.

-   Help clients prioritize aspects of their lives.

-   Help clients make a plan to be responsible about managing their
    lives.

-   Help clients understand the importance of taking "baby steps."

### *Handout*

-   RP 15---Managing Life; Managing Money

### *Presentation of Topic (15 minutes)*

1.  *Understanding How Substance Dependence Encourages Irresponsibility*

People who are substance dependent spend much of their time and energy
preparing to use, using, and recovering from using. People who are
abusing substances narrow their world until most activities not related
to substance use are excluded. They neglect the normal day-to-day
activities that are necessary for a healthy and satisfying life.

People in recovery need to widen their view. They need to stop focusing
on substance abuse and take all aspects of their lives into account.
Clients can think about entering recovery as an end to the tunnel vision
of substance dependence. Now, instead of focusing on a tiny portion of
their lives and being surrounded by darkness, as in a tunnel, clients
can lift their heads and see the full panorama of their lives.

2.  *Understanding the Necessity of Bringing Life Back Into Control if
    Recovery Is To Be Successful*

> People who are substance dependent often spend their time and money in
> irresponsible ways. Along with deciding to stop abusing substances,
> clients need to decide to use their time and money more wisely because
> these practices go a long way in determining quality of life.
> Exercising discipline in how they spend time and money helps support
> clients in their recovery. Behaving responsibly also helps them move
> beyond the guilt and shame they experienced as a result of abusing
> substances.

3.  *Understanding the Importance of Setting Goals To Be Responsible in
    Daily Living*

The newfound awareness of all that they had been neglecting can be
overwhelming to people in recovery. The counselor should reassure
clients that they are capable of taking up long-forgotten
responsibilities and getting on with their lives. Setting reasonable
goals is integral to reassuming responsibilities. Taken together, home
repairs, debts, taxes, and court dates may seem like too much for anyone
to handle. Clients should prioritize the things they need to
accomplish---set a goal that they can achieve, achieve the goal, and
then move on to the next goal.

4.  *Understanding the Importance of Taking "Baby Steps"*

Clients often want to do too much too early in their recovery. The
counselor should stress that clients need to set small, manageable goals
to avoid becoming overwhelmed and placing their recovery at risk.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 15---Managing Life; Managing Money.

-   Ask clients to discuss the ways in which their lives were out of
    control when they were using.

-   Ask clients what changes they have made since entering treatment
    that have helped them regain control.

-   Ask clients whether they are still struggling with problems related
    to daily life. What are they?

-   Ask clients to determine which problems to tackle first.

-   Ask the recovering co-leader to recount how he or she regained
    control of daily activities.

-   Ask clients whether they have changed how they handle money since
    they have entered treatment.

-   Ask clients what plans they have for opening a savings account and
    paying off debts.

-   Ask the recovering co-leader to share how he or she regained control
    of finances.

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

Have clients write a step-by-step plan for achieving one of their
financial goals. Clients can write in their journals or use pages 14 and
15 of their *Client's Treatment Companion.*

**Session 16: Relapse Justification I**

## *Goals of Session*

-   Help clients understand what relapse justification is.

-   Help clients identify the justifications to which they are
    susceptible.

-   Help clients formulate plans to counter relapse justifications.

### *Handout*

-   RP 16---Relapse Justification I

### *Presentation of Topic (15 minutes)*

1.  *Understanding the Dangers Posed by Relapse Justifications*

Relapse justifications narrow the distance between abstinence and
relapse so that it is easier for people in recovery to go back to using.
A relapse justification can seem harmless. A client's addicted brain may
be telling him it is OK to hang out at a club where he used to use. The
client is not intending to use when he goes out, but he makes relapse
much more likely by giving himself permission to go to the club. Another
example is a woman who reasons that it is fine to go out with her old
using friends because they all know she is in recovery now and say they
are supportive. Her addicted brain convinces her she is reconnecting
with old friends who say they want to help, but she also is placing
herself in a situation that makes relapse a distinct possibility.

2.  *Understanding Specific Justifications to Which Clients Are
    Susceptible*

Relapses often *seem* to come out of nowhere. However, the addicted
brain of a person who has entered recovery recently is often busy making
dangerous behaviors seem reasonable. This happens at a subconscious
level. Using a substance as a response to a certain event (e.g., a fight
with a spouse, the loss of a job) seems to be an automatic process. But
the justification was ready, just waiting for the right set of
circumstances to emerge. Clients need to understand and anticipate the
situations in which they are vulnerable to relapse justifications.
Knowing their weaknesses in advance allows clients to halt the automatic
process that leads from event to justification to relapse.

3.  *Addressing Specific Situations That Might Lead to Relapse*

Relapse justifications are hard to avoid. Clients still may feel a
physiological craving for the substance until their minds and bodies are
fully healed. Addicted brains will try to push clients to respond to
situations in ways that put them at risk. Although the justifications
may pop into clients' minds, clients need to use their rational brains
to resist relapse justifications and choose behaviors that support
recovery. The counselor should encourage clients to recognize the
justifications that have worked against them in the past and find safer
responses to those dangerous situations. Clients should plan what they
will say if, for example, friends they formerly used with call to invite
them out. Having a plan allows clients to avoid hesitating, then being
cajoled into going along. Clients should consider making a list of
potential relapse situations and determining how to avoid them in the
future.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 16---Relapse Justification I.

-   Ask whether clients have tried to stop using before and ended up
    relapsing. How did the relapses occur? Did they seem to come out of
    the blue?

-   Ask clients to discuss the relapse justifications to which they feel
    especially vulnerable.

-   Have the recovering co-leader discuss experiences with relapse
    justifications, both the times when relapse occurred and the times
    when anticipating a potential relapse situation helped prevent
    relapse.

-   Have clients discuss specific catastrophic events and negative
    emotions that make them more likely to use. Are there events and
    emotions not listed on the worksheet that are troublesome?

-   Ask clients whether they are more vulnerable to relapse from
    positive or negative emotions.

-   Have clients discuss specific relapse justifications their addicted
    brains have used on them.

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

# 

# Have clients identify a relapse justification, write a description of it, and script a response that will help them avoid relapse. 

# **Session 17: Taking Care of Yourself**

## *Goals of Session*

-   Help clients understand the importance of taking care of themselves.

-   Help clients understand the importance of self-esteem to recovery.

-   Help clients identify aspects of their lives that require change.

### *Handout*

-   RP 17---Taking Care of Yourself

### *Presentation of Topic (15 minutes)*

1.  *Understanding the Ways in Which Taking Care of Themselves Can Aid
    Clients' Recovery*

One of the many things clients can do to support their recovery is boost
their self-esteem. Client's substance abuse may have resulted partly
from low self-esteem; low self-esteem also can be one of the effects of
substance dependence. Clients can get caught in a downward spiral in
which they feel bad about their lives, so they use. Using confirms that
their lives have little value, which lowers their self-esteem and leads
to more substance abuse.

Clients in treatment have stopped their substance use, but they also
need to break the cycle of low self-esteem and begin to see value in
their lives and themselves. Looking after their health and grooming
helps clients respect themselves. Clients who respect themselves have
more of an investment in their future and in succeeding in recovery.

2.  *Prioritizing Aspects of Life That Require Change*

Some people can make a lot of changes to their lives at once and be
successful. However, most people need to take major life changes one
step at a time. Most clients need to prioritize their changes, first
making those that are most urgent. Overdue visits to the doctor and the
dentist probably should come before other lifestyle changes. Even before
clients implement any changes, they already will have begun to take
control of their lives by prioritizing the changes they need to make. As
clients begin to address their health and grooming, the whole process of
reclaiming their self-esteem gathers momentum. After clients have
visited a doctor for a checkup, they are more likely to eat right and
exercise. When their diet and fitness are under control, clients are
more likely to pay attention to their clothes and hygiene.

The counselor might draw connections between the concerns raised in this
session and those raised in Session 15: Managing Life; Managing Money.
The counselor should help clients see that staying healthy, managing
finances, paying attention to personal grooming, and attending to the
responsibilities of day-to-day living are part of the larger picture of
recovery. As was noted in session 15, however, the counselor should
ensure that clients do not feel overwhelmed by this larger picture. They
can address one aspect of their lives at a time and gradually fill in
the larger picture.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 17---Taking Care of Yourself.

-   Make sure that clients understand that self-esteem can help support
    recovery.

-   Ask clients how they felt about their self-esteem when they were
    using.

-   Ask clients whether they feel more self-respect now that they are in
    treatment and abstaining from substance use.

-   Ask the recovering co-leader to discuss the changes in his or her
    self-esteem from the period of substance dependence to treatment and
    recovery.

-   Ask clients to identify and discuss the areas of their lives that
    need particular attention.

-   Have each client propose and share with the group a plan to address
    the most important area in his or her life.

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

# 

# Have clients write their plans for addressing the first thing they need to do to take better care of themselves. Encourage them to be as detailed as possible. 

# **Session 18: Emotional Triggers**

## *Goals of Session*

-   Help clients understand how certain emotions can act as triggers.

-   Help clients examine and understand their emotions.

-   Help clients identify tools that will help them avoid emotions that
    can act as triggers.

### *Handout*

-   RP 18---Emotional Triggers

### *Presentation of Topic (15 minutes)*

1.  *Learning To Look Out for Dangerous Emotional Triggers*

Each client probably has emotional triggers that are unique to him or
her. Feelings that might lead to relapse for one client may not cause
the same response in others. For example, some clients are at greater
risk of relapse when things are going well than when negative emotions
arise. But some emotions are dangerous triggers for most clients:
loneliness, anger, and feeling deprived. If clients are feeling these
emotions, they should be aware that they are at a higher risk of
relapse. Loneliness arises because clients often feel isolated---they
cannot hang out with using friends, and other friends and family may not
be ready to trust them again. Anger is a consequence of the frustrating
struggle to remain abstinent. Clients may begin to feel deprived because
the life of partying with friends that they left behind for abstinence
and recovery begins to look appealing. These feelings of deprivation are
a signal that clients are very vulnerable to relapse.

2.  *Ensuring That Certain Emotions, if Encountered, Do Not Lead to
    Relapse*

> Like relapse justifications, some emotions may seem to lead
> automatically to substance abuse. Clients need to understand their
> emotional responses and know which ones put them at increased risk of
> relapse. As was discussed in Early Recovery Skills session 7, it is
> important for clients to be able to separate emotions from behavior.
> The goal is for clients to examine their emotions in the abstract so
> that they can experience a negative feeling without having it result
> in substance abuse. In this way, clients' rational minds, not their
> emotions, control their behavior.

3.  *Using Strategies for Understanding Emotions and Avoiding Relapse*

One of the best ways for clients to gain a better understanding of their
emotions and how they respond to them is by writing about their
feelings. Some clients already may be keeping a journal or writing in a
diary. Others may be new to the practice. For both groups, the process
of writing about a problem to understand it better can be beneficial.
This is focused writing; clients should write with a specific emotional
question or issue in mind. The writing process itself, though, should be
fluid. This often is called free writing; the writer does not let
punctuation, penmanship, or spelling stop the flow of ideas. Clients do
not need to write for a long time; they just need to write honestly and
focus on the question they decided to address. When they have finished
writing, they should go back and read what they have written, returning
to it several more times in subsequent days.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 18---Emotional Triggers.

-   Ask clients which emotions make them feel most vulnerable to
    relapse.

-   Ask clients to recall times when one of these emotions seems to have
    *caused* a relapse.

-   Ask clients whether they have experienced loneliness and anger and
    felt deprived since they have been in treatment.

-   Ask clients whether emotions have acted as triggers. If so, how did
    they respond?

-   Have the recovering co-leader share how he or she became more aware
    of these "red flag" emotions (e.g., loneliness, anger, feeling
    deprived). How did that awareness help the co-leader avoid relapse?

-   Ask clients whether they have kept a diary or a journal or written
    about their problems.

-   Ask clients how this process has helped them.

-   Ask the recovering co-leader to share his or her experience with
    writing about emotional problems as a way to avoid relapse.

-   Ask clients what other strategies they have used to try to
    understand their emotions better.

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

# 

Have clients set aside 15 minutes to write about an emotional problem
that has been troubling them.

# **Session 19: Illness**

## *Goals of Session*

-   Help clients understand that becoming ill can be a relapse trigger.

-   Help clients understand the importance of engaging in healthful
    behaviors.

-   Help clients understand the importance of being responsible about
    recovery, even during illness.

### *Handout*

-   RP 19---Illness

### *Presentation of Topic (15 minutes)*

1.  *Understanding That Fighting a Physical Illness Takes Energy and
    Focus Away From Recovery*

Illness can be a major setback to recovery. Missing treatment sessions
at the clinic and skipping mutual-help meetings can let clients slip
toward relapse. However, clients also should be aware that sickness
poses more subtle relapse risks. Early Recovery Skills session 8 (in
which some clients already may have participated) points out that people
are vulnerable to relapse when they are tired. (This concept should be
familiar to clients who have attended 12-Step meetings.) Sickness saps
the physical and mental energy clients need to maintain abstinence.

2.  *Taking Responsibility for Preventing Illness and Maintaining
    Recovery*

Clients should view staying healthy in the same way they view avoiding
triggers. Doing their best not to get sick should be regarded as an
important goal in clients' recovery, especially early in recovery. The
same behaviors that help ward off sickness also support recovery in
general. Clients should be sure to get enough sleep, eat healthful
meals, exercise regularly, and minimize the stress in their lives. They
also should avoid activities that will leave them fatigued or prone to
illness (e.g., excessive work, elective surgery).

3.  *Keeping Recovery on Track Even During Periods of Illness*

> No matter how healthful a lifestyle clients lead, everyone gets sick
> at some point. It is important for clients to recognize early on when
> they are getting sick so they can be on the alert for thoughts and
> feelings that might lead to relapse. The unstructured time alone that
> is part of being sick can be a trigger for some people. Being sick
> also can encourage relapse justifications. For example, clients may
> think, I can't *stop* myself from getting sick; it's out of my
> control, just like my substance use. Or clients might use because at a
> time when they do not feel good, they think substance use will help
> them feel better. Clients also may slide into relapse because typical
> behavior is suspended when people are sick. Without the structure of
> work and responsibilities, it is easier for clients to set aside their
> commitment to remain abstinent.

Because illness can be a relapse trigger, clients should ensure that
they get the rest and medical attention they need to recover. If clients
seek medical attention, they should be sure to inform the doctor that
they are in recovery so the doctor can take this into consideration if
prescribing medication. Clients should do all they can to minimize the
amount of time they are ill. Getting healthy will allow them to return
to their regular recovery activities (e.g., attending treatment
sessions, going to mutual-help meetings, following their scheduled
activities) more quickly.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to read the handout before the discussion
begins. The handout is primarily a tool for discussion. The counselor
encourages clients to converse about the issues the handout raises. The
counselor ensures that all clients have an opportunity to participate.

-   Go over handout RP 19---Illness.

-   Ask whether any client has been sick since entering treatment. Was
    it hard to maintain abstinence while sick?

-   Ask clients what recovery activities they abandoned when they were
    sick. What effect did this have on their recovery?

-   Ask the recovering co-leader to share his or her experiences with
    being sick during early recovery. How did he or she remain abstinent
    when faced with diminished mental and physical energy?

-   Ask clients to discuss their current approach to maintaining good
    health. Are they regularly eating healthful meals? Are they
    exercising three or four times a week?

-   Ask the recovering co-leader to discuss the importance of diet and
    exercise to his or her recovery.

-   Ask clients to plan for illness. Do they usually get sick during
    certain times of the year (e.g., flu in the winter, allergies in the
    spring)? They should be thinking ahead and preparing for the times
    when they are sick. What can they do to limit the amount of time
    they are sick? What can they do to keep their focus on recovery,
    even if they are tired?

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

#### 

#### Have clients list the ways in which their lifestyles are unhealthful and measures they can take to live a healthier life. 

#### **Session 20: Recognizing Stress**

## *Goals of Session*

-   Help clients recognize signs of stress in their lives.

-   Help clients understand the threat stress poses to recovery.

-   Help clients identify strategies to cope with stress.

### *Handout*

-   RP 20---Recognizing Stress

### *Presentation of Topic (15 minutes)*

1.  *Recognizing Signs of Stress*

The prevalence of the term "stress" has tended to empty it of specific
meaning; clients may equate stress with worry, anxiety, nervousness,
tension, or other similar words. Stress refers to an accumulation of
concerns that unbalances a person's life. Stress represents an overload
that throws people's lives out of equilibrium. People complain about
stress so much that clients may assume it is a fact of modern life about
which they can do little. However, clients need to recognize the signs
of stress and minimize the effects that it has on their lives. Stress
makes it harder for clients to remain abstinent and focused on recovery.
It is easy for people to become accustomed to a certain level of stress
and not even be aware of its presence until physical warning signs
appear.

Clients should be on the alert for the following warning signs of
stress:

-   Irritability

-   Difficulty communicating

-   Sleep disturbances

-   Headaches

-   Weight loss or gain

-   Tremors or muscle twitching

-   Gastrointestinal problems

-   Constant fatigue

-   Memory problems

-   Disorientation or confusion

-   Difficulty making decisions

-   Depression

-   Apathy

These are the warning signs that clients may not be able to handle the
level of stress in their lives. Staying committed to recovery is more
difficult when stress reaches high levels.

2.  *Understanding That Stress May Indicate That Clients Are Trying To
    Do Too Much*

Stress can result when people place excessive demands on themselves.
People in recovery often want to try to live a perfect life or make up
for the damage they have done when they were substance dependent. They
take on too much responsibility or too much work in too short a time,
and their recovery suffers. An example is an employee who often missed
work because of substance abuse now putting in a lot of overtime to
compensate. Clients should be reminded that it is important to balance
the various aspects of their lives and that recovery needs to come
first. If they are too busy and are experiencing stress that could
distract them from their recovery, they may need to back away from some
other obligations.

3.  *Coping With Stress*

RP session 22 will address ways to help clients reduce stress in various
areas of their lives. For now, clients should know that many of the
practices they explore in Early Recovery Skills and Relapse Prevention
sessions also will help reduce stress. Exercise is an excellent way to
manage stress. Scheduling activities helps impose order and exerts
control over clients' lives. Talking with supportive friends and mentors
(e.g., participating in mutual-help groups) helps manage stress levels.
Being aware of triggers and staying alert for relapse help keep recovery
on track and help clients understand themselves better. Being mindful of
how one conducts one's life is key to reducing stress.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 20---Recognizing Stress.

-   Ask clients to discuss how they know they are experiencing stress in
    their lives. What physical or emotional changes do they notice?

-   Sometimes people are unaware of signs of stress that are obvious to
    others. Ask clients whether they have noticed signs of stress in
    other group members.

-   Ask clients whether they think there is an acceptable level of
    stress. Is *some* stress unavoidable in today's world?

-   Ask the recovering co-leader to share his or her experience of
    recognizing and coping with stress during recovery.

-   Ask clients how they coped with stress when they were abusing
    substances.

-   Ask clients whether they are experiencing different types of stress
    now that they are in recovery.

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

# 

# Have clients list two sources of stress in their lives, the emotional or physical signs of stress, and the danger the stress poses to their recovery. 

# **Session 21: Relapse Justification II**

## *Goals of Session*

-   Help clients understand the processes by which relapse
    justifications lead to relapse.

-   Help clients understand that moving closer to substance use is never
    a good idea.

-   Help clients identify strategies to resist relapse justifications.

### *Handout*

-   RP 21---Relapse Justification II

### *Presentation of Topic (15 minutes)*

1.  *Recognizing That Overconfidence in Personal Strength Is Dangerous*

Often, after several weeks of abstinence, clients begin to feel that
their substance dependence is under control. This is called the
Honeymoon---usually weeks 3 through 7 of recovery. (Clients who have
already participated in Early Recovery Skills session 5 will be familiar
with this term and concept.) Clients begin to have more energy during
this time and may begin to feel more positive about recovery. An
optimistic approach to recovery is welcome, but it can prompt some
clients to think their substance dependence is "cured."

Clients who feel that they are in control of their substance use
disorder are vulnerable to relapse; they may try to test the strength of
their recovery by putting themselves in situations where drugs are
prevalent. They may go to a club or call up friends they formerly used
with. Overconfident clients also may decide that it is all right to try
just a little bit of the substance they were dependent on, just to prove
to themselves that they have conquered their problem.

2.  *Remembering That for Recovery Being Smart Is Part of Being Strong*

> Although it is true that it requires personal strength to stop taking
> drugs and to remain abstinent, clients cannot rely on this strength in
> all situations. Clients who try to test themselves as discussed above
> are relying exclusively on their willpower rather than their
> intelligence. Some clients feel that only by getting close to
> substance use and not using will they be able to gauge their recovery.
> But the most important measurement in recovery is abstinence. Anything
> that moves clients closer to using and farther from abstinence is a
> bad idea. Clients' willpower might fail them, but sticking to a smart
> plan for abstinence will help clients maintain their recovery.

3.  *Countering Relapse Justifications*

Relapse justifications abound. Clients will be able to think of a lot of
reasonable-sounding excuses for why they should use again. No matter how
clients try to rationalize using, the end point of all justifications is
relapse, with the danger of a return to life driven by substance abuse.

A good way for clients to short circuit the connection between relapse
justification and relapse is to anticipate likely relapse situations and
plan their responses. Each client knows best the relapse justifications
to which he or she is susceptible and how his or her addicted brain has
been successful in the past. Some people might not be swayed at all by
the temptation to hang out with old using friends or to use drugs as
part of a celebration. But the notion of drinking while watching a
sporting event or testing their willpower by trying a little of the drug
on which they were dependent formerly might seem very appealing. Clients
need to be honest with themselves about their vulnerabilities and plan
detailed responses to specific relapse justifications.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 21---Relapse Justification II.

-   This session is a continuation of RP session 16. If necessary,
    return to the description of session 16, and review what relapse
    justification is.

-   Ask clients whether they have entered the Honeymoon stage of
    recovery. Do they feel as if they have their substance use problem
    under control now? What are the inherent dangers in feeling this
    way?

-   Personal strength *is* part of recovery. But clients should rely on
    being smart, not strong, to maintain their recovery. Ask clients to
    discuss this idea. How much of their recovery is the result of
    personal strength? How much is the result of being smart? How do
    clients balance being strong with being smart?

-   Ask the recovering co-leader to discuss his or her experiences with
    the relapse justifications listed on the handout.

-   Celebrations may pose particular challenges to recovery for many
    clients. Celebrations are usually public events, and drinking or
    other substance use often is expected. Ask clients how they plan to
    handle, for example, a toast at a wedding, when friends and
    strangers are encouraging them to take a drink.

-   Have clients discuss specific strategies and responses they can use
    when confronted with relapse justifications.

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

# 

# Have clients identify a relapse justification, write a description of a dangerous relapse situation, and script a response that will help them avoid relapse. (Clients who have already participated in RP session 16 should address a different scenario.) 

# **Session 22: Reducing Stress**

## *Goals of Session*

-   Help clients understand that stress can affect recovery adversely.

-   Help clients identify the aspects of their daily lives that are
    stressful.

-   Help clients identify strategies to reduce stress.

### *Handout*

-   RP 22---Reducing Stress

### *Presentation of Topic (15 minutes)*

1.  *Understanding the Risk Posed by Accumulation of Daily Stress*

Clients who enter treatment have added major stressors to their lives.
In addition to the stress of stopping all substance use, clients must
handle the demands that treatment places on their time, their families,
and their emotions. Faced with these imposing sources of stress, clients
may be less attuned to the accumulation of daily stress in their lives.
A previous RP session (session 20) addressed ways for clients to
recognize signs of stress. It is important for clients to be alert to
signs of stress so that they can prevent a buildup of stressors that
will put their recovery in jeopardy. Energy that is sapped by coping
with stress is energy that cannot be directed toward recovery.

2.  *Focusing on Signs of Stress*

> Clients should be encouraged to undertake a thorough examination of
> their lives, looking for signs and sources of stress. They might
> approach this task as they would taking an inventory, checking each
> aspect of their lives (e.g., family, work, friends) for stressors.
> Minimizing stress is important to recovery. Clients should make this
> survey of stressors a regular practice.
>
> When clients are experiencing stress, they need to find a way to
> relax. Often, physical activity helps people minimize stress.
> Stretching, deep breathing, exercise, even a brief walk help defuse
> stress. Clients need to explore various options for reducing stress,
> find out what works for them, and then use that intervention when they
> feel stress.

3.  *Making Changes to Daily Life To Reduce Stress*

It may help clients to have a few general strategies that they can apply
to minimize stress in their lives:

-   **Moderation.** One useful strategy is to do things in moderation;
    balance is always important to a healthy, happy life, but never more
    so than during recovery. Clients need to ensure that they do not
    experience large swings in physical energy from sleeping too much or
    not enough, from overeating or eating infrequently, from exercising
    too much or not at all, or from ingesting too much caffeine or
    sugar.

-   **Management.** A second strategy that clients may find useful is
    planning ahead (scheduling) and breaking down goals into small steps
    that can be tackled one at a time. This practice helps clients
    assert control over their lives. The feeling that events in life are
    not under control can be a major source of stress.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 22---Reducing Stress.

-   Ask clients how they know when they are coping with a stressful
    situation. How does stress manifest itself physically? Emotionally?

-   Ask clients what long-term effects of stress they have observed in
    their lives.

-   Ask clients about their techniques for relaxing when they are in a
    stressful situation. What techniques work for them?

-   Ask clients how they work to minimize the stress that enters their
    lives. Have they tried applying the principles of moderation and
    management?

-   Ask the recovering co-leader to share his or her experiences coping
    with and minimizing stress.

-   Ask clients whether they make it a habit to reflect quietly on their
    lives. This can be meditation, prayer, writing in a diary, or just
    taking a few minutes before going to sleep. But it is important for
    clients to think about their lives and calmly address the things
    that produce stress.

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

# 

# On each day between this session and the next RP session, have clients set aside a few minutes to reflect on their lives, focusing on the factors that produce the most stress. Clients can use their journals or pages 16 and 17 of their *Client's Treatment Companion* to write about five ways they reduce stress. 

# **Session 23: Managing Anger**

## *Goals of Session*

-   Help clients understand that anger can be an emotional trigger that
    leads to relapse.

-   Help clients recognize when anger is building up.

-   Help clients identify strategies to address anger positively.

### *Handout*

-   RP 23---Managing Anger

### *Presentation of Topic (15 minutes)*

1.  *Understanding How Anger Can Lead to Relapse*

For many people, substance use is a way to cope with feelings that are
uncomfortable. When faced with a troubling emotion, such as anger,
people often choose not to cope with it and turn to substance use
instead. Clients in recovery no longer can turn to drugs and alcohol for
a temporary escape from difficult emotions. However, these emotions
still act as triggers for substance use. Once clients are in recovery,
their refusal to come to terms with their troubling feelings can lead to
relapse.

2.  *Recognizing How Anger Builds Up*

People usually think of anger as a response to a person or an event.
Someone makes a nasty remark or cuts you off in traffic, and this causes
you to be angry. However, anger is not caused by people or events but is
caused by how one thinks about them. If clients look for someone to
blame when they feel angry, they can end up feeling victimized. This can
lead to a downward spiral in which the more clients focus on being
victims, the angrier they get.

3.  *Exploring Ways To Understand and Manage Anger*

The following steps may help clients better understand and manage their
anger:

-   **Be honest with yourself.** Admit when you are experiencing anger.

-   **Be aware of how your anger shows itself.** Physical sensations and
    patterns of behavior can help you recognize when you are angry.

-   **Think about how anger affects others.** Being aware of anger's
    effects on those you care about might motivate you to minimize its
    effects in your life.

-   **Identify and implement coping strategies.** Keep using strategies
    that have always worked, and find new ones that may be useful.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 23---Managing Anger.

-   Ask clients to discuss times when they have felt victimized. How did
    they break out of the cycle of anger and victimization?

-   Ask clients to discuss the physical and behavioral clues that let
    them know they are angry. Why is it important to be aware of anger?

-   Ask clients about the advantages of speaking their mind when they
    are angry, as opposed to bottling up their anger. What are the
    potential disadvantages to speaking up?

-   Ask clients what it means when someone is passive--aggressive. What
    types of behaviors are typical of this response? Why is this an
    unhealthy way to manage anger?

-   Ask clients what strategies for coping with anger have worked for
    them in the past. What new strategies might be helpful?

-   Ask the recovering co-leader to share his or her experiences with
    anger in recovery.

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

Have clients identify one new strategy for coping with anger and write
the benefits of the strategy.

#  

# **Session 24: Acceptance**

## *Goals of Session*

-   Help clients understand that accepting their substance use disorder
    is the first step in gaining control of their lives.

-   Help clients understand that accepting their substance use disorder
    is not a sign of weakness.

-   Help clients identify sources of strength to draw on.

### *Handout*

-   RP 24---Acceptance

### *Presentation of Topic (15 minutes)*

1.  *Accepting the Power of Substance Dependence*

Clients confront a paradox when admitting and accepting the power of
their substance use disorder. Remaining abstinent and in recovery will
require that clients be smart and strong. Before they can get to the
point where their recovery is underway, clients must admit that
substance dependence is stronger than they are and that it controls
their lives. Even though it may seem counterintuitive to clients,
especially those who have made attempts to stop using on their own
without the benefit of treatment or support groups, surrendering control
is the first step to reclaiming control. Clients who have attended
12-Step meetings may be familiar with this idea because it constitutes
the first of the 12 Steps.

2.  *Understanding That People Have Limits and That Some Things Are
    Beyond Their Control*

> It is normal for clients not to recognize the extent of their
> substance use disorder. Knowing that they are substance dependent, in
> part, because their bodies now have a chemical need for drugs may help
> some clients accept that their problem is beyond their control. In
> this sense, substance use disorders are much like any other chronic
> medical disorder, such as diabetes or heart disease. There is no shame
> in admitting the need for help, just as there is no shame in admitting
> the need for insulin by people who have diabetes. This is not to say
> that their substance dependence is out of clients' hands. Clients need
> to take responsibility for their actions, but the first step in that
> process is admitting that they cannot stop using substances on their
> own.

3.  *Identifying Sources of Support and Strength*

Clients should be aware that admitting and accepting that they have a
problem is not something they do only once at the beginning of
treatment. Even people who have been in recovery for months can let down
their guard and begin to think they are stronger than the substance
dependence that brought them to treatment in the first place. (In fact,
clients who are several weeks into recovery often feel that they are
"cured." This often happens during the Honeymoon stage of recovery, as
discussed in Early Recovery Skills session 5.)

Because acceptance can be an ongoing problem throughout recovery,
clients need sources of strength they can draw on to help them stay
abstinent. The fellow members of 12-Step, mutual-help, or spiritually
oriented programs can be a strong support during recovery. Clients
should find a meeting group they are comfortable with and attend
regularly. Friends and loved ones also can provide needed support.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 24---Acceptance.

-   Ask clients to discuss their experiences with trying to stop using
    substances before they entered treatment. Did they try to "just say
    no"? Were some clients practicing "white-knuckle sobriety," just
    hanging on for dear life?

-   Ask clients whether they have accepted their substance dependence.
    How did their approach to abstinence and recovery change once they
    accepted their problem?

-   Ask the recovering co-leader to discuss the negative effects of his
    or her substance use.

-   Some clients may have heard that it is necessary to "hit bottom"
    before they can begin recovery. Tell clients that studies indicate
    that "hitting bottom" is not correlated with success in recovery.

-   Ask the recovering co-leader to discuss the paradox of surrendering
    control to take back control of his or her life. Have clients
    discuss this paradox as well.

-   Introduce the idea that substance dependence can be thought of as a
    disorder just like other chronic medical disorders. Discuss with
    clients whether this concept makes them feel less guilt and shame.

-   Ask the recovering co-leader to share the supports and sources of
    strength that helped him or her during early recovery. What sources
    of strength can clients draw on to help them stay abstinent and in
    recovery?

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

Have clients make a list of at least three sources of strength and
support on which they can draw during recovery.

# **Session 25: Making New Friends**

## *Goals of Session*

-   Help clients understand the need to surround themselves with
    supportive, abstinent friends.

-   Help clients learn how to determine whether people they meet will be
    appropriate friends.

-   Help clients explore new places and ways to meet people and make
    friends.

### Handout

-   RP 25---Making New Friends

### *Presentation of Topic (15 minutes)*

1.  *Understanding the Important Role Friends Play in Recovery*

Sometimes when clients enter treatment, they expect to stop using
substances but maintain old friendships with people who still use.
Clients who are serious about living a substance-free life will need to
find new friends who can be supportive of their recovery. Relationships
with friends help shape individuals. Being around people who are
committed to recovery and people whose lives are balanced and fulfilling
has a positive effect on clients, especially those who are new to
abstinence and recovery. Perhaps the most important role friends can
play for clients in recovery is to be a resource for support and
strength. However, clients also rely on friends for fun activities that
are an important part of recovery.

2.  *Recognizing That Behavior Change May Be Necessary for Clients To
    Make New Friends*

Friendships are built on common interests. Many clients entering
treatment will have had friendships that were based primarily on
substance use. Some clients' social skills for making new friends might
be rusty. Clients who are reluctant to seek out new friendships will
gain confidence and self-assurance as their recovery progresses. The
counselor should remind clients that friendship is a two-way street. In
addition to looking for support from friends, clients can benefit from
being a good friend to others in recovery or to new people they meet.

3.  *Exploring New Places and Ways To Meet People and Make Friends*

The counselor should encourage clients to attend 12-Step, mutual-help,
or spiritually oriented meetings; try to make abstinent friends; and
find a sponsor. Clients also should be encouraged to resume old hobbies
or activities that they allowed to languish or explore new interests.
Taking a class, joining a club or a gym, and volunteering are good ways
to meet people with whom clients can form meaningful friendships. The
counselor should remind clients that personal friendships and business
dealings with other clients in group are not recommended, especially
early in recovery.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 25---Making New Friends.

-   Ask clients whether they have friends from before they entered
    treatment who will be good friends to keep now that they are in
    recovery. What qualities do these friends have?

-   Ask clients how the friends they used substances with affected their
    lives.

-   Ask clients whether they have spoken with friends with whom they
    used to use substances. What have they talked about? Have clients
    severed these friendships? Tried to maintain them?

-   Ask the recovering co-leader to share his or her experience with
    friends during the transition from using to recovery. Did any of the
    former friendships last?

-   Ask clients how they met new people and made friends while they were
    abusing substances. Will they be able to meet new nonusing friends
    in the same ways?

-   Ask clients what qualities they look for in a good friend. What role
    do acquaintances play in clients' lives? How is this different from
    the role friends play?

-   Ask the recovering co-leader to discuss personal changes he or she
    made to find new friends after entering treatment.

-   Have clients discuss ways to meet new friends.

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

Have clients identify three things (other than attending 12-Step or
mutual-help meetings) that will help them meet new friends.

# **Session 26: Repairing Relationships**

## *Goals of Session*

-   Help clients understand the need to repair relationships by making
    amends.

-   Help clients understand that making amends must go beyond stopping
    substance use.

-   Help clients prepare to address people who refuse to forgive.

### Handout

-   RP 26---Repairing Relationships

### *Presentation of Topic (15 minutes)*

1.  *Acknowledging Past Behaviors for Which Amends Should Be Made*

As discussed in RP session 24, clients first must admit to themselves
that they have a substance use disorder and that it has control over
their lives. Another aspect of recovery is clients' acknowledgment that
they have hurt the people close to them because of their substance
abuse. In addition to clients' being honest with themselves about the
hurt they have done to others, clients must rebuild the relationships
that were broken as a result of their substance abuse. Clients who have
attended 12-Step meetings may be familiar with the process of
acknowledging that amends must be made; this process constitutes Step 8
of the 12 Steps.

2.  *Exploring Ways To Make Amends and Repair Relationships*

Stopping substance use, entering treatment, and staying abstinent are
difficult. Some clients may feel that by accomplishing these things they
have done enough work toward repairing their damaged relationships. By
themselves, these things are not sufficient. Clients must speak with the
people they have wronged, acknowledge the harm they caused, and explain
that they have entered treatment and are in recovery. For some people,
clients' taking responsibility for the harm they have caused will be
enough to repair past damage. Others may not be so quick to forgive.
Clients may have to work with the people they have hurt to restore
relationships. As discussed in RP session 12, restoring trust can be an
arduous process.

3.  *Forgiving Oneself and Others*

The damage done to relationships by substance use disorders is not a
one-way street. Friends and loved ones do hurtful things to the person
who is abusing substances, too. Clients should be prepared to forgive
people who have hurt them, even if the people are not ready to
acknowledge the hurt or apologize for it. Clients should work to let go
of grudges and resentment; bitterness is a dangerous emotion (like
anger) that can act as a trigger for relapse. To leave bitterness
behind, clients must be able to forgive themselves for their past
behaviors. They cannot change the past; once they have entered
treatment, made amends, and resolved not to make the same mistakes
again, clients have done all they can do to address past mistakes.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 26---Repairing Relationships.

-   Ask clients to whom they need to make amends.

-   Ask clients what they need to make amends for.

-   Ask clients to discuss the difference between apologizing and making
    amends.

-   Ask clients how they plan to handle a situation where someone is
    still angry and refuses to forgive them.

-   Ask the recovering co-leader to share his or her experience with
    going to people to make amends. How did the co-leader handle people
    who refused to forgive and accept him or her?

-   Ask clients how they are prepared to make amends. Beyond
    apologizing, what else might they have to do to repair
    relationships?

-   Ask the recovering co-leader to share the various ways he or she
    went about making amends.

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

# 

# Have clients list one person to whom they need to make amends and the measures they will take to repair the relationship. Clients can use their journals or pages 18 and 19 of their *Client's Treatment Companion*. 

##### Session 27: Serenity Prayer

## *Goals of Session*

-   Help clients understand the importance of distinguishing between
    things that can be changed and those that cannot.

-   Help clients understand that the Serenity Prayer is not strictly
    religious and is applicable in many situations.

-   Help clients identify things that they can change.

### *Handout*

-   RP 27---Serenity Prayer

### *Presentation of Topic (15 minutes)*

1.  *Distinguishing Things That Can Be Changed From Those That Cannot*

Making distinctions between what can be changed and what cannot is a
critical skill for clients in recovery. If clients are unsuccessful at
making these distinctions, they can experience frustration, anger, and
increased stress that make them more vulnerable to relapse. Staying
abstinent and progressing in recovery demand clients' full attention;
clients do not have time or energy for worrying about things over which
they have no control. The counselor should take clients through some
specific scenarios and have clients discuss and evaluate whether they
can change the situations and how they should respond. For example:

-   A client is stuck in traffic and is late for an appointment.

-   The grocery store is out of a key ingredient a client needs to make
    a special dish.

-   A client's boss reprimands him for being late to work.

-   A client's partner still does not trust her, even though she has
    been abstinent for months.

2.  *Understanding What Serenity Means in the Context of Recovery*

> The Serenity Prayer was popularized by Alcoholics Anonymous (AA). (A
> version of the 12 Steps, adapted for people who are recovering from
> stimulant use, is available at www.crystalmeth.org.) Like 12-Step
> programs, the Serenity Prayer has specific religious overtones: the
> first word in the saying is *God.* Prayer provides many people with
> inner calm, but the serenity that is beneficial to recovery can be
> achieved through other means, such as meditation or journal writing.
> Clients who are not religious or do not believe in God can benefit
> still from the principles in the Serenity Prayer. These clients can
> think of the prayer as a poem or a wise saying. Every aspect of the
> Matrix method or 12-Step meetings may not be useful to clients. The
> counselor should encourage clients to take what they can use and leave
> the rest. In other words, clients should accept the wisdom of this
> saying even if its form is not to their liking.

3.  *Identifying Areas That Require Change*

Achieving the inner peace mentioned in the Serenity Prayer requires not
only the ability to set aside those things that clients cannot change
but also the commitment to work on those things that they can change.
The important aspects of clients' lives are things that will support
them in recovery. Relationships with friends and family can be a
powerful source of strength during recovery. Often, relationships can be
improved and are worth repairing. The counselor should help clients
identify other areas of their lives that are both important to recovery
and capable of being changed.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 27---Serenity Prayer.

-   Ask clients to discuss what this saying means to them.

-   The name of this saying focuses on serenity, but courage and wisdom
    also are mentioned in the saying. Ask clients how courage and wisdom
    are part of recovery. How do courage and wisdom contribute to
    serenity?

-   Ask clients whether they are troubled by the fact that, according to
    the saying, God provides serenity. Can clients appreciate the saying
    even if they are not religious or do not believe in God?

-   Ask the recovering co-leader to discuss his or her understanding of
    the Serenity Prayer. Did the co-leader struggle with the religious
    aspects of the saying? Was the idea of a higher power comforting and
    helpful?

-   Have clients discuss the things in their lives that they cannot
    change. How do they identify these things?

-   Ask clients what things in their lives should be changed. What steps
    are they taking to make those changes?

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

Ask clients to identify one thing about their lives that they can change
and that would help strengthen their recovery. Have clients list the
steps they will take to make that change.

#  

# **Session 28: Compulsive Behaviors**

## *Goals of Session*

-   Help clients understand what compulsive behaviors are and how
    compulsive behaviors other than substance abuse can affect recovery
    negatively.

-   Help clients understand the dangers of abstinence violation
    syndrome.

-   Help clients recognize and eliminate compulsive behaviors.

### *Handout*

-   RP 28---Compulsive Behaviors

### *Presentation of Topic (15 minutes)*

1.  *Getting Life Under Control by Eliminating Compulsive Behaviors*

The counselor should define "compulsive behaviors" as irrational or
destructive actions people take in response to irresistible impulses.

As clients used stimulants and became more dependent on them, what
started out as a casual practice---something they did when they were at
a party or with certain friends---progressed to compulsive use. Now that
clients are abstinent and in recovery, they may be replacing their
compulsive stimulant use with other compulsive behaviors. Signs of
compulsion include overindulging in food, tobacco, caffeinated sodas and
coffee, sweets, exercise, work, and masturbation. Gambling, spending a
lot of money, and abusing drugs other than stimulants also may be
compulsive behaviors. It is important for clients to eliminate
compulsive behaviors from their lives. As long as some aspect of their
life is out of control, it is easy for clients to slip back into the
out-of-control use of stimulants.

Some clients may need help beyond the scope of substance abuse treatment
to address compulsive behaviors (e.g., eating disorders, gambling
addictions). The counselor should be alert for clients who need more
help and refer them for additional treatment.

2.  *Understanding How Abstinence Violation Syndrome Can Derail
    Recovery*

> Clients can feel as if they are walking a narrow path when they are in
> recovery. For some clients, as long as everything in their recovery
> goes according to plan, they are fine. But if they make even one small
> misstep, they can feel that they have fallen off the recovery path.
> This pattern of thinking is called abstinence violation syndrome, and
> it is dangerous. By this strict logic, even a small slip-up is the
> equivalent of using again. A client who skips his regular evening swim
> may end up relapsing because in his mind he already has ruined his
> recovery. Clients need to understand that no one's recovery happens
> "perfectly"; making a mistake does not mean that all is lost and that
> using drugs again is inevitable.

3.  *Balancing Lifestyle Change With a Healthful and Successful
    Recovery*

Clients may have different approaches to the goal of eliminating
compulsive behaviors from their lives. Some people find that it is
easier to make sweeping changes all at once. They figure they already
are girding themselves to do something difficult, so they might as well
tackle all their compulsive behaviors at once. Other people need to make
changes gradually, one or two at a time. For them, the thought of trying
to eliminate all their compulsive behaviors at once is overwhelming.
Clients need to work toward the goal of eliminating their compulsive
behaviors in a way that is comfortable for them and allows them to keep
their lives and recovery in balance.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 28---Compulsive Behaviors.

-   Ensure that clients understand what it means to act compulsively and
    what compulsive behaviors are.

-   Ask clients to discuss their compulsive behaviors. Did clients find
    themselves engaging in more compulsive behaviors when they became
    abstinent?

-   Ask clients what steps they have taken to eliminate compulsive
    behaviors. How much success have they had? What approach are they
    using? Are they tackling all behaviors at once or one or two at a
    time?

-   Ask the recovering co-leader to discuss his or her experiences with
    abstinence violation syndrome.

-   Small things go wrong during recovery. Ask clients to discuss their
    attitude toward small slip-ups. Encourage clients to put small
    missteps in perspective. If they are overly rigid in their approach
    to recovery, they may overreact---and relapse---because of a minor
    problem.

-   Ask clients to discuss relapse prevention techniques they have
    learned about. If clients are new to recovery, make sure they
    understand the necessity to avoid triggers, practice thought
    stopping, and use scheduling.

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

# Have clients choose one of the relapse prevention strategies on handout RP 28 that they think will work best for them. Have them describe when and how they will put this strategy into action. 

# **Session 29: Coping With Feelings and Depression**

## *Goals of Session*

-   Help clients recognize and understand their emotional responses.

-   Help clients recognize signs of depression.

-   Help clients explore strategies for coping with emotions and
    depression.

### *Handout*

-   RP 29---Coping With Feelings and Depression

### *Presentation of Topic (15 minutes)*

1.  *Understanding Emotional Patterns in Recovery*

It is important for people in recovery to be able to recognize and
understand their emotional responses. Accustomed to experiencing
emotions that make them uncomfortable (e.g., shame, anger, sadness),
some clients may have ceased to be honest with themselves about what
they are feeling. Until clients can label their feelings accurately,
they cannot address feelings that may build up and cause problems. Even
if clients experience negative or painful emotions, it is important that
they acknowledge these feelings. The counselor should remind clients
that there is nothing wrong with having these feelings; clients still
can choose *not* to act on emotions that trouble them.

Clients also can gain a better understanding of their feelings by
looking for patterns in how they respond to situations and to people.
Are clients more susceptible to some feelings than others? Do certain
situations always make clients depressed? Do certain people always make
clients angry?

2.  *Understanding the Importance of Identifying and Addressing
    Depression*

> People in recovery often experience bouts of depression. For some
> clients, this is just a normal part of the recovery process. They
> become depressed right after becoming abstinent or several months into
> recovery (during the period known as the Wall). If these clients stay
> abstinent and keep their recovery on track, the depressive symptoms
> should abate. In other clients, however, stimulant use had masked
> symptoms of a depressive disorder that is laid bare once they are
> abstinent. The counselor should be alert for clients with symptoms of
> depression that do not improve and ensure that these clients receive
> proper evaluation and treatment.

Counselors may find the following resources from the Substance Abuse and
Mental Health Services Administration (SAMHSA) helpful:

-   Treatment Improvement Protocol 42, *Substance Abuse Treatment for
    Persons With Co-Occurring Disorders* (CSAT 2005*a*)

-   SAMHSA's Web site on Populations With Co-Occurring Substance Use and
    Mental Disorders (www.samhsa.gov/Matrix/matrix_cooc.aspx)

-   SAMHSA's Co-Occurring Center for Excellence (coce.samhsa.gov)

3.  *Using Coping Strategies To Manage Emotions and Depression*

Many of the best ways to address symptoms of depression coincide with
strategies clients already should be using to prevent relapse. It is
especially important for clients to reach out to supportive friends and
family if they are feeling depressed. Talking to a counselor or a
physician also is a good idea. Activities that get clients out of the
house and force them to interact with other people also are a good way
to cope with depression. Exercise can stabilize the body's rhythms,
allowing clients to return to more regular patterns of eating and
sleeping. Exercise also can help alleviate symptoms of depression that
occur during the Wall.

However, when these steps do not help mitigate a client's depression,
the counselor should consider whether the client is experiencing
clinical depression and should be referred for more intensive treatment.
The counselor should follow up immediately with clients who are
suspected of being clinically depressed.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 29---Coping With Feelings and Depression.

-   Ask clients whether they are being honest with themselves about
    their feelings. Do they feel that there are some feelings that are
    off-limits?

-   Encourage clients to accept the emotions that they experience. If
    clients feel that some emotions are off-limits, ask them why they
    feel this way.

-   Ask clients whether they notice patterns in their feelings. Do they
    often feel angry? Sad? Bitter? If so, what are these emotions in
    response to?

-   Ask the recovering co-leader to share his or her experiences with
    depressive episodes in recovery. Did the depressive feelings abate
    after the Wall?

-   Ask clients whether they have been through depressive episodes
    before. How do they recognize them?

-   Ask clients whether they feel depressed now. What symptoms are they
    experiencing?

-   Ask clients to share strategies that have helped them cope with
    periods of depression.

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

Have clients write down three responses, other than the ones listed on
the handout, that they can use to combat depression.

# **Session 30: 12-Step and Mutual-Help Programs** 

## *Goals of Session*

-   Help clients understand how 12-Step and mutual-help programs can
    support recovery.

-   Help clients realize the many benefits from 12-Step and mutual-help
    programs.

-   Help clients understand the breadth of 12-Step and mutual-help
    programs available.

### *Handout*

-   RP 30---12-Step Programs

### *Presentation of Topic (15 minutes)*

1.  *Understanding the Basics of 12-Step Groups (e.g., what meetings are
    like, how to find a meeting)*

> Some clients will be familiar with AA and other 12-Step groups. The
> counselor should take time to walk clients through the rudiments of
> 12-Step group participation. Professional substance abuse treatment
> combined with 12-Step participation is one of the most effective
> interventions for substance dependence. These components are very
> important to recovery; clients should be given every opportunity to
> understand and become comfortable with 12-Step programs. Important
> points to cover include the following:

-   **Meeting format.** Meetings are held throughout the day and evening
    and usually last 1 hour, with time before and after for socializing.
    The counselor should provide clients with a list of local meetings
    and contact information.

-   **Participant-specific meetings.** Large communities may have
    special group meetings (e.g., for doctors, lawyers, members of other
    professions, people with mental disorders; gender-specific meetings;
    meetings based on participants' sexual orientation). Some
    communities have meetings especially for people in recovery from
    methamphetamine use. (See www.crystalmeth.org to access a list of
    communities that have methamphetamine-specific meetings.)

-   **Types of meetings.** The content of some meetings has a special
    focus:

    -   Speaker meetings feature a person in recovery telling his or her
        story of drug and alcohol use and recovery.

    -   Topic meetings have a discussion on a specific topic such as
        fellowship, honesty, acceptance, or patience. Everyone is given
        a chance to talk, but no one is forced.

    -   Step/Tradition meetings are special meetings where the 12 Steps
        and 12 Traditions are discussed.

    -   Book study meetings focus on reading a chapter from the main
        text of the 12-Step group. (For AA, this is the Big Book; for
        Narcotics Anonymous \[NA\], the Basic Text.) Book study meetings
        often focus on someone's experience or a recovery-related topic.

Clients should visit different meetings until they find a group they
like. Not every aspect of a meeting or a particular discussion will be
useful. But clients should strive to find a group they can attend
regularly and try to learn something that will strengthen their recovery
each time they go to a meeting.

2.  *Understanding the Social and Emotional Support Available Through
    12-Step Attendance*

> Twelve-Step groups consist of people with the same problem working
> together to help one another. The group process reminds clients that
> they are not alone and provides them the opportunity to make abstinent
> friends and begin to build a support network. Clients can receive
> guidance and encouragement from others who have been in recovery
> longer than they have.

3.  *Exploring Alternatives to 12-Step Programs*

Twelve-Step programs such as AA, Cocaine Anonymous, and NA are the most
prevalent groups available. But they may not be for everyone. Crystal
Meth Anonymous is a 12-Step group that provides fellowship and support
for people in recovery from methamphetamine use (see
www.crystalmeth.org). The counselor should research local options to
12-Step programs and expose clients to other types of recovery support
in addition to 12-Step programs, such as mutual-help groups. (In small
communities, a 12-Step meeting may be clients' only option.) Even groups
that do not adhere to 12-Step principles offer the fellowship and
support that are crucial to recovery. The counselor may want to discuss
the alternatives to traditional 12-Step meetings listed on pages 44 and
45.

The counselor also may want to devote some time to describing the
various support programs for families of clients (e.g., Nar-Anon,
Al-Anon, Alateen).

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to read the handout before the discussion
begins. The handout is primarily a tool for discussion. The counselor
encourages clients to converse about the issues the handout raises. The
counselor ensures that all clients have an opportunity to participate.

-   Go over handout RP 30---12-Step Programs.

-   Take care to respect group members who are reluctant to attend
    12-Step meetings; ensure that they do not feel coerced to attend
    12-Step meetings.

-   Ask clients whether they have participated in 12-Step or any of the
    other groups mentioned above. Ask clients who have participated to
    describe the ways in which attending meetings helped them.

-   Ask clients whether they attend any special-focus meetings that they
    find helpful.

-   Ask the recovering co-leader to discuss any reservations or
    difficulties that he or she had with attending 12-Step meetings when
    first starting in recovery.

-   Ask clients to discuss the spiritual dimensions of 12-Step meetings.
    Do they find comfort in the notion of a higher power?

-   Ask clients whether they are troubled by the references to a higher
    power in 12-Step meetings. If so, how do they reconcile those
    objections with continued attendance?

-   Ask clients whether they have attended mutual-help or spiritually
    oriented meetings. If so, ask them to describe their experiences.

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

Have clients attend a 12-Step or mutual-help meeting and write down five
benefits from the meeting.

# **Session 31: Looking Forward; Managing Downtime**

## *Goals of Session*

-   Help clients appreciate the risks of boredom as a relapse trigger.

-   Help clients understand the benefits of planning rewards and
    downtime.

-   Help clients explore different ways to break the monotony of
    recovery.

### *Handout*

-   RP 31---Looking Forward; Managing Downtime

### *Presentation of Topic (15 minutes)*

1.  *Understanding That Boredom Can Be a Relapse Trigger*

It is normal for clients to feel bored, listless, and unexcited during
recovery. This boredom may be caused by chemical changes that are part
of the brain's healing. It also may be a function of the rigid structure
of recovery. Although the structure of recovery is necessary, the
boredom that it can breed acts as a relapse trigger for many clients;
using was the way many clients filled their free time and made their
lives more interesting. In addition, clients who are bored may lack the
mental energy to maintain a smart and strong recovery. It is necessary
for clients to fight through their feelings of boredom to keep their
recovery on track.

2.  *Understanding the Benefits of Breaking Recovery Into Manageable
    Chunks of Time*

One way for clients to combat the routine nature of recovery is to plan
little rewards for themselves every couple of weeks. These rewards need
not be large purchases or big events. In fact, it is better if clients
think of small things that they enjoy but that still constitute a
special treat (e.g., eating a favorite meal, buying a new CD, taking a
day trip). The rewards should be things that clients can look forward to
and that will pull them through the dreary parts of recovery. It also is
important that the rewards not disrupt recovery. For example, leaving
town for more than a few days would not be a good idea during treatment.
Clients can think of these rewards as extensions of the marking progress
activity from the Early Recovery Skills sessions. Both components are
exercises in breaking the sameness of recovery into smaller periods that
are punctuated by rewards.

3.  *Exploring Ways To Enhance Recovery by Planning Activities and
    Structuring Downtime*

In addition to occasional rewards such as rest and fun, clients may need
more frequent breaks from the predictability of the recovery routine.
For most clients, relaxing from the stress of everyday life used to
involve substance use. Now that they are in recovery, many clients need
to find new ways to unwind or to cope with the stress of their lives.
Physical activity is an excellent way for clients to relax. Exercise is
known to reduce stress levels. When clients exercise, they also boost
their self-esteem and help ameliorate any remaining physical symptoms
from stopping substance use. Exercise need not be vigorous---just
consistent; walking or bicycling several times a week is good exercise
during recovery.

Activities that involve clients' minds are important, too. Starting a
new hobby or picking up an old interest is an excellent way to fight
boredom. Clients might consider taking lessons or classes; learning
something new (e.g., how to play a musical instrument or speak another
language) orients clients toward the future. When clients become engaged
in learning something or participating regularly in an activity, they
make a commitment that supports their recovery.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 31---Looking Forward; Managing Downtime.

-   Ask clients whether they have been experiencing boredom and
    emotional tedium. To what do they attribute these feelings?

-   Ask clients what effect boredom has on their recovery. What do they
    do now to relieve daily boredom?

-   Ask the recovering co-leader to discuss how he or she used the
    practice of building islands (from handout RP 31) to stay engaged in
    the recovery process.

-   Ask clients what activities they can use as rewards to combat the
    routine nature of treatment and recovery.

-   Ask clients how they know whether they need to relax. What physical
    or emotional signs tell them that they need some downtime?

-   Ask clients to describe hobbies and activities that they have found
    relaxing and satisfying.

-   Ask the recovering co-leader to discuss his or her experience using
    activities to combat boredom. To relieve stress, what does the
    co-leader do in place of substance use?

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

# 

# Have clients explain in detail one of their islands and one of the activities or hobbies they are going to pursue. 

# **Session 32: One Day at a Time**

## *Goals of Session*

-   Help clients avoid feeling overwhelmed by the past.

-   Help clients understand that the past does not define the future.

-   Help clients explore different strategies for focusing on the
    present.

### *Handout*

-   RP 32---One Day at a Time

### *Presentation of Topic (15 minutes)*

1.  *Avoiding Defeatist and Fatalistic Ideas About the Past*

When many clients enter treatment, their immediate past is characterized
by failure. They can use little in their histories to build their
self-confidence. Little in their experience convinces them that they can
succeed in recovery. Paradoxically, once clients are in recovery, the
process of clearing up problems from the past often leaves them
overwhelmed and unable to face the present or the future optimistically.
Negative feelings and a bleak outlook on the future add stress to
clients' lives and increase the chances of relapse. The counselor needs
to persuade clients that they are capable of making a break with their
past behavior. As evidence that this is possible, the counselor can
point to the fact that clients made the decision to enter treatment.
They can build on this decision to make their future different from the
past.

2.  *Understanding That the Future Is Determined by the Individual, Not
    by Past Behavior*

Clients often feel that, because they have failed to stay abstinent in
the past, they will fail to do so in the future. Although it is true
that people often repeat past behavior, they do so by choice, for the
most part. The mere fact that a client had quit using and then went back
to stimulant use does not mean that the same thing will happen again.
Clients decide whether they will be abstinent. Taking a smart approach
to recovery helps clients succeed where before they did not.

> The counselor should remind clients of the times in their lives when
> they decided to change their behavior and succeeded. For example,
> perhaps some clients altered their diet or gave up cursing. Most
> clients probably can identify some point in their lives when they made
> a decision to change their behavior and stuck with it.
>
> The counselor also should be aware that some clients come to treatment
> with serious psychological problems other than substance use. These
> problems may be the result of significant trauma that has scarred
> clients. If the counselor notices serious psychological problems in
> clients, the counselor should refer the clients to a mental health
> professional for assessment.

3.  *Exploring Strategies To Keep Recovery on Track by Focusing on the
    Present*

The phrase "One Day at a Time" comes from 12-Step programs and is useful
for clients to bear in mind. Twelve-Step and mutual-help programs teach
clients a new way to structure their experience so that they are focused
more on their immediate reality. Clients should strive to be less
concerned about the past and less fretful about the future. The
counselor might suggest exercise (especially repetitive exercise like
walking, running, or swimming), meditation, or journal writing, but
clients will know better than the counselor what practices and thoughts
will help them focus more on the present.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP 32---One Day at a Time.

-   Ask clients whether they let thoughts from the past affect their
    current behavior. What kind of thoughts about the past do they have?

-   Ask clients whether they tend to focus on negative thoughts about
    the past. What positive aspects of their past could clients recall
    instead?

-   Ask clients whether fears about the future overwhelm them. What
    fears do clients have about the future?

-   Ask clients whether they find it hard to make changes in their
    lives. Can they point to a time when they made a change in their
    lives and stuck with it?

-   Ask the recovering co-leader to share his or her experiences of
    letting go of past worries and future fears and focusing on the
    present.

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

Have clients describe one activity that will help them focus more on the
present and put it into practice before the next RP session.

# **Elective Session A: Client Status Review**

## *Goals of Session*

-   Help clients see an overview of the many issues involved in their
    recovery.

-   Help clients establish a pattern of regular self-review.

### *Handout*

-   RP Elective A---Client Status Review

### *Presentation of Topic (15 minutes)*

1.  *Understanding That Recovery Is a Dynamic Process That Must Be
    Actively Managed*

Recovery is a complicated process. Remaining abstinent is the most
important part of recovery, but there is much more to recovery. As
clients are going through treatment, it is important for them to realize
that once the structure of daily group sessions is gone, they will need
to manage the complicated process of recovery on their own. From the
beginning of the Matrix intervention, clients have been encouraged to
attend 12-Step or mutual-help meetings. By the time they leave
treatment, all clients should be attending meetings and benefiting from
the structure and support meetings provide. Clients also will have the
support of their families, friends, and, for those who are in a 12-Step
program, sponsors. But it will be up to clients to make daily decisions
that influence their recovery and monitor how they are doing in the
various aspects of recovery. Successful relapse prevention requires
regular, frequent reviews of the broad spectrum of issues that are
involved in recovery.

2.  *Using Members of the Group To Explore Ways To Improve Recovery*

Clients should be encouraged to draw inspiration and take suggestions
from other members of the group. A client who has been successful in a
certain aspect of recovery should talk about the success so that the
rest of the group can be encouraged and can use or adapt the client's
strategies and approach. Clients should treat the group as a think tank
of good ideas and approaches to recovery, taking the best ideas and
applying them to their lives.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP Elective A---Client Status Review.

-   Ask clients to assess honestly their progress in the aspects of
    recovery listed on the handout. This type of self-review should
    become a regular part of clients' lives because it will help them
    remain abstinent.

-   Ask clients whether they can discern patterns in their responses. Do
    some aspects of recovery come more easily for them? Why?

-   Ask clients to focus on the areas with which they are most
    satisfied. Have them share their ideas on why they have been
    successful. Encourage each client to share at least one story of
    success along with the approach that led to the success.

-   Ask clients what they can do to improve the areas with which they
    were unsatisfied.

-   Ask the recovering co-leader to discuss how gleaning ideas and
    suggestions from other people in recovery has helped his or her
    recovery.

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

#### ***Homework***

Ask clients to write down one of the ideas from the group discussion
that they think will help them improve their recovery. Have them explain
how they will implement this idea and how it will help them.

# **Elective Session B: Holidays and Recovery**

## *Goals of Session*

-   Help clients understand that the added stress of holidays increases
    the risk of relapse.

-   Help clients assess their level of holiday stress and identify ways
    to alleviate it.

### *Handout*

-   RP Elective B---Holidays and Recovery

### *Presentation of Topic (15 minutes)*

1.  *Understanding That Holidays Pose Particular Risks for Recovering
    Individuals*

The counselor should consider using this session before a major holiday.
The weeks around Christmas and New Year's Day can be a particularly
troublesome time, but the Fourth of July, Memorial Day, Labor Day, and
other holidays also feature celebrations and parties that put clients at
increased risk of relapse. Holidays come with increased stressors, such
as hectic schedules, travel, and increased spending. In addition, many
people experience intense emotional swings during the holidays---either
joyous or depressed. In this environment, faced with increased triggers,
clients find it easier to relapse.

2.  *Understanding the Importance of Scheduling and Planning To Avoid
    Triggers*

Clients experience disruptions in the normal routine of recovery during
holidays. They may be away from home, find themselves with more
unstructured time, and have difficulty going to meetings. As a holiday
nears, clients need to be aware of the added risks and make plans that
will help them avoid triggers. If clients have gotten away from the
practice of scheduling their activities, they should reinstitute the
practice as a holiday approaches. If clients know they will be out of
town, they should make arrangements to keep up the activities that have
been preventing them from relapsing. This may mean locating a 12-Step
meeting in the town they are visiting, scheduling phone calls with their
sponsor, being sure they can get some exercise, or setting aside some
time for meditation or journal writing.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP Elective B---Holidays and Recovery.

-   Ask clients whether holidays are stressful times for them. How can
    holidays affect their recovery?

-   Ask clients whether they have tried to remain abstinent through
    holidays, for example Christmas and New Year's. What additional
    stressors did they face during holidays?

-   New Year's Eve can be an especially troubling holiday for people in
    recovery. People are expected to be festive, to drink alcohol, and
    to assess the previous year---all of which can be stressful for
    people in recovery. Ask clients how they plan to cope with the added
    stress of New Year's Eve this year.

-   Ask clients about the specific risks posed by holidays.

-   Ask the recovering co-leader to discuss his or her experience with
    planning and scheduling to keep recovery on track during holidays.

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

###### Homework

# 

# Have clients select the holiday that is most stressful for them or think about the next holiday. Have them write a plan for how they will avoid relapse during this time. 

# **Elective Session C: Recreational Activities**

## *Goals of Session*

-   Help clients understand the importance of introducing new activities
    into their lives.

-   Help clients understand that new activities and old pursuits may not
    feel like fun right away.

### *Handout*

-   RP Elective C---Recreational Activities

### *Presentation of Topic (15 minutes)*

1.  *Understanding the Role Activities and Hobbies Play in Recovery*

> Activities and hobbies are important during recovery for several
> reasons. Any interest clients take up helps orient them toward the
> future. The whole notion of *pursuing* a hobby or an activity suggests
> that clients are involved in a process that stretches out in front of
> them. In this way, the activities that clients choose help them
> reengage in their lives and enhance their commitment to recovery.
>
> Physical exercise helps the body and mind get over lingering effects
> of substance use, relieves stress, and bolsters clients' self-esteem.
> Taking a class, joining a club, or volunteering helps clients meet
> people who share their interests and builds a repertoire of interests
> and activities that do not focus on substance use.

2.  *Finding Activities That Are Stimulating and Engaging May Take
    Patience*

As clients resume old activities or pick up new ones, they should not be
surprised if the activities are not rewarding immediately. Their
motivation at the beginning of an activity should be to strengthen their
recovery. As they become involved in activities over time, clients will
enjoy them more. The counselor should encourage clients to look on
recovery as a fresh opportunity. Now that they are not spending time,
energy, and money supporting their substance use, clients can explore
and develop interests that they have been putting off or that seemed
beyond their reach.

### *Handout and Focused Discussion (45 minutes)*

Clients should be given time to complete the handout before the
discussion begins. Clients should not be forced to comply if they find
it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients
away from reading their responses and encourages them to converse about
the issues the handout raises. The counselor ensures that all clients
have an opportunity to participate.

-   Go over handout RP Elective C---Recreational Activities.

-   Ask clients what activities they would like to pursue now that they
    are abstinent and in recovery. Clients should be encouraged to
    imagine and describe a lot of different activities, helping one
    another think of fun and involving interests to pursue. It is
    important to note here that personal friendships among clients in
    the group are not encouraged. The counselor may want to discourage
    clients from making arrangements to pursue activities with people
    who have been abstinent for less time than they have.

-   Ask clients about former hobbies they used to enjoy. What were the
    benefits of those activities? How did they enrich clients' lives?

-   Ask clients whether they have begun new activities or resumed old
    hobbies. How has their recovery been affected?

-   Ask clients whether they have begun exercising since entering
    treatment. How has their recovery been affected?

-   Ask the recovering co-leader to discuss the role that exercise,
    interests, and hobbies played in his or her recovery. How has the
    co-leader used these activities to help him or her avoid triggers
    and prevent relapse?

## 

## *Open Discussion (30 minutes)*

The counselor should carry over from the previous discussion any
important issues that have not been addressed fully. Although it is
important for clients to be able to speak about what is on their minds,
the counselor should make sure that the session's topic has been
explored completely.

#### 

Five minutes before the end of open discussion, the counselor should ask
clients to share briefly their experience of doing the homework from the
previous session. The counselor can decide how detailed the followup on
homework should be. The goal of asking is not to discover which clients
have not done the homework but to encourage clients to work on their
recovery between sessions and to share that work with the group.

###### Homework

Have clients list five new activities they have pursued or want to
pursue to help them avoid triggers and prevent relapse. Clients can use
their journals or pages 20 and 21 of their *Client's Treatment
Companion.*

**Handouts for Relapse Prevention Group Sessions**

The handouts that follow are to be used by clients with the counselor's
guidance. The handouts will help clients make the most of the 32 RP
sessions.

**RP 1---Alcohol**

It is often difficult for people to stop drinking when they enter
treatment. Some reasons for this follow.

Triggers for alcohol use are everywhere. It is sometimes hard to do
anything social without facing people who are drinking. **How can you
get together with your friends without drinking?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Many people use alcohol in response to internal triggers. Depression and
anxiety seem to go away when they have a drink. It's difficult for
people to realize that sometimes the alcohol causes the depression.
**What moods and feelings make you want to have a drink?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

If a person is dependent on an illicit drug and uses alcohol less often,
alcohol may not be viewed as a problem until the person tries to stop
drinking. **What challenges have you faced in stopping drinking since
you entered treatment?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Alcohol affects the rational, thinking part of the brain. It is
difficult to think reasonably about a substance that makes thinking
clearly more difficult. **How does it feel to be sober at a party and
watch people drink and act stupidly?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Alcohol dulls the rational brain. Alcohol lowers people's inhibitions
and can make people more sexually aggressive, less self-conscious, and
more sociable. People who use alcohol to decrease inhibitions and help
them socialize may feel uncomfortable without it. **In what ways have
you depended on alcohol? For sexual or social reasons?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Many of us grow up using alcohol to mark special occasions. It is hard
to learn how to celebrate those times without drinking. **What special
occasions did your family celebrate with alcohol?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**How do you celebrate now?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

In many families and social groups, drinking is a sign of strength or
maturity. Drinking often is seen as a way of being "one of the gang."
**Do you feel less "with it" when you are not drinking? If so, in what
ways?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Drinking can become linked to certain activities. It can seem difficult
during early recovery to do those things without a beer or other drink
(for example, eating certain kinds of foods, going to sporting events).
**What activities seem to go with drinking for you?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

It is important to remember that everyone who stops drinking has these
problems at first. As you work through the difficult situations and
spend more time sober, it does get easier.

**RP 2---Boredom**

Often people who stop using drugs say life feels boring. Some reasons
for this feeling include the following:

-   A structured, routine life feels different from a lifestyle built
    around substance use.

-   Brain chemical changes during recovery can make people feel listless
    (or bored).

-   People who use substances often have huge emotional swings (high to
    low and back to high). Normal emotions can feel flat by comparison.

People who have been abstinent a long time rarely complain of continual
boredom. The problem of boredom in recovery does improve. Meanwhile you
should try some different activities to help remedy the problem of
boredom in recovery.

**List five recreational activities you want to pursue.**

1.  \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2.  \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3.  \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4.  \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5.  \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Have you started doing things that you enjoyed before using drugs?
Have you begun new activities that interest you? What are they?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Can you plan something to look forward to? What will you plan?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**How long has it been since you've taken a vacation? A vacation doesn't
have to involve travel---just time away from your regular routine. What
kind of break will you plan for yourself?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Here are some tips to reduce feelings of boredom:

-   Recognize that a structured, routine life feels different from a
    lifestyle built around substance use.

-   Make sure you are scheduling activities. Forcing yourself to write
    down daily activities helps you fit in more interesting experiences.

-   Try not to become complacent in recovery. Do something that will
    further your growth. Some­times boredom results from not challenging
    yourself enough in your daily living.

Which of the suggestions listed above might work for you? It is
important to try new ways of fighting boredom. Boredom can be a trigger
that moves you toward relapse.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**RP 3A---Avoiding Relapse Drift**

######## How Relapse Happens

Relapse does not happen without warning, and it does not happen quickly.
The gradual movement from abstinence to relapse can be subtle and easily
explained away or denied. So a relapse often feels as if it happens
suddenly. This slow movement away from abstinence can be compared to a
ship gradually drifting away from where it was moored. The drifting
movement can be so slow that you don't even notice it.

######## Interrupting Relapse Drift

During recovery people do specific things that keep them abstinent.
These activities can be called "mooring lines." People need to
understand what they are doing to keep themselves abstinent. They need
to list these mooring lines in a specific way so they are clear and
measurable. These activities are the "ropes" that hold recovery in place
and prevent relapse drift from happening without being noticed.

######## Maintaining Recovery

Use the Mooring Lines Recovery Chart (RP 3B) to list and track the
things that are holding your recovery in place. Follow these guidelines
when filling out the form:

-   Identify four or five *specific* things that now are helping you
    stay abstinent (for example, working out for 20 minutes, 3 times a
    week).

-   Include items such as exercise, therapist and group appointments,
    scheduling activities, 12-Step meetings, eating patterns.

-   Do not list attitudes. They are not as easy to measure as behaviors.

-   Note specific people or places that are known triggers and need to
    be avoided during recovery.

You should complete your Mooring Lines Recovery Chart weekly. Place a
checkmark next to each mooring line that you know is secure and record
the date. When two or more items cannot be checked, it means that
relapse drift is happening. Sometimes events interfere with your mooring
lines. Emergencies and illnesses cannot be controlled. The mooring lines
disappear. Many people relapse during these times. Use the chart to
recognize when you are more likely to relapse, and decide what to do to
keep this from happening. (After 5 weeks when the chart is full,
transfer the list of mooring lines to a journal or pages 12 and 13 of
your *Client's Treatment Companion*, and continue to check your mooring
lines.)

**RP 3B---Mooring Lines Recovery Chart**

You have learned new behaviors that keep you in recovery. These
behaviors are the mooring lines that keep your recovery steady and in
place. It is important to chart the new behaviors and check every week
to make sure the lines are secure. Dropping one or more of the mooring
lines allows you to drift toward relapse.

Use the chart below to list activities that are important to your
continuing recovery. If there are specific people or things you need to
avoid, list those. Check your list each week to make sure you are
continuing to stay anchored in your recovery.

  ---------------------------- -------- --------- -------- -------- --------
  **Mooring Line Behaviors**   **Date   **Date    **Date   **Date   **Date
                               (√)**    (√)**     (√)**    (√)**    (√)**

                                                                    

                                                                    

                                                                    

                                                                    

  **I Am Avoiding**            **Date   **Date    **Date   **Date   **Date
                               (√)**    (√)**     (√)**    (√)**    (√)**

                                                                    

                                                                    

                                                                    

                                                                    
  ---------------------------- -------- --------- -------- -------- --------

**RP 4---Work and Recovery**

Certain employment situations can make treatment and recovery more
difficult. Some difficult situations are outlined below.

**Employed in a Demanding Job That Makes Treatment Difficult**

Your treatment won't work unless you give it 100 percent of your effort.
People in recovery need to find a way to balance work with treatment so
they can give recovery their full effort. Some jobs require long or
unusual hours. Often the very nature of the work schedule has
contributed to the substance use problem. The first task, if you have
such a job, is to adjust your schedule to accommodate treatment. Work
with your counselor and your boss or representative from your employee
assistance program to do this. You also should find out whether flextime
is an option. Recovery needs to be the first priority while you are in
treatment.

**Working in an Unsatisfactory Job; Thinking of Making a Change**

During recovery major changes (in jobs, in relationships, etc.) should
be delayed for 6 months to 1 year whenever possible. Reasons for this
include the following:

-   People in recovery go through big changes. Sometimes they change
    their views on personal situations.

-   Any change is stressful. Major stress should be avoided as much as
    possible during recovery.

**Working in a Situation Where Recovery Will Be Difficult**

Some jobs lend themselves to recovery more than others. Work situations
that are difficult to combine with outpatient treatment include

-   Situations where it is necessary to be with other people who are
    drinking or using

-   Jobs in which large sums of cash are available at unpredictable
    times

People in these types of jobs may want to plan for a job change.

**Unemployed and Needing To Find a Job**

When people are out of work, treatment becomes more difficult for the
following reasons:

-   Looking for work is often the first priority.

-   Abundant free time is difficult to fill, and the structure that
    makes outpatient treatment effective is lacking.

-   Resources often are more limited, making transportation and child
    care more of a problem.

If you are out of work and in treatment, remember that recovery still
needs to be your first priority. Make sure the counselor knows your
situation, and strive to balance job-seeking activities and treatment.

There are no easy solutions to these problems. It is important to be
aware of the issues so that you can plan to make your recovery as strong
as possible.

**RP 5---Guilt and Shame**

Guilt is feeling bad about what you've done: "I am sorry I spent so much
time using drugs and not paying attention to my family."

**What are some things you have done in the past that you feel guilty
about?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Feeling guilty can be a healthy reaction. It often means you have done
something that doesn't agree with your values and morals. It is not
unusual for people to do things they feel guilty about. You can't change
the past. It is important to make peace with yourself. Sometimes that
means making amends for things you've said and done.

Remember the following:

-   It's all right to make mistakes.

-   It's all right to say, "I don't know," "I don't care," or "I don't
    understand."

-   You don't have to explain yourself to anyone if you're acting
    responsibly.

# **Do you still feel guilty about the things you listed? What can you do to improve the situation?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Shame is feeling bad about who you are: "I am hopeless and worthless."

**Do you feel ashamed of being dependent on substances?** Yes \_\_\_ No
\_\_\_

**Do you feel you are weak because you couldn't or can't stop using?**
Yes \_\_\_ No \_\_\_

**Do you feel you are stupid because of what you have done?** Yes \_\_\_
No \_\_\_

**Do you feel that you are a bad person because you are involved with**
Yes \_\_\_ No \_\_\_

**substance use?**

Recovery is always a hard process. No one knows why some people can stop
using substances once they enter treatment and decide to be abstinent
and other people struggle to maintain abstinence. Research shows that
family histories, genes, and individual physical differences in people
play a role. Being dependent on drugs or alcohol does not mean you are
bad, stupid, or weak.

What we do know is that you cannot recover by

-   Trying to use willpower

-   Trying to be strong

-   Trying to be good

Two things to make recovery work are

-   Being smart

-   Working hard

Everyone who is successful at recovery will tell you, "It was the
hardest thing I ever did." No one can do it *for* you, and it will not
happen *to* you.

  -----------------------------------------------------------------------
  **DO THE NECESSARY WORK, AND RECOVERY IS POSSIBLE.**

  -----------------------------------------------------------------------

**RP 6---Staying Busy**

Learning to schedule activities and structure your recovery is important
in outpatient treatment. Staying busy is important for several reasons.

Often relapses begin in the head of a person who has nothing to do and
nowhere to go. The addicted brain begins to think about past using, and
the thoughts can start the craving process. **How has free time been a
trigger for you?**

**How could you respond to prevent relapse if free time led to thoughts
of using?**

Often people who abuse substances begin to isolate themselves. Being
around people is uncomfortable and annoying. Being alone results in
fewer hassles.

**Did you isolate yourself when you used? If so, how did this isolation
affect your substance abuse?**

######## 

######## How does being alone now remind you of that experience?

Being involved with people and doing things keeps life interesting.
Living a substance-free life can sometimes feel pretty tame. You begin
to think being abstinent is boring and using is exciting and desirable.
People have to work at finding ways to make abstinence fun.

**What have you done lately to have fun?**

When people's lives become consumed with substance use, many things they
used to do and people they used to do them with get left behind.
Beginning to reconnect or to build a life around substance-free
activities and people is critical to a successful recovery.

**How have you reconnected with old activities and friends? How have you
built new activities and brought new people into your life?**

**If you have not reconnected with old activities and friends or added
some new activities and people to your life, what are your plans to do
so?**

**RP 7---Motivation for Recovery**

Ask any group of people who are new to recovery *why* they want to stop
using right now and you will get many different answers:

-   I was arrested, and it's either this or jail.

-   My wife says if I don't stop, we are finished.

-   Last time I used I thought I was going to die; I know I'll die if I
    use again.

-   They are going to take the children from us unless we stop.

-   I've been using for 20 years now; it's time to change.

Which of the people quoted is most likely to be successful in recovery?
It seems logical to think that people who want to stop using for
themselves and not because someone else wants them to are more likely to
do well in treatment. However, that may not be true. Research shows that
the reasons people stop using don't predict whether they will be able to
lead substance-free lives.

What does make a difference is whether they can stay substance free long
enough to appreciate the benefits of a different lifestyle. When debts
are not overwhelming, relationships are rewarding, work is going well,
and health is good, the person in recovery *wants* to stay abstinent.

  -----------------------------------------------------------------------
  **FEAR WILL GET PEOPLE INTO TREATMENT, BUT FEAR ALONE IS NOT ENOUGH TO
  KEEP THEM IN RECOVERY.**

  -----------------------------------------------------------------------

**List some of your reasons for entering treatment (for example, medical
problems, family pressure, job problems, depression).**

**List some of your reasons for continuing to work on your recovery
today.**

**Do you feel that your reasons for initially stopping substance use are
the same as your reasons for staying abstinent today? Why or why not?**

**RP 8---Truthfulness**

######## During Substance Dependence

Not being truthful is part of substance dependence. It is hard to meet
the demands of daily living (relationships, families, jobs) and use
substances regularly. As you become more dependent on the substance, the
activities that are necessary to obtain, use, and recover from the
substance take up more of your life. It becomes more and more difficult
to keep your life on track. People who are substance dependent often
find themselves doing and saying whatever is necessary to avoid
problems. Telling the truth is not important to them.

######## In what ways were you less than truthful when you were using substances?

# \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

######## During Recovery

Being honest with yourself and with others during the recovery process
is critically important. Sometimes being truthful is very difficult for
the following reasons:

-   You may not seem to be a nice person.

-   Your counselor or group members may be unhappy with your behavior.

-   You may be embarrassed.

-   Other people's feelings may be hurt.

Being in treatment without being truthful may make everything you are
doing a waste of time.

# **How has truthfulness been difficult for you in recovery?** 

# \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Being partly honest is not being truthful. **Do you ever**

**Decide to let someone believe a partial truth?** Yes \_\_\_ No \_\_\_

**Tell people what they want to hear?** Yes \_\_\_ No \_\_\_

**Tell people what you wish were true?** Yes \_\_\_ No \_\_\_

**Tell less than the whole truth?** Yes \_\_\_ No \_\_\_

  -----------------------------------------------------------------------
  **ATTENDING GROUPS, ATTENDING MEETINGS, GOING TO A HOSPITAL, AND GOING
  TO A COUNSELOR ARE WASTES OF TIME AND MONEY WITHOUT TRUTHFULNESS.
  RECOVERY FROM ADDICTION IS IMPOSSIBLE WITHOUT TRUTHFULNESS.**

  -----------------------------------------------------------------------

**RP 9---Total Abstinence**

Have you ever found yourself saying any of the following?

-   My problem is my meth use. Alcohol (or marijuana) is not a problem
    for me.

-   Having a beer or glass of wine is not really drinking.

-   I drink only when I choose to. My drinking is not out of control.

-   I don't really care about alcohol. I drink only to be sociable.

If you entered the program to stop using stimulants, you may have
wondered why you were asked to sign an agreement stating your
willingness also to stop using other substances, including alcohol. For
many reasons, total abstinence is a necessary goal for people in
recovery:

-   Followup studies show that people who use stimulants are eight times
    more likely to relapse if they use alcohol and three times more
    likely to relapse if they use marijuana than people who do not use
    these substances. You can reduce your chances of relapsing greatly
    by maintaining total abstinence.

-   Places and people associated with drinking often are the very places
    and people who are triggers for substance use.

-   When you're learning to handle problems without taking stimulants,
    using another drug or alcohol to numb the uncomfortable learning
    process is harmful for two reasons. First, such use prevents you
    from directly confronting your stimulant use problem. Second, it
    puts you at risk of becoming dependent on alcohol or another
    substance while you try to overcome your dependence on stimulants.

Remember, if it's more difficult to stop drinking than you expected,
maybe you are more dependent on alcohol than you think.

**RP 10---Sex and Recovery**

## Intimate Sex

Intimate sex involves a significant other. The sex is a part of the
relationship. Sometimes the sexual feelings are warm and mellow.
Sometimes they are wild and passionate. But they result from and add to
the feelings each partner has for the other.

## Impulsive Sex

In this definition of impulsive sex, the partner is usually irrelevant;
the person is a vehicle for the high. Impulsive sex can take the form of
excessive masturbation. Impulsive sex can be used and abused in the same
way drugs are used and abused. It is possible to become addicted to
impulsive sex.

# **What kind of experiences have you had with impulsive sex?** 

**Is impulsive sex linked to your drug use? How?**

**Describe a healthy, intimate sexual relationship that you have had or
hope to have.**

Impulsive sex is not part of a healthy recovery lifestyle. It can be the
first step in the relapse process. Like using alcohol or a drug other
than stimulants, engaging in impulsive sex can trigger a relapse and
result in use of stimulants.

**RP 11---Anticipating and Preventing Relapse**

**Why Is Relapse Prevention Important?**

Recovery is more than not using drugs and alcohol. The first step in
treatment is stopping drug and alcohol use. The next step is not
starting again. This is very important. The process for doing it is
called *relapse prevention*.

**What Is Relapse?**

Relapse is going back to substance use and to all the behaviors and
patterns that come with it. Often the behaviors and patterns return
before the substance use. Learning to recognize the beginning of a
relapse can help people in recovery stop the process before they start
using again.

+-----------------------------------------------------------------------+
| Addiction                                                             |
|                                                                       |
|                                                                      |
|                                                                       |
| Treatment                                                             |
|                                                                       |
|                                                                      |
|                                                                       |
| Recovery                                                              |
|                                                                       |
|                                                                      |
|                                                                       |
| Addictive Behavior                                                    |
|                                                                       |
| Addictive Thinking                                                    |
|                                                                       |
| Emotional Buildup                                                     |
|                                                                       |
|                                                                      |
|                                                                       |
|                                                                     |
|                                                                       |
| Relapse Prevention No Relapse Prevention                              |
|                                                                       |
|                                                                     |
|                                                                       |
|                                                                     |
|                                                                       |
| Continued Recovery Relapse                                            |
+-----------------------------------------------------------------------+

**What Are Addictive Behaviors?**

The things people do as part of abusing drugs or alcohol are called
addictive behaviors. Often these are things that addicted people do to
get drugs or alcohol, to cover up substance abuse, or as part of
abusing. Lying, stealing, being unreliable, and acting compulsively are
types of addictive behaviors. When these behaviors reappear, people in
recovery should be alerted that relapse will soon follow if they do not
intervene.

**What are your addictive behaviors?**

**What Is Addictive Thinking?**

Addictive thinking means having thoughts that make substance use seem
OK. (In 12-Step programs this is known as "stinking thinking.") Some
examples follow:

-   I can handle just one drink.

-   If they think I'm using, I might as well.

-   I have worked hard. I need a break.

**How have you tried to find excuses to use substances?**

**What Is Emotional Buildup?**

Feelings that don't seem to go away and just keep getting stronger cause
emotional buildup. Sometimes the feelings seem unbearable. Some feelings
that can build are boredom, anxiety, sexual frustration, irritability,
and depression.

**Have you experienced a buildup of any of these emotions?**

The important step is to *take action* as soon as you recognize the
danger signs.

**Which actions might help you prevent relapse?**

**Calling a counselor** **Taking a day off**

**Calling a friend** **Talking to your family**

**Going to a 12-Step or outside** **Talking to your spouse**

**mutual-help support meeting** **Scheduling time more**

**Exercising** **rigorously**

**Other:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**RP 12---Trust**

###### How has substance use affected the trust between you and people you care about?

**If you tell someone you're not using and the person doesn't believe
you, does it make you feel like using? Do you think, "If people are
going to treat me as if I'm using, I might as well use"?**

People who are substance dependent find it difficult to have open,
honest relationships. Things are said and done that destroy trust and
damage relationships. Substance abuse becomes as important as or more
important than other people.

When substance abuse stops, the trust does not return right away. To
trust means to feel certain you can rely on someone. People cannot be
certain just because they want to be. Trust can be lost in an instant,
but it can be rebuilt only over time. Trust will return gradually as the
person who violated the trust gives another person reasons to trust
again. One or both people may want the trust to return sooner, but it
takes time for feelings to change.

+-----------------------------------------------------------------------+
| > **RECOVERY IS A LONG PROCESS. REGAINING LOST TRUST IS PART OF THE   |
| > PROCESS. IT MAY BE ONE OF THE LAST CHANGES TO OCCUR.**              |
+-----------------------------------------------------------------------+

######## How do you cope with suspicions about drug use?

**What can you do to help the process of reestablishing trust?**

**RP 13---Be Smart, Not Strong**

> "I can be around drugs or alcohol. I'm sure I don't want to use, and
> once I make up my mind, I'm very strong."
>
> "I have been doing well, and I think it's time to test myself to see
> whether I can be around friends who are using. It's just a matter of
> willpower."
>
> "I can have a drink and not use. I never had a problem with alcohol
> anyway."

Staying abstinent has little to do with how strong you are. People who
maintain abstinence do it by being smart. They know that the key to not
drinking and not using is to keep far away from situations in which they
might use. If you are in an environment where drugs might appear (for
example, at a club or party) or with friends who are drinking and using,
your chances of using are much greater than if you weren't in that
situation. Smart people stay abstinent by avoiding triggers and relapse
situations.

# 

  -----------------------------------------------------------------------
  **DON'T COUNT ON BEING STRONG. BE SMART.**

  -----------------------------------------------------------------------

# **How smart are you being? Rate how well you are doing in avoiding relapse. (Circle the appropriate number.)**

**[Poor]{.underline} [Fair]{.underline} [Good]{.underline}
[Excellent]{.underline}**

> **1. Practicing thought stopping 1 2 3 4**
>
> **2. Scheduling 1 2 3 4**
>
> **3. Keeping appointments 1 2 3 4**
>
> **4. Avoiding triggers 1 2 3 4**
>
> **5. Not using alcohol 1 2 3 4**
>
> **6. Not using drugs 1 2 3 4**
>
> **7. Avoiding people who use**
>
> **drugs and alcohol 1 2 3 4**
>
> **8. Avoiding places where you might**
>
> **encounter drugs or alcohol 1 2 3 4**
>
> **9. Exercising 1 2 3 4**
>
> **10. Being truthful 1 2 3 4**
>
> **11. Going to 12-Step or**
>
> **mutual-help meetings 1 2 3 4**

**Add up the circled numbers. The higher your total, the better your
Recovery IQ. The best possible Recovery IQ is 44.**

**I scored \_\_\_\_\_\_\_\_\_\_\_.**

**This is your Recovery IQ. What can you do to improve your Recovery
IQ?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

####### **RP 14---Defining Spirituality**

###### Look at these definitions of spirituality. Which ones describe what spirituality means to you? 

**Spirituality is**

> **1. A person's relationship with God**
>
> **2. The deepest level from which a human being operates**
>
> **3. The philosophical context of a person's life (values, rules,
> attitudes, and views)**

4.  **The same as religion**

> **5. Other:**

The second and third definitions describe spirituality in a broad sense.
When it comes to recovery, these broad definitions are the most useful
way to think of spirituality. They describe being spiritual as having to
do with a person's spirit or soul, as distinguished from his or her
physical being. Some people believe the level and degree of spirituality
in a person's life help determine the quality of life. One way to assess
the quality of your spirituality is by answering the following
questions:

**What do you want from life? Are you getting it?**

**On what is your spiritual security based? (What would it take to
destroy your sense of self-worth?)**

**Who do you have to be before you approve of yourself? (What qualities
are most important to you?)**

**What does success mean to you? (What does "making it" mean?)**

To live an abstinent life, the person in recovery has to be comfortable
within himself or herself. Gaining a sense of spirituality gives many
people the inner peace that makes abusing substances unnecessary.
Twelve-Step and mutual-help programs provide one way to gain or regain a
love of oneself and of life.

**RP 15---Managing Life; Managing Money**

## 

## Managing Life

Maintaining a substance-dependent lifestyle takes a lot of time and
energy. People who are substance dependent give little time or thought
to everyday responsibilities. When recovery begins, long-neglected
responsibilities come flooding back. It sometimes is overwhelming to
think about all the things that need to be done. It also is frustrating
and time consuming to catch up on so many responsibilities.

Determine how well you are managing your life by answering the following
questions:

-   **Do you have outstanding traffic tickets?**
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

-   **Have you filed all your tax returns to date?**
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

-   **Are there unpaid bills you need to make arrangements to pay?**
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

-   **What repair and maintenance does your house or apartment need?**
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_

-   **Does your car need to be serviced or repaired?**
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

-   **Do you have adequate insurance?**
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

-   **Do you have a checking account or a way to manage your finances?**
    \_\_\_\_\_\_\_\_\_\_\_\_\_

-   **Are you handling daily living chores (for example, buying
    groceries, doing laundry, cleaning)?**
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

If you try to do all this at once, you may feel overwhelmed and
hopeless. Take one item each week and focus on clearing up one area at a
time. Handling these issues will help you regain control over your life.

**The first item I need to take care of is:**

**I will start by:**

**The second item I need to take care of is:**

**I will start by:**

## Managing Money

## Being in control of your finances is being in control of your life. When people who are substance dependent are using, the out-of-control lifestyle often affects their finances. 

## 

## How many of the following have been true for you?

**Any amount of money over** \_\_\_\_\_\_\_\_\_\_\_ **is a trigger to
buy drugs.**

**I have concealed money to buy drugs.**

**I have large debts.**

**I gamble with my money.**

**I spend compulsively when I feel bad.**

**I frequently argue about money with family members.**

**I have stolen to get money to buy substances.**

When they first enter treatment, some clients choose to give control of
their money to someone they trust. If you make that decision, you are
controlling your finances and asking the trusted person to act as your
banker. Together with your counselor, you should decide when you can
handle money again safely. Then you can begin working toward financial
maturity. You may choose to have some of the following goals:

-   Arrange to pay off large debts in small, regular payments.

-   Budget your money carefully, as you schedule your time.

-   Arrange spending agreements with anyone who shares your finances.

-   Use bank accounts to help you manage your money.

-   Live within your means.

-   Make a savings plan.

**What are your other financial goals?**

#### **RP 16---Relapse Justification I**

Once a person decides not to use drugs anymore, how does he or she end
up using again? Do relapses happen completely by accident? Or are there
warning signs and ways to avoid relapse?

Relapse justification is a process that happens in people's minds. A
person may have decided to stop using, but the person's brain is still
healing and still feels the need for the substances. The addicted brain
invents excuses that allow the person in recovery to edge close enough
to relapse situations that accidents can happen. You may remember a time
when you intended to stay substance free but you invented a
justification for using. Then, before you knew it, you had used again.

Use the questions below to help you identify justifications invented by
your addicted brain. Identifying and anticipating the justifications
will help you interrupt the process.

**Someone Else's Fault**

Does your addicted brain ever convince you that you have no choice but
to use? Does an unexpected situation catch you off guard? **Have you
ever said any of the following to yourself?**

-   **An old friend called, and we decided to get together.**

-   **I had friends come for dinner, and they brought me some wine.**

-   **I was in a bar, and someone offered me a beer.**

-   **Other:** .

**Catastrophic Events**

Is there one unlikely, major event that is the *only* reason you would
use? **What might such an event be for you?**

-   **My spouse left me. There's no reason to stay clean.**

-   **I just got injured. It's ruined all of my plans. I might as well
    use.**

-   **I just lost my job. Why not use?**

-   **There was a death in the family. I can't get through this without
    using.**

-   **Other:** .

**For a Specific Purpose**

**Has your addicted brain ever suggested that using drugs or alcohol is
the only way to accomplish something?**

-   **I'm gaining weight and need stimulants to control my weight.**

-   **I'm out of energy. I'll function better if I use.**

-   **I need drugs to meet people more easily.**

-   **I can't enjoy sex without using.**

-   **Other:** .

**Depression, Anger, Loneliness, and Fear**

**Does feeling depressed, angry, lonely, or afraid make using seem like
the answer?**

-   **I'm depressed. What difference does it make whether I use?**

-   **When I get mad enough, I can't control what I do.**

-   **I'm scared. I know if I use, the feeling will go away.**

-   **If my partner thinks I've used, I might as well use.**

-   **Other:** .

**What might you do when your addicted brain suggests these excuses to
use?**

#### **RP 17---Taking Care of Yourself**

People who are substance dependent often do not take care of themselves.
They don't have the time or energy to pay attention to health and
grooming. Health and personal appearance become less important than
substance use. Not caring for oneself is a major factor in losing
self-esteem. To esteem something means to see value in it, to
acknowledge its importance.

People in recovery need to recognize their own value. In recovery, your
own health and appearance become more important as you care more for
yourself. Taking care of yourself is part of starting to like and
respect yourself again.

Paying attention to the following concerns will strengthen your image of
yourself as a person who is healthy, abstinent, and recovering:

-   Have you seen a doctor for a checkup?

-   When was the last time you went to the dentist?

-   Have you considered getting a new look?

-   Are you paying attention to what you are eating?

-   Do you wear the same clothes you wore when you were using?

-   Do you need to have your vision or hearing checked?

-   Do you exercise regularly?

-   Is your caffeine or nicotine intake out of control?

Some people find it is easier to make sweeping lifestyle changes all at
once. However, if addressing all these health and grooming issues at
once is too overwhelming, work on one or two items each week. Decide
which are the most important, and do those first. As you look and feel
better, you will increase both the strength and the pleasure of your
recovery.

**The first thing I need to do to take care of myself is:**

#### **RP 18---Emotional Triggers**

For many people certain emotional states are directly connected to
substance use, almost as if the emotion *causes* the substance use. It
seems to people in recovery that if they could avoid ever feeling those
emotions (for example, loneliness, anger, feeling deprived), they would
never relapse. These emotional triggers should act as warnings or "red
flags" for clients.

The most common negative emotional triggers are the following:

**Loneliness:** It is difficult to give up friends and activities that
are part of a substance-using lifestyle. Being separated from friends
and family leaves people feeling lonely. Often friends and family
members who do not use are not ready to risk getting back into a
relationship that didn't work earlier. The person in recovery is
stranded between groups of friends. The feeling of loneliness can drive
the person back toward using.

**Anger:** The intense irritability experienced in the early stages of
recovery can result in floods of anger that act as instant triggers. A
person in that frame of mind is only a few steps from substance use.
Once a person uses, it can be a long trip back to a rational state of
mind.

**Feeling Deprived:** Maintaining abstinence is a real accomplishment.
Usually people in recovery feel justifiably good and proud about what
they have been able to achieve. Sometimes people in recovery feel as if
they have to give up good times and good things. Recovery seems like a
jail sentence, something to be endured. This reverses the actual state
of recovery: substance use begins to look good and recovery seems bad.
This upside-down situation quickly leads to relapse.

It is important to be aware of these red flag emotions. Allowing
yourself to be flooded with these powerful negative emotions is allowing
yourself to be swept rapidly toward relapse. **Have some of these
emotional states been a trigger for you in the past? Which ones?**

######## 

######## Are there other negative emotional states that are dangerous for you? What are they?

One of the goals during the recovery process is learning to separate
thoughts, behaviors, and emotions so that you can control what you think
and how you behave. It is important to recognize and understand your
emotions so that your actions are not always dictated by your feelings.

Many people find that writing about their feelings is a good way to
recognize and understand their emotions. You don't need to be a good
writer to use this tool. People who do not like to write and who have
never written much in the past still can learn valuable things about
themselves by putting their feelings into words. Follow the simple
instructions, and try a new way of getting to know yourself:

1.  Find a private, comfortable, quiet place and a time just for
    writing. Try to write each day, even if you can write only for a few
    minutes.

2.  Begin by taking several deep breaths and relaxing.

3.  Write in a response to a question that you have asked yourself about
    your feelings (for example, "What am I feeling right now?" "Why am I
    angry?" "Why am I sad?").

4.  Forget spelling and punctuation; just let the words flow.

Writing about your feelings makes them clearer to you. It also can help
you avoid the emotional buildup that often leads to relapse.

#### **RP 19---Illness**

Getting sick often predicts a relapse. This might seem strange, even
unfair. After all, you can't really do anything about getting sick,
right? Many people get a few colds a year. Although you may not be able
to prevent yourself from getting sick, you can be aware of the added
relapse risk that comes with illness, and you can take precautions to
avoid getting sick.

**Sickness as Relapse Justification**

Illness can be a powerful relapse justification. When you are sick, you
make a lot of exceptions to your regular routine. You stay home from
work; you sleep more than usual; you eat different foods. You may feel
justified in pampering yourself (for example, "I'm sick, so it's OK if I
watch TV and lie around most of the day"; "I don't feel good---I deserve
a few extra cookies"). Because people feel that getting sick is out of
their control, it seems OK to take a break from their regular behaviors.
You need to be careful that, while you are taking a break from other
routines, you don't allow sickness to be an excuse for using.

**Relapse Risks During Illness**

When you are sick, you are physically weaker. You also may have less
mental energy to maintain your recovery. In addition to lacking the
energy to fight your substance use disorder, you may face the following
relapse risks when you are sick:

-   Missing treatment sessions

-   Missing mutual-help meetings

-   Not exercising

The following relapse risks also can act as triggers when you're sick:

-   Spending a lot of time alone

-   Recovering in bed (which reminds some people of recovering from
    using)

-   Having a lot of unstructured time

**Healthful Behaviors**

Although you can't always prevent yourself from getting sick, you can do
things to minimize your chances of getting sick. The following behaviors
help support your recovery in general and help keep you healthy:

-   Exercise regularly (even when you feel as if you're getting sick,
    light exercise can be good for you).

-   Eat healthful meals.

-   Get adequate sleep.

-   Minimize stress.

Early in recovery from substance use, you also should avoid activities
that put your health at risk or require recovery time. Elective surgery,
serious dental work, and extended exertion may leave you fatigued and
make you susceptible to illness.

**Recognize When You're at Risk**

Because you may be more likely to relapse when you're sick, you should
be alert for the signs of illness. Soreness, tiredness, headaches,
congestion, or a scratchy throat can signal the onset of illness. Even
something like premenstrual syndrome (PMS) can weaken you physically and
make relapse more likely.

If you do get sick, try to keep the negative effects of illness from
interfering with your recovery by getting well as quickly as possible.
Get proper rest and medical attention so that you can return to your
regular recovery routine as soon as possible. You will feel stronger,
and your recovery will be stronger.

**RP 20---Recognizing Stress**

Stress is a physical and emotional response to difficult or upsetting
events, particularly those that continue for a long time.

Stress is the experience people have when the demands they make on
themselves or those placed on them disrupt their lives. Sometimes we are
unaware of this emotional state until the stress produces physical
symptoms. **Place a checkmark next to any of the following problems you
have experienced in the past 30 days:**

\_\_\_\_\_\_\_\_\_\_ **Sleep problems (for example, difficulty falling
asleep, waking up off and on during the night, nightmares, waking up
early and being unable to fall back to sleep)**

\_\_\_\_\_\_\_\_\_\_ **Headaches**

\_\_\_\_\_\_\_\_\_\_ **Stomach problems**

\_\_\_\_\_\_\_\_\_\_ **Chronic illness**

\_\_\_\_\_\_\_\_\_\_ **Fatigue**

\_\_\_\_\_\_\_\_\_\_ **Moodiness**

\_\_\_\_\_\_\_\_\_\_ **Irritability**

\_\_\_\_\_\_\_\_\_\_ **Difficulty concentrating**

\_\_\_\_\_\_\_\_\_\_ **General dissatisfaction with life**

\_\_\_\_\_\_\_\_\_\_ **Feeling overwhelmed**

If you checked two or more of these items, you may need to make some
changes in your life to reduce the level of stress. Becoming more aware
of stress is the first step to reducing it. You may have been accustomed
to turning to substance use in times of stress. Learning new ways to
cope with stress is part of the recovery process. Another Relapse
Prevention session will address techniques for reducing stress.

**RP 21---Relapse Justification II**

Once a person decides not to use drugs anymore, how does that person end
up using again? Do relapses happen completely by accident? Or are there
warning signs and ways to avoid relapse?

Relapse justification is a process that happens in people's minds. A
person may have decided to stop using, but the person's brain is still
healing and still feels the need for the substances. The addicted brain
invents excuses that allow the person in recovery to edge close enough
to relapse situations that accidents can happen. You may remember a time
when you intended to stay drug free but you invented a justification for
using, and before you knew it, you had used again.

Understanding and anticipating the justifications help you interrupt the
process. Use the questions below to help you identify justifications you
might be susceptible to.

**Substance Dependence Is Cured**

**Has your addicted brain ever convinced you that you could use just
once or use just a little? For example, have you said any of the
following?**

-   **I'm back in control. I'll be able to stop when I want to.**

-   **I've learned my lesson. I'll only use small amounts and only once
    in a while.**

-   **This substance was not my problem---stimulants were. So I can use
    this and not relapse.**

-   **Other:**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

**Testing Yourself**

It's very easy to forget that being smart, not being strong, is the key
to staying abstinent. **Have you ever wanted to prove you could be
stronger than drugs? For example, have you said any of the following?**

-   **I'm strong enough to be around it now.**

-   **I want to see whether I can say "No" to drinking and using.**

-   **I want to see whether I can be around my old friends.**

-   **I want to see how the high feels now that I've stopped using.**

-   **Other:**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Celebrating**

You may be encouraged by other people or your addicted brain to make an
exception to your abstinence. **Have you ever tried to justify using
with the following thoughts?**

-   **I'm feeling really good. One time won't hurt.**

-   **I'm on vacation. I'll go back to not using when I get home.**

-   **I'm doing so well. Things are going great. I owe myself a
    reward.**

-   **This is such a special event that I want to celebrate.**

-   **Other:**
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

**What might you do when confronted with these excuses to use?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**RP 22---Reducing Stress**

Answering the following questions as honestly as possible will help you
identify which parts of your daily living are most stressful. Take steps
to correct these problems, and you will reduce stress in your life.

1.  In deciding how to spend your time, energy, and money, you determine
    the direction of your life. **Are you investing them in work and
    hobbies that you find rewarding?** Yes \_\_\_\_\_\_\_\_ No
    \_\_\_\_\_\_\_\_ **If not, how might you change this?**

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2.  Focusing on the present means giving your attention to the task at
    hand without past and future fears crippling you. **Are you usually
    able to stay in the here and now?** Yes \_\_\_\_\_\_\_\_ No
    \_\_\_\_\_\_\_\_ **If not, what prevents you from focusing on the
    present? How can you change the situation?**

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3.  **Do you take time each day to do something relaxing** **(for
    example, playing with your children, taking a walk, reading a book,
    listening to music)?** Yes \_\_\_\_\_\_\_ No \_\_\_\_\_\_\_ **If
    not, what relaxing activity will you add to your day?**

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4.  **Are you challenging yourself to do things that increase
    self-confidence?** Yes \_\_\_\_\_\_\_\_ No \_\_\_\_\_\_\_\_\_ **If
    not, what changes could you make to boost your self-confidence?**

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5.  **Do you tackle large goals by breaking them into smaller, more
    manageable tasks?** Yes \_\_\_\_\_\_\_\_ No \_\_\_\_\_\_\_\_ **If
    not, how do you think breaking goals into smaller steps would help
    you manage stress?**

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6.  **Are you careful to make your environment (home, workplace)
    peaceful, whenever possible?** Yes \_\_\_\_\_\_\_ No
    \_\_\_\_\_\_\_\_ **If not, how can you make your environment more
    peaceful?**

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

7.  **Can you and do you say "No" when that is how you feel?** Yes
    \_\_\_\_\_\_ No \_\_\_\_\_\_ **If not, how do you think saying "No"
    could help you cope with stress in your life?**

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

8.  **Do you know how to use self-relaxation techniques to relax your
    body?** Yes \_\_\_\_\_\_\_ No \_\_\_\_\_\_\_\_ **If not, what can
    you do to learn more about ways to relax?**

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**9. Are you careful to avoid large swings in body energy caused by
taking in excess sugar and caffeine?** Yes \_\_\_\_\_\_\_\_ No
\_\_\_\_\_\_\_\_ **If not, what changes can you make to limit your
intake of sugar and caffeine?**

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

10. **Are there specific ways you cope with anger to get it out of your
    system?** Yes \_\_\_\_\_\_\_\_ No \_\_\_\_\_\_\_\_ **If not, how
    would reducing anger help you manage stress?**

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**11. What techniques can you start using that will help you get rid of
anger?**

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> **RP 23---Managing Anger**

Anger is an emotion that leads many people to relapse. This is
particularly true early in treatment. Frequently, anger slowly builds on
itself as you constantly think about things that make you angry.
Sometimes it seems that the issue causing the anger is the only
important thing in life.

Often a sense of victimization accompanies the anger. **Do the following
questions seem familiar to you?**

-   **Why do I get all the bad breaks?**

-   **How come she doesn't understand my needs?**

-   **Why won't he just do what I want him to do?**

**How do you recognize when you are angry? Does your behavior change? Do
you notice physical changes (for example, pacing, clenching your jaw,
feeling restless or "keyed up")?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**How do you express anger? Do you hold it in and eventually explode? Do
you become sarcastic and passive--aggressive?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**What positive ways do you know to cope with anger?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Here are some alternative ways to cope with anger. **Which of the
following will work for you?**

-   **Talk to the person you are angry with.**

-   **Talk to a counselor, a 12-Step sponsor, or another person who can
    give you guidance.**

-   **Talk about the anger in an outside support group meeting.**

-   **Write about your feelings of anger.**

-   **Exercise.**

-   **Other:**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**RP 24---Acceptance**

"Just say no" is good advice to stop people from trying drugs. But it
does not help people who are substance dependent. Overcoming substance
dependence requires that you recognize its power and accept the personal
limitations that occur because of it. Many people accept the hold that
substance dependence has over them when they enter treatment. But
entering treatment is the first act of acceptance. It cannot be the only
one. Recovery is an ongoing process of accepting that substance
dependence is more powerful than you are.

Accepting that dependence on drugs has power over you means accepting
that human beings have limits. Refusal to accept a substance use
disorder is one of the biggest problems in staying drug free. This
refusal to give in to treatment can lead to what is called
"white-knuckle abstinence"---hanging on to abstinence desperately
because you isolate yourself and refuse to accept help. Admitting that
you have a problem and seeking help are not weaknesses. Does getting
treatment for diabetes or a heart condition mean you are a weak-willed
person?

Accepting the idea that you have a substance use disorder does not mean
you cannot control your life. It means there are some things you cannot
control. One of them is the use of drugs. If you continue to struggle
with trying to control the disorder, you end up giving it more power.

There is a paradox in the recovery process. People who accept the
reality of substance dependence to the greatest degree benefit the most
in recovery. Those who do not fight with the idea that they have a
substance use disorder are the ones who ultimately are most successful
in recovery. The only way to win this fight is to surrender. The only
way to be successful in recovery and get control of your problem is
first to admit that it has control over you.

  -----------------------------------------------------------------------
  **YOU DO NOT NEED TO "HIT BOTTOM" TO BEGIN RECOVERY.**

  -----------------------------------------------------------------------

**I have a substance use disorder.** Yes\_\_\_\_\_\_\_\_
No\_\_\_\_\_\_\_\_

**I hope someday I can use again.** Yes\_\_\_\_\_\_\_\_
No\_\_\_\_\_\_\_\_

**I need to work on acceptance of**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**RP 25---Making New Friends**

A blessed thing it is for any person to have a friend:

One human soul whom we can trust utterly,

Who knows the best and worst of us,

And who loves us in spite of our faults.

Anonymous

Relationships are very important to the recovery process. Friends and
family can offer strength and help us understand who we are. The
relationships you establish can support or weaken recovery. It has been
said, "You will become like those people with whom you spend your time."
Use the following questions to help you think about your friendships.

**Do you have any friends like the one described in the poem above? If
yes, who are they?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Have you become like the people around you? In what ways?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**What is the difference between a friend and an acquaintance?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Where can you make some new acquaintances who might become friends?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**To whom are you a friend?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**What behaviors do you need to change to be better able to have honest
relationships?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

#### **RP 26---Repairing Relationships**

Friends and family of people who are substance dependent often get hurt
as a result of the substance abuse. People who are substance dependent
often cannot take care of themselves and certainly cannot take care of
others.

As part of your recovery, you should think about whom you have hurt. You
should also think about whether you need to do anything to repair the
relationships that are most important to you. In 12-Step programs this
process is called "making amends."

######## What are some of the past behaviors you might want to amend?

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

######## Are there things you neglected to do or say when you were using that should be addressed now?

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**How are you planning to make amends?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Do you feel that being in recovery and stopping the use of drugs is
enough?**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Making amends does not have to be complicated. Acknowledging the hurt
you caused while you were using substances will probably help reduce
conflict in your relationships. Not everyone will be ready to forgive
you, but an important part of this process is beginning to forgive
yourself. Another aspect of repairing relationships involves your
forgiving others for things that they did when you were using
substances.

######## 

######## Whom do you need to forgive?

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

######## 

######## What resentments do you need to let go of?

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

#### **RP 27---Serenity Prayer**

**God grant me the serenity to accept the things I cannot change,**

**The courage to change the things I can,**

**And the wisdom to know the difference.**

**What does this saying mean to you?**

**How can you find meaning in this saying, even if you are not religious
or don't believe in God?**

**What parts of your life or yourself do you know you cannot change?**

######## 

######## What have you changed already?

**What parts of your life or yourself do you need to change?**

**RP 28---Compulsive Behaviors**

Many people who are substance dependent enter treatment just to stop
using a certain drug. They do not intend to change their lives entirely.
When they enter treatment, they are told that recovery requires making
other changes in the way they live. The lifestyle changes put people in
recovery back in control of their lives.

######## In what ways was your life out of control before you entered treatment?

**Have you noticed yourself behaving excessively in any of the following
ways?**

**Working all the time**

**Abusing prescription medications**

**Using illicit drugs other than the one you entered treatment for**

**Drinking a lot of caffeinated sodas or coffee**

**Smoking**

**Eating foods high in sugar**

**Exercising to the extreme**

**Masturbating compulsively**

**Gambling**

**Spending too much money**

**Other:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

######## What changes have you tried to make so far?

Does the following sound familiar? "I stopped smoking and using drugs.
It was hard. Then one day I gave in and had a cigarette. I felt so bad
that I had messed up, I ended up using." This pattern is called the
"abstinence violation syndrome." Once you compromise one part of your
recovery, it becomes easier to slide into relapse.

######## Do you have a similar story from the past? What event led to your relapse?

**What major lifestyle changes are you making in recovery?**

**Is it uncomfortable for you to make these changes?** Yes No \_\_

**Are you avoiding being uncomfortable by switching to other compulsive
behaviors? If so, what are they?**

**Are there changes you still need to make? If so, what are they?**

## 

## Relapse and Sex

Like substance use, high-risk sex is controlled by a trigger process.
(High-risk sex includes sex with a stranger, unprotected sex, and
trading sex for drugs.) Triggers lead to thoughts of sex. Thoughts of
sex lead to arousal and action. For many people, high-risk sex is
associated with substance use. High-risk sex can be a trigger for
substance use. Engaging in high-risk sex can bring on a relapse to
substance use.

**What are some of your triggers for substance use?**

**What are some of your triggers for high-risk sex?**

**Have you experienced a relapse when sex was a trigger to use?**

## 

## Prevention

Once you are aware of the things that are triggers for you, you can take
steps to prevent a relapse. Here are some suggestions you can do to
prevent a relapse:

-   **Prevent exposure to triggers.** Stay away from people, places, and
    activities that you associate with drug use.

-   **Stop the thoughts that may lead to relapse.** Many techniques can
    be used to do this. Some examples of thought-stopping techniques are
    the following:

```{=html}
<!-- -->
```
-   **Relaxation**---Take three slow, deep breaths.

-   **Snapping**---Wear a rubberband loosely on your wrist and every
    time you become aware of a triggering thought, snap the rubberband
    and mentally say, "No!" to the thought.

-   **Visualization**---Imagine an ON/OFF switch in your head. Turn it
    to OFF to stop the triggering thoughts.

```{=html}
<!-- -->
```
-   **Schedule your time.** Structure your day and fill blocks of free
    time with activities. You can exercise, do volunteer work, or spend
    time with friends who do not use drugs,

-   **Break your typical pattern.** Take a trip out of town. Go to a
    movie or watch a video. Go out to eat. Go to a 12-Step or
    mutual-help meeting at a time you normally would be doing something
    else.

######## What are some other things you could do to prevent a relapse?

######## 

######## What do you plan to do next time you're aware of being in a relapse situation?

**RP 29---Coping With Feelings and Depression**

## Feelings

# 

# **Can You Recognize Your Feelings?**

# Sometimes people don't allow themselves to have certain emotions (for example, you tell yourself, "Feeling angry is not all right"). Sometimes people aren't honest with themselves about their emotions (for example, saying, "I'm just having a bad day," when the truth is they're sad). When you mislabel emotions or deny them, you cannot address them and they build up inside you.

######## Are You Aware of Physical Signs of Certain Feelings?

######## Maybe you get an upset stomach when you are anxious, bite your fingernails when you are stressed, or shake when you are angry. Think about the emotions that trouble you, and try to identify how they show physically.

######## How Do You Cope With Your Feelings Now?

How do you respond when you experience negative emotions? How do your
feelings affect you and others around you? For instance, do your
feelings interfere with your relationships with others? Do people avoid
you, try to keep you from getting upset, or try to make you feel better?
Focus on one or two emotions you need to cope with better.

######## How Do You Express Your Emotions?

It is important to find an appropriate way to express emotions. You can
express feelings indirectly (to a trusted group, friend, or counselor),
or you can express feelings directly to others about whom you have the
feelings. You need to learn in which situations it is appropriate to
express feelings directly. You also can change your thinking in ways
that result in your feeling different. For example, instead of saying,
"I am so angry she doesn't agree with me, I feel like using," you can
frame your feelings as, "It's all right for someone not to agree with
me, and using will not make anything better."

Do not let out-of-control feelings drive you back to using. Learning to
cope with emotions means allowing yourself to feel and balancing an
honest response with intelligent behavior.

## Depression

Although we know drug use and depression are related, it is not always
clear how the two interact. Most people in recovery report having
problems with depression from time to time. Depression can be a
particular problem for people who have been using stimulants. Stimulants
make people feel "high" by flooding the brain with chemicals called
neurotransmitters that regulate feelings of pleasure. During recovery
there are periods when the brain doesn't supply enough of those
neurotransmitters. The undersupply of neurotransmitters causes a
temporary feeling of depression. But this is different from being
clinically depressed. For some people, depression left untreated can
result in relapse. It is important to be aware of signs of depression
and be prepared to cope with the feelings. If you feel that you cannot
cope with your depression or if your depression lasts for a long time,
seek help from a mental health professional. Your counselor or someone
else at your treatment program can refer you to someone for help.

These are some symptoms that might indicate depression. **Check all that
apply to you:**

**Low energy**

**Overeating or not eating**

**Sad thoughts**

**Losing interest in career or hobbies**

**Sleeping more than usual**

**Decreased sex drive**

**Increased thoughts of drinking**

**Insomnia**

**Stopping attendance at 12-Step or mutual-help meetings**

**Stopping exercise program**

**Avoiding social activities**

**Feelings of boredom, irritability, or anger**

**Crying spells**

**Suicidal thoughts or actions**

**Stopping normal activities such as work, cleaning house, buying
groceries**

**What other signs indicate depression?**

# 

# **Responses to depression include the following:**

-   Increase exercise.

-   Talk to a spouse.

-   Plan some new activities.

-   Talk to a friend.

-   Talk to a counselor.

-   Consult a doctor; medication may help.

**Do you have any other ways of coping effectively with depression?**

**RP 30---12-Step Programs**

**What Is AA?**

Alcoholics Anonymous (AA) is a worldwide organization. It has been in
existence since the 1930s. It was started by two men who could not
recover from their alcoholism with psychiatry or medicine. AA holds
free, open meetings to help people who want to stop being controlled by
their need for alcohol. Meetings are available throughout the day and
evening, 7 days a week. The principles of AA have been adapted to help
people who are dependent on drugs or who have other compulsive
disorders, such as gambling or overeating.

**Are These Meetings Like Treatment?**

No. They are groups of people in recovery helping one another stay
abstinent.

**Does a Person Need To Enroll or Make an Appointment?**

No, just show up. Times and locations of meetings are available through
this treatment program or by calling AA directly.

**What Are the 12 Steps?**

The basis of groups such as AA is the 12 Steps. These beliefs and
activities provide a structured program for abstinence. There is a
strong spiritual aspect to both the 12 Steps and AA.

##### *The 12 Steps of Alcoholics Anonymous*[^1]

1.  We admitted that we were powerless over alcohol---that our lives had
    become unmanageable.

2.  Came to believe that a power greater than ourselves could restore us
    to sanity.

3.  Made a decision to turn our will and our lives over to the care of
    God, as we understood Him.

4.  Made a searching and fearless moral inventory of ourselves.

5.  Admitted to God, to ourselves, and to another human being the exact
    nature of our wrongs.

6.  Were entirely ready to have God remove all these defects of
    character.

7.  Humbly asked Him to remove our shortcomings.

8.  Made a list of all persons we had harmed and became willing to make
    amends to them all.

9.  Made direct amends to such people wherever possible, except when to
    do so would injure them or others.

10. Continued to take personal inventory, and when we were wrong,
    promptly admitted it.

11. Sought through prayer and meditation to improve our conscious
    contact with God, as we understood Him, praying only for knowledge
    of His will for us and the power to carry it out.

12. Having had a spiritual awakening as a result of these Steps, we
    tried to carry this message to addicts and to practice these
    principles in all our affairs.

**What Are CA and NA?**

Cocaine Anonymous and Narcotics Anonymous. Other 12-Step groups include
Marijuana Anonymous, Pills Anonymous, Gamblers Anonymous, Overeaters
Anonymous, Emotions Anonymous, and more. Here are the Web site addresses
for these support groups:

-   Cocaine Anonymous (CA): www.ca.org

-   Narcotics Anonymous (NA): www.na.org

-   Marijuana Anonymous (MA): www.marijuana-anonymous.org

-   Pills Anonymous (PA): groups.msn.com/PillsAnonymous

-   Gamblers Anonymous (GA): www.gamblersanonymous.org

-   Overeaters Anonymous (OA): www.oa.org

-   Emotions Anonymous (EA): www.emotionsanonymous.org

The methods and principles of the groups are similar although the
specific focus differs.

Spinoff groups that use the 12 Steps include Al-Anon and Alateen, Adult
Children of Alcoholics, Co-Dependents Anonymous, and Adult Children of
Dysfunctional Families. Here are the Web site addresses for some of
these support groups:

-   Al-Anon and Alateen: www.al-anon.alateen.org

-   Nar-Anon: www.naranon.com

-   Adult Children of Alcoholics (ACoA): www.adultchildren.org

-   Co-Dependents Anonymous (CoDA): www.codependents.org

Often people go to more than one type of group. Most people shop around
for the type of group and the specific meetings that they find most
comfortable, relevant, and useful.

###### What Is CMA?

Crystal Meth Anonymous (www.crystalmeth.org). CMA is a 12-Step group
that offers fellowship and support for people who want to stop using
meth. CMA meetings are open to anyone with a desire to end dependence on
meth. Like other 12-Step programs, CMA has a spiritual focus and
encourages participants to work the 12 Steps with the help of a sponsor.
CMA advocates complete abstinence from nonprescribed medication.

**What if a Person Is Not Religious?**

One can benefit from 12-Step or mutual-help meetings without being
religious or working the 12 Steps. Many people in 12-Step and
mutual-help groups are not religious. These people may think of the
higher power mentioned in the 12 Steps as a bigger frame of reference or
a bigger source of knowledge than themselves.

**What Do 12-Step Programs Offer?**

-   A safe place to go during recovery

-   A place to meet other people who don't use drugs and alcohol

-   A spiritual component to recovery

-   Emotional support

-   Exposure to people who have achieved long-term abstinence

-   A worldwide network of support that is always available

It is strongly recommended that you attend 12-Step or mutual-support
meetings while you are in treatment. Ask other clients for help in
choosing the best meeting for you. Try several different meetings. Be
open to the ways that 12-Step meetings can support your recovery:
social, emotional, or spiritual.

**RP 31---Looking Forward; Managing Downtime**

######## Islands To Look Forward To

There are many important elements to a successful recovery. Structure is
important. Scheduling is important. Balance is important. Your recovery
works because you work at it. Amid the hard work and the structure of
recovery, do you feel as if something is missing? The activities and
routines of recovery can seem stifling. Do you feel that you need to
take a break from the routine and get excited about something?

The emotional flatness you experience during recovery may be explained
by the following:

-   Many people feel particularly bored and tired 2 to 4 months into
    recovery (during the period known as the Wall).

-   The recovery process the body is going through may prevent you from
    feeling strong emotions of any kind.

-   Life feels less "on the edge" than it did when you were using.

Planning enjoyable things to look forward to is one way to put a sense
of anticipation and excitement into your life. Some people think of this
as building islands of rest, recreation, or fun. These are islands to
look forward to so that the future doesn't seem so predictable and
routine. The islands don't need to be extravagant things. They can be
things like

-   Going out of town for a 3-day weekend

-   Taking a day off work

-   Going to a play or a concert

-   Attending a sporting event

-   Visiting relatives

-   Going out to eat

-   Visiting an old friend

-   Having a special date with your partner

Plan these little rewards often enough so that you don't get too
stressed, tired, or bored in between them.

# **List some islands that you used to use as What are some possible islands for you**

**rewards. now?**

## \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

## 

## Handling Downtime

***The Problem***

Being in recovery means living responsibly. Always acting intelligently
and constantly guarding against relapse can be exhausting. It is easy to
run out of energy and become tired and bitter. Life can become a cycle
of sameness: getting up, going to work, coming home, lying on the couch,
going to bed, and then doing it again the next day. People in recovery
who allow themselves to get to this state of boredom and exhaustion are
very vulnerable to relapse. It is difficult to resist triggers and
relapse justifications when your energy level is so low.

***The Old Answer***

Drugs and alcohol provided quick relief from boredom and listlessness.
All the reasons for not using substances can be forgotten quickly when
the body and mind desperately need refueling.

***A New Answer***

Each person needs to decide what can replace substance use and provide a
refreshing, satisfying break from the daily grind. What works for you
may not work for someone else. It doesn't matter what nonusing
activities you pursue during your downtime, but it is necessary to find
a way to relax and rejuvenate. The more tired and beaten down you
become, the less energy you will have for staying smart and committed to
recovery.

Notice how often you feel stressed, impatient, angry, or closed off
emotionally. These are signs of needing more downtime. **Which
activities listed below would help rejuvenate you?**

**Walking** **Taking a class** \_\_\_\_\_ **Going to the movies**

**Reading** **Playing team sports** **Writing**

**Meditating or doing yoga** **Bicycling** **Knitting**

**Listening to music** **Painting, drawing** **Fishing**

**Playing with a pet** **Exercising at the gym** **Scrapbooking**

\_\_\_\_\_ **Becoming active in a church** \_\_\_\_\_ **Cooking**
**Window shopping**

\_\_\_\_\_ **Talking with a friend who** **Going to 12-Step** **Playing
a musical**

**does not use** **or mutual-help** **instrument**

**meetings**

**On a day when you're stressed and you realize that in the past you
would have said, "I really need a drink" or "I need to get high today,"
what will you do now? What will you do in your downtime?**

### RP 32---One Day at a Time

People in recovery usually do not relapse because they cannot handle one
difficult day or one troubling situation. Any given day or any single
event usually is manageable. Things become unmanageable when the person
in recovery allows events from the past or fears of the future to
contaminate the present.

Beating yourself up about the past makes you less able to handle the
present. You allow the past to make your recovery more difficult when
you tell yourself

-   "I can never do anything right. I always mess up every opportunity."

-   "If I try to do something difficult, I will fail. I always do."

-   "I always am letting people down. I always have disappointed
    everyone."

You need to find a way to reject those negative thoughts when they come
up. The thought-stopping techniques you learned in Early Recovery Skills
(session 1) can help you move past these negative thoughts. Exercise,
meditation, and journal writing also help you focus your mind and
control your thoughts.

**Can you think of a recent situation in which you allowed the past to
make the present more difficult?**

Don't allow things that *might* happen in the future to overwhelm you in
the present. You can plan ahead and be prepared, but you can do little
else about the unknown. You can address only what is happening right
now, today. You are filling yourself with fear when you tell yourself

-   "Tomorrow something will happen to ruin this."

-   "That person is going to hate me for this."

-   "I will never be able to make it."

**What things do you tell yourself that make you fear the future?**

When you have these thoughts, it may help to remind yourself of times
when you did not let your past behavior influence the future. Think of
times when you broke away from an old, destructive pattern. Calling a
friend who can remind you of your successes is a good way to keep
yourself focused on today and reject fearful thoughts of the future.

**What things can you tell yourself that will bring you back to the
present?**

**RP 33---Drug Dreams During Recovery**

## 

## Early Recovery (0--6 weeks)

Drug use interferes with normal sleeping. When people stop using, they
experience frequent and intense dreams. The dreams seem real and
frightening. These dreams are a normal part of the recovery process. You
are not responsible for whether you use in a dream. Regular exercise may
help lessen the dream activity.

## 

## Middle Recovery (7--16 weeks)

For most people, dreams are less frequent during this phase of recovery.
When they do occur, however, dreams can leave powerful feelings well
into the following day. It is important to be careful to avoid relapse
on days following powerful dream activity. Often dreams during this
period are about choosing to use or not to use, and they can indicate
how you feel about those choices.

## 

## Late Recovery (17--24 weeks)

Dreaming during this period is very important and can be helpful in
warning the person in recovery. Sudden dreaming about drug or alcohol
use can be a clear message that there may be a problem and that the
dreamer is more vulnerable to relapse than usual. It is important to
review your situation and correct any problems you discover.

Listed below are some of the actions people take when their dreams
become intense and troubling. **Add to the list things that would help
you in this situation:**

-   **Exercise**

-   **Go to a 12-Step or mutual-help meeting**

-   **Call a counselor**

-   **Talk to friends**

-   **Take a break from your routine**

-   **Other:**

**RP Elective A---Client Status Review**

**Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

Rate how satisfied you are with the following areas of your life by
placing a checkmark in the appropriate boxes.

+----------------------+--------+--------+--------+--------+--------+
|                      | > **   | >      | >      | >      | **     |
|                      | Very** | **Some |  **Neu | **Some | Very** |
|                      |        | what** | tral** | what** |        |
|                      | **Di   | >      |        | >      | *      |
|                      | ssatis | > **Di |        | > *    | *Satis |
|                      | fied** | ssatis |        | *Satis | fied** |
|                      |        | fied** |        | fied** |        |
+----------------------+--------+--------+--------+--------+--------+
| **Career**           | >      | >      | >      | >      | ****  |
|                      |  **** |  **** |  **** |  **** |        |
+----------------------+--------+--------+--------+--------+--------+
| **Friends**          | >      | >      | >      | >      | ****  |
|                      |  **** |  **** |  **** |  **** |        |
+----------------------+--------+--------+--------+--------+--------+
| **Family**           | >      | >      | >      | >      | ****  |
|                      |  **** |  **** |  **** |  **** |        |
+----------------------+--------+--------+--------+--------+--------+
| **Romantic           | >      | >      | >      | >      | ****  |
| Relationships**      |  **** |  **** |  **** |  **** |        |
+----------------------+--------+--------+--------+--------+--------+
| **Drug               | >      | >      | >      | >      | ****  |
| Use/Cravings**       |  **** |  **** |  **** |  **** |        |
+----------------------+--------+--------+--------+--------+--------+
| **Alcohol            | >      | >      | >      | >      | ****  |
| Use/Cravings**       |  **** |  **** |  **** |  **** |        |
+----------------------+--------+--------+--------+--------+--------+
| **Self-Esteem**      | >      | >      | >      | >      | ****  |
|                      |  **** |  **** |  **** |  **** |        |
+----------------------+--------+--------+--------+--------+--------+
| **Physical Health**  | >      | >      | >      | >      | ****  |
|                      |  **** |  **** |  **** |  **** |        |
+----------------------+--------+--------+--------+--------+--------+
| **Psychological      | >      | >      | >      | >      | ****  |
| Well-Being**         |  **** |  **** |  **** |  **** |        |
+----------------------+--------+--------+--------+--------+--------+
| **Sexual             | >      | >      | >      | >      | ****  |
| Fulfillment**        |  **** |  **** |  **** |  **** |        |
+----------------------+--------+--------+--------+--------+--------+
| **Spiritual          | >      | >      | >      | >      | ****  |
| Well-Being**         |  **** |  **** |  **** |  **** |        |
+----------------------+--------+--------+--------+--------+--------+

**Which of these areas improved the most since you entered treatment?**

**Which are your weakest areas? How are you planning to improve them?**

**What would need to change for you to be satisfied with the areas you
rated lowest?**

**RP Elective B---Holidays and Recovery**

Holiday seasons and the celebrations that come with them are difficult
for people in recovery. Many things can happen to increase the risk of
relapse. **Review the list below and check the items that might cause
problems for you and your recovery program during the holidays. Then
total up the number of checkmarks and assess your relapse risk below:**

**More alcohol and drugs at parties**

**Shortage of money because of travel or gift buying**

**More stress caused by hectic pace (for example, traffic, crowds)**

**Normal routine of life interrupted**

**Stopping exercise**

**Not going to AA meetings**

**Not going to therapy**

**Party atmosphere**

**More contact with family**

**Increased emotions from holiday memories**

**Increased anxiety regarding triggers and craving**

**Frustration of not having time to meet responsibilities**

**Coping with "New Year's Eve" type occasions**

**Extra free time with no structure**

**Other:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Mild:** If you checked one to three items, the holidays produce only a
slightly increased risk of relapse.

**Moderate:** If you checked four to six items, the holidays add a lot
of stress to your life. Relapse risk is related to how well you cope
with increased stress. Your score indicates that you need to plan
carefully for your recovery during the holidays.

**Severe:** If you checked seven or more items, the holidays add a major
amount of stress to your life. Relapse prevention means learning how to
recognize added stress and taking extra care during dangerous periods.
Your score indicates the holidays are one of these periods for you.

  -----------------------------------------------------------------------
  **NO ONE HAS TO RELAPSE. NO ONE BENEFITS FROM A RELAPSE. THINK ABOUT
  YOUR RECOVERY PLAN. ADD SOME MEETINGS. SCHEDULE YOUR TIME. SEE YOUR
  COUNSELOR. TO GET THROUGH THIS STRESSFUL TIME, USE THE TOOLS THAT HAVE
  HELPED YOU STAY ABSTINENT IN RECOVERY.**

  -----------------------------------------------------------------------

**RP Elective C---Recreational Activities**

In addition to abstaining from substance use, it is important for you to
put some interesting activities in your life. For many people in
recovery, substance use was the main thing they did to relax and have a
good time. Now that you are abstinent and in recovery, it is important
to find fun things to do that can take the place of substance use. You
might try returning to old activities you used to enjoy before you
started using substances.

**What are some hobbies or activities that you used to enjoy and might
like to try again?**

New activities and hobbies are an excellent way to support your recovery
while you meet new people. Now is the time to take a class, learn a new
skill, try your hand at making art, take up a new sport, do volunteer
work, or try out other new interests. Ask your friends about hobbies
that they enjoy. See about adult classes that are offered at local
colleges. Consult your local community's directory or Web site for
listings of activities and classes. Check the newspaper for lectures,
movies, plays, and concerts.

**What new activities and interests would you like to pursue?**

It is important to remember that not all new activities will be fun
right away. It may take a while before you can really enjoy a new
activity or become proficient at a new skill. Old activities that you
enjoyed may not feel the same now that you're abstinent and in recovery.
Regardless of how new or old activities feel, you need to make them part
of your life.

[^1]: The Twelve Steps are reprinted with permission of Alcoholics
    Anonymous World Services, Inc. (A.A.W.S.). Permission to reprint the
    Twelve Steps does not mean that A.A.W.S. has reviewed or approved
    the contents of this publication, or that A.A.W.S. necessarily
    agrees with the views expressed herein. A.A. is a program of
    recovery from alcoholism *only*---use of the Twelve Steps in
    connection with programs and activities which are patterned after
    A.A., but which address other problems, or in any other non-A.A.
    context, does not imply otherwise.