### Client's Handbook

Matrix Intensive Outpatient Treatment for People With Stimulant Use
Disorders

**U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES**

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

1 Choke Cherry Road

Rockville, MD 20857

**Acknowledgments**

Numerous people contributed to this document, which is part of the
Methamphetamine Treatment Project (MTP). The document was written by
Jeanne L. Obert, M.F.T., M.S.M.; Richard A. Rawson, Ph.D.; Michael J.
McCann, M.A.; and Walter Ling, M.D. The MTP Corporate Authors provided
valuable guidance and support on this document.

This publication was developed with support from the University of
California at Los Angeles (UCLA) Coordinating Center through Grant No.
TI11440. MTP was funded by the Center for Substance Abuse Treatment
(CSAT), Substance Abuse and Mental Health Services Administration
(SAMHSA), U.S. Department of Health and Human Services (DHHS). The
research was conducted from 1998 to 2002 in cooperation with the
following institutions: County of San Mateo, San Mateo, CA (TI11411);
East Bay Recovery Project, Hayward, CA (TI11484); Friends Research
Institute, Inc., Concord, CA (TI11425); Friends Research Institute,
Inc., Costa Mesa, CA (TI11443); Saint Francis Medical Center of Hawaii,
Honolulu, HI (TI11441); San Diego Association of Governments, San Diego,
CA (TI11410); South Central Montana Regional Mental Health Center,
Billings, MT (TI11427); and UCLA Coordinating Center, Los Angeles, CA
(TI11440). The publication was produced by JBS International, Inc.
(JBS), under Knowledge Application Program (KAP) contract numbers
270-99-7072 and 270-04-7049 with SAMHSA, DHHS. Christina Currier served
as the CSAT Government Project Officer. Andrea Kopstein, Ph.D., M.P.H.,
served as the Deputy Government Project Officer. Cheryl Gallagher, M.A.,
served as CSAT content advisor. Lynne MacArthur, M.A., A.M.L.S, served
as JBS KAP Executive Project Co-Director; Barbara Fink, RN, M.P.H.,
served as JBS KAP Managing Project Co-Director; and Emily Schifrin,
M.S., and Dennis Burke, M.S., M.A., served as JBS KAP Deputy Directors
for Product Development. Other JBS KAP personnel included Candace Baker,
M.S.W., Senior Writer; Elliott Vanskike, Ph.D., Senior Writer; Wendy
Caron, Editorial Quality Assurance Manager; Frances Nebesky, M.A.,
Quality Control Editor; and Pamela Frazier, Document Production
Specialist.

**Disclaimer**

The opinions expressed herein are the views of the authors and do not
necessarily reflect the official position of CSAT, SAMHSA, or DHHS. No
official support of or endorsement by CSAT, SAMHSA, or DHHS for these
opinions or for particular instruments, software, or resources described
in this document is intended or should be inferred. The guidelines in
this document should not be considered substitutes for individualized
client care and treatment decisions.

**Public Domain Notice**

All materials appearing in this volume except those taken directly from
copyrighted sources are in the public domain and may be reproduced or
copied without permission from SAMHSA/CSAT or the authors. Do not
reproduce or distribute this publication for a fee without specific,
written authorization from SAMHSA's Office of Communications.

**Electronic Access and Copies of Publication**

Copies may be obtained free of charge from SAMHSA's National
Clearinghouse for Alcohol and Drug Information (NCADI), 800-729-6686 or
301-468-2600; TDD (for hearing impaired) 800-487-4889; or electronically
through www.ncadi.samhsa.gov.

**Recommended Citation**

Center for Substance Abuse Treatment. *Client's Handbook: Matrix
Intensive Outpatient Treatment for People With Stimulant Use Disorders.*
DHHS Publication No. (SMA) 06-4154. Rockville, MD: Substance Abuse and
Mental Health Services Administration, 2006.

**Originating Office**

Practice Improvement Branch, Division of Services Improvement, Center
for Substance Abuse Treatment, Substance Abuse and Mental Health
Services Administration, 1 Choke Cherry Road, Rockville, MD 20857.

DHHS Publication No. (SMA) 06-4154

Printed 2006

**Contents**

**Introduction 6**

**Individual/Conjoint Session Handouts**

IC 1---Sample Service Agreement and Consent 8

IC 2A---Recovery Checklist 11

IC 2B---Relapse Analysis Chart 12

IC 3A---Treatment Evaluation 13

IC 3B---Continuing Treatment Plan 14

**Early Recovery Skills Handouts**

SCH 1---The Importance of Scheduling 16

SCH 2---Daily/Hourly Schedule 18

CAL 1---Marking Progress 20

CAL 2---Calendar 21

ERS 1A---Triggers 22

ERS 1B---Trigger--Thought--Craving--Use 24

ERS 1C---Thought-Stopping Techniques 25

ERS 2A---External Trigger Questionnaire 27

ERS 2B---External Trigger Chart 28

ERS 3A---Internal Trigger Questionnaire 29

ERS 3B---Internal Trigger Chart 30

ERS 4A---12-Step Introduction 31

ERS 4B---The Serenity Prayer and the 12 Steps of Alcoholics Anonymous 35

ERS 5---Roadmap for Recovery 36

ERS 6A---Five Common Challenges in Early Recovery 39

ERS 6B---Alcohol Arguments 41

ERS 7A---Thoughts, Emotions, and Behavior 43

ERS 7B---Addictive Behavior 44

ERS 18---12-Step Sayings 45

**Relapse Prevention Handouts**

RP 1---Alcohol 47

RP 2---Boredom 49

RP 3A---Avoiding Relapse Drift 51

RP 3B---Mooring Lines Recovery Chart 53

RP 4---Work and Recovery 54

RP 5---Guilt and Shame 56

RP 6---Staying Busy 58

RP 7---Motivation for Recovery 60

RP 8---Truthfulness 62

RP 9---Total Abstinence 64

RP 10---Sex and Recovery 65

RP 11---Anticipating and Preventing Relapse 66

RP 12---Trust 69

RP 13---Be Smart, Not Strong 70

RP 14---Defining Spirituality 72

RP 15---Managing Life; Managing Money 74

RP 16---Relapse Justification I 77

RP 17---Taking Care of Yourself 79

RP 18---Emotional Triggers 80

RP 19---Illness 82

RP 20---Recognizing Stress 84

RP 21---Relapse Justification II 85

RP 22---Reducing Stress 87

RP 23---Managing Anger 89

RP 24---Acceptance 91

RP 25---Making New Friends 92

RP 26---Repairing Relationships 93

RP 27---Serenity Prayer 94

RP 28---Compulsive Behaviors 95

RP 29---Coping With Feelings and Depression 98

RP 30---12-Step Programs 101

RP 31---Looking Forward; Managing Downtime 105

RP 32---One Day at a Time 108

RP 33---Drug Dreams During Recovery 110

RP Elective A---Client Status Review 111

RP Elective B---Holidays and Recovery 112

RP Elective C---Recreational Activities 114

**Introduction**

Welcome. You have taken a big step by deciding to come into treatment.
You should be very proud of your decision to enter treatment and your
commitment to recovery.

This is your *Client's Handbook.* It contains most of the handouts you
will need for your treatment. In this book you will find handouts for
three types of sessions: Individual/Conjoint, Early Recovery Skills, and
Relapse Prevention. Family Education sessions also use handouts. Those
handouts will be given to you by your counselor during the Family
Education sessions.

**Client Handouts**

The handouts in this book will help you get the most out of your Matrix
treatment. Some handouts ask questions and have spaces for your answers.
Other handouts ask you to read and think about a subject or an idea, or
they contain advice or reminders about recovery. It is a good idea to
keep and review the handouts after you have used them. They will help
you stay strong as you continue in your recovery.

During each treatment session, your counselor will ask you to follow
along on the handout while he or she goes over it with the group. The
counselor will give you time to think about what it says and write your
answers to questions it may ask. The group will then discuss the
handout. You should share your thoughts and ask questions during this
time. If you still have questions, there will be more time to ask
questions during the last part of each session.

**Making the Most of Group Sessions**

The more work you put into group therapy, the more benefit you will
receive from it. Part of the work you should be doing is reading and
thinking about the handouts. But there are other things you can do to
make sure you benefit fully from group therapy:

-   Attend every group session.

-   Arrive for group sessions on time or a little early.

-   Listen carefully and respectfully to the counselor and the other
    clients.

-   Be supportive of other clients. If you disagree with someone, be
    polite when you speak to him or her. Do not attack people
    personally.

-   Do not talk about other clients' personal information outside group.
    Clients must be able to trust one another if they are to feel
    comfortable sharing their thoughts.

-   Think about what you read and about what the counselor and other
    clients say.

-   Ask questions when you do not understand something.

-   Participate in group discussions.

-   Do not dominate the conversation. Allow time for other clients to
    participate.

-   Be honest.

-   After the session is over, think about what you learned and try to
    apply it to your recovery.

-   Work on the homework assignments that the counselor gives you. (The
    homework assignments are usually an activity. These are different
    from the handouts that you work on during the session.)

### IC 1---Sample Service Agreement and Consent

\[Each program uses an agreement and consent form that it has developed
to meet its particular needs. This form is provided as a sample.\]

It is important that you understand the kinds of services you will be
provided and the terms and conditions under which these services will be
offered.

I, , am requesting treatment from the staff of
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.
As a condition of that treatment, I acknowledge the following items and
agree to them. (Please initial each item.) I understand:

1\. The staff believes that the outpatient treatment strategies the
program uses provide a useful intervention for chemical dependence
problems; however, no specific outcome can be guaranteed.

2\. Treatment participation requires some basic ground rules. These
conditions are essential for a successful treatment experience.
Violation of these rules can result in treatment termination.

I agree to the following:

> a\. It is necessary to arrive on time for appointments. At each visit
> I will be prepared to take urine and breath-alcohol tests.
>
> b\. Conditions of treatment require *abstinence from all drug and
> alcohol use for the entire duration of the treatment program*. If I am
> unable to make this commitment, I will discuss other treatment options
> with the program staff.
>
> c\. I will discuss any drug or alcohol use with the staff and group
> while in treatment.
>
> d\. Treatment consists of individual and group sessions. Individual
> appointments can be rescheduled, if necessary. *I understand that
> group appointments cannot be rescheduled and attendance is extremely
> important.* I will notify the counselor in advance if I am going to
> miss a group session. Telephone notification may be made for
> last-minute absence or lateness.
>
> e\. Treatment will be terminated if I attempt to sell drugs or
> encourage drug use by other clients.
>
> f\. I understand that graphic stories of drug or alcohol use will not
> be allowed.
>
> g\. I agree not to become involved romantically or sexually with other
> clients.
>
> > h\. I understand that it is not advisable to be involved in any
> > business transactions with other clients.
>
> i\. I understand that all matters discussed in group sessions and the
> identity of all group members are absolutely confidential. I will not
> share this information with nonmembers.
>
> j\. All treatment is voluntary. If I decide to terminate treatment, I
> will discuss this decision with the staff.

3\. Staff: Services are provided by psychologists, licensed marriage and
family counselors, master's-level counselors-in-training, or other
certified addiction staff people. All nonlicensed counselors are
supervised by a licensed counselor trained in the treatment of
addictions.

4\. Consent to Videotape/Audiotape: To help ensure the high quality of
services provided by the program, therapy sessions may be audiotaped or
videotaped for training purposes. The client and, if applicable, the
client's family consent to observation, audiotaping, and videotaping.

5\. Confidentiality: All information disclosed in these sessions is
strictly confidential and may not be revealed to anyone outside the
program staff without the written permission of the client or the
client's family. The only exceptions are when disclosures are required
or permitted by law. Those situations typically involve substantial risk
of physical harm to oneself or to others or suspected abuse of children
or the elderly.

6\. Accomplishing treatment goals requires the cooperation and active
participation of clients and their families. Very rarely, lack of
cooperation by a client may interfere substantially with the program's
ability to render services effectively to the client or to others. Under
such circumstances, the program may discontinue services to the client.

+-----------------------------------------------------------------------+
| I certify that I have read, understand, and accept this Service       |
| Agreement and Consent. This agreement and consent covers the length   |
| of time I am involved in treatment activities at this facility.       |
|                                                                       |
| Client's Signature: Date:                                             |
+-----------------------------------------------------------------------+

## IC 2A---Recovery Checklist

Outpatient treatment requires a great deal of motivation and commitment.
To get the most from treatment, it is necessary for you to replace many
old habits with new behaviors.

**Check all the things that you do regularly or have done since entering
treatment:**

\_\_\_\_\_ **Schedule activities daily**

**\_\_\_\_\_ Visit physician for checkup**

**\_\_\_\_\_ Destroy all drug paraphernalia**

**\_\_\_\_\_ Avoid people who use alcohol**

**\_\_\_\_\_ Avoid people who use drugs**

**\_\_\_\_\_ Avoid bars and clubs**

**\_\_\_\_\_ Stop using alcohol**

**\_\_\_\_\_ Stop using all drugs**

**\_\_\_\_\_ Pay financial obligations promptly**

**\_\_\_\_\_ Identify addictive behaviors**

**\_\_\_\_\_ Avoid triggers (when possible)**

**\_\_\_\_\_ Use thought stopping for cravings**

**\_\_\_\_\_ Attend Individual/Conjoint sessions**

**\_\_\_\_\_ Attend Early Recovery Skills and**

**Relapse Prevention sessions**

**\_\_\_\_\_ Attend 12-Step or mutual-help**

**meetings**

**\_\_\_\_\_ Get a sponsor**

**\_\_\_\_\_ Exercise daily**

**\_\_\_\_\_ Discuss thoughts, feelings,**

**and behaviors honestly with your**

**counselor**

**What other behaviors have you decided to start since you entered
treatment?**

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

**Which behaviors have been easy for you to do?**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Which behaviors take the most effort for you to do?

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

**Which behavior have you not begun yet? What might need to change for
you to begin this behavior?**

**Behavior Not Begun Change Needed**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

# IC 2B---Relapse Analysis Chart

Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date of
Relapse:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

A relapse episode does not begin when you take a drug. Often, things
that happen *before* you use indicate the beginning of a relapse.
Identifying your patterns of behavior will help you recognize and
interrupt the relapse. Using the chart below, note events that occurred
during the week immediately before the relapse.

+---------+---------+---------+---------+---------+---------+---------+
| ###     | ###     | **Tr    | **Drug- | **Beh   | **      | ###     |
|         |         | eatment | Related | avioral | Relapse |         |
| ###     | ### P   | E       | Beha    | Pat     | Tho     | ###     |
|  Career | ersonal | vents** | viors** | terns** | ughts** | Health  |
|  Events |  Events |         |         |         |         | Status  |
+---------+---------+---------+---------+---------+---------+---------+
|         |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| ### Fee |         |         |         |         |         |         |
| lings a |         |         |         |         |         |         |
| bout th |         |         |         |         |         |         |
| e above |         |         |         |         |         |         |
|  events |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
|         |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+

**IC 3A---Treatment Evaluation**

Recovery requires specific actions and behavioral changes in many areas
of life. Before you end your treatment, it is important to set new goals
and plan for a different lifestyle. This guide will help you develop a
plan and identify the steps necessary for reaching your goals. Write
your current status and goals for the areas of life listed in the left
column.

+----------+------------+-----------------+--------------------+------+
| **S      | **Where    | **Where would   | **What steps do    | ##   |
| ubject** | are you    | you like to     | you need to        | ## W |
|          | now?**     | be?**           | take?**            | hen? |
+----------+------------+-----------------+--------------------+------+
| **       |            |                 |                    |      |
| Family** |            |                 |                    |      |
+----------+------------+-----------------+--------------------+------+
| **Work/  |            |                 |                    |      |
| Career** |            |                 |                    |      |
+----------+------------+-----------------+--------------------+------+
| **Frien  |            |                 |                    |      |
| dships** |            |                 |                    |      |
+----------+------------+-----------------+--------------------+------+
| **Fi     |            |                 |                    |      |
| nancial, |            |                 |                    |      |
| Legal    |            |                 |                    |      |
| Oblig    |            |                 |                    |      |
| ations** |            |                 |                    |      |
+----------+------------+-----------------+--------------------+------+
| **S      | **Where    | **Where would   | **What steps do    | *    |
| ubject** | are you    | you like to     | you need to        | *Whe |
|          | now?**     | be?**           | take?**            | n?** |
+----------+------------+-----------------+--------------------+------+
| **Edu    |            |                 |                    |      |
| cation** |            |                 |                    |      |
+----------+------------+-----------------+--------------------+------+
| **Ex     |            |                 |                    |      |
| ercise** |            |                 |                    |      |
+----------+------------+-----------------+--------------------+------+
| *        |            |                 |                    |      |
| *Leisure |            |                 |                    |      |
| Acti     |            |                 |                    |      |
| vities** |            |                 |                    |      |
+----------+------------+-----------------+--------------------+------+
| *        |            |                 |                    |      |
| *12-Step |            |                 |                    |      |
| or       |            |                 |                    |      |
| Mut      |            |                 |                    |      |
| ual-Help |            |                 |                    |      |
| Me       |            |                 |                    |      |
| etings** |            |                 |                    |      |
+----------+------------+-----------------+--------------------+------+
| \_       |            |                 |                    |      |
| \_\_\_\_ |            |                 |                    |      |
| \_\_\_\_ |            |                 |                    |      |
| \_\_\_\_ |            |                 |                    |      |
| \_\_\_\_ |            |                 |                    |      |
| \_\_\_\_ |            |                 |                    |      |
| \_\_\_\_ |            |                 |                    |      |
| \_\_\_\_ |            |                 |                    |      |
| \_\_\_\_ |            |                 |                    |      |
| \_\_\_\_ |            |                 |                    |      |
| \_       |            |                 |                    |      |
| \_\_\_\_ |            |                 |                    |      |
| \_\_\_\_ |            |                 |                    |      |
| \_       |            |                 |                    |      |
| \_\_\_\_ |            |                 |                    |      |
| \_\_\_\_ |            |                 |                    |      |
| \_\_\_\_ |            |                 |                    |      |
| \_\_\_\_ |            |                 |                    |      |
| \_\_\_\_ |            |                 |                    |      |
| \_\_\_\_ |            |                 |                    |      |
| \_\_\_\_ |            |                 |                    |      |
| \_\_\_\_ |            |                 |                    |      |
| \_       |            |                 |                    |      |
| \_\_\_\_ |            |                 |                    |      |
| \_\_\_\_ |            |                 |                    |      |
|          |            |                 |                    |      |
| Client's |            |                 |                    |      |
| S        |            |                 |                    |      |
| ignature |            |                 |                    |      |
| Date     |            |                 |                    |      |
| Cou      |            |                 |                    |      |
| nselor's |            |                 |                    |      |
| S        |            |                 |                    |      |
| ignature |            |                 |                    |      |
| Date     |            |                 |                    |      |
+----------+------------+-----------------+--------------------+------+

##### IC 3B---Continuing Treatment Plan

Recovery is a lifelong process. You can stop drug and alcohol use and
begin a new lifestyle during the first 4 months of treatment. Developing
an awareness of what anchors your recovery is an important part of that
process. But this is only the beginning of your recovery. As you move
forward with your recovery after treatment, you will need a lot of
support. And you may need different kinds of support than you did during
treatment. You and your counselor can use the information below to help
you decide how best to support your recovery.

**Group Work**

You should participate in at least one regular recovery group every week
after treatment. The program offers a Social Support group that meets
once a week. Other recovery groups are often available in the community.
Ask your counselor about local recovery groups.

**Individual Therapy**

Individual sessions with an addiction counselor might be helpful. When
your current treatment ends, you have choices about continuing with
therapy. You may choose this time to enter therapy with another
professional. You may want to return to therapy with the professional
who referred you for the Matrix IOP method. Or you may choose to
continue to see your current Matrix IOP counselor.

**Couples Therapy**

It is often a good idea at this point for couples to begin seeing a
marriage counselor together to work on relationship issues.

**12-Step or Mutual-Help Meetings**

Attendance at a 12-Step or mutual-help meeting is a critical part of the
recovery process. It is essential to find a meeting that you will attend
regularly.

**My plan for the months following treatment is:**

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

### 

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

### Client's Signature Date

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

Counselor's Signature Date

**SCH 1---The Importance of Scheduling**

Scheduling may be a difficult and boring task if you're not used to it.
It is, however, an important part of the recovery process. People with
substance use disorders do not schedule their time. Scheduling your time
will help you achieve and maintain abstinence.

1.  **Why Is Scheduling Necessary?**

If you began your recovery in a hospital, you would have the structure
of the program and the building to help you stop using. As a person in
outpatient treatment, you have to build that structure to help support
you as you continue functioning in the world. Your schedule is your
structure.

2.  **Do I Need To Write Down My Schedule?**

Absolutely. Schedules that are in your head are too easily revised. If
you write down your schedule while your rational brain is in control and
then follow the schedule, you will be doing what you *think* you should
be doing instead of what you *feel like* doing.

3.  **What if I Am Not an Organized Person?**

Learn to be organized. Buy a schedule book and work with your counselor.
Thorough scheduling of your activities is very important to treating
your substance use disorder. Remember, your rational brain plans the
schedule. If you follow the schedule, you won't use. Your addicted brain
wants to be out of control. If you go off the schedule, your addicted
brain may be taking you back to using drugs or drinking.

4.  **Who Decides What I Schedule?**

You do! You may consider suggestions made by your counselor or family
members, but the final decision is yours. Just be sure you do what you
wrote down. Follow your schedule; try not to make any changes.

Most people can schedule a 24-hour period and follow it. If you can, you
are on your way to gaining control of your life. If you cannot, you may
need to consider a higher level of care as a start.

**SCH 2---Daily/Hourly Schedule**

Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

7:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

8:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

9:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

10:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

11:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

12:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

1:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

7:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

8:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

9:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

10:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

11:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

12:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

1:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

7:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

8:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

9:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

10:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

11:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

12:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

1:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

7:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

8:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

9:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

10:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

11:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

7:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

8:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

9:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

10:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

11:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

7:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

8:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

9:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

10:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

11:00 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

How many hours will you sleep? \_\_\_\_\_\_\_\_\_\_\_\_ From
\_\_\_\_\_\_\_\_\_\_\_\_\_\_ To \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Notes:**

**Reminders:**

**CAL 1---Marking Progress**

It is useful for both you and your counselor to know where you are in
the recovery process at all times. Marking a calendar as you go helps in
several ways:

-   It's a reminder of how far you've come in your recovery.

-   A feeling of pride often results from seeing the number of days you
    have been abstinent.

-   Recovery can seem very long unless you can measure your progress in
    short units of time.

Make a mark to record on the calendar pages every day of abstinence you
achieve. You may decide to continue the exercise following the program.

If you record your abstinent days regularly, this simple procedure will
help you and your counselor see your progress.

**CAL 2---Calendar**

**MONTH:**

  ------------ ------------ ------------- --------------- -------------- ------------ --------------
  **SUNDAY**   **MONDAY**   **TUESDAY**   **WEDNESDAY**   **THURSDAY**   **FRIDAY**   **SATURDAY**

                                                                                      

                                                                                      

                                                                                      

                                                                                      

                                                                                      
  ------------ ------------ ------------- --------------- -------------- ------------ --------------

####### 

####### **ERS 1A---Triggers**

Triggers are people, places, objects, feelings, and times that cause
cravings. For example, if every Friday night someone cashes a paycheck,
goes out with friends, and uses stimulants, the triggers might be

-   Friday night

-   After work

-   Money

-   Friends who use

-   A bar or club

Your brain associates the triggers with substance use. As a result of
constant triggering and using, one trigger can cause you to move toward
substance use. The trigger--thought--craving--use cycle feels
overwhelming.

Stopping the craving process is an important part of treatment. The best
way to do that is to do the following:

1\. Identify triggers.

2\. Prevent exposure to triggers whenever possible (for example, do not
handle large amounts of cash).

3\. Cope with triggers differently than in the past (for example,
schedule exercise and a 12-Step or mutual-help meeting for Friday
nights).

Remember, triggers affect your brain and cause cravings even though you
have decided to stop substance use. Your intentions to stop must
translate into behavior changes, which keep you away from possible
triggers.

**What are some of the strongest triggers for you?**

**What particular triggers might be a problem in the near future?**

### ERS 1B---Trigger--Thought--Craving--Use

######## **The Losing Argument**

If you decide to stop drinking or using but at some point end up moving
toward using substances, your brain has given you permission by using a
process called relapse justification. Thoughts about using start an
argument inside your head---your rational self versus your
substance-dependent self. You feel as though you are in a fight, and you
must come up with many reasons to stay abstinent. Your mind is looking
for an excuse to use again. You are looking for a relapse justification.
The argument inside you is part of a series of events leading to
substance use. How often in the past has your substance dependence lost
this argument?

######## **Thoughts Become Cravings**

Craving does not always occur in a straightforward, easily recognized
form. Often the thought of using passes through your head with little or
no effect. But it's important to identify these thoughts and try to
eliminate them. It takes effort to identify and stop a thought. However,
allowing yourself to continue thinking about substance use is choosing
to relapse. The further the thoughts are allowed to go, the more likely
you are to relapse.

######## **The "Automatic" Process**

During addiction, triggers, thoughts, cravings, and use seem to run
together. However, the usual sequence goes like this:

**TRIGGER → THOUGHT → CRAVING → USE**

**Thought Stopping**

The only way to ensure that a thought won't lead to a relapse is to stop
the thought before it leads to craving. Stopping the thought when it
first begins prevents it from building into an overpowering craving. It
is important to do it as soon as you realize you are thinking about
using.

**ERS 1C---Thought-Stopping Techniques**

######## **A New Sequence**

To start recovery, it is necessary to interrupt the
trigger--thought--craving--use sequence. Thought stopping provides a
tool for disrupting the process.

Thought-stopping

techniques

Trigger Thought

Continued Cravings Use

thoughts

This process is not automatic. You make a choice either to continue
thinking about using (and start on the path toward relapse) or to stop
those thoughts.

######## **Thought-Stopping Techniques**

Try the techniques described below, and use those that work best for
you:

-   **Visualization.** Imagine a scene in which you deny the power of
    thoughts of use. For example, picture a switch or a lever in your
    mind. Imagine yourself actually moving it from ON to OFF to stop the
    using thoughts. Have another picture ready to think about in place
    of those thoughts.

-   **Snapping.** Wear a rubberband loosely on your wrist. Each time you
    become aware of thoughts of using, snap the rubberband and say,
    "No!" to the thoughts as you make yourself think about another
    subject. Have a subject ready that is meaningful and interesting to
    you.

-   **Relaxation.** Feelings of hollowness, heaviness, and cramping in
    the stomach are cravings. These often can be relieved by breathing
    in deeply (filling lungs with air) and breathing out slowly. Do this
    three times. You should be able to feel the tightness leaving your
    body. Repeat this whenever the feeling returns.

-   **Call someone.** Talking to another person provides an outlet for
    your feelings and allows you to hear your thinking process. Have
    phone numbers of supportive, available people with you always, so
    you can use them when you need them.

+-----------------------------------------------------------------------+
| **ALLOWING THE THOUGHTS TO DEVELOP INTO**                             |
|                                                                       |
| **CRAVINGS IS MAKING A CHOICE TO REMAIN DEPENDENT ON SUBSTANCES.**    |
+-----------------------------------------------------------------------+

**ERS 2A---External Trigger Questionnaire**

**Place a checkmark next to activities, situations, or settings in which
you frequently used substances; place a zero next to activities,
situations, or settings in which you never have used substances.**

\_\_\_\_ **Home alone** \_\_\_\_ **Before a date** \_\_\_\_ **After
payday**

\_\_\_\_ **Home with friends** \_\_\_\_ **During a date** \_\_\_\_
**Before going out to dinner**

\_\_\_\_ **Friend's home** \_\_\_\_ **Before sexual activities**
\_\_\_\_ **Before breakfast**

\_\_\_\_ **Parties** \_\_\_\_ **During sexual activities** \_\_\_\_ **At
lunch break**

\_\_\_\_ **Sporting events** \_\_\_\_ **After sexual activities**
\_\_\_\_ **While at dinner**

\_\_\_\_ **Movies** \_\_\_\_ **Before work** \_\_\_\_ **After work**

\_\_\_\_ **Bars/clubs** \_\_\_\_ **When carrying mone**y \_\_\_\_
**After passing a particular**

\_\_\_\_ **Beach** \_\_\_\_ **After going past dealer's** **street or
exit**

\_\_\_\_ **Concerts** **residence** \_\_\_\_ **School**

\_\_\_\_ **With friends who** \_\_\_\_ **Driving** \_\_\_\_ **The park**

**use drugs** \_\_\_\_ **Liquor store** \_\_\_\_ **In the neighborhood**

\_\_\_\_ **When gaining weight** \_\_\_\_ **During work**
\_\_\_\_**Weekends**

\_\_\_\_ **Vacations/holidays** \_\_\_\_ **Talking on the phone**
\_\_\_\_**With family members**

\_\_\_\_ **When it's raining** \_\_\_\_ **Recovery groups**
\_\_\_\_**When in pain**

**List any other activities, situations, or settings where you
frequently have used.**

**List activities, situations, or settings in which you would not use.**

List people you could be with and not use.

**ERS 2B---External Trigger Chart**

Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Instructions:** List people, places, objects, or situations below
according to their degree of association with substance use.

0% 100%

Chance of Using Chance of Using

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

Never Use Almost Never Use Almost Always Use Always Use

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

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

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

These situations are "safe." These situations are low risk, These
situations are high Involvement in but caution is needed. risk. Staying
in these is these situations

extremely dangerous. is deciding

to stay addicted.

Avoid totally.

### ERS 3A---Internal Trigger Questionnaire

During recovery certain feelings or emotions often trigger the brain to
think about using substances. Read the following list of feelings and
emotions, and place a checkmark next to those that might trigger
thoughts of using for you. Place a zero next to those that are not
connected with using.

\_\_\_\_\_ **Afraid** \_\_\_\_\_ **Frustrated** \_\_\_\_\_ **Neglected**

\_\_\_\_\_ **Angry** \_\_\_\_\_ **Guilty** \_\_\_\_\_ **Nervous**

\_\_\_\_\_ **Confident** \_\_\_\_\_ **Happy** \_\_\_\_\_ **Passionate**

\_\_\_\_\_ **Criticized** \_\_\_\_\_ **Inadequate** \_\_\_\_\_
**Pressured**

\_\_\_\_\_ **Depressed** \_\_\_\_\_ **Insecure** \_\_\_\_\_ **Relaxed**

\_\_\_\_\_ **Embarrassed** \_\_\_\_\_ **Irritated** \_\_\_\_\_ **Sad**

\_\_\_\_\_ **Excited** \_\_\_\_\_ **Jealous** \_\_\_\_\_ **Bored**

\_\_\_\_\_ **Exhausted** \_\_\_\_\_ **Lonely** \_\_\_\_\_ **Envious**

\_\_\_\_\_ **Deprived** \_\_\_\_\_ **Humiliated** \_\_\_\_\_ **Anxious**

\_\_\_\_\_ **Aroused** \_\_\_\_\_ **Revengeful** \_\_\_\_\_ **Worried**

\_\_\_\_\_ **Grieving** \_\_\_\_\_ **Resentful** \_\_\_\_\_
**Overwhelmed**

\_\_\_\_\_ **Misunderstood** \_\_\_\_\_ **Paranoid** \_\_\_\_\_
**Hungry**

**What emotional states that are not listed above have triggered you to
use substances?**

Was your use in the weeks before entering treatment

\_\_\_\_\_ **Tied primarily to emotional conditions?**

\_\_\_\_\_ **Routine and automatic without much emotional triggering?**

**Were there times in the recent past when you were not using and a
specific change in your mood clearly resulted in your wanting to use
(for example, you got in a fight with someone and wanted to use in
response to getting angry)?** Yes \_\_\_\_\_ No \_\_\_\_\_

**If yes, describe:**

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

**ERS 3B---Internal Trigger Chart**

Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Instructions:** List emotional states below according to their degree
of association with substance use.

0% 100%

Chance of Using Chance of Using

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

Never Use Almost Never Use Almost Always Use Always Use

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

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

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

These emotions are "safe." These emotions are low risk, These emotions
are high Persisting in these

but caution is needed. risk. emotions is deciding to stay

addicted. Avoid them totally.

**ERS 4A---12-Step Introduction**

**Meetings**

***What Is a 12-Step Program?***

In the 1930s, Alcoholics Anonymous (AA) was founded by two men who could
not cope with their own alcoholism through psychiatry or medicine. They
found a number of specific principles helped people overcome their
alcohol dependence. They formed AA to introduce people who were
dependent on alcohol to these self-help principles. The AA concepts have
been adapted to stimulant and other drug addictions (for example,
Crystal Meth Anonymous, Narcotics Anonymous \[NA\], and Cocaine
Anonymous) and to compulsive behaviors such as gambling and overeating.

People dependent on drugs or alcohol have found that others who also are
dependent can provide enormous support and help to one another. For this
reason, these groups are called fellowships, where participants show
concern and support for one another through sharing and understanding.

***Do I Need To Attend 12-Step Meetings?***

If treatment in this program is going to work for you, it is essential
to establish a network of support for your recovery. Attending treatment
sessions without going to 12-Step meetings may produce a temporary
effect. But without involvement in self-help programs, it is very
unlikely that you will successfully recover. Clients in these programs
should attend three 12-Step meetings per week during their treatment
involvement. Many successfully abstinent people go to 90 meetings in 90
days. The more you participate in treatment and 12-Step meetings, the
greater your chance for recovery.

***Are All Meetings the Same?***

No. There are different types of meetings:

-   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 NA, the Basic
    Text.) Book study meetings often focus on someone's experience or a
    recovery-related topic.

-   Depending on where you live, there may be language-specific
    meetings, gender-specific meetings, open meetings, meetings based on
    participants' sexual orientation, and meetings for people who also
    have a mental disorder ("double trouble" Dual Recovery Anonymous
    meetings).

***Are the 12-Step Programs Religious?***

No. None of the 12-Step programs are religious, but spiritual growth is
considered a part of recovery. Spiritual choices are very personal and
individual. Each person decides for himself or herself what the term
"higher power" means. Both nonreligious and religious people can find
value and support in 12-Step programs.

***How Do I Find a Meeting?***

You can call directory assistance or check the phonebook for Alcoholics
Anonymous, Cocaine Anonymous, or Narcotics Anonymous. Listings for
Crystal Meth Anonymous meetings can be found at www.crystalmeth.org. You
can call the numbers available from the Web site and speak to someone
who can tell you when and where meetings are scheduled. At meetings,
directories are available that list meetings by city, street address,
and meeting time and include information about the meeting (for example,
speaker, step study, nonsmoking, men's, or women's). Another way to find
a good meeting is to ask someone who goes to 12-Step meetings.

**Sponsors**

The first few weeks and months of recovery are frustrating. Many things
happen that are confusing and frightening. During this difficult period,
there are many times when people in recovery need to talk about problems
and fears. A sponsor helps guide a newcomer through this process.

***What Do Sponsors Do?***

-   Sponsors help the newcomer by answering questions and explaining the
    12-Step recovery process.

-   Sponsors agree to be available to listen to their sponsorees'
    difficulties and frustrations and to share their insights and
    solutions.

-   Sponsors provide guidance and help address problems their sponsorees
    are having. This advice comes from their personal experiences with
    long-term abstinence.

-   Sponsors are people with whom addiction-related secrets and guilt
    feelings can be shared easily. They agree to keep these secrets
    confidential and to protect the newcomer's anonymity.

-   Sponsors warn their sponsorees when they get off the path of
    recovery. Sponsors often are the first people to know when their
    sponsorees experience a slip or relapse. So, sponsors often push
    their sponsorees to attend more meetings or get help for problems.

-   Sponsors help their sponsorees work through the 12 Steps.

######## **How Do I Pick a Sponsor?**

The process of choosing a sponsor is easy. The newcomer simply asks
someone to be his or her sponsor. But you need to think carefully about
whom you will ask to sponsor you. Most people select a sponsor who seems
to be living a healthy and responsible life, the kind of life a person
in recovery would want to lead. Some general guidelines for selecting a
sponsor include the following:

-   A sponsor should have several years of abstinence from all
    mood-altering drugs.

-   A sponsor should have a healthful lifestyle and not be struggling
    with major problems or addiction.

-   A sponsor should be an active and regular participant in 12-Step
    meetings. Also, a sponsor should be someone who actively "works" the
    12 Steps.

-   A sponsor should be someone to whom you can relate. You may not
    always agree with your sponsor, but you need to be able to respect
    your sponsor.

-   A sponsor should be someone you would not become romantically
    interested in.

######### **Alternatives to 12-Step Programs**

There are alternatives to 12-Step groups, many of which are not based on
the concept of a higher power. Although the philosophies of these groups
differ, most offer a mutual-help approach that focuses on personal
responsibility, personal empowerment, and strength through an abstinent
social network. Here are a few notable alternatives to 12-Step groups:

-   Women for Sobriety (www.womenforsobriety.org) helps women overcome
    alcohol dependence through emotional and spiritual growth.

-   Jewish Alcoholics, Chemically Dependent Persons and Significant
    Others (JACS) (www.jacsweb.org) helps people explore recovery in a
    nurturing Jewish environment.

-   Self-Management and Recovery Training (SMART)
    (www.smartrecovery.org) is a cognitive--behavioral group approach
    that focuses on self-reliance, problemsolving, coping strategies,
    and a balanced lifestyle.

-   Secular Organizations for Sobriety (www.secularhumanism.org)
    maintains that sobriety is a separate issue from religion or
    spirituality and credits the individual for achieving and
    maintaining sobriety.

-   Community-based spiritual fellowships, which take place in churches,
    synagogues, mosques, temples, and other spiritually focused
    meetings, often help people clarify their values and change their
    lives.

######## 

######## **Questions To Consider**

-   Have you ever been to a 12-Step meeting? If so, what was your
    experience?

-   Have you attended any other types of recovery meetings (such as
    those listed above)?

-   Do you plan to attend any 12-Step meetings? Where? When?

-   How might you make use of 12-Step meetings to stop using?

-   Are there alternatives to 12-Step meetings that you might consider
    attending?

> **ERS 4B---The Serenity Prayer and the**
>
> **12 Steps of Alcoholics Anonymous**

######## **The 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.

######## **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 that out.

12. Having had a spiritual awakening as a result of the steps, we tried
    to carry this message to alcoholics and to practice these principles
    in all our affairs.

**ERS 5---Roadmap for Recovery**

Recovery from a substance use disorder is not a mysterious process.
After the use of substances is stopped, the brain goes through a
biological readjustment. This readjustment process is essentially a
"healing" of the chemical changes that were produced in the brain by
substance use. It is important for people in the beginning stages of
recovery to understand why they may experience some physical and
emotional difficulties. The durations of the stages listed below are a
rough guide of recovery, not a schedule. The length of stages will vary
from person to person. The substance used will affect the client's
progress through the stages, too. Clients who had been using
methamphetamine will tend to spend more time in each stage than clients
who were using cocaine or other stimulants.

######### **The Stages**

***Withdrawal Stage (1 to 2 weeks)***

During the first days after substance use is stopped, some people
experience difficult symptoms. The extent of the symptoms often is
related to the amount, frequency, and type of their previous substance
use.

For people who use stimulants, withdrawal can be accompanied by drug
craving, depression, low energy, difficulty sleeping or excessive sleep,
increased appetite, and difficulty concentrating. Although people who
use stimulants do not experience the same degree of physical symptoms as
do people who use alcohol, the psychological symptoms of craving and
depression can be quite severe. Clients may have trouble coping with
stress and may be irritable.

People who drank alcohol in large amounts may have the most severe
symptoms. The symptoms can include nausea, low energy, anxiety,
shakiness, depression, intense emotions, insomnia, irritability,
difficulty concentrating, and memory problems. These symptoms typically
last 3 to 5 days but can last up to several weeks. Some people must be
hospitalized to detox safely.

For people who used opioids or prescription drugs, the 7- to 10-day
withdrawal period (or longer for people who use benzodiazepines) can be
physically uncomfortable and may require hospitalization and medication.
It is essential to have a physician closely monitor withdrawal in people
dependent on these substances. Along with the physical discomfort, many
people experience nervousness, trouble sleeping, depression, and
difficulty concentrating. Successfully completing withdrawal from these
substances is a major achievement in early recovery.

######## **Early Abstinence (4 weeks; follows Withdrawal)**

For people who used stimulants, this 4-week period is called the
Honeymoon. Most people feel quite good during this period and often feel
"cured." As a result, clients may want to drop out of treatment or stop
attending 12-Step meetings during the Honeymoon period. Early abstinence
should be used as an opportunity to establish a good foundation for
recovery. If clients can direct the energy, enthusiasm, and optimism
felt during this period into recovery activities, they can lay the
foundation for the future success.

For people who used alcohol, this 4-week period is marked by the brain's
recovery. Although the physical withdrawal symptoms have ended, clients
still are getting used to the absence of substances. Thinking may be
unclear, concentration may be poor, nervousness and anxiety may be
troubling, sleep is often irregular, and, in many ways, life feels too
intense.

For those who used opioids or prescription drugs, there is essentially a
gradual normalization during this period. In many ways the process is
similar to the alcohol recovery timetable. Slow, gradual improvement in
symptoms is evidence that the recovery is progressing.

######## **Protracted Abstinence (3.5 months; follows Early Abstinence)**

From 6 weeks to 5 months after clients stop using, they may experience a
variety of annoying and troublesome symptoms. These
symptoms---difficulties with thoughts and feelings---are caused by the
continuing healing process in the brain. This period is called the Wall.
It is important for clients to be aware that some of the feelings during
this period are the result of changes in brain chemistry. If clients
remain abstinent, the feelings will pass. The most common symptoms are
depression, irritability, difficulty concentrating, low energy, and a
general lack of enthusiasm. Clients also may experience strong cravings
during protracted abstinence. Relapse risk goes up during this period.
Clients must stay focused on remaining abstinent one day at a time.
Exercise helps tremendously during this period. For most clients,
completing this phase in recovery is a major achievement.

***Readjustment (2 months; follows Protracted Abstinence)***

After 5 months, the brain has recovered substantially. Now, the client's
main task is developing a life that has fulfilling activities that
support continued recovery. Although a difficult part of recovery is
over, hard work is needed to improve the quality of life. Because
cravings occur less often and feel less intense 6 months into recovery,
clients may be less aware of relapse risk and put themselves in
high-risk situations and increase their relapse risk.

**ERS 6A---Five Common Challenges in Early Recovery**

Everyone who attempts to stop using substances runs into situations that
make it difficult to maintain abstinence. Listed below are five of the
most common situations that are encountered during the first few weeks
of treatment. Next to these problems are some suggested alternatives for
handling these situations.

+-----------------------+----------------------------------------------+
| **Challenges**        | **New Approaches**                           |
+=======================+==============================================+
| Friends and           | -   Try to make new friends at 12-Step or    |
| associates who use:   |     mutual-help meetings.                    |
| You want to continue  |                                              |
| associations with old | -   Participate in new activities or hobbies |
| friends or friends    |     that will increase your chances of       |
| who use.              |     meeting abstinent people.                |
|                       |                                              |
|                       | -   Plan activities with abstinent friends   |
|                       |     or family members.                       |
+-----------------------+----------------------------------------------+
| Anger, irritability:  | -   Remind yourself that recovery involves a |
| Small events can      |     healing of brain chemistry. Strong,      |
| create feelings of    |     unpredictable emotions are a natural     |
| anger that seem to    |     part of recovery.                        |
| preoccupy your        |                                              |
| thoughts and can lead | -   Engage in exercise.                      |
| to relapse.           |                                              |
|                       | -   Talk to a counselor or a supportive      |
|                       |     friend.                                  |
+-----------------------+----------------------------------------------+
| Substances in the     | -   Get rid of all drugs and alcohol.        |
| home: You have        |                                              |
| decided to stop       | -   Ask others to refrain from using and     |
| using, but others in  |     drinking at home.                        |
| your house may still  |                                              |
| be using.             | -   If you continue to have a problem, think |
|                       |     about moving out for a while.            |
+-----------------------+----------------------------------------------+
| Boredom, loneliness:  | -   Put new activities in your schedule.     |
| Stopping substance    |                                              |
| use often means that  | -   Go back to activities you enjoyed before |
| activities you did    |     your addiction took over.                |
| for fun and the       |                                              |
| people with whom you  | -   Develop new friends at 12-Step or        |
| did them must be      |     mutual-help meetings.                    |
| avoided.              |                                              |
+-----------------------+----------------------------------------------+
| Special occasions:    | -   Have a plan for answering questions      |
| Parties, dinners,     |     about not using substances.              |
| business meetings,    |                                              |
| and holidays without  | -   Start your own abstinent celebrations    |
| substance use can be  |     and traditions.                          |
| difficult.            |                                              |
|                       | -   Have your own transportation to and from |
|                       |     events.                                  |
|                       |                                              |
|                       | -   Leave if you get uncomfortable or start  |
|                       |     feeling deprived.                        |
+-----------------------+----------------------------------------------+

######## **Are some of these issues likely to be problems for you in the next few weeks? Which ones?** 

**How will you handle them?**

**ERS 6B---Alcohol Arguments**

Have you been able to stop using alcohol completely? At about 6 weeks
into the recovery process, many people return to alcohol use. Has your
addicted brain played with the idea? These are some of the most common
arguments against stopping the use of alcohol and answers to the
arguments.

**I came here to stop using speed, not to stop drinking.**

Part of stopping methamphetamine use is stopping all substance use,
including alcohol use.

**I've had drinks and not used, so it doesn't make any difference.**

Drinking over time greatly increases the risk of relapse. A single drink
does not necessarily cause relapse anymore than a single cigarette
causes lung cancer. However, with continued drinking, the risks of
relapse greatly increase.

**Drinking actually helps. When I have a craving, a drink calms me down,
and the craving goes away.**

Alcohol interferes with the brain's chemical healing process. Continued
alcohol use eventually intensifies cravings, even if one drink seems to
reduce cravings.

**I'm not an alcoholic, so why do I need to stop drinking.**

If you're not an alcoholic, you should have no problem stopping alcohol
use. If you can't stop, maybe alcohol is more of a problem than you
realize.

**I'm never going to use drugs again, but I'm not sure I'll never drink
again.**

Make a 6-month commitment to total abstinence. Give yourself the chance
to make a decision about alcohol with a drug-free brain. If you reject
alcohol abstinence because "forever" scares you, then you're justifying
drinking now and risking relapse to substance use.

**Has your addicted brain presented you with other justifications? If
so, what are they?**

**How are you planning to handle alcohol use in the future?**

**ERS 7A---Thoughts, Emotions, and Behavior**

Habitual substance use changes the way people think, how they feel, and
how they behave. How do these changes affect the recovery process?

######## **Thoughts**

Thoughts happen in the rational part of the brain. They are like
pictures on the TV screen of the mind. Thoughts can be controlled. As
you become aware of your thoughts, you can learn to change channels in
your brain. Learning to turn off thoughts of substance use is a very
important part of the recovery process. It is not easy to become aware
of your thinking and to learn to control the process. With practice it
gets easier.

######## **Emotions**

Emotions are feelings. Happiness, sadness, anger, and fear are some
basic emotions. Feelings are the mind's response to things that happen
to you. Feelings cannot be controlled; they are neither good nor bad. It
is important to be aware of your feelings. Talking to family members,
friends, or a counselor can help you recognize how you feel. People
normally feel a range of emotions. Drugs can change your emotions by
changing the way your brain works. During recovery, emotions are often
still mixed up. Sometimes you feel irritated for no reason or great even
though nothing wonderful has happened. You cannot control or choose your
feelings, but you can control what you do about them.

######## **Behavior**

What you do is behavior. Work is behavior. Play is behavior. Going to
treatment is behavior, and substance use is behavior. Behavior can
result from an emotion, from a thought, or from a combination of both.
Repeated use of a substance changes your thoughts and pushes your
emotions toward substance use. This powerful, automatic process has to
be brought back under control for recovery to occur. Structuring time,
attending 12-Step or mutual-help meetings, and engaging in new
activities are all ways of regaining control. The goal in recovery is to
learn to combine your thinking and feeling self and behave in ways that
are best for you and your life.

**ERS 7B---Addictive Behavior**

People who abuse substances often feel that their lives are out of
control. Maintaining control becomes harder and harder the longer they
have been abusing substances. People do desperate things to continue to
appear normal. These desperate behaviors are called addictive
behaviors---behaviors related to substance use. Sometimes these
addictive behaviors occur only when people are using or moving toward
using. Recognize when you begin to engage in these behaviors. That's
when you know to start fighting extra hard to move away from relapse.

**Which of these behaviors do you think are related to your drug or
alcohol use?**

**Lying**

**Stealing**

**Being irresponsible (for example, not meeting family or work
commitments)**

**Being unreliable (for example, being late for appointments, breaking
promises)**

**Being careless about health and grooming (for example, wearing "using"
clothes, avoiding exercise, eating poorly, having a messy appearance)**

**Getting sloppy in housekeeping**

**Behaving impulsively (without thinking)**

**Behaving compulsively (for example, too much eating, working, sex)**

**Changing work habits (for example, working more, less, not at all, new
job, change in hours)**

**Losing interest in things (for example, recreational activities,
family life)**

**Isolating (staying by yourself much of the time)**

**Missing or being late for treatment**

**Using other drugs or alcohol**

**Stopping prescribed medication (for example, disulfiram, naltrexone)**

**ERS 8---12-Step Sayings**

The program of Alcoholics Anonymous has developed some short sayings
that help people in their day-to-day efforts at staying sober. These
concepts are often useful tools in learning how to establish sobriety.

######## **One day at a time**

This is a key concept in staying abstinent. Don't obsess about staying
abstinent forever. Just focus on today.

######## **Turn it over**

Sometimes people with addictions jeopardize their recovery by tackling
problems that cannot be solved. Finding a way to let go of issues so
that you can focus on staying abstinent is a very important skill.

######## **Keep it simple**

Learning to stay abstinent can get complicated and seem overwhelming if
you let it. In fact, there are some simple concepts involved. Don't make
this process difficult: keep it simple.

######## **Take what you need and leave the rest** 

Not everyone benefits from every part of 12-Step meetings. It is not a
perfect program. However, if you focus on the parts you find useful,
rather than the ones that bother you, the program has something for you.

######## **Bring your body, the mind will follow** 

The most important aspect of 12-Step programs is attending the meetings.
It takes a while to feel completely comfortable. Try different meetings,
try to meet people, and read the materials. Just go and keep going.

**HALT**

This acronym is familiar to people in the 12-Step programs. It is a
shorthand way of reminding people in recovery that they are especially
vulnerable to relapse when they are too hungry, angry, lonely, or tired.

-   **H**ungry: When people are using, they often ignore their
    nutritional needs. People in recovery need to relearn the importance
    of eating regularly. Being hungry can cause changes in body
    chemistry that make people less able to control themselves or avoid
    cravings. Often the person feels anxious and upset but doesn't
    associate the feelings with hunger. Eating regularly increases
    emotional stability.

-   **A**ngry: This emotional state is probably the most common cause of
    relapse to drug use. Learning to cope with anger in a healthy way is
    difficult for many people. It is not healthy to act in anger without
    thinking about the consequences. Nor is it healthy to hold anger in
    and try to pretend it doesn't exist. Talking about anger-producing
    situations and how to handle them is an important part of recovery.

-   **L**onely: Recovery is often a lonely process. People lose
    relationships because of their substance use. As part of staying
    abstinent, people in recovery may have to give up friends who still
    use. The feelings of loneliness are real and painful. They make
    people more vulnerable to relapse.

-   **T**ired: Sleep disorders are often a part of early recovery.
    People in recovery frequently have to give up chemical aids to sleep
    that they used in the past. Being tired is often a trigger for
    relapse. Feeling exhausted and low on energy leaves people
    vulnerable and unable to function in a healthy way.

######## **How often do you find yourself in one or more of these emotional states?**

**What could you do differently to avoid being so vulnerable?**

**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[^2]

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 islands that you used to use as rewards. What are some possible islands for you 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.

[^2]: 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.