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; Pamela Frazier, Document Production Specialist; and Claire Speights, Graphic Artist.

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
iii

Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Individual/Conjoint Session Handouts

IC 1—Sample Service Agreement and Consent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

IC 2A—Recovery Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

IC 2B—Relapse Analysis Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

IC 3A—Treatment Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

IC 3B—Continuing Treatment Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Early Recovery Skills Handouts

SCH 1—The Importance of Scheduling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

SCH 2—Daily/Hourly Schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

CAL 1—Marking Progress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

CAL 2—Calendar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

ERS 1A—Triggers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

ERS 1B—Trigger–Thought–Craving–Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

ERS 1C—Thought-Stopping Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

ERS 2A—External Trigger Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

ERS 2B—External Trigger Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

ERS 3A—Internal Trigger Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

ERS 3B—Internal Trigger Chart. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

ERS 4A—12-Step Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

ERS 4B—The Serenity Prayer and the 12 Steps of Alcoholics Anonymous . . . . . . . . . . . . . . 28

ERS 5—Roadmap for Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

ERS 6A—Five Common Challenges in Early Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

ERS 6B—Alcohol Arguments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

ERS 7A—Thoughts, Emotions, and Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

ERS 7B—Addictive Behavior. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

ERS 8—12-Step Sayings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Relapse Prevention Handouts

RP 1—Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

RP 2—Boredom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
iv

Client’s Handbook: Matrix Intensive Outpatient Treatment

RP 3A—Avoiding Relapse Drift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

RP 3B—Mooring Lines Recovery Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

RP 4—Work and Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

RP 5—Guilt and Shame. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

RP 6—Staying Busy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

RP 7—Motivation for Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

RP 8—Truthfulness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

RP 9—Total Abstinence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

RP 10—Sex and Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

RP 11—Anticipating and Preventing Relapse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

RP 12—Trust . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

RP 13—Be Smart, Not Strong . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

RP 14—Defining Spirituality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

RP 15—Managing Life; Managing Money . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

RP 16—Relapse Justification I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

RP 17—Taking Care of Yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

RP 18—Emotional Triggers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

RP 19—Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

RP 20—Recognizing Stress. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

RP 21—Relapse Justification II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

RP 22—Reducing Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

RP 23—Managing Anger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

RP 24—Acceptance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

RP 25—Making New Friends. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

RP 26—Repairing Relationships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

RP 27—Serenity Prayer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

RP 28—Compulsive Behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

RP 29—Coping With Feelings and Depression. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

RP 30—12-Step Programs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

RP 31—Looking Forward; Managing Downtime . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

RP 32—One Day at a Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

RP 33—Drug Dreams During Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100

RP Elective A—Client Status Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

RP Elective B—Holidays and Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

RP Elective C—Recreational Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
1

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: 
2

Client’s Handbook: Matrix Intensive Outpatient Treatment

l Attend every group session.

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

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

l Be supportive of other clients. If you disagree with someone, be polite

when you speak to him or her. Do not attack people personally.

l 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.

l Think about what you read and about what the counselor and other

clients say.

l Ask questions when you do not understand something.

l Participate in group discussions.

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

l Be honest.

l After the session is over, think about what you learned and try to apply 

it to your recovery.

l 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.)
3

[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.

IC 1 Sample Service Agreement

and Consent

1 of 2
4

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.

IC 1 Sample Service Agreement

and Consent

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: _____________

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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

5

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:

IC 2A Recovery Checklist

c Schedule activities daily

c Visit physician for checkup

c Destroy all drug paraphernalia

c Avoid people who use alcohol

c Avoid people who use drugs

c Avoid bars and clubs

c Stop using alcohol

c Stop using all drugs

c Pay financial obligations promptly

c Identify addictive behaviors

c Avoid triggers (when possible)

c Use thought stopping for cravings

c Attend Individual/Conjoint sessions

c Attend Early Recovery Skills and 

Relapse Prevention sessions

c Attend 12-Step or mutual-help meetings

c Get a sponsor

c Exercise daily

c Discuss thoughts, feelings, and behaviors honestly with your counselor
6 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 andinterrupt the relapse. Using the chart below, note events that occurred during the week immediatelybefore the relapse.

IC 2B Relapse Analysis Chart Career Events Personal Events Treatment Events Drug- Related Behaviors Behavioral Patterns Relapse Thoughts Health Status Feelings about the above events
7

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

1 of 2

IC 3A Treatment Evaluation Subject Where are you now? Where would you like to be? What steps do you need to take? When? Family Work/Career Friendships Financial, Legal

Obligations
8 2 of 2

IC 3A Treatment Evaluation Subject Where are you now? Where would you like to be? What steps do you need to take? When? Education Exercise Leisure Activities 12-Step or Mutual-Help Meetings ___________________________________ _________ _________________________________ ________ Client’s Signature Date Counselor’s Signature Date
9

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.

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IC 3B Continuing

Treatment Plan
10

My plan for the months following treatment is:

2 of 2

IC 3B Continuing

Treatment Plan

__________________________________________________________ _____________

Client’s Signature Date

__________________________________________________________ _____________

Counselor’s Signature Date
11

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.

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. 

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. 

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. 

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 1 The Importance

of Scheduling
12

SCH 2 Daily/Hourly Schedule

7:00 AM

8:00 AM

9:00 AM

10:00 AM

11:00 AM

12:00 PM

1:00 PM

2:00 PM

3:00 PM

4:00 PM

5:00 PM

6:00 PM

7:00 PM

8:00 PM

9:00 PM

10:00 PM

11:00 PM

How many hours will you sleep? _____

From _______ To _______ 

Notes:

Reminders:

Date:
13

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:

l It’s a reminder of how far you’ve come in your recovery. 

l A feeling of pride often results from seeing the number of days you

have been abstinent.

l 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 1 Marking Progress
14

CAL 2 Calendar

Month:

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY
15

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

l Friday night l After work l Money

l Friends who use l 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 1A Triggers

Trigger

Thought

Craving

Use
16

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 1B Trigger–Thought–Craving–Use
17

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. 

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. 

1 of 2

ERS 1C Thought-Stopping

Techniques

ThoughtStopping

Techniques

Trigger Thought

Cravings Continued

Thoughts Use
18

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.

2 of 2

ERS 1C

ALLOWING THE THOUGHTS TO

DEVELOP INTO CRAVINGS IS 

MAKING A CHOICE TO REMAIN

DEPENDENT ON SUBSTANCES.

Thought-Stopping

Techniques
19

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.

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.

c Home alone

c Home with friends

c Friend’s home

c Parties

c Sporting events

c Movies

c Bars/clubs

c Beach

c Concerts

c With friends who 

use drugs

c When gaining weight

c Vacations/holidays

c When it’s raining

c Before a date

c During a date

c Before sexual activities

c During sexual activities

c After sexual activities

c Before work

c When carrying money

c After going past 

dealer’s residence

c Driving

c Liquor store

c During work

c Talking on the phone

c Recovery groups

c After payday

c Before going out to 

dinner

c Before breakfast

c At lunch break

c While at dinner

c After work

c After passing a 

particular street or exit

c School

c The park

c In the neighborhood

c Weekends

c With family members

c When in pain

ERS 2A External Trigger

Questionnaire
Never Use

These situations

are “safe.”

Almost Never Use

These situations

are low risk, but

caution is needed.

Almost Always Use

These situations

are high risk.

Staying in these 

situations is

extremely 

dangerous. 

Always Use

Involvement in

these situations is

deciding to stay

addicted. Avoid

totally.

20

Name: __________________________ Date:_________

Instructions: List people, places, objects, or situations below 

according to their degree of association with substance use. 

ERS 2B External Trigger Chart

0% 100%

Chance of Using Chance of Using
21

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.

c Afraid

c Frustrated

c Neglected

c Angry

c Guilty

c Nervous

c Confident

c Happy

c Passionate

c Criticized

c Inadequate

c Pressured

c Depressed

c Insecure

c Relaxed

c Embarrassed

c Irritated

c Sad

c Excited

c Jealous

c Bored

c Exhausted

c Lonely

c Envious

c Deprived

c Humiliated

c Anxious

c Aroused

c Revengeful

c Worried

c Grieving

c Resentful

c Overwhelmed

c Misunderstood

c Paranoid

c 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 3A Internal Trigger

Questionnaire
22

Name: __________________________ Date:_________

Instructions: List emotional states below according to their degree

of association with substance use.

ERS 3B Internal Trigger Chart

Never Use

These emotions are

“safe.”

Almost Never Use

These emotions are

low risk, but caution

is needed.

Almost Always Use

These emotions are

high risk. 

Always Use

Persisting in 

these emotions is

deciding to stay

addicted. Avoid

totally.

0% 100%

Chance of Using Chance of Using
23

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: 

l Speaker meetings feature a person in recovery telling his or her

story of drug and alcohol use and recovery.

1 of 5

ERS 4A 12-Step

Introduction
24

l 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.

l Step/Tradition meetings are special meetings where the 12 Steps

and 12 Traditions are discussed. 

l 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.

l 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,

2 of 5

ERS 4A 12-Step

Introduction
25

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?

l Sponsors help the newcomer by answering questions and 

explaining the 12-Step recovery process.

l Sponsors agree to be available to listen to their sponsorees’ 

difficulties and frustrations and to share their insights and solutions.

l Sponsors provide guidance and help address problems their 

sponsorees are having. This advice comes from their personal

experiences with long-term abstinence.

l 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.

l 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.

l Sponsors help their sponsorees work through the 12 Steps.

3 of 5

ERS 4A 12-Step

Introduction
26

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:

l A sponsor should have several years of abstinence from all 

mood-altering drugs.

l A sponsor should have a healthful lifestyle and not be struggling

with major problems or addiction.

l 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.

l 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.

l 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:

4 of 5

ERS 4A 12-Step

Introduction
27

l Women for Sobriety (www.womenforsobriety.org)

helps women overcome alcohol dependence

through emotional and spiritual growth.

l Jewish Alcoholics, Chemically Dependent Persons and Significant

Others (JACS) (www.jacsweb.org) helps people explore recovery in

a nurturing Jewish environment.

l 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.

l 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.

l Community-based spiritual fellowships, which take place in churches,

synagogues, mosques, temples, and other spiritually focused settings,

often help people clarify their values and change their lives. 

Questions To Consider

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

experience?

l Have you attended any other types of recovery meetings (such as

those listed above)?

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

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

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

attending?

5 of 5

ERS 4A 12-Step

Introduction
28

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 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*

*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.
29

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.

1 of 3

ERS 5 Roadmap for

Recovery
30

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

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.

2 of 3

ERS 5 Roadmap for

Recovery
31

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.

3 of 3

ERS 5 Roadmap for

Recovery
32 1 of 2

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.

ERS 6A Five Common Challenges

in Early Recovery

Challenges New Approaches

Friends and

associates

who use: You want to

continue associations

with old friends or

friends who use.

Anger, 

irritability:

Small events can create feelings of anger

that seem to preoccupy your thoughts and

can lead to relapse.

Substances

in the home:

You have decided to

stop using, but others

in your house may still

be using. 

l Try to make new friends at 12-Step or mutual-help

meetings.

l Participate in new activities or hobbies that will

increase your chances of meeting abstinent people.

l Plan activities with abstinent friends or family members.

l Remind yourself that recovery involves a healing of

brain chemistry. Strong, unpredictable emotions are

a natural part of recovery.

l Engage in exercise.

l Talk to a counselor or a supportive friend.

l Get rid of all drugs and alcohol.

l Ask others to refrain from using and drinking at home.

l If you continue to have a problem, think about 

moving out for a while.
2 of 2 33

ERS 6A

Challenges New Approaches

Boredom, 

loneliness:

Stopping substance use

often means that activities

you did for fun and the

people with whom you did

them must be avoided.

l Put new activities in your schedule.

l Go back to activities you enjoyed before your 

addiction took over.

l Develop new friends at 12-Step or mutual-help

meetings.

l Have a plan for answering questions about not

using substances.

l Start your own abstinent celebrations and traditions.

l Have your own transportation to and from events.

l 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?

Special 

occasions:

Parties, dinners, business

meetings, and holidays

without substance use

can be difficult.

Five Common Challenges

in Early Recovery
34

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 6B Alcohol Arguments
35

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 7A Thoughts, Emotions, and

Behavior
36

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?

c Lying 

c Stealing

c Being irresponsible (for example, not meeting family or work 

commitments)

c Being unreliable (for example,

being late for appointments,

breaking promises)

c Being careless about health and

grooming (for example, wearing

“using” clothes, avoiding exercise, eating poorly, having a

messy appearance)

c Getting sloppy in housekeeping 

c Behaving impulsively (without

thinking)

c Behaving compulsively (for

example, too much eating,

working, sex)

c Changing work habits (for example, working more, less, not at

all, new job, change in hours)

c Losing interest in things (for

example, recreational activities,

family life)

c Isolating (staying by yourself

much of the time)

c Missing or being late for 

treatment

c Using other drugs or alcohol

c Stopping prescribed medication (for example, disulfiram,

naltrexone)

ERS 7B Addictive Behavior
37

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.

Hungry: 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.

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ERS 8 12-Step Sayings
38

Angry: 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.

Lonely: 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.

Tired: 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?

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ERS 8 12-Step Sayings
39

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?

1 of 2

RP 1 Alcohol
40

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.

2 of 2

RP 1 Alcohol
41

Often people who stop using drugs say life feels boring. Some reasons for this feeling

include the following:

l A structured, routine life feels different from a lifestyle built around

substance use.

l Brain chemical changes during recovery can make people feel 

listless (or bored).

l 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?

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RP 2 Boredom
42

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: 

l Recognize that a structured, routine life feels different from a

lifestyle built around substance use.

l Make sure you are scheduling activities. Forcing yourself to write

down daily activities helps you fit in more interesting experiences.

l 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.

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RP 2 Boredom
43

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:

l Identify four or five specific things that now are helping you stay

abstinent (for example, working out for 20 minutes, 3 times a week).

l Include items such as exercise, therapist and group appointments,

scheduling activities, 12-Step meetings, eating patterns.

l Do not list attitudes. They are not as easy to measure as behaviors.

l Note specific people or places that are known triggers and need to

be avoided during recovery.

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RP 3A Avoiding Relapse Drift
44

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.)

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RP 3A Avoiding Relapse Drift
45

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.

RP 3B Mooring Lines Recovery

Chart

Mooring Line Behaviors Date Date Date Date Date

I Am Avoiding Date Date Date Date Date
46

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:

l People in recovery go through big changes. Sometimes they

change their views on personal situations.

l 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

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RP 4 Work and

Recovery
47

l Situations where it is necessary to be with other people who are

drinking or using

l 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:

l Looking for work is often the first priority.

l Abundant free time is difficult to fill, and the structure

that makes outpatient treatment effective is lacking.

l 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.

2 of 2

RP 4 Work and Recovery
48

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:

l It’s all right to make mistakes.

l It’s all right to say, “I don’t know,” “I don’t care,” or “I don’t 

understand.”

l 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 ___

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RP 5 Guilt and Shame
49

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 

substance use? Yes ___ No ___

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

l Trying to use willpower l Trying to be good

l Trying to be strong

Two things to make recovery work are

l Being smart l 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.

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RP 5 Guilt and Shame
50

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?

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RP 6 Staying Busy
51

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?

2 of 2

RP 6 Staying Busy
52

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:

l I was arrested, and it’s either this or jail.

l My wife says if I don’t stop, we are finished.

l Last time I used I thought I was going to die; I know I’ll die if 

I use again.

l They are going to take the children from us unless we stop.

l 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.

1 of 2

RP 7 Motivation for Recovery

FEAR WILL GET PEOPLE INTO TREATMENT,

BUT FEAR ALONE IS NOT ENOUGH

TO KEEP THEM IN RECOVERY.
53

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?

2 of 2 

RP 7 Motivation for Recovery
54

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:

l You may not seem to be a nice person.

l Your counselor or group members may be unhappy with 

your behavior.

l You may be embarrassed.

l Other people’s feelings may be hurt.

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RP 8 Truthfulness
55

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 ___

2 of 2

RP 8 Truthfulness

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.
56

Have you ever found yourself saying any of the following?

l My problem is my meth use. Alcohol (or marijuana) is not a problem

for me.

l Having a beer or glass of wine is not really drinking.

l I drink only when I choose to. My drinking is not out of control.

l 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:

l 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.

l Places and people associated with drinking often are the very

places and people who are triggers for substance use.

l 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 9 Total Abstinence
57

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 10 Sex and Recovery
58

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. 

1 of 3

RP 11 Anticipating and

Preventing Relapse
59

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:

l I can handle just one drink. 

l If they think I’m using, I might as well. 

l I have worked hard. I need a break.

How have you tried to find excuses to use substances?

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RP 11 Anticipating and 

Preventing Relapse
60

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?

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RP 11 Anticipating and

Preventing Relapse

c Calling a counselor

c Calling a friend

c Taking a day off

c Talking to your family

c

Going to a 12-Step or outside

mutual-help support meeting

c Exercising

c Talking to your spouse

c Scheduling time more rigorously

c Other: _________________________

_______________________________

_______________________________
61

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. 

How do you cope with suspicions about drug use?

What can you do to help the process of reestablishing trust?

RP 12 Trust
62

“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.

How smart are you being? Rate how well you are doing in avoiding relapse.

(Circle the appropriate number.)

Poor Fair Good Excellent

1. Practicing thought stopping 1 2 3 4

2. Scheduling 1 2 3 4

3. Keeping appointments 1 2 3 4

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RP 13 Be Smart, Not Strong

DON’T COUNT ON BEING STRONG. BE SMART.
63

Poor Fair Good Excellent

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?

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RP 13 Be Smart, Not Strong
64

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?

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RP 14 Defining Spirituality
65

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 mutualhelp programs provide one way to gain or regain a love of oneself and of life.

2 of 2

RP 14 Defining Spirituality
66

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:

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RP 15 Managing Life; Managing

Money
67

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:

What are your other financial goals? 

2 of 2

RP 15 Managing Life; Managing

Money

l Arrange to pay off large debts

in small, regular payments.

l Budget your money carefully,

as you schedule your time.

l Arrange spending agreements with anyone who

shares your finances.

l Use bank accounts to help

you manage your money.

l Live within your means.

l Make a savings plan.
68

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?

l An old friend called, and we decided to get together.

l I had friends come for dinner, and they brought me

some wine.

l I was in a bar, and someone offered me a beer.

l 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?

l My spouse left me. There’s no reason to stay clean.

l I just got injured. It’s ruined all of my plans. I might as well use.

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RP 16 Relapse Justification I
69

l I just lost my job. Why not use?

l There was a death in the family. I can’t get through this without using.

l Other: 

For a Specific Purpose

Has your addicted brain ever suggested that using drugs or alcohol is the

only way to accomplish something?

l I’m gaining weight and need stimulants to control my weight.

l I’m out of energy. I’ll function better if I use.

l I need drugs to meet people more easily.

l I can’t enjoy sex without using.

l Other: 

Depression, Anger, Loneliness, and Fear

Does feeling depressed, angry, lonely, or afraid make using seem like 

the answer? 

l I’m depressed. What difference does it make whether I use?

l When I get mad enough, I can’t control what I do.

l I’m scared. I know if I use, the feeling will go away.

l If my partner thinks I’ve used, I might as well use.

l Other: 

What might you do when your addicted brain suggests these excuses to

use? 

2 of 2

RP 16 Relapse Justification I
70

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:

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 17 Taking Care of

Yourself

l Have you seen a doctor for a

checkup?

l When was the last time you

went to the dentist?

l Have you considered getting

a new look?

l Are you paying attention to

what you are eating?

l Do you wear the same

clothes you wore when you

were using?

l Do you need to have your

vision or hearing checked?

l Do you exercise regularly?

l Is your caffeine or nicotine

intake out of control?
71

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 substanceusing 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?

1 of 2

RP 18 Emotional Triggers

Trigger

Thought

Craving

Use
72

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. 

2 of 2

RP 18 Emotional Triggers
73

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:

l Missing treatment sessions

l Missing mutual-help meetings

l Not exercising

The following relapse risks also can act as triggers when you’re sick: 

l Spending a lot of time alone

1 of 2

RP 19 Illness
74

l Recovering in bed (which reminds some people of recovering from using)

l 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:

l Exercise regularly (even when you feel as if you’re

getting sick, light exercise can be good for you).

l Eat healthful meals.

l Get adequate sleep.

l 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.

2 of 2

RP 19 Illness
75

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:

c

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)

c Headaches c Irritability

c Stomach problems c Difficulty concentrating

c Chronic illness c General dissatisfaction with life

c Fatigue c Feeling overwhelmed

c Moodiness 

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 20 Recognizing Stress
76

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?

l I’m back in control. I’ll be able to stop when I want to.

l I’ve learned my lesson. I’ll only use small amounts and only once

in a while.

l This substance was not my problem—stimulants were. So I can

use this and not relapse.

l Other: 

1 of 2

RP 21 Relapse Justification II
77

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?

l I’m strong enough to be around it now.

l I want to see whether I can say “No” to drinking and using.

l I want to see whether I can be around my old friends.

l I want to see how the high feels now that I’ve stopped using.

l 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?

l I’m feeling really good. One time won’t hurt.

l I’m on vacation. I’ll go back to not using when I get home.

l I’m doing so well. Things are going great. I owe myself a reward.

l This is such a special event that I want to celebrate.

l Other: 

What might you do when confronted with these excuses to use? 

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RP 21 Relapse Justification II
78

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?

1 of 2

RP 22 Reducing Stress
79

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?

2 of 2

RP 22 Reducing Stress
80

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? 

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?

l Talk to the person you are angry with.

l Talk to a counselor, a 12-Step sponsor, or another person who

can give you guidance.

l Talk about the anger in an outside support group meeting.

l Write about your feelings of anger.

l Exercise.

l Other: 

RP 23 Managing Anger

l Why do I get all the bad

breaks? 

l How come she doesn’t

understand my needs? 

l Why won’t he just do what I

want him to do? 
81

“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.

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 24 Acceptance

YOU DO NOT NEED TO “HIT BOTTOM” TO BEGIN RECOVERY.
82

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 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
83

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 26 Repairing

Relationships
84

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 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.
85

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?

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.

1 of 3

RP 28 Compulsive Behaviors

l Working all the time

l Abusing prescription 

medications

l Using illicit drugs other than the

one you entered treatment for

l Drinking a lot of caffeinated

sodas or coffee

l Smoking

l Eating foods high in sugar

l Exercising to the extreme

l Masturbating compulsively

l Gambling

l Spending too much money

l Other: 
86

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, highrisk 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: 

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RP 28 Compulsive Behaviors
87

l Prevent exposure to triggers. Stay away from people, places,

and activities that you associate with drug use.

l 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:

í Relaxation—Take three slow, deep breaths. 

í 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.

í Visualization—Imagine an ON/OFF switch in your head. Turn it

to OFF to stop the triggering thoughts. 

l 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.

l 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 mutualhelp 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?

3 of 3

RP 28 Compulsive Behaviors
88

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.

1 of 3

RP 29 Coping With Feelings

and Depression
89

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:

2 of 3

RP 29 Coping With Feelings

and Depression

c Low energy

c Overeating or not eating

c Sad thoughts

c Losing interest in career or 

hobbies

c Sleeping more than usual

c Decreased sex drive

c Increased thoughts of drinking

c Insomnia

c Stopping attendance at 12-Step

or mutual-help meetings

c Stopping exercise program

c Avoiding social activities

c Feelings of boredom, irritability,

or anger

c Crying spells

c Suicidal thoughts or actions

c Stopping normal

activities such as

work, cleaning

house, buying 

groceries
90

What other signs indicate depression?

Responses to depression include the following:

l Increase exercise. l Talk to a spouse.

l Plan some new activities. l Talk to a friend.

l Consult a doctor; medication l Talk to a counselor.

may help.

Do you have any other ways of coping effectively with depression?

3 of 3

RP 29 Coping With Feelings

and Depression
91

What Is AA?

Alcoholics Anonymous (AA) is a worldwide organization. It has been in existence since

the 1930s. It was started by two men who could not recover from their alcoholism with

psychiatry or medicine. AA holds free, open meetings to help people who want to stop

being controlled by their need for alcohol. Meetings are available throughout the day

and evening, 7 days a week. The principles of AA have been adapted to help people

who are dependent on drugs or who have other compulsive disorders, such as gambling or overeating.

Are These Meetings Like Treatment?

No. They are groups of people in recovery helping one another stay abstinent.

Does a Person Need To Enroll or Make an Appointment?

No, just show up. Times and locations of meetings are available through this treatment

program or by calling AA directly.

What Are the 12 Steps?

The basis of groups such as AA is the 12 Steps. These beliefs and activities provide a

structured program for abstinence. There is a strong spiritual aspect to both the 12

Steps and AA.

The 12 Steps of Alcoholics Anonymous*

1. 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.

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RP 30 12-Step Programs

* 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.
92

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:

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RP 30 12-Step Programs
93

l Cocaine Anonymous (CA): www.ca.org

l Narcotics Anonymous (NA): www.na.org

l Marijuana Anonymous (MA): www.marijuana-anonymous.org

l Pills Anonymous (PA): groups.msn.com/PillsAnonymous

l Gamblers Anonymous (GA): www.gamblersanonymous.org

l Overeaters Anonymous (OA): www.oa.org

l 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:

l Al-Anon and Alateen: www.al-anon.alateen.org

l Nar-Anon: www.naranon.com

l Adult Children of Alcoholics (ACoA): www.adultchildren.org

l 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 

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RP 30 12-Step Programs
94

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?

l A safe place to go during recovery

l A place to meet other people who don’t use drugs and alcohol

l A spiritual component to recovery

l Emotional support

l Exposure to people who have achieved long-term abstinence

l 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.

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RP 30 12-Step Programs
95

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:

l Many people feel particularly bored and tired 2 to 4 months into

recovery (during the period known as the Wall).

l The recovery process the body is going through may prevent you

from feeling strong emotions of any kind. 

l 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

l Going out of town for a 3-day weekend

l Taking a day off work

l Going to a play or a concert

l Attending a sporting event

l Visiting relatives

l Going out to eat

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RP 31 Looking Forward;

Managing Downtime
96

l Visiting an old friend

l Having a special date with your partner

Plan these little rewards often enough so that you don’t get too 

stressed, tired, or bored in between them.

List some islands that you used What are some possible islands 

to use as rewards. ______________ 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.

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RP 31 Looking Forward;

Managing Downtime
97

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?

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?

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RP 31 Looking Forward;

Managing Downtime

c Walking

c Reading

c Meditating or doing

yoga

c Listening to music

c Playing with a pet

c Becoming active in a

church

c Talking with a friend

who does not use

c Taking a class

c Playing team sports

c Bicycling

c Painting, drawing

c Exercising at the gym

c Cooking

c

Going to 12-Step 

or mutual-help 

meetings 

c Going to the movies

c Writing

c Knitting

c Fishing

c Scrapbooking

c Window shopping

c Playing a musical

instrument
98

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

l “I can never do anything right. I always mess up every opportunity.”

l “If I try to do something difficult, I will fail. I always do.”

l “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

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RP 32 One Day at a Time
99

l “Tomorrow something will happen to ruin this.”

l “That person is going to hate me for this.”

l “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?

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RP 32
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: 

l Exercise

l Go to a 12-Step or mutual-help meeting

l Call a counselor

l Talk to friends

l Take a break from your normal routine

l Other:

RP 33 Drug Dreams During

Recovery

100
101

Name: _________________________________________________ Date: __________ Rate how satisfied you are with the following areas of your life by placing a checkmark in the appropriate boxes.

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VeryDissatisfied

SomewhatDissatisfied Neutral

SomewhatSatisfied

VerySatisfied

CareerFriends

Family

Romantic Relationships

Drug Use/Cravings

Alcohol Use/Cravings

Self-Esteem

Physical HealthPsychological Well-BeingSexual Fullfillment

Spiritual Well-Being

RP Elective A Client Status Review
102

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?

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RP Elective A Client Status Review
103

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:

c More alcohol and drugs at parties

c Shortage of money because of travel or gift buying

c More stress caused by hectic pace (for example, traffic, crowds)

c Normal routine of life interrupted

c Stopping exercise

c Not going to AA meetings

c Not going to therapy 

c Party atmosphere

c More contact with family

c Increased emotions from holiday memories

c Increased anxiety regarding triggers and craving

c Frustration of not having time to meet responsibilities

c Coping with “New Year’s Eve” type occasions

c Extra free time with no structure

c Other:________________________________________________

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RP Elective B Holidays and Recovery
104

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.

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RP Elective B Holidays and Recovery

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.

NO ONE HAS

TO RELAPSE!
105

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.

RP Elective C Recreational

Activities