Counselor’s Treatment

Manual

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
 V. Relapse Prevention Group
for discussion by the group for 45 minutes.
Introduction Over the first hour of the meeting, the counselor
Goals of Relapse Prevention Group ensures that all the important aspects of the
topic are covered and that premature digres-
 Allow clients to interact with other people
sions from the main topic are avoided. Clients
in recovery.
with concerns or questions unrelated to the
 Alert clients to the pitfalls of recovery and topic can be assured that the final 30 minutes
precursors of relapse. of the group meeting will be devoted to issues
that individual clients are struggling with. The
 Give clients the strategies and tools to
counselor wraps up the discussion period with
use in sustaining their recovery.
a reiteration of the session topic and the impor-
 Allow group members to benefit from the tant issues relevant to it.
long-term sobriety experience of the
recovering co-leader. Open Discussion
 Allow the counselor to witness the person- During the last 30 minutes of each group ses-
al interactions of clients. sion, the counselor asks clients whether they
have had any recent problems or whether they
 Allow clients to benefit from participating wish to bring up any matters. Individual clients,
in a long-term group experience. particularly those who have been having prob-
lems or those who have not participated in the
Session Format and Counseling group session, should be encouraged to partici-
Approach pate. General questions that usually evoke a
response include the following:
New Member Introductions
Each 90-minute Relapse Prevention (RP) group  How are things going?
meeting begins with new members introducing
themselves and giving a brief description of  Are there any new developments with the
their substance use history. This description problem you brought up last time?
should not be detailed or graphic, nor should  Have you had any cravings?
it be a litany of “war stories.” New members
provide basic information such as type of sub-  If so, how did you handle them?
stances used and their reasons for entering  How are you planning to stay abstinent
treatment. Clients who ramble or provide this week?
unnecessary substance use details should be
prompted gently to finish their introduction. End of Session
The counselor ties up loose ends, summarizes
Topic Presentation and Discussion the discussion, and acknowledges any unre-
Following the introductions and during the solved issues. Discussion of these issues can be
first 15 minutes of the session, the counselor carried over to the next meeting. The counselor
presents a specific topic in a casual, didactic can ask clients who during the session men-
manner. The counselor then opens up the topic tioned cravings or who appear troubled, angry, or

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Counselor’s Treatment Manual: Matrix Intensive Outpatient Treatment

depressed to stay afterward to talk briefly and to Balancing Group Cohesion With Excessive
schedule them for individual sessions as soon as Interdependence
possible. All sessions should end on a positive Along with 12-Step or other mutual-help meetings,
note and with a reminder that what is said in the RP group is the most consistent element of
group stays in group and a commitment by Matrix treatment. Each of the initial 16 weeks of
clients to attend the next RP group meeting. treatment features an RP group meeting on
Monday and Friday. The frequency and intensity
Special Considerations of these group meetings foster interdependence
Clients who are quiet and uncommunicative among clients. The resulting bonding and cohe-
may be concealing issues that should be elicited sion can support and motivate clients and help
and discussed. sustain treatment involvement. However, bal-
ancing clients’ responsibility to their fellow group
The group provides an opportunity for clients to members with the need to take charge of their
solicit input from and give encouragement to own recovery can be tricky. The counselor
other group members. The counselor should needs to ensure that clients gain support and
ask for comments from all clients on the issue encouragement from the group without develop-
being discussed, especially if particular group ing exclusive dependence on the group for their
members have coped with the issue. For abstinence and recovery. Each client should
example, clients who have moved beyond the view recovery as a personal achievement that
protracted abstinence period could be asked to has been supported and encouraged by other
describe how they handled problems they group members. If several group members
encountered during that time. The counselor experience relapse, the independence of each
should not, however, relinquish control of the client’s personal recovery can help prevent
group or promote directionless crosstalk about relapse contagion, in which relapse seems to
how each person feels about what the others spread from member to member of a group like
have said. The counselor must maintain the an infectious disease.
group’s focus and direction and be ready to redi-
rect discussions that are moving into redundan- The camaraderie and cohesion of an RP group
cy, irrelevance, inappropriateness, or volatility. are extremely valuable to the treatment
process. However, clients should be cautioned
The recovering co-leader can be a positive role against treatment program romances and out-
model, reinforce suggestions, and share advice side involvement with other group members
from experiences. Rather than lecture or talk (e.g., entering into a business relationship).
down to the group, the recovering co-leader When they start treatment, clients must sign an
should speak in the first person about his or her agreement to avoid intense relationships out-
experiences. The recovering co-leader may be side group. The counselor should remind clients
effective in instances where clients are resistant of this agreement and discuss with them the
to the counselor’s input. In such cases, the rationale for prohibiting intense personal
co-leader’s discussion of what worked for involvement between group members. If two
him or her may be offered in a “for what it’s clients are becoming inappropriately involved,
worth” manner, with the aim of providing a the counselor should meet with them briefly
strategy that worked for one person and the after group to remind them that such relation-
encouragement that comes with knowing that ships are discouraged and to discuss appropriate
others have succeeded. ways that the clients can handle the situation.

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 V. Relapse Prevention Group

In the first few months of recovery, the main der of the group; this client’s concerns should be
forums for social support in the context of the discussed individually after the group meeting.
Matrix method are the RP group and outside
spiritual and mutual-help support groups.
Behavior: Making threatening, insulting, or
Clients should be encouraged to find a long-
personally directed remarks; behaving in a
term support system through their involvement
manner obviously indicative of intoxication.
in these groups. By attending meetings and
socializing with 12-Step members, recovering Intervention: Take the client out of the
clients will be able to find a sponsor to help group, and let the recovering co-leader lead the
guide their recovery as well as make recovering group. Have a brief individual session with the
friends with whom to pursue substance-free difficult client, or have another counselor inter-
activities. To build a vital support system that vene. Be sure that the client has calmed down
will help them avoid relapse, clients in early before leaving him or her. Arrange for trans-
recovery need to expand their network of sup- portation home, if the client cannot drive or get
port beyond the people they meet in treatment home safely.
to include people with longer term abstinence.
Behavior: Having a general lack of commit-
Handling Troublesome Client Behaviors ment to treatment, as evidenced by poor atten-
At times, the counselor may need to intervene dance, resistance to treatment intervention,
assertively in response to specific types of client disruptive behavior, or repeated relapses.
behavior in the group. This intervention may Intervention: Reassess and adjust the
consist of quieting a client, limiting a client’s treatment plan in an individual or conjoint session
involvement in the group, or removing a client with the uncommitted client. If the client agrees
from the group. Below are some strategies for not to show up intoxicated or engage in inappro-
handling troublesome client behaviors. priate behavior, he or she can be allowed to
attend the meeting but should be asked to listen
Behavior: Occupying too much session time and not to speak. The client should be given
with an issue that has been addressed. some discussion time at the end of this session,
Intervention: Politely suggest that it is contingent on appropriate behavior.
time to allow others to discuss their issues and
move on. Addressing Drug Dreams During Recovery
It is not unusual for clients in recovery to have
Behavior: Arguing in favor of behavior that is frequent and intense dreams about substance
counter to recovery (e.g., using, dropping out of use. The counselor should reassure clients that
group, using self-control instead of avoiding trig- these dreams—which can be frightening—are a
gers) after receiving repeated feedback. normal part of recovery. Stimulant use interferes
with normal sleep patterns; when people stop
Intervention: Point out the futility of these
using substances, vivid dreams are part of the
sorts of approaches in light of the realities of
brain’s recovery process. Intense dreams of
addiction and the experience of others. If the
substance use can produce feelings that persist
client continues along the same lines, ask him
into the waking day and can act as triggers for
or her to listen and not to speak for the remain-
use. Clients who have detailed dreams about

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Counselor’s Treatment Manual: Matrix Intensive Outpatient Treatment

using should be alert to the added risk of Adapting Client Handouts

relapse during the ensuing day. The counselor Client handouts are written in simpler language
should encourage clients to express their con- than the session descriptions for counselors.
cerns about drug dreams during the open dis- The client materials should be understandable
cussion period of RP sessions. However, clients for someone with an eighth grade reading level.
should be discouraged from describing their Difficult words (e.g., abstinence, justification)
dreams of using in detail because they may act are occasionally used. Counselors should be
as triggers for other clients. If, during a group prepared to help clients who struggle with the
session, a client mentions having dreamed material. Counselors should be aware that
about using substances, the counselor should handouts will need to be adapted for clients
have clients look at handout RP 33—Drug with reading difficulties.
Dreams During Recovery and go over it with
them. The handout discusses how drug dreams Session Descriptions
affect early (0–6 weeks), middle (7–16 weeks),
Pages 92 through 165 provide structured
and late (17–24 weeks) recovery and provides
guidance to the counselor for organizing and
some suggestions to help clients address the
conducting the RP group sessions. Figure V-1
issue of drug dreams. This handout also can be
provides an overview of the RP sessions.
used to supplement RP sessions that focus on
triggers and cravings (e.g., sessions 3, 9, 11,
Following the presentation of the 32 RP sessions
13, 16, 18, and 21).
are descriptions of 3 elective sessions that can
be used as substitute sessions whenever the
Rational Brain Versus Addicted Brain counselor deems appropriate. For example,
The RP group session descriptions use the Elective Session B addresses the difficulties
metaphorical struggle between a client’s rational clients may face around major holidays, such as
brain and addicted brain as a way to talk about Christmas or the Fourth of July. The counselor
recovery. The terms rational brain and addicted may wish to substitute this session for 1 of the
brain do not correspond to physiological regions 32 regular sessions if a holiday is approaching.
of the brain, but they give clients a way to con- The handouts indicated in all the RP session
ceptualize the struggle between the desire to descriptions are provided after the session
stay committed to recovery and the desire to descriptions for the counselor’s use and are
begin using stimulants again. duplicated in the Client’s Handbook.

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 V. Relapse Prevention Group

Figure V-1. Relapse Prevention Sessions Overview

Session
Topic Content Pages
Number
Clients learn how alcohol can jeopardize recovery. Clients discuss
1 Alcohol
and plan for situations in which they are likely to drink.
92–93

Clients learn that boredom in recovery is to be expected and will

2 Boredom diminish over time. Clients discuss activities to help alleviate 94–95
boredom.
Avoiding Re- Clients learn about relapse drift and discuss things that anchor
3 lapse Drift their recovery.
96–97

Work and Clients learn how their work life affects their recovery and
4 Recovery explore ways to balance work and recovery.
98–99

Guilt and Clients learn to distinguish between guilt and shame and
5 Shame discuss ways to cope with each.
100–101

Clients learn that idle time can be a trigger and discuss how
6 Staying Busy
scheduling activities can help them avoid relapse.
102–103

Clients learn that the same motivation that brought them to

Motivation
7 for Recovery
treatment may not sustain them. Clients discuss new motiva- 104–105
tions and strategies for staying abstinent.

Clients learn that although truthfulness is not always easy,

8 Truthfulness it is integral to successful recovery. Clients discuss the conse- 106–107
quences and benefits of always telling the truth.

Clients learn that substance use of any kind will cloud their
Total
9 Abstinence
decisionmaking and endanger recovery. Clients discuss 108–109
changes they must make to eliminate all substance use.

Clients learn that impulsive sex can be a form of dependence

Sex and
10 Recovery
and can lead to relapse. Clients discuss the ways that stable 110–111
relationships can contribute to recovery.
Anticipating
Clients learn to recognize the warning signs of relapse and
11 and Prevent-
explore strategies for avoiding relapse.
112–113
ing Relapse

Clients learn the necessity of restoring lost trust and discuss ways
12 Trust
to cope with being suspected of continued substance abuse.
114–115

Clients learn that recovery is not a test of will but of commitment

Be Smart,
13 Not Strong
and smart planning. Clients discuss the efficacy of their approach 116–117
to recovery.

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Counselor’s Treatment Manual: Matrix Intensive Outpatient Treatment

Figure V-1. Relapse Prevention Sessions Overview

(continued)
Session
Topic Content Pages
Number
Defining Clients explore the difference between spirituality and religion
14 Spirituality and discuss ways that spiritual beliefs can support recovery.
118–119

Managing
Life; Clients identify aspects of their life that have been neglected
15 Managing and explore ways to manage their lives responsibly.
120–121

Money
Clients learn about relapse justification. Clients discuss justifi-
Relapse
16 Justification I
cations to which they are susceptible and formulate plans to 122–123
counter them.
Taking Care Clients learn the importance of self-esteem to recovery and
17 of Yourself explore aspects of their lives that require change.
124–125

Emotional Clients learn that emotions can act as triggers and discuss
18 Triggers tools that will help them avoid dangerous emotions.
126–127

Clients learn that becoming ill can be a trigger and discuss

19 Illness
ways to keep their recovery on track when they are sick.
128–129

Recognizing Clients learn the threat that stress poses to recovery. Clients
20 Stress discuss how to identify and cope with stressful situations.
130–132

Clients learn that moving closer to relapse (e.g., to test the

Relapse
21 Justification II
strength of their recovery) is dangerous. Clients explore 133–135
strategies to resist relapse justifications.

Reducing Clients are reminded that stress can endanger their recovery
22 Stress and discuss strategies to reduce stress.
136–137

Managing Clients learn that anger can be a trigger. Clients discuss ways
23 Anger to recognize and address a buildup of anger.
138–139

Clients learn that accepting their substance use disorder is not

24 Acceptance
a sign of weakness. Clients explore strengths to rely on.
140–141

Clients learn that abstinent friends can support their recovery.

Making New
25 Friends
Clients discuss people who can serve as supportive friends and 142–143
how to meet them.

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 V. Relapse Prevention Group

Figure V-1. Relapse Prevention Sessions Overview

(continued)

Session
Topic Content Pages
Number
Repairing Clients learn the importance of making amends and discuss
26 Relationships how to address people who refuse to forgive them.
144–145

Clients learn to distinguish between things that can be changed

Serenity
27 Prayer
and those that cannot. Clients discuss things in their lives that 146–147
they will change.

Clients learn what compulsive behaviors are and how they can
Compulsive
28 Behaviors
endanger recovery. Clients discuss ways to recognize and elim- 148–149
inate compulsive behaviors.

Coping With Clients learn to recognize their emotional responses, especially

29 Feelings and signs of depression. Clients explore strategies for coping with 150–152
Depression depression.

12-Step and Clients learn how 12-Step and mutual-help programs support
30 Mutual-Help recovery. Clients explore the variety of 12-Step and mutual-help 153–155
Programs programs available.

Looking
Forward; Clients learn that boredom can be a relapse trigger. Clients dis-
31 Managing cuss ways to break the monotony of recovery.
156–157

Downtime

One Day at Clients learn to avoid feeling overwhelmed by the past and
32 a Time explore strategies for focusing on the present.
158–159

Elective Clients learn that establishing a regular pattern of self-review

Client Status
Session Review
will help support recovery. Clients discuss areas in which they 160–161
A need to improve.

Elective
Holidays and Clients learn that holidays pose risks for recovery and discuss
Session 162–163
Recovery ways to alleviate the added stress that comes with holidays.
B
Elective Clients learn how new hobbies and pursuits can help support
Recreational
Session recovery. Clients discuss old hobbies they would like to pick up 164–165
Activities
C again or new pursuits they wish to try.

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Counselor’s Treatment Manual: Matrix Intensive Outpatient Treatment

Session 1: Alcohol
Goals of Session
 Help clients understand that alcohol is a substance whose use can jeopardize recovery.
 Help clients identify the situations in which they are most likely to drink.
 Help clients plan for those situations so they can remain abstinent.

Handout
 RP 1—Alcohol

Presentation of Topic (15 minutes)

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

2. Being Alert for External and Internal Triggers for Drinking

Alcohol consumption is a significant and pervasive part of U.S. culture. Clients who are trying to stop
using alcohol face a difficult struggle. External triggers bombard clients; consumption of alcohol is
assumed to be the norm, especially at social functions and celebrations. It is hard for clients to go
through a typical day without coming across many reminders—both cultural and personal—of alcohol.
Advertisements, movies, and TV shows link drinking with being happy, popular, and successful.
Clients encounter colleagues, friends, and family members with whom they used to drink and pass by
bars or liquor stores that they used to frequent.

Internal triggers also pose problems for clients. Depression, anxiety, and loneliness are all characteristic
of recovery. These emotional states also are cues to drink for many people. Facing the emotional
fallout from quitting other substances, clients feel justified in turning to alcohol to “relieve” their mental
state. It is difficult for clients to realize that alcohol may be responsible for their depression or other
emotional problems.

3. Preparing for Situations Involving Alcohol

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

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 V. Relapse Prevention Group

Handout and Focused Discussion (45 minutes)

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

 Go over handout RP 1—Alcohol.

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

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

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

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

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

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

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

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

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

Open Discussion (30 minutes)

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

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

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Counselor’s Treatment Manual: Matrix Intensive Outpatient Treatment

Session 2: Boredom
Goals of Session
 Help clients understand that boredom poses a risk to their recovery.

 Help clients understand that the situation will improve with time.

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

Handout
 RP 2—Boredom

Presentation of Topic (15 minutes)

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

2. Understanding the Reasons for Boredom

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

It is important for clients to know that, as their body and mind adjust to recovery, boredom will become
less of an issue.

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

The danger of boredom during recovery is that it encourages clients just to float along. Before they
know it, clients can drift from abstinence into relapse. The most important thing clients can do is take an

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 V. Relapse Prevention Group

active role in their recovery. Engaging in some kind of process and working toward a goal—taking up a
hobby, planning a vacation, starting a friendship—also help clients move toward their recovery goals.

Handout and Focused Discussion (45 minutes)

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

 Go over handout RP 2—Boredom.

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

 Ask what actions clients have taken to counter boredom.

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

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

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Session 3: Avoiding Relapse Drift

Goals of Session
 Help clients understand the process of relapse drift.

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

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

Handouts
 RP 3A—Avoiding Relapse Drift

 RP 3B—Mooring Lines Recovery Chart

Presentation of Topic (15 minutes)

1. Understanding How Relapse Drift Can Lead to Relapse
In the group session on boredom (RP session 2) clients learned that boredom can be a sign that they
are not taking an active role in their recovery, that they are just going with the flow. Relapse drift is the
process by which people slide from abstinence to relapse without even realizing what is happening. A
useful comparison is that of sailors who anchor a boat before going to sleep below decks. If the
anchor is not properly set, the boat will drift away during the night; the sailors wake up to find they
are in unfamiliar waters, far from their safe anchorage.

Although relapse may feel like a sudden occurrence—an unforeseeable disruption of recovery—often
it is the result of a gradual movement away from abstinence that is so subtle clients can explain it
away or deny responsibility for it. Relapse rarely occurs without warning signs. Clients need to remain
vigilant for signs of relapse. (In Early Recovery Skills session 7, these early warnings of relapse were
referred to as addictive behaviors.)

2. Understanding the Importance of Mooring Lines

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

3. Monitoring Mooring Lines

To monitor their mooring lines, clients need to identify them and list them as specifically as possible.
Merely listing “Exercise” is not as helpful to the client as listing “Ride bike for at least 30 minutes,
4 times a week.” Likewise, listing a friend as a mooring line is not as helpful as writing “Talk on the phone
with Louisa once a week.” Clients should avoid listing attitudes or things that are not quantifiable as

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mooring lines. Although a feeling of optimism may help clients stay abstinent, it is not easy to monitor.
The goal is to have clients make a list of activities or behaviors whose presence or absence they can
note. Detailed, concrete listings give clients better indications of whether their mooring lines are secure.

Handout and Focused Discussion (45 minutes)

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

 Go over handout RP 3A—Avoiding Relapse Drift. Cover any aspects of the topic that were not
addressed in the didactic portion of the session.
 Go over handout RP 3B—Mooring Lines Recovery Chart. Give clients 5 to 10 minutes to
complete this chart.
 Ask clients to share the activities, behaviors, and people they identified as mooring lines.
 Have clients explain how one of their mooring lines helps keep them abstinent and secure in
their recovery.
 Ask the recovering co-leader to share his or her experience with mooring lines. Have they
stayed the same over time? Or has the co-leader added new mooring lines as recovery has
progressed?
 Ask clients to share the activities, behaviors, and people they must avoid if their recovery is to
remain anchored.
 Ask clients how often they will check their mooring lines. It is recommended that they check
them at least weekly.
 Review with clients the steps they can take if they realize that more than two of their mooring
lines are missing and they are drifting toward relapse.

Open Discussion (30 minutes)

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

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

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

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Session 4: Work and Recovery

Goals of Session
 Help clients understand how their work life affects their recovery.

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

Handout
 RP 4—Work and Recovery

Presentation of Topic (15 minutes)

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

2. Finding Balance Between Work and Recovery

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

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

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

Handout and Focused Discussion (45 minutes)

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

 Go over handout RP 4—Work and Recovery.

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

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

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

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

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

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

Open Discussion (30 minutes)

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

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

Homework
Ask clients to examine their commitment to recovery and come up with two new strategies for effec-
tively balancing work and recovery.

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Session 5: Guilt and Shame

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

Goals of Session
 Help clients understand the difference between guilt and shame.

 Help clients learn strategies for coping with guilt and shame.

Handout
 RP 5—Guilt and Shame

Presentation of Topic (15 minutes)

1. Differentiating Guilt From Shame
Guilt refers to feeling bad about things one has done or failed to do. For example, one might feel
guilty for cheating on a spouse or for neglecting to keep promises to a child. Shame goes beyond a
response to a specific action or behavior. Shame means feeling bad about who one is—a belief that
one is defective or unworthy.

Feelings of guilt and shame are often part of people’s responses to substance abuse. But it is impor-
tant for clients to distinguish between the two. Guilt can be a useful reaction in recovery, indicating to
clients that they have done something that goes against their value system. Guilt can motivate clients
to seek forgiveness and make amends for the pain and trouble they have caused others. However, if
clients are convinced they are bad people, they may feel unworthy of recovery and feel that they have
a license to use substances. Shame can be an impediment to abstinence.

2. Addressing Feelings of Guilt and Shame

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

Handout and Focused Discussion (45 minutes)

Clients should be given time to complete the handout before the discussion begins. Clients should not
be forced to comply if they find it difficult or uncomfortable to complete the handout in the group. The
handout is primarily a tool for discussion. The counselor steers clients away from reading their

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responses and encourages them to converse about the issues the handout raises. The counselor
ensures that all clients have an opportunity to participate.

 Go over handout RP 5—Guilt and Shame.

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

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

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

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Session 6: Staying Busy

Goals of Session
 Help clients understand the importance of scheduling activities.

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

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

Handout
 RP 6—Staying Busy

Presentation of Topic (15 minutes)

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

2. Understanding How Free Time Can Act as a Trigger

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

3. Incorporating New Activities and New People

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

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Handout and Focused Discussion (45 minutes)

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

 Go over handout RP 6—Staying Busy.

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

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

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

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Session 7: Motivation for Recovery

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

 Help clients recognize new motivations and strategies for staying abstinent.

 Help clients identify benefits from recovery.

Handout
 RP 7—Motivation for Recovery

Presentation of Topic (15 minutes)

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

2. Using New Strategies as Motivations Evolve

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

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

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

Handout and Focused Discussion (45 minutes)

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

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 Go over handout RP 7—Motivation for Recovery.

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

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

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

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Session 8: Truthfulness
Goals of Session
 Help clients understand that substance dependence and truthfulness are irreconcilable states.

 Help clients acknowledge that truthfulness will not always be easy.

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

Handout
 RP 8—Truthfulness

Presentation of Topic (15 minutes)

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

2. Understanding the Difficulties Posed by Truthfulness

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

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

3. Understanding That Recovery Cannot Be Successful Without Truthfulness

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

Handout and Focused Discussion (45 minutes)

Clients should be given time to complete the handout before the discussion begins. Clients should
not be forced to comply if they find it difficult or uncomfortable to complete the handout in the group.

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The handout is primarily a tool for discussion. The counselor steers clients away from reading their
responses and encourages them to converse about the issues the handout raises. The counselor
ensures that all clients have an opportunity to participate.

 Go over handout RP 8—Truthfulness.

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

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

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Session 9: Total Abstinence

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

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

Handout
 RP 9—Total Abstinence

Presentation of Topic (15 minutes)

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

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

2. Understanding That It Is Not Possible To Learn How To Cope Without Stimulants if Clients
Turn to Alcohol or Marijuana or Other Substances To Escape
The counselor reminds clients that they signed an agreement not to use any substances when they
began treatment. Even if clients have not used stimulants during treatment, use of alcohol or other
mood-altering substances is a way of avoiding a full commitment to recovery. By continuing to use
substances, clients are hedging their bets, using alcohol or marijuana as an escape hatch in the event
that recovery is too hard. Clients lessen their chances of successful recovery for stimulant depend-
ence if they continue to use alcohol and other substances, even once in a while. Alcohol use makes
relapse to stimulant use eight times more likely; marijuana use makes relapse three times more likely
(Rawson et al. 1995).

Handout and Focused Discussion (45 minutes)

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

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 Go over handout RP 9—Total Abstinence.

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

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

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Session 10: Sex and Recovery

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

Goals of Session
 Help clients understand distinctions between intimate sex and impulsive sex.

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

 Help clients appreciate the importance of stable relationships.

Handout
 RP 10—Sex and Recovery

Presentation of Topic (15 minutes)

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

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

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

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

3. Understanding How Intimacy and Stable Relationships Can Support Recovery

Many components of a stable relationship also are important to a successful recovery. Clients who
have relationships characterized by trust, honesty, and support should find it easier to participate fully

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in recovery activities, support others in group sessions, and be truthful about their lives. A stable
relationship that includes intimate sex can help support recovery.

Handout and Focused Discussion (45 minutes)

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

 Go over handout RP 10—Sex and Recovery.

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

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

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

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

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

 Ask what features of these relationships help support clients’ recovery.

Open Discussion (30 minutes)

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

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

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

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Session 11: Anticipating and Preventing Relapse

Goals of Session
 Help clients understand what relapse is and how it develops.

 Help clients recognize the warning signs of relapse.

 Help clients develop strategies for avoiding relapse.

Handout
 RP 11—Anticipating and Preventing Relapse

Presentation of Topic (15 minutes)

1. Understanding That Staying Abstinent Is Different From Deciding To Stop Using Substances
The decision to stop using substances and enter treatment is important. But having decided once to
stop using, clients must now decide every day not to start using again. Now that they have stopped
using and are in treatment, clients need to be vigilant about signs of relapse. Using is familiar and
comfortable behavior; clients’ bodies and minds will want to return to using. So clients must anticipate
and prevent relapse.

2. Learning To Recognize Emotional Buildup and Addictive Behaviors

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

3. Enacting a Plan To Avoid Relapse

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

Handout and Focused Discussion (45 minutes)

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

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 Go over handout RP 11—Anticipating and Preventing Relapse.

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

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

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

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Session 12: Trust

Goals of Session
 Help clients understand the role that trust plays in their relationships.

 Help clients understand the necessity of restoring lost trust.

 Help clients cope with suspicions of continued substance abuse.

Handout
 RP 12—Trust

Presentation of Topic (15 minutes)

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

2. Restoring Trust in Relationships

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

3. Coping With Suspicions of Continued Substance Use

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

Handout and Focused Discussion (45 minutes)

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

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 Go over handout RP 12—Trust.

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

 Ask clients whether they can work to rebuild these relationships.

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

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Session 13: Be Smart, Not Strong

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

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

 Help clients assess the efficacy of their approach to recovery.

Handout
 RP 13—Be Smart, Not Strong

Presentation of Topic (15 minutes)

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

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

3. Assessing How Well Prepared Clients Are To Avoid Relapse

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

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Handout and Focused Discussion (45 minutes)

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

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

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

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

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

 Have clients calculate their Recovery IQ.

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

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

Open Discussion (30 minutes)

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

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

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

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Session 14: Defining Spirituality

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

Goals of Session
 Help clients understand the difference between religion and spirituality.

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

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

Handout
 RP 14—Defining Spirituality

Presentation of Topic (15 minutes)

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

2. Assessing What Spirituality Means for Individual Clients

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

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

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

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the Serenity Prayer can be thought of as a wise saying about achieving inner peace rather than as a
supplication to God.

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

Handout and Focused Discussion (45 minutes)

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

 Go over handout RP 14—Defining Spirituality.

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Session 15: Managing Life; Managing Money

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

 Help clients prioritize aspects of their lives.

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

 Help clients understand the importance of taking “baby steps.”

Handout
 RP 15—Managing Life; Managing Money

Presentation of Topic (15 minutes)

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

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

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

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

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

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

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4. Understanding the Importance of Taking “Baby Steps”

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

Handout and Focused Discussion (45 minutes)

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

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

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

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

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

 Ask clients to determine which problems to tackle first.

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Session 16: Relapse Justification I

Goals of Session
 Help clients understand what relapse justification is.

 Help clients identify the justifications to which they are susceptible.

 Help clients formulate plans to counter relapse justifications.

Handout
 RP 16—Relapse Justification I

Presentation of Topic (15 minutes)

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

2. Understanding Specific Justifications to Which Clients Are Susceptible

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

3. Addressing Specific Situations That Might Lead to Relapse

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

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Handout and Focused Discussion (45 minutes)

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

 Go over handout RP 16—Relapse Justification I.

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

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

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Session 17: Taking Care of Yourself

Goals of Session
 Help clients understand the importance of taking care of themselves.

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

 Help clients identify aspects of their lives that require change.

Handout
 RP 17—Taking Care of Yourself

Presentation of Topic (15 minutes)

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

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

2. Prioritizing Aspects of Life That Require Change

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

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

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Handout and Focused Discussion (45 minutes)

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

 Go over handout RP 17—Taking Care of Yourself.

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

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

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Session 18: Emotional Triggers

Goals of Session
 Help clients understand how certain emotions can act as triggers.

 Help clients examine and understand their emotions.

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

Handout
 RP 18—Emotional Triggers

Presentation of Topic (15 minutes)

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

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

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

3. Using Strategies for Understanding Emotions and Avoiding Relapse

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

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Handout and Focused Discussion (45 minutes)

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

 Go over handout RP 18—Emotional Triggers.

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

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

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

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

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

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

 Ask clients how this process has helped them.

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

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

Open Discussion (30 minutes)

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

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

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

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Session 19: Illness

Goals of Session
 Help clients understand that becoming ill can be a relapse trigger.

 Help clients understand the importance of engaging in healthful behaviors.

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

Handout
 RP 19—Illness

Presentation of Topic (15 minutes)

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

2. Taking Responsibility for Preventing Illness and Maintaining Recovery

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

3. Keeping Recovery on Track Even During Periods of Illness

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

Because illness can be a relapse trigger, clients should ensure that they get the rest and medical
attention they need to recover. If clients seek medical attention, they should be sure to inform the

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doctor that they are in recovery so the doctor can take this into consideration if prescribing medication.
Clients should do all they can to minimize the amount of time they are ill. Getting healthy will allow
them to return to their regular recovery activities (e.g., attending treatment sessions, going to mutual-
help meetings, following their scheduled activities) more quickly.

Handout and Focused Discussion (45 minutes)

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

 Go over handout RP 19—Illness.

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

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

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Session 20: Recognizing Stress

Goals of Session
 Help clients recognize signs of stress in their lives.

 Help clients understand the threat stress poses to recovery.

 Help clients identify strategies to cope with stress.

Handout
 RP 20—Recognizing Stress

Presentation of Topic (15 minutes)

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

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

 Irritability  Constant fatigue

 Difficulty communicating  Memory problems

 Sleep disturbances  Disorientation or confusion

 Headaches  Difficulty making decisions

 Weight loss or gain  Depression

 Tremors or muscle twitching  Apathy

 Gastrointestinal problems

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

2. Understanding That Stress May Indicate That Clients Are Trying To Do Too Much
Stress can result when people place excessive demands on themselves. People in recovery often
want to try to live a perfect life or make up for the damage they have done when they were substance
dependent. They take on too much responsibility or too much work in too short a time, and their
recovery suffers. An example is an employee who often missed work because of substance abuse

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now putting in a lot of overtime to compensate. Clients should be reminded that it is important to
balance the various aspects of their lives and that recovery needs to come first. If they are too busy
and are experiencing stress that could distract them from their recovery, they may need to back away
from some other obligations.

3. Coping With Stress

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

Handout and Focused Discussion (45 minutes)

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

 Go over handout RP 20—Recognizing Stress.

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

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

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

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

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

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

Open Discussion (30 minutes)

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

Five minutes before the end of open discussion, the counselor should ask clients to share briefly their
experience of doing the homework from the previous session. The counselor can decide how detailed

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the followup on homework should be. The goal of asking is not to discover which clients have not
done the homework but to encourage clients to work on their recovery between sessions and to share
that work with the group.

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

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Session 21: Relapse Justification II

Goals of Session
 Help clients understand the processes by which relapse justifications lead to relapse.

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

 Help clients identify strategies to resist relapse justifications.

Handout
 RP 21—Relapse Justification II

Presentation of Topic (15 minutes)

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

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

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

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

3. Countering Relapse Justifications

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

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

Handout and Focused Discussion (45 minutes)

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

 Go over handout RP 21—Relapse Justification II.

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

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

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Session 22: Reducing Stress

Goals of Session
 Help clients understand that stress can affect recovery adversely.

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

 Help clients identify strategies to reduce stress.

Handout
 RP 22—Reducing Stress

Presentation of Topic (15 minutes)

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

2. Focusing on Signs of Stress

Clients should be encouraged to undertake a thorough examination of their lives, looking for signs
and sources of stress. They might approach this task as they would taking an inventory, checking
each aspect of their lives (e.g., family, work, friends) for stressors. Minimizing stress is important to
recovery. Clients should make this survey of stressors a regular practice.

When clients are experiencing stress, they need to find a way to relax. Often, physical activity helps
people minimize stress. Stretching, deep breathing, exercise, even a brief walk help defuse stress.
Clients need to explore various options for reducing stress, find out what works for them, and then
use that intervention when they feel stress.

3. Making Changes to Daily Life To Reduce Stress

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

 Moderation. One useful strategy is to do things in moderation; balance is always important

to a healthy, happy life, but never more so than during recovery. Clients need to ensure that
they do not experience large swings in physical energy from sleeping too much or not enough,
from overeating or eating infrequently, from exercising too much or not at all, or from ingesting
too much caffeine or sugar.

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

Handout and Focused Discussion (45 minutes)

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

 Go over handout RP 22—Reducing Stress.

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

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

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Session 23: Managing Anger

Goals of Session
 Help clients understand that anger can be an emotional trigger that leads to relapse.

 Help clients recognize when anger is building up.

 Help clients identify strategies to address anger positively.

Handout
 RP 23—Managing Anger

Presentation of Topic (15 minutes)

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

2. Recognizing How Anger Builds Up

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

3. Exploring Ways To Understand and Manage Anger

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

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

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

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

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

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Handout and Focused Discussion (45 minutes)

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

 Go over handout RP 23—Managing Anger.

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

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

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Session 24: Acceptance

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

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

 Help clients identify sources of strength to draw on.

Handout
 RP 24—Acceptance

Presentation of Topic (15 minutes)

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

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

3. Identifying Sources of Support and Strength

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

Because acceptance can be an ongoing problem throughout recovery, clients need sources of strength
they can draw on to help them stay abstinent. The fellow members of 12-Step, mutual-help, or spiritually

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oriented programs can be a strong support during recovery. Clients should find a meeting group they are
comfortable with and attend regularly. Friends and loved ones also can provide needed support.

Handout and Focused Discussion (45 minutes)

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

 Go over handout RP 24—Acceptance.

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

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

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

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Session 25: Making New Friends

Goals of Session
 Help clients understand the need to surround themselves with supportive, abstinent friends.

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

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

Handout
 RP 25—Making New Friends

Presentation of Topic (15 minutes)

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

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

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

Handout and Focused Discussion (45 minutes)

Clients should be given time to complete the handout before the discussion begins. Clients should not
be forced to comply if they find it difficult or uncomfortable to complete the handout in the group. The

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handout is primarily a tool for discussion. The counselor steers clients away from reading their
responses and encourages them to converse about the issues the handout raises. The counselor
ensures that all clients have an opportunity to participate.

 Go over handout RP 25—Making New Friends.

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

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

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

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

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

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

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

 Have clients discuss ways to meet new friends.

Open Discussion (30 minutes)

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

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

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

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Session 26: Repairing Relationships

Goals of Session
 Help clients understand the need to repair relationships by making amends.

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

 Help clients prepare to address people who refuse to forgive.

Handout
 RP 26—Repairing Relationships

Presentation of Topic (15 minutes)

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

2. Exploring Ways To Make Amends and Repair Relationships

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

3. Forgiving Oneself and Others

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

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Handout and Focused Discussion (45 minutes)

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

 Go over handout RP 26—Repairing Relationships.

 Ask clients to whom they need to make amends.

 Ask clients what they need to make amends for.

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

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Session 27: Serenity Prayer

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

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

 Help clients identify things that they can change.

Handout
 RP 27—Serenity Prayer

Presentation of Topic (15 minutes)

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

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

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

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

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

2. Understanding What Serenity Means in the Context of Recovery

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

3. Identifying Areas That Require Change

Achieving the inner peace mentioned in the Serenity Prayer requires not only the ability to set aside
those things that clients cannot change but also the commitment to work on those things that they can

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change. The important aspects of clients’ lives are things that will support them in recovery. Relationships
with friends and family can be a powerful source of strength during recovery. Often, relationships can be
improved and are worth repairing. The counselor should help clients identify other areas of their lives that
are both important to recovery and capable of being changed.

Handout and Focused Discussion (45 minutes)

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

 Go over handout RP 27—Serenity Prayer.

 Ask clients to discuss what this saying means to them.

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

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Session 28: Compulsive Behaviors

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

 Help clients understand the dangers of abstinence violation syndrome.

 Help clients recognize and eliminate compulsive behaviors.

Handout
 RP 28—Compulsive Behaviors

Presentation of Topic (15 minutes)

1. Getting Life Under Control by Eliminating Compulsive Behaviors
The counselor should define “compulsive behaviors” as irrational or destructive actions people take in
response to irresistible impulses.

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

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

2. Understanding How Abstinence Violation Syndrome Can Derail Recovery

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

3. Balancing Lifestyle Change With a Healthful and Successful Recovery

Clients may have different approaches to the goal of eliminating compulsive behaviors from their lives.
Some people find that it is easier to make sweeping changes all at once. They figure they already are
girding themselves to do something difficult, so they might as well tackle all their compulsive behaviors

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at once. Other people need to make changes gradually, one or two at a time. For them, the thought of
trying to eliminate all their compulsive behaviors at once is overwhelming. Clients need to work toward
the goal of eliminating their compulsive behaviors in a way that is comfortable for them and allows them
to keep their lives and recovery in balance.

Handout and Focused Discussion (45 minutes)

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

 Go over handout RP 28—Compulsive Behaviors.

 Ensure that clients understand what it means to act compulsively and what compulsive
behaviors are.
 Ask clients to discuss their compulsive behaviors. Did clients find themselves engaging in more
compulsive behaviors when they became abstinent?
 Ask clients what steps they have taken to eliminate compulsive behaviors. How much success
have they had? What approach are they using? Are they tackling all behaviors at once or one or
two at a time?
 Ask the recovering co-leader to discuss his or her experiences with abstinence violation syndrome.
 Small things go wrong during recovery. Ask clients to discuss their attitude toward small slip-ups.
Encourage clients to put small missteps in perspective. If they are overly rigid in their approach
to recovery, they may overreact—and relapse—because of a minor problem.
 Ask clients to discuss relapse prevention techniques they have learned about. If clients are new
to recovery, make sure they understand the necessity to avoid triggers, practice thought stop-
ping, and use scheduling.

Open Discussion (30 minutes)

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

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

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

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Session 29: Coping With Feelings and Depression

Goals of Session
 Help clients recognize and understand their emotional responses.

 Help clients recognize signs of depression.

 Help clients explore strategies for coping with emotions and depression.

Handout
 RP 29—Coping With Feelings and Depression

Presentation of Topic (15 minutes)

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

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

2. Understanding the Importance of Identifying and Addressing Depression

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

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

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

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

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

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3. Using Coping Strategies To Manage Emotions and Depression

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

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

Handout and Focused Discussion (45 minutes)

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

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

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

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

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

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Session 30: 12-Step and Mutual-Help Programs

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

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

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

Handout
 RP 30—12-Step Programs

Presentation of Topic (15 minutes)

1. Understanding the Basics of 12-Step Groups (e.g., what meetings are like, how to find
a meeting)
Some clients will be familiar with AA and other 12-Step groups. The counselor should take time to walk
clients through the rudiments of 12-Step group participation. Professional substance abuse treatment
combined with 12-Step participation is one of the most effective interventions for substance dependence.
These components are very important to recovery; clients should be given every opportunity to under-
stand and become comfortable with 12-Step programs. Important points to cover include the following:

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

 Participant-specific meetings. Large communities may have special group meetings

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

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

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

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

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

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

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

2. Understanding the Social and Emotional Support Available Through 12-Step Attendance
Twelve-Step groups consist of people with the same problem working together to help one another.
The group process reminds clients that they are not alone and provides them the opportunity to make
abstinent friends and begin to build a support network. Clients can receive guidance and encouragement
from others who have been in recovery longer than they have.

3. Exploring Alternatives to 12-Step Programs

Twelve-Step programs such as AA, Cocaine Anonymous, and NA are the most prevalent groups avail-
able. But they may not be for everyone. Crystal Meth Anonymous is a 12-Step group that provides
fellowship and support for people in recovery from methamphetamine use (see www.crystalmeth.org).
The counselor should research local options to 12-Step programs and expose clients to other types of
recovery support in addition to 12-Step programs, such as mutual-help groups. (In small communities,
a 12-Step meeting may be clients’ only option.) Even groups that do not adhere to 12-Step principles
offer the fellowship and support that are crucial to recovery. The counselor may want to discuss the
alternatives to traditional 12-Step meetings listed on pages 33 and 34.

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

Handout and Focused Discussion (45 minutes)

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

 Go over handout RP 30—12-Step Programs.

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

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

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

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Session 31: Looking Forward; Managing Downtime

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

 Help clients understand the benefits of planning rewards and downtime.

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

Handout
 RP 31—Looking Forward; Managing Downtime

Presentation of Topic (15 minutes)

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

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

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

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

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

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

Handout and Focused Discussion (45 minutes)

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

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

 Ask clients whether they have been experiencing boredom and emotional tedium. To what do
they attribute these feelings?
 Ask clients what effect boredom has on their recovery. What do they do now to relieve daily
boredom?
 Ask the recovering co-leader to discuss how he or she used the practice of building islands
(from handout RP 31) to stay engaged in the recovery process.
 Ask clients what activities they can use as rewards to combat the routine nature of treatment
and recovery.
 Ask clients how they know whether they need to relax. What physical or emotional signs tell
them that they need some downtime?
 Ask clients to describe hobbies and activities that they have found relaxing and satisfying.
 Ask the recovering co-leader to discuss his or her experience using activities to combat
boredom. To relieve stress, what does the co-leader do in place of substance use?

Open Discussion (30 minutes)

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

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

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

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Session 32: One Day at a Time

Goals of Session
 Help clients avoid feeling overwhelmed by the past.

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

 Help clients explore different strategies for focusing on the present.

Handout
 RP 32—One Day at a Time

Presentation of Topic (15 minutes)

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

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

The counselor should remind clients of the times in their lives when they decided to change their
behavior and succeeded. For example, perhaps some clients altered their diet or gave up cursing.
Most clients probably can identify some point in their lives when they made a decision to change their
behavior and stuck with it.

The counselor also should be aware that some clients come to treatment with serious psychological
problems other than substance use. These problems may be the result of significant trauma that has
scarred clients. If the counselor notices serious psychological problems in clients, the counselor
should refer the clients to a mental health professional for assessment.

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

The phrase “One Day at a Time” comes from 12-Step programs and is useful for clients to bear in
mind. Twelve-Step and mutual-help programs teach clients a new way to structure their experience so

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that they are focused more on their immediate reality. Clients should strive to be less concerned about
the past and less fretful about the future. The counselor might suggest exercise (especially repetitive
exercise like walking, running, or swimming), meditation, or journal writing, but clients will know better
than the counselor what practices and thoughts will help them focus more on the present.

Handout and Focused Discussion (45 minutes)

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

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

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

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Elective Session A: Client Status Review

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

 Help clients establish a pattern of regular self-review.

Handout
 RP Elective A—Client Status Review

Presentation of Topic (15 minutes)

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

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

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

Handout and Focused Discussion (45 minutes)

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

 Go over handout RP Elective A—Client Status Review.

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

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

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

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

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

Open Discussion (30 minutes)

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

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

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

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Elective Session B: Holidays and Recovery

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

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

Handout
 RP Elective B—Holidays and Recovery

Presentation of Topic (15 minutes)

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

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

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

Handout and Focused Discussion (45 minutes)

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

 Go over handout RP Elective B—Holidays and Recovery.

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

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

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 V. Relapse Prevention Group

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

 Ask clients about the specific risks posed by holidays.

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

Open Discussion (30 minutes)

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

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

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

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Elective Session C: Recreational Activities

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

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

Handout
 RP Elective C—Recreational Activities

Presentation of Topic (15 minutes)

1. Understanding the Role Activities and Hobbies Play in Recovery
Activities and hobbies are important during recovery for several reasons. Any interest clients take up
helps orient them toward the future. The whole notion of pursuing a hobby or an activity suggests that
clients are involved in a process that stretches out in front of them. In this way, the activities that
clients choose help them reengage in their lives and enhance their commitment to recovery.

Physical exercise helps the body and mind get over lingering effects of substance use, relieves stress,
and bolsters clients’ self-esteem. Taking a class, joining a club, or volunteering helps clients meet
people who share their interests and builds a repertoire of interests and activities that do not focus
on substance use.

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

Handout and Focused Discussion (45 minutes)

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

 Go over handout RP Elective C—Recreational Activities.

 Ask clients what activities they would like to pursue now that they are abstinent and in recovery.
Clients should be encouraged to imagine and describe a lot of different activities, helping one
another think of fun and involving interests to pursue. It is important to note here that personal

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friendships among clients in the group are not encouraged. The counselor may want to discourage
clients from making arrangements to pursue activities with people who have been abstinent for
less time than they have.

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

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

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

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

Open Discussion (30 minutes)

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

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

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

Handouts for Relapse Prevention Group Sessions

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

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 RP 1 Alcohol

It is often difficult for people to stop drinking when they

enter treatment. Some reasons for this follow.

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

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

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

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

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

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 RP 1 Alcohol

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.

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 RP 2 Boredom

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

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

substance use.

 Brain chemical changes during recovery can make people feel

listless (or bored).

 People who use substances often have huge emotional swings

(high to low and back to high). Normal emotions can feel flat by
comparison.

People who have been abstinent a long time rarely complain of continual boredom.
The problem of boredom in recovery does improve. Meanwhile you should try some
different activities to help remedy the problem of boredom in recovery.

List five recreational activities you want to pursue.

1. ___________________________________________________________________

2. ___________________________________________________________________

3. ___________________________________________________________________

4. ___________________________________________________________________

5. ___________________________________________________________________

Have you started doing things that you enjoyed before using drugs? Have
you begun new activities that interest you? What are they?

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 RP 2 Boredom

Can you plan something to look forward to? What will you plan?

How long has it been since you’ve taken a vacation? A vacation doesn’t
have to involve travel—just time away from your regular routine. What kind
of break will you plan for yourself?

Here are some tips to reduce feelings of boredom:

 Recognize that a structured, routine life feels different from a

lifestyle built around substance use.

 Make sure you are scheduling activities. Forcing yourself to write

down daily activities helps you fit in more interesting experiences.

 Try not to become complacent in recovery. Do something that will

further your growth. Sometimes boredom results from not challeng-
ing 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 3A Avoiding Relapse Drift

How Relapse Happens

Relapse does not happen without warning, and it does not happen quickly. The grad-
ual movement from abstinence to relapse can be subtle and easily explained away or
denied. So a relapse often feels as if it happens suddenly. This slow movement away
from abstinence can be compared to a ship gradually drifting away from where it was
moored. The drifting movement can be so slow that you don’t even notice it.

Interrupting Relapse Drift

During recovery people do specific things that keep them abstinent. These activities
can be called “mooring lines.” People need to understand what they are doing to keep
themselves abstinent. They need to list these mooring lines in a specific way so they
are clear and measurable. These activities are the “ropes” that hold recovery in place
and prevent relapse drift from happening without being noticed.

Maintaining Recovery
Use the Mooring Lines Recovery Chart (RP 3B) to list and track the things that are
holding your recovery in place. Follow these guidelines when filling out the form:

 Identify four or five specific things that now are helping you stay
abstinent (for example, working out for 20 minutes, 3 times a week).

 Include items such as exercise, therapist and group appointments,

scheduling activities, 12-Step meetings, eating patterns.

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

 Note specific people or places that are known triggers and need to
be avoided during recovery.

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 RP 3A Avoiding Relapse Drift

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 con-
trolled. 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 3B Mooring Lines Recovery
Chart
You have learned new behaviors that keep you in recovery. These behaviors are the
mooring lines that keep your recovery steady and in place. It is important to chart the
new behaviors and check every week to make sure the lines are secure. Dropping
one or more of the mooring lines allows you to drift toward relapse.

Use the chart below to list activities that are important to your
continuing recovery. If there are specific people or things you
need to avoid, list those. Check your list each week to make
sure you are continuing to stay anchored in your recovery.

Mooring Line Behaviors Date Date Date Date Date

I Am Avoiding Date Date Date Date Date

 RP 4 Work and
Recovery
Certain employment situations can
make treatment and recovery more
difficult. Some difficult situations are outlined below.

Employed in a Demanding Job That

Makes Treatment Difficult
Your treatment won’t work unless you give it 100 percent of your
effort. People in recovery need to find a way to balance work with treatment so they
can give recovery their full effort. Some jobs require long or unusual hours. Often the
very nature of the work schedule has contributed to the substance use problem. The
first task, if you have such a job, is to adjust your schedule to accommodate treat-
ment. Work with your counselor and your boss or representative from your employee
assistance program to do this. You also should find out whether flextime is an option.
Recovery needs to be the first priority while you are in treatment.

Working in an Unsatisfactory Job; Thinking of Making

a Change
During recovery major changes (in jobs, in relationships, etc.) should be delayed for 6
months to 1 year whenever possible. Reasons for this include the following:

 People in recovery go through big changes. Sometimes they

change their views on personal situations.

 Any change is stressful. Major stress should be avoided as much

as possible during recovery.

Working in a Situation Where Recovery Will Be Difficult

Some jobs lend themselves to recovery more than others. Work situations that are
difficult to combine with outpatient treatment include

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 RP 4 Work and Recovery

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

drinking or using

 Jobs in which large sums of cash are available at unpredictable times

People in these types of jobs may want to plan for a job change.

Unemployed and Needing To Find a Job

When people are out of work, treatment becomes more difficult
for the following reasons:

 Looking for work is often the first priority.

 Abundant free time is difficult to fill, and the structure

that makes outpatient treatment effective is lacking.

 Resources often are more limited, making transportation and child

care more of a problem.

If you are out of work and in treatment, remember that recovery still
needs to be your first priority. Make sure the counselor knows your
situation, and strive to balance job-seeking activities and treatment.

There are no easy solutions to these problems. It is important to be aware of the

issues so that you can plan to make your recovery as strong as possible.

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 RP 5 Guilt and Shame

Guilt is feeling bad about what you’ve done: “I am sorry I spent

so much time using drugs and not paying attention to my family.”

What are some things you have done in the past that you feel guilty about?

Feeling guilty can be a healthy reaction. It often means you have done something that
doesn’t agree with your values and morals. It is not unusual for people to do things
they feel guilty about. You can’t change the past. It is important to make peace with
yourself. Sometimes that means making amends for things you’ve said and done.

Remember the following:

 It’s all right to make mistakes.

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

understand.”

 You don’t have to explain yourself to anyone if you’re acting

responsibly.

Do you still feel guilty about the things you listed? What can you do to
improve the situation?

Shame is feeling bad about who you are: “I am hopeless and worthless.”

Do you feel ashamed of being dependent on substances? Yes ___ No ___

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 RP 5 Guilt and Shame

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

 Trying to use willpower  Trying to be good

 Trying to be strong

Two things to make recovery work are

 Being smart  Working hard

Everyone who is successful at recovery will tell you, “It was the hardest thing I ever
did.” No one can do it for you, and it will not happen to you.

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 RP 6 Staying Busy

Learning to schedule activities and structure your recovery is important in outpatient

treatment. Staying busy is important for several reasons.

Often relapses begin in the head of a person who has nothing to do and nowhere to
go. The addicted brain begins to think about past using, and the thoughts can start the
craving process. How has free time been a trigger for you?

How could you respond to prevent relapse if free time led to thoughts
of using?

Often people who abuse substances begin to isolate themselves. Being around people
is uncomfortable and annoying. Being alone results in fewer hassles. Did you isolate
yourself when you used? If so, how did this isolation affect your substance
abuse?

How does being alone now remind you of that experience?

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 RP 6 Staying Busy

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?

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 RP 7 Motivation for Recovery

Ask any group of people who are new to recovery why they want to stop using right
now and you will get many different answers:

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

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

 Last time I used I thought I was going to die; I know I’ll die if
I use again.

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

 I’ve been using for 20 years now; it’s time to change.

Which of the people quoted is most likely to be successful in recovery? It seems

logical to think that people who want to stop using for themselves and not because
someone else wants them to are more likely to do well in treatment. However, that
may not be true. Research shows that the reasons people stop using don’t predict
whether they will be able to lead substance-free lives.

What does make a difference is whether they can stay substance free long enough
to appreciate the benefits of a different lifestyle. When debts are not overwhelming,
relationships are rewarding, work is going well, and health is good, the person in
recovery wants to stay abstinent.

FEAR WILL GET PEOPLE INTO TREATMENT,

BUT FEAR ALONE IS NOT ENOUGH
TO KEEP THEM IN RECOVERY.

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 RP 7 Motivation for Recovery

List some of your reasons for entering treatment (for example, medical
problems, family pressure, job problems, depression).

List some of your reasons for continuing to work on your recovery today.

Do you feel that your reasons for initially stopping substance use are the
same as your reasons for staying abstinent today? Why or why not?

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 RP 8 Truthfulness

During Substance Dependence

Not being truthful is part of substance dependence. It is hard
to meet the demands of daily living (relationships, families,
jobs) and use substances regularly. As you become more
dependent on the substance, the activities that are necessary
to obtain, use, and recover from the substance take up more
of your life. It becomes more and more difficult to keep your life on track. People
who are substance dependent often find themselves doing and saying whatever is
necessary to avoid problems. Telling the truth is not important to them.

In what ways were you less than truthful when you were using substances?

During Recovery
Being honest with yourself and with others during the recovery process is critically
important. Sometimes being truthful is very difficult for the following reasons:

 You may not seem to be a nice person.

 Your counselor or group members may be unhappy with

your behavior.

 You may be embarrassed.

 Other people’s feelings may be hurt.

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 RP 8 Truthfulness

Being in treatment without being truthful may make everything you are doing a waste
of time.

How has truthfulness been difficult for you in recovery?

Being partly honest is not being truthful. Do you ever

Decide to let someone believe a partial truth? Yes ___ No ___

Tell people what they want to hear? Yes ___ No ___

Tell people what you wish were true? Yes ___ No ___

Tell less than the whole truth? Yes ___ No ___

ATTENDING GROUPS, ATTENDING MEETINGS, GOING TO A

HOSPITAL, AND GOING TO A COUNSELOR ARE WASTES OF TIME
AND MONEY WITHOUT TRUTHFULNESS.

RECOVERY FROM ADDICTION IS IMPOSSIBLE

WITHOUT TRUTHFULNESS.

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 RP 9 Total Abstinence

Have you ever found yourself saying any of the following?

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

for me.

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

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

 I don’t really care about alcohol. I drink only to be sociable.

If you entered the program to stop using stimulants, you may have wondered why
you were asked to sign an agreement stating your willingness also to stop using other
substances, including alcohol. For many reasons, total abstinence is a necessary goal
for people in recovery:

 Followup studies show that people who use stimulants are eight
times more likely to relapse if they use alcohol and three times
more likely to relapse if they use marijuana than people who do not
use these substances. You can reduce your chances of relapsing
greatly by maintaining total abstinence.

 Places and people associated with drinking often are the very
places and people who are triggers for substance use.

 When you’re learning to handle problems without taking stimulants,

using another drug or alcohol to numb the uncomfortable learning
process is harmful for two reasons. First, such use prevents you
from directly confronting your stimulant use problem. Second, it
puts you at risk of becoming dependent on alcohol or another sub-
stance while you try to overcome your dependence on stimulants.

Remember, if it’s more difficult to stop drinking than you expected, maybe you are
more dependent on alcohol than you think.
 RP 10 Sex and Recovery

Intimate Sex
Intimate sex involves a significant other. The sex is a part of the relationship.
Sometimes the sexual feelings are warm and mellow. Sometimes they are wild and
passionate. But they result from and add to the feelings each partner has for the other.

Impulsive Sex
In this definition of impulsive sex, the partner is usually irrelevant; the person is a
vehicle for the high. Impulsive sex can take the form of excessive masturbation.
Impulsive sex can be used and abused in the same way drugs are used and abused.
It is possible to become addicted to impulsive sex.

What kind of experiences have you had with impulsive sex?

Is impulsive sex linked to your drug use? How?

Describe a healthy, intimate sexual relationship that you have had or hope
to have.

Impulsive sex is not part of a healthy recovery lifestyle. It can be the first step in the
relapse process. Like using alcohol or a drug other than stimulants, engaging in
impulsive sex can trigger a relapse and result in use of stimulants.
 RP 11 Anticipating and
Preventing Relapse
Why Is Relapse Prevention Important?
Recovery is more than not using drugs and alcohol. The first step in treatment is stop-
ping 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.

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 RP 11 Anticipating and
Preventing Relapse
What Are Addictive Behaviors?
The things people do as part of abusing drugs or alcohol are called addictive behaviors.
Often these are things that addicted people do to get drugs or alcohol, to cover up
substance abuse, or as part of abusing. Lying, stealing, being unreliable, and acting
compulsively are types of addictive behaviors. When these behaviors reappear, people
in recovery should be alerted that relapse will soon follow if they do not intervene.

What are your addictive behaviors?

What Is Addictive Thinking?

Addictive thinking means having thoughts that make substance use seem OK.
(In 12-Step programs this is known as “stinking thinking.”) Some examples follow:

 I can handle just one drink.

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

 I have worked hard. I need a break.

How have you tried to find excuses to use substances?

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 RP 11 Anticipating and
Preventing Relapse
What Is Emotional Buildup?
Feelings that don’t seem to go away and just keep getting
stronger cause emotional buildup. Sometimes the feelings seem
unbearable. Some feelings that can build are boredom, anxiety,
sexual frustration, irritability, and depression.

Have you experienced a buildup of any of these emotions?

The important step is to take action as soon as you recognize the danger signs.

Which actions might help you prevent relapse?

 Calling a counselor  Exercising

 Calling a friend  Talking to your spouse

 Taking a day off  Scheduling time more rigorously

 Talking to your family  Other: _________________________

_______________________________
Going to a 12-Step or outside
 _______________________________
mutual-help support meeting

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 RP 12 Trust

How has substance use affected the trust between you and people you
care about?

If you tell someone you’re not using and the person doesn’t believe you,
does it make you feel like using? Do you think, “If people are going to treat
me as if I’m using, I might as well use”?

People who are substance dependent find it difficult to have open, honest relation-
ships. 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 13 Be Smart, Not Strong

“I can be around drugs or alcohol. I’m sure I don’t want to use,

and once I make up my mind, I’m very strong.”

“I have been doing well, and I think it’s time to test myself to see
whether I can be around friends who are using. It’s just a matter
of willpower.”

“I can have a drink and not use. I never had a problem with
alcohol anyway.”

Staying abstinent has little to do with how strong you are. People who maintain absti-
nence do it by being smart. They know that the key to not drinking and not using is to
keep far away from situations in which they might use. If you are in an environment
where drugs might appear (for example, at a club or party) or with friends who are
drinking and using, your chances of using are much greater than if you weren’t in that
situation. Smart people stay abstinent by avoiding triggers and relapse situations.

DON’T COUNT ON BEING STRONG. BE SMART.

How smart are you being? Rate how well you are doing in avoiding relapse.
(Circle the appropriate number.)

Poor 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

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 14 Defining Spirituality

Look at these definitions of spirituality. Which ones

describe what spirituality means to you?

Spirituality is
1. A person’s relationship with God
2. The deepest level from which a human being operates
3. The philosophical context of a person’s life (values, rules,
attitudes, and views)
4. The same as religion
5. Other: __________________________________________________________

The second and third definitions describe spirituality in a broad sense. When it comes
to recovery, these broad definitions are the most useful way to think of spirituality.
They describe being spiritual as having to do with a person’s spirit or soul, as
distinguished from his or her physical being. Some people believe the level and
degree of spirituality in a person’s life help determine the quality of life. One way to
assess the quality of your spirituality is by answering the following questions:

What do you want from life? Are you getting it?

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 RP 14 Defining Spirituality

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 comfort-

able within himself or herself. Gaining a sense of spirituality gives many people the
inner peace that makes abusing substances unnecessary. Twelve-Step and mutual-
help programs provide one way to gain or regain a love of oneself and of life.

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 RP 15 Managing Life; Managing
Money
Managing Life
Maintaining a substance-dependent lifestyle takes a lot of time and energy. People
who are substance dependent give little time or thought to everyday responsibilities.
When recovery begins, long-neglected responsibilities come flooding back. It some-
times is overwhelming to think about all the things that need to be done. It also is frus-
trating 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
Managing Money
Being in control of your finances is being in control of your life. When people who are
substance dependent are using, the out-of-control lifestyle often affects their finances.

How many of the following have been true for you?

_____ Any amount of money over __________ is a trigger to buy drugs.

_____ I have concealed money to buy drugs.
_____ I have large debts.
_____ I gamble with my money.
_____ I spend compulsively when I feel bad.
_____ I frequently argue about money with family members.
_____ I have stolen to get money to buy substances.

When they first enter treatment, some clients choose to give control of their money to
someone they trust. If you make that decision, you are controlling your finances and
asking the trusted person to act as your banker. Together with your counselor, you
should decide when you can handle money again safely. Then you can begin working
toward financial maturity. You may choose to have some of the following goals:

 Arrange to pay off large debts  Use bank accounts to help

in small, regular payments. you manage your money.
 Budget your money carefully,  Live within your means.
as you schedule your time.
 Make a savings plan.
 Arrange spending agree-
ments with anyone who
shares your finances.

What are your other financial goals?

2 of 2
 RP 16 Relapse Justification I

Once a person decides not to use drugs anymore, how does he or she end up using
again? Do relapses happen completely by accident? Or are there warning signs and
ways to avoid relapse?

Relapse justification is a process that happens in people’s minds. A person may have
decided to stop using, but the person’s brain is still healing and still feels the need for
the substances. The addicted brain invents excuses that allow the person in recovery
to edge close enough to relapse situations that accidents can happen. You may
remember a time when you intended to stay substance free but you invented a
justification for using. Then, before you knew it, you had used again.

Use the questions below to help you identify justifications invented by your addicted
brain. Identifying and anticipating the justifications will help you interrupt the process.

Someone Else’s Fault

Does your addicted brain ever convince you that you have no choice but to use?
Does an unexpected situation catch you off guard? Have you ever said any of
the following to yourself?

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

 I had friends come for dinner, and they brought me
some wine.
 I was in a bar, and someone offered me a beer.
 Other:

Catastrophic Events
Is there one unlikely, major event that is the only reason you would
use? What might such an event be for you?

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

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

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 RP 16 Relapse Justification I

 I just lost my job. Why not use?

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

For a Specific Purpose

Has your addicted brain ever suggested that using drugs or alcohol is the
only way to accomplish something?

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

 I’m out of energy. I’ll function better if I use.
 I need drugs to meet people more easily.
 I can’t enjoy sex without using.
 Other:

Depression, Anger, Loneliness, and Fear

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

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

 When I get mad enough, I can’t control what I do.
 I’m scared. I know if I use, the feeling will go away.
 If my partner thinks I’ve used, I might as well use.
 Other:

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

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 RP 17 Taking Care of
Yourself
People who are substance dependent often do not take care of
themselves. They don’t have the time or energy to pay attention to
health and grooming. Health and personal appearance become less important than
substance use. Not caring for oneself is a major factor in losing self-esteem. To
esteem something means to see value in it, to acknowledge its importance.

People in recovery need to recognize their own value. In recovery, your own health
and appearance become more important as you care more for yourself. Taking care of
yourself is part of starting to like and respect yourself again.

Paying attention to the following concerns will strengthen your image of yourself as a
person who is healthy, abstinent, and recovering:

 Have you seen a doctor for a  Do you wear the same

checkup? clothes you wore when you
were using?
 When was the last time you
went to the dentist?  Do you need to have your
vision or hearing checked?
 Have you considered getting
a new look?  Do you exercise regularly?

 Are you paying attention to  Is your caffeine or nicotine

what you are eating? intake out of control?

Some people find it is easier to make sweeping lifestyle changes all at once. However,
if addressing all these health and grooming issues at once is too overwhelming, work
on one or two items each week. Decide which are the most important, and do those
first. As you look and feel better, you will increase both the strength and the pleasure
of your recovery.

The first thing I need to do to take care of myself is:

 Trigger
RP 18 Emotional Triggers Use

Thought
Craving
For many people certain emotional states are directly connected
to substance use, almost as if the emotion causes the substance use. It seems to
people in recovery that if they could avoid ever feeling those emotions (for example,
loneliness, anger, feeling deprived), they would never relapse. These emotional
triggers should act as warnings or “red flags” for clients.

The most common negative emotional triggers are the following:

Loneliness: It is difficult to give up friends and activities that are part of a substance-
using lifestyle. Being separated from friends and family leaves people feeling lonely.
Often friends and family members who do not use are not ready to risk getting back
into a relationship that didn’t work earlier. The person in recovery is stranded between
groups of friends. The feeling of loneliness can drive the person back toward using.

Anger: The intense irritability experienced in the early stages of recovery can result in
floods of anger that act as instant triggers. A person in that frame of mind is only a few
steps from substance use. Once a person uses, it can be a long trip back to a rational
state of mind.

Feeling Deprived: Maintaining abstinence is a real accomplishment. Usually people

in recovery feel justifiably good and proud about what they have been able to achieve.
Sometimes people in recovery feel as if they have to give up good times and good
things. Recovery seems like a jail sentence, something to be endured. This reverses
the actual state of recovery: substance use begins to look good and recovery seems
bad. This upside-down situation quickly leads to relapse.

It is important to be aware of these red flag emotions. Allowing yourself to be flooded with
these powerful negative emotions is allowing yourself to be swept rapidly toward relapse.
Have some of these emotional states been a trigger for you in the past?
Which ones?

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 RP 18 Emotional Triggers

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 sim-
ple 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.

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 RP 19 Illness

Getting sick often predicts a relapse. This might seem strange, even unfair. After all,
you can’t really do anything about getting sick, right? Many people get a few colds a
year. Although you may not be able to prevent yourself from getting sick, you can be
aware of the added relapse risk that comes with illness, and you can take precautions
to avoid getting sick.

Sickness as Relapse Justification

Illness can be a powerful relapse justification. When you are sick, you make a lot of
exceptions to your regular routine. You stay home from work; you sleep more than
usual; you eat different foods. You may feel justified in pampering yourself (for example,
“I’m sick, so it’s OK if I watch TV and lie around most of the day”; “I don’t feel good—
I deserve a few extra cookies”). Because people feel that getting sick is out of their
control, it seems OK to take a break from their regular behaviors. You need to be
careful that, while you are taking a break from other routines, you don’t allow sickness
to be an excuse for using.

Relapse Risks During Illness

When you are sick, you are physically weaker. You also may have less mental energy
to maintain your recovery. In addition to lacking the energy to fight your substance use
disorder, you may face the following relapse risks when you are sick:

 Missing treatment sessions

 Missing mutual-help meetings

 Not exercising

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

 Spending a lot of time alone

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 RP 19 Illness

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

 Having a lot of unstructured time

Healthful Behaviors
Although you can’t always prevent yourself from getting sick, you can do things to
minimize your chances of getting sick. The following behaviors help support your
recovery in general and help keep you healthy:

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

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

 Eat healthful meals.

 Get adequate sleep.

 Minimize stress.

Early in recovery from substance use, you also should avoid activities that put your
health at risk or require recovery time. Elective surgery, serious dental work, and
extended exertion may leave you fatigued and make you susceptible to illness.

Recognize When You’re at Risk

Because you may be more likely to relapse when you’re sick, you should be alert for
the signs of illness. Soreness, tiredness, headaches, congestion, or a scratchy throat
can signal the onset of illness. Even something like premenstrual syndrome (PMS)
can weaken you physically and make relapse more likely.

If you do get sick, try to keep the negative effects of illness from interfering with your
recovery by getting well as quickly as possible. Get proper rest and medical attention
so that you can return to your regular recovery routine as soon as possible. You will
feel stronger, and your recovery will be stronger.

2 of 2
 RP 20 Recognizing Stress

Stress is a physical and emotional response to difficult

or upsetting events, particularly those that continue
for a long time.

Stress is the experience people have when

the demands they make on themselves or
those placed on them disrupt their lives.
Sometimes we are unaware of this emotional state until the stress produces physical
symptoms. Place a checkmark next to any of the following problems you
have experienced in the past 30 days:

Sleep problems (for example, difficulty falling asleep, waking up


off and on during the night, nightmares, waking up early and
being unable to fall back to sleep)

 Headaches  Irritability

 Stomach problems  Difficulty concentrating

 Chronic illness  General dissatisfaction with life

 Fatigue  Feeling overwhelmed

 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 21 Relapse Justification II

Once a person decides not to use drugs anymore, how does that person end up using
again? Do relapses happen completely by accident? Or are there warning signs and
ways to avoid relapse?

Relapse justification is a process that happens in people’s minds. A person may have
decided to stop using, but the person’s brain is still healing and still feels the need for
the substances. The addicted brain invents excuses that allow the person in recovery
to edge close enough to relapse situations that accidents can happen. You may
remember a time when you intended to stay drug free but you invented a justification
for using, and before you knew it, you had used again.

Understanding and anticipating the justifications help you interrupt the process. Use
the questions below to help you identify justifications you might be susceptible to.

Substance Dependence Is Cured

Has your addicted brain ever convinced you that you could use just once or
use just a little? For example, have you said any of the following?

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

 I’ve learned my lesson. I’ll only use small amounts and only once
in a while.

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

use this and not relapse.

 Other:

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 RP 21 Relapse Justification II

Testing Yourself
It’s very easy to forget that being smart, not being strong, is the key to staying abstinent.
Have you ever wanted to prove you could be stronger than drugs? For
example, have you said any of the following?

 I’m strong enough to be around it now.

 I want to see whether I can say “No” to drinking and using.
 I want to see whether I can be around my old friends.
 I want to see how the high feels now that I’ve stopped using.
 Other:

Celebrating
You may be encouraged by other people or your addicted brain to make an exception
to your abstinence. Have you ever tried to justify using with the following
thoughts?

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

 I’m on vacation. I’ll go back to not using when I get home.
 I’m doing so well. Things are going great. I owe myself a reward.
 This is such a special event that I want to celebrate.
 Other:

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

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 RP 22 Reducing Stress

Answering the following questions as honestly as possible will help you identify which
parts of your daily living are most stressful. Take steps to correct these problems, and
you will reduce stress in your life.

1. In deciding how to spend your time, energy, and money, you determine the
direction of your life. Are you investing them in work and hobbies that you find
rewarding? Yes ___ No ___ If not, how might you change this?

2. Focusing on the present means giving your attention to the task at hand without
past and future fears crippling you. Are you usually able to stay in the here and
now? Yes ___ No ___ If not, what prevents you from focusing on the
present? How can you change the situation?

3. Do you take time each day to do something relaxing (for example, play-
ing 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?

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 RP 22 Reducing Stress

6. Are you careful to make your environment (home, work-

place) 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 23 Managing Anger

Anger is an emotion that leads many people to relapse. This is

particularly true early in treatment. Frequently, anger slowly builds
on itself as you constantly think about things that make you angry.
Sometimes it seems that the issue causing the anger is the only important thing in life.

Often a sense of victimization accompanies the anger. Do the following questions

seem familiar to you?
 Why do I get all the bad  Why won’t he just do what I
breaks? want him to do?
 How come she doesn’t
understand my needs?

How do you recognize when you are angry? Does your behavior change?
Do you notice physical changes (for example, pacing, clenching your jaw,
feeling restless or “keyed up”)?

How do you express anger? Do you hold it in and eventually explode?

Do you become sarcastic and passive–aggressive?

What positive ways do you know to cope with anger?

Here are some alternative ways to cope with anger. Which of the following will
work for you?

 Talk to the person you are angry with.

 Talk to a counselor, a 12-Step sponsor, or another person who
can give you guidance.
 Talk about the anger in an outside support group meeting.
 Write about your feelings of anger.
 Exercise.
 Other:
 RP 24 Acceptance
“Just say no” is good advice to stop people from trying drugs.
But it does not help people who are substance dependent. Overcoming substance
dependence requires that you recognize its power and accept the personal limitations
that occur because of it. Many people accept the hold that substance dependence has
over them when they enter treatment. But entering treatment is the first act of accept-
ance. 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 ultimate-
ly are most successful in recovery. The only way to win this fight is to surrender. The
only way to be successful in recovery and get control of your problem is first to admit
that it has control over you.

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

I have a substance use disorder. Yes____ No____

I hope someday I can use again. Yes____ No____

I need to work on acceptance of

 RP 25 Making New
Friends
A blessed thing it is for any person to have a friend:
One human soul whom we can trust utterly, who knows the best and
worst of us, and who loves us in spite of our faults.
Anonymous

Relationships are very important to the recovery process. Friends and family can offer
strength and help us understand who we are. The relationships you establish can support
or weaken recovery. It has been said, “You will become like those people with whom you
spend your time.” Use the following questions to help you think about your friendships.
Do you have any friends like the one described in the poem above? If yes,
who are they?

Have you become like the people around you? In what ways?

What is the difference between a friend and an acquaintance?

Where can you make some new acquaintances who might become friends?

To whom are you a friend?

What behaviors do you need to change to be better able to have honest

relationships?
 RP 26 Repairing
Relationships
Friends and family of people who are substance dependent often get hurt as a result
of the substance abuse. People who are substance dependent often cannot take care
of themselves and certainly cannot take care of others.

As part of your recovery, you should think about whom you have hurt. You should also
think about whether you need to do anything to repair the relationships that are most
important to you. In 12-Step programs this process is called “making amends.”
What are some of the past behaviors you might want to amend?

Are there things you neglected to do or say when you were using that
should be addressed now?
How are you planning to make amends?

Do you feel that being in recovery and stopping the use of drugs is enough?

Making amends does not have to be complicated. Acknowledging the hurt you caused
while you were using substances will probably help reduce conflict in your relation-
ships. Not everyone will be ready to forgive you, but an important part of this process
is beginning to forgive yourself. Another aspect of repairing relationships involves your
forgiving others for things that they did when you were using substances.
Whom do you need to forgive?

What resentments do you need to let go of?

 RP 27 Serenity Prayer

God grant me the serenity to accept the things

I cannot change,
The courage
to change the things I can,
And the wisdom
to know the difference.

What does this saying mean to you?

How can you find meaning in this saying, even if you are not religious or
don’t believe in God?

What parts of your life or yourself do you know you cannot change?

What have you changed already?

What parts of your life or yourself do you need to change?

 RP 28 Compulsive Behaviors

Many people who are substance dependent enter treatment just to stop using a certain
drug. They do not intend to change their lives entirely. When they enter treatment,
they are told that recovery requires making other changes in the way they live. The
lifestyle changes put people in recovery back in control of their lives.
In what ways was your life out of control before you entered treatment?

Have you noticed yourself behaving excessively in any of the following ways?
 Working all the time  Eating foods high in sugar
 Abusing prescription  Exercising to the extreme
medications  Masturbating compulsively
 Using illicit drugs other than the  Gambling
one you entered treatment for
 Spending too much money
 Drinking a lot of caffeinated
sodas or coffee  Other:
 Smoking

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.

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 RP 28 Compulsive Behaviors

Do you have a similar story from the past? What event led to your relapse?

What major lifestyle changes are you making in recovery?

Is it uncomfortable for you to make these changes? Yes ___ No ___

Are you avoiding being uncomfortable by switching to other compulsive
behaviors? If so, what are they?

Are there changes you still need to make? If so, what are they?

Relapse and Sex

Like substance use, high-risk sex is controlled by a trigger process. (High-risk sex
includes sex with a stranger, unprotected sex, and trading sex for drugs.) Triggers lead
to thoughts of sex. Thoughts of sex lead to arousal and action. For many people, high-
risk sex is associated with substance use. High-risk sex can be a trigger for substance
use. Engaging in high-risk sex can bring on a relapse to substance use.

What are some of your triggers for substance use?

What are some of your triggers for high-risk sex?

Have you experienced a relapse when sex was a trigger to use?

Prevention
Once you are aware of the things that are triggers for you, you can take steps to
prevent a relapse. Here are some suggestions you can do to prevent a relapse:

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 RP 28 Compulsive Behaviors

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

and activities that you associate with drug use.

 Stop the thoughts that may lead to relapse. Many techniques

can be used to do this. Some examples of thought-stopping tech-
niques are the following:

 Relaxation—Take three slow, deep breaths.

 Snapping—Wear a rubberband loosely on your wrist

and every time you become aware of a triggering thought, snap
the rubberband and mentally say, “No!” to the thought.

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

to OFF to stop the triggering thoughts.

 Schedule your time. Structure your day and fill blocks of free time
with activities. You can exercise, do volunteer work, or spend time
with friends who do not use drugs.

 Break your typical pattern. Take a trip out of town. Go to a

movie or watch a video. Go out to eat. Go to a 12-Step or mutual-
help meeting at a time you normally would be doing something else.

What are some other things you could do to prevent a relapse?

What do you plan to do next time you’re aware of being in a relapse situation?

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 RP 29 Coping With Feelings
and Depression
Feelings
Can You Recognize Your Feelings?
Sometimes people don’t allow themselves to have certain emotions (for example, you
tell yourself, “Feeling angry is not all right”). Sometimes people aren’t honest with
themselves about their emotions (for example, saying, “I’m just having a bad day,”
when the truth is they’re sad). When you mislabel emotions or deny them, you cannot
address them and they build up inside you.

Are You Aware of Physical Signs of Certain Feelings?

Maybe you get an upset stomach when you are anxious, bite your fingernails when
you are stressed, or shake when you are angry. Think about the emotions that trouble
you, and try to identify how they show physically.

How Do You Cope With Your Feelings Now?

How do you respond when you experience negative emotions? How do your feelings
affect you and others around you? For instance, do your feelings interfere with your rela-
tionships 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.

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 RP 29 Coping With Feelings
and Depression
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 stimu-
lants. Stimulants make people feel “high” by flooding the brain with chemicals called
neurotransmitters that regulate feelings of pleasure. During recovery there are periods
when the brain doesn’t supply enough of those neurotransmitters. The undersupply of
neurotransmitters causes a temporary feeling of depression. But this is different from
being clinically depressed. For some people, depression left untreated can result in
relapse. It is important to be aware of signs of depression and be prepared to cope with
the feelings. If you feel that you cannot cope with your depression or if your depression
lasts for a long time, seek help from a mental health professional. Your counselor or
someone else at your treatment program can refer you to someone for help.

These are some symptoms that might indicate depression. Check all that apply to you:

 Low energy  Stopping exercise program

 Overeating or not eating  Avoiding social activities

 Sad thoughts  Feelings of boredom, irritability,

 Losing interest in career or

or anger
hobbies  Crying spells

 Sleeping more than usual  Suicidal thoughts or actions

 Decreased sex drive  Stopping normal

 Increased thoughts of drinking

activities such as
work, cleaning
 Insomnia house, buying
 Stopping attendance at 12-Step groceries
or mutual-help meetings

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 RP 29 Coping With Feelings
and Depression
What other signs indicate depression?

Responses to depression include the following:

 Increase exercise.  Talk to a spouse.

 Plan some new activities.  Talk to a friend.

 Consult a doctor; medication  Talk to a counselor.

may help.

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

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 RP 30 12-Step Programs

What Is AA?
Alcoholics Anonymous (AA) is a worldwide organization. It has been in existence since
the 1930s. It was started by two men who could not recover from their alcoholism with
psychiatry or medicine. AA holds free, open meetings to help people who want to stop
being controlled by their need for alcohol. Meetings are available throughout the day
and evening, 7 days a week. The principles of AA have been adapted to help people
who are dependent on drugs or who have other compulsive disorders, such as gam-
bling 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.

* 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.

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 RP 30 12-Step Programs

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

 Cocaine Anonymous (CA): www.ca.org

 Narcotics Anonymous (NA): www.na.org

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

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

 Gamblers Anonymous (GA): www.gamblersanonymous.org

 Overeaters Anonymous (OA): www.oa.org

 Emotions Anonymous (EA): www.emotionsanonymous.org

The methods and principles of the groups are similar although the specific focus differs.

Spinoff groups that use the 12 Steps include Al-Anon and Alateen, Adult Children of
Alcoholics, Co-Dependents Anonymous, and Adult Children of Dysfunctional Families.
Here are the Web site addresses for some of these support groups:

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

 Nar-Anon: www.naranon.com

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

 Co-Dependents Anonymous (CoDA): www.codependents.org

Often people go to more than one type of group. Most people shop around for the
type of group and the specific meetings that they find most comfortable, relevant,
and useful.

What Is CMA?
Crystal Meth Anonymous (www.crystalmeth.org). CMA is a 12-Step group that offers
fellowship and support for people who want to stop using meth. CMA meetings are

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 RP 30 12-Step Programs

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 work-
ing the 12 Steps. Many people in 12-Step and mutual-help groups are not religious.
These people may think of the higher power mentioned in the 12 Steps as a bigger
frame of reference or a bigger source of knowledge than themselves.

What Do 12-Step Programs Offer?

 A safe place to go during recovery

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

 A spiritual component to recovery

 Emotional support

 Exposure to people who have achieved long-term abstinence

 A worldwide network of support that is always available

It is strongly recommended that you attend 12-Step or mutual-support meetings

while you are in treatment. Ask other clients for help in choosing the best meeting for
you. Try several different meetings. Be open to the ways that 12-Step meetings can
support your recovery: social, emotional, or spiritual.

4 of 4
 RP 31 Looking Forward;
Managing Downtime
Islands To Look Forward To
There are many important elements to a successful recovery. Structure is important.
Scheduling is important. Balance is important. Your recovery works because you work
at it. Amid the hard work and the structure of recovery, do you feel as if something is
missing? The activities and routines of recovery can seem stifling. Do you feel that
you need to take a break from the routine and get excited about something?

The emotional flatness you experience during recovery may be explained by the following:

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

recovery (during the period known as the Wall).

 The recovery process the body is going through may prevent you
from feeling strong emotions of any kind.

 Life feels less “on the edge” than it did when you were using.

Planning enjoyable things to look forward to is one way to put a sense of anticipation
and excitement into your life. Some people think of this as building islands of rest,
recreation, or fun. These are islands to look forward to so that the future doesn’t seem
so predictable and routine. The islands don’t need to be extravagant things. They can
be things like

 Going out of town for a 3-day weekend

 Taking a day off work

 Going to a play or a concert

 Attending a sporting event

 Visiting relatives

 Going out to eat

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 RP 31 Looking Forward;
Managing Downtime
 Visiting an old friend

 Having a special date with your partner

Plan these little rewards often enough so that you don’t get too
stressed, tired, or bored in between them.

List some islands that you used 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.

2 of 3
 RP 31 Looking Forward;
Managing Downtime
A New Answer
Each person needs to decide what can replace substance use and provide a refreshing,
satisfying break from the daily grind. What works for you may not work for someone
else. It doesn’t matter what nonusing activities you pursue during your downtime, but it is
necessary to find a way to relax and rejuvenate. The more tired and beaten down you
become, the less energy you will have for staying smart and committed to recovery.

Notice how often you feel stressed, impatient, angry, or closed off emotionally. These
are signs of needing more downtime. Which activities listed below would help
rejuvenate you?

 Walking  Taking a class  Going to the movies

 Reading  Playing team sports  Writing
 Meditating or doing  Bicycling  Knitting
yoga  Painting, drawing  Fishing
 Listening to music  Exercising at the gym  Scrapbooking
 Playing with a pet  Cooking  Window shopping
 Becoming active in a Going to 12-Step
church  Playing a musical
 or mutual-help instrument
 Talking with a friend meetings
who does not use

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?

3 of 3
 RP 32 One Day at a Time

People in recovery usually do not relapse because they cannot handle one difficult
day or one troubling situation. Any given day or any single event usually is manage-
able. Things become unmanageable when the person in recovery allows events from
the past or fears of the future to contaminate the present.

Beating yourself up about the past makes you less able to handle the present. You
allow the past to make your recovery more difficult when you tell yourself

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

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

 “I always am letting people down. I always have disappointed everyone.”

You need to find a way to reject those negative thoughts when they come up. The
thought-stopping techniques you learned in Early Recovery Skills (session 1) can help
you move past these negative thoughts. Exercise, meditation, and journal writing also
help you focus your mind and control your thoughts.

Can you think of a recent situation in which you allowed the past to make
the present more difficult?

Don’t allow things that might happen in the future to overwhelm you in the present.
You can plan ahead and be prepared, but you can do little else about the unknown.
You can address only what is happening right now, today. You are filling yourself with
fear when you tell yourself

1 of 2
 RP 32

 “Tomorrow something will happen to ruin this.”

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

 “I will never be able to make it.”

What things do you tell yourself that make you fear the future?

When you have these thoughts, it may help to remind yourself of times when you
did not let your past behavior influence the future. Think of times when you broke
away from an old, destructive pattern. Calling a friend who can remind you of your
successes is a good way to keep yourself focused on today and reject fearful
thoughts of the future.

What things can you tell yourself that will bring you back to the present?

2 of 2
 RP 33 Drug Dreams During
Recovery
Early Recovery (0–6 weeks)
Drug use interferes with normal sleeping. When people stop using, they experience
frequent and intense dreams. The dreams seem real and frightening. These dreams
are a normal part of the recovery process. You are not responsible for whether you
use in a dream. Regular exercise may help lessen the dream activity.

Middle Recovery (7–16 weeks)

For most people, dreams are less frequent during this phase of recovery. When they
do occur, however, dreams can leave powerful feelings well into the following day. It is
important to be careful to avoid relapse on days following powerful dream activity.
Often dreams during this period are about choosing to use or not to use, and they can
indicate how you feel about those choices.

Late Recovery (17–24 weeks)

Dreaming during this period is very important and can be helpful in warning the person
in recovery. Sudden dreaming about drug or alcohol use can be a clear message that
there may be a problem and that the dreamer is more vulnerable to relapse than
usual. It is important to review your situation and correct any problems you discover.

Listed below are some of the actions people take when their dreams become intense
and troubling. Add to the list things that would help you in this situation:

 Exercise
 Go to a 12-Step or mutual-help meeting
 Call a counselor
 Talk to friends
 Take a break from your normal routine
 Other:
 Name: _________________________________________________ Date: __________

Rate how satisfied you are with the following areas of your life by placing a check-
mark in the appropriate boxes.

Very Somewhat Somewhat Very

Dissatisfied Dissatisfied Neutral Satisfied Satisfied
RP Elective A

Career

Friends

Family

Romantic Relationships

1 of 2
Drug Use/Cravings

Alcohol Use/Cravings

Self-Esteem

Physical Health

Psychological Well-Being
Client Status Review

Sexual Fullfillment

Spiritual Well-Being
RP Elective A
Client Status Review

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?

2 of 2
 RP Elective B
Holidays and Recovery

Holiday seasons and the celebrations that come with them are difficult for people in
recovery. Many things can happen to increase the risk of relapse. Review the list
below and check the items that might cause problems for you and your
recovery program during the holidays. Then total up the number of
checkmarks and assess your relapse risk below:

 More alcohol and drugs at parties

 Shortage of money because of travel or gift buying

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

 Normal routine of life interrupted

 Stopping exercise

 Not going to AA meetings

 Not going to therapy

 Party atmosphere

 More contact with family

 Increased emotions from holiday memories

 Increased anxiety regarding triggers and craving

 Frustration of not having time to meet responsibilities

 Coping with “New Year’s Eve” type occasions

 Extra free time with no structure

 Other:________________________________________________

1 of 2
 RP Elective B
Holidays and Recovery

Mild: If you checked one to three items, the holidays produce only a slightly increased
risk of relapse.

Moderate: If you checked four to six items, the holidays add a lot of stress to your
life. Relapse risk is related to how well you cope with increased stress. Your score
indicates that you need to plan carefully for your recovery during the holidays.

Severe: If you checked seven or more items, the holidays add a major amount of
stress to your life. Relapse prevention means learning how to recognize added stress
and taking extra care during dangerous periods. Your score indicates the holidays are
one of these periods for you.

NO ONE HAS TO RELAPSE. NO ONE BENEFITS FROM A

RELAPSE. THINK ABOUT YOUR RECOVERY PLAN. ADD SOME
MEETINGS. SCHEDULE YOUR TIME. SEE YOUR COUNSELOR.
TO GET THROUGH THIS STRESSFUL TIME, USE THE TOOLS
THAT HAVE HELPED YOU STAY ABSTINENT IN RECOVERY.

NO ONE HAS
TO RELAPSE!

2 of 2
RP Elective C Recreational
Activities
In addition to abstaining from substance use, it is important for you to put some
interesting activities in your life. For many people in recovery, substance use was the
main thing they did to relax and have a good time. Now that you are abstinent and in
recovery, it is important to find fun things to do that can take the place of substance
use. You might try returning to old activities you used to enjoy before you started
using substances.

What are some hobbies or activities that you used to enjoy and might like
to try again?

New activities and hobbies are an excellent way to support your recovery while you
meet new people. Now is the time to take a class, learn a new skill, try your hand at
making art, take up a new sport, do volunteer work, or try out other new interests. Ask
your friends about hobbies that they enjoy. See about adult classes that are offered at
local colleges. Consult your local community’s directory or Web site for listings of
activities and classes. Check the newspaper for lectures, movies, plays, and concerts.

What new activities and interests would you like to pursue?

It is important to remember that not all new activities will be fun right away. It may take
a while before you can really enjoy a new activity or become proficient at a new skill.
Old activities that you enjoyed may not feel the same now that you’re
abstinent and in recovery. Regardless of how new or old activities feel,
you need to make them part of your life.