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Matrix Model Relapse Prevention Group Handouts

The document outlines a 16-week relapse prevention program using the Matrix Model for individuals in alcohol and drug treatment. It includes various handouts covering topics such as triggers for alcohol use, boredom in recovery, and maintaining sobriety through structured activities. The program emphasizes the importance of identifying specific behaviors and support systems to avoid relapse and promote long-term recovery.

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0% found this document useful (0 votes)

165 views84 pages

Matrix Model Relapse Prevention Group Handouts

Uploaded by

kaylam

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as PDF, TXT or read online on Scribd

T H E M A T R I X M O D E L

B
Relapse Prevention
Group Handouts

I N T E N S I V E O U T PAT I E N T
A L C O H O L & D R U G T R E AT M E N T

A 16 -Week Individualized Program

Richard A. Rawson, Ph.D., Jeanne L. Obert, M.F.T., M.S.M.,

Michael J. McCann, M.A., and Walter Ling, M.D.

HAZELDEN
®
Hazelden
Center City, Minnesota 55012-0176

1-800-328-9000
1-651-213-4590 (Fax)
[Link]

© 2005 by Matrix Institute

All rights reserved. Published 2005
Printed in the United States of America
Duplicating these handouts for personal or group use is permissible

The Matrix Model is a registered trademark of the Matrix Institute.

B
Relapse Prevention Group Handouts

DATE
COMPLETED
Session 1
____________ Handout 1: Alcohol: The Legal Drug . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Session 2
____________ Handout 2: Boredom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Session 3
____________ Handout 3A: Avoiding Relapse Drift ....................................... 7
____________ Handout 3B: Mooring Lines Recovery Chart ............................... 9

Session 4
____________ Handout 4: Work and Recovery ............................................ 11

Session 5
____________ Handout 5: Guilt and Shame ............................................... 13

Session 6
____________ Handout 6: Staying Busy ................................................... 15

Session 7
____________ Handout 7: Motivation for Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Session 8
____________ Handout 8: Truthfulness ................................................... 19

Session 9
____________ Handout 9: Total Abstinence ............................................... 21

Session 10
____________ Handout 10: Sex and Recovery ............................................. 23

Session 11
____________ Handout 11: Relapse Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

continued

iii
Relapse Prevention Group Handouts

DATE
COMPLETED
Session 12
____________ Handout 12: Trust .......................................................... 27

Session 13
____________ Handout 13: Be Smart, Not Strong ......................................... 29

Session 14
____________ Handout 14: Defining Spirituality .......................................... 31

Session 15
____________ Handout 15: Taking Care of Business and Managing Money .............. 33

Session 16
____________ Handout 16: Relapse Justification I ........................................ 37

Session 17
____________ Handout 17: Taking Care of Yourself ....................................... 39

Session 18
____________ Handout 18: Dangerous Emotions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Session 19
____________ Handout 19: Illness ........................................................ 43

Session 20
____________ Handout 20: Recognizing Stress ............................................ 45

Session 21
____________ Handout 21: Relapse Justification II ....................................... 47

Session 22
____________ Handout 22: Reducing Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Session 23
____________ Handout 23: Managing Anger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

continued

iv
Relapse Prevention Group Handouts

DATE
COMPLETED
Session 24
____________ Handout 24: Acceptance .................................................... 53

Session 25
____________ Handout 25: Making New Friends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Session 26
____________ Handout 26: Repairing Relationships ...................................... 57

Session 27
____________ Handout 27: Serenity Prayer ............................................... 59

Session 28
____________ Handout 28: Compulsive Behavior ......................................... 61

Session 29
____________ Handout 29: Dealing with Feelings and Depression . . . . . . . . . . . . . . . . . . . . . . . . 65

Session 30
____________ Handout 30: Twelve Step Programs (or Other Spiritual Groups) ........... 69

Session 31
____________ Handout 31: Looking Forward: Dealing with Downtime ................... 71

Session 32
____________ Handout 32: One Day at a Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Session 33 (Optional)
____________ Handout 33: Recreational Activities ........................................ 75
____________ Handout 34: Holidays and Recovery ....................................... 77

◆ ◆ ◆

v
Handout 1 • Relapse Prevention Group

Alcohol: The Legal Drug

It is often difficult for patients to stop drinking when they enter
treatment. Some of the reasons for this include the following:

1. Triggers for alcohol use are everywhere. It is sometimes hard to do anything social
without facing people who are drinking.
Do you have friends who get together without drinking? If so, write their
names here.

______________________________________________________________________________________________________

2. Many people use alcohol in response to internal triggers. Depression and anxiety
seem to go away when people have a drink. It’s difficult for them to realize that
sometimes the alcohol causes the depression.
Does feeling a certain way make you want to have a drink? Explain.

______________________________________________________________________________________________________

3. If a person is addicted to an illicit drug and uses alcohol less often, alcohol may
not be viewed as a problem. The problem isn’t recognized until the person tries to
stop drinking.
Have you been able to stop drinking since you entered treatment? Explain.

______________________________________________________________________________________________________

4. Alcohol affects the rational, thinking part of the brain. It is hard to think reasonably
about a drug that makes thinking clearly more difficult.
Have you ever been sober at a party and watched people drink and “get
stupid” ? If so, describe the experience.

______________________________________________________________________________________________________

1 continued on other side

Handout 1 • Relapse Prevention Group Page 2 of 3

ALCOHOL: THE LEGAL DRUG continued

5. Because alcohol dulls the rational brain, it promotes less controlled activity in the
lower brain. This results in alcohol helping people become more sexual, less self-
conscious, and more social. When you are used to using alcohol to increase sexual
pleasure and help you socialize, these activities feel uncomfortable without it.
Do you depend on alcohol for sexual or social reasons? Explain.

______________________________________________________________________________________________________

6. 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?

______________________________________________________________________________________________________

7. In many families and social groups, drinking is a sign of strength, of being

“with it,” or of being sophisticated. Our culture encourages drinking.
Do you feel less “with it” when you are not drinking? Explain.

______________________________________________________________________________________________________

2
Handout 1 • Relapse Prevention Group Page 3 of 3

ALCOHOL: THE LEGAL DRUG

8. The habit of drinking gets to be part of certain activities. It seems difficult, at first,
to eat certain foods, go to sporting events, or relax without a beer or other drink.
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.

Triggers for alcohol use are everywhere. It is sometimes hard to do

anything social without facing people who are drinking.

3
Handout 2 • Relapse Prevention Group

Boredom
Often, people who stop using
drugs and alcohol say life feels boring.

Some of the reasons for this feeling might be these:

1. A structured, routine life feels different from an addict lifestyle.

2. Brain chemical changes during recovery can make people feel flat (or bored).

3. Drug and alcohol users often have huge emotional swings (high to low and
back to high). Normal emotions can feel flat by comparison.

People with longer sobriety rarely complain of continual boredom, so these feelings
do change. Meanwhile, there are some ways to help reduce this feeling.

1. Review your recreational activity list. Have you started doing things that you
enjoyed before using drugs and alcohol? Have you begun new activities that
interest you?

2. Can you plan something to look forward to? How long has it been since you’ve
taken a vacation?

3. Talk about this feeling with a mate or close friend. Does he or she feel bored, too?
Does he or she have any interesting suggestions?

4. Try going back to scheduling. Forcing yourself to write out daily activities helps
you see where you can schedule in more interesting experiences.

5. Do something risky that will further your personal growth. Sometimes boredom
results from not challenging yourself enough in your daily living.

•••

Which of the above might work for you? It is important to try new ways of fighting the
bored feeling. Untreated, it can be a trigger and move you toward relapse.

5
Handout 3A • Relapse Prevention Group

Avoiding Relapse Drift

How It Happens

Relapse does not suddenly occur. It does not

happen without warning, and it does not happen quickly.
The gradual movement, however, can be so subtle and so easily explained away
(denied) that often a relapse feels like it happened suddenly. This slow movement
away from sobriety 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 the Process

During recovery, each person does specific things that work to keep him or her sober.
These “mooring lines” need to be clearly stated and listed in a very specific way so
they are understandable and measurable. These are the ropes that hold the recovery
in place and prevent the relapse drift from happening without being noticed.

Maintaining a Recovery
Use the Mooring Lines Recovery Chart (page 9) to list and track the things that are
holding your recovery in place. Follow these guidelines when filling out the form:

1. Identify four or five specific things that are now helping you stay sober
(for example, working out for twenty minutes, three times per week).

2. Include items such as exercise, therapist and group appointments, scheduling,

outside spiritually based meetings, and eating patterns.

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

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

The checklist should be completed regularly (probably weekly). When two or more
items cannot be checked, it means that relapse drift is happening. Sometimes things
loosen your mooring lines. Vacations, illnesses, and holidays sometimes cannot be
controlled. The mooring lines disappear. Many people relapse during these times. Use
the chart to recognize when you are more likely to relapse and decide what to do to
keep this from happening.

•••

7
Handout 3B • Relapse Prevention Group

Mooring Lines Recovery Chart

In becoming sober, you have had to learn to adopt certain new
behaviors—behaviors that work for you to keep you sober.
It is too easy to accidentally drop one or more of these mooring lines and allow your
recovery to drift toward relapse. Charting the new behaviors and occasionally checking
to make sure the lines are secure can be very useful.

Use the chart below to list those activities that are very important to your continuing
recovery. If there are specific people or things you need to avoid, list them. Then look
back at your list regularly and check those items that you are continuing to follow to
stay anchored in your recovery.

Mooring Line Behaviors Date (✓) Date (✓) Date (✓) Date (✓) Date (✓)

I Am Avoiding Date (✓) Date (✓) Date (✓) Date (✓) Date (✓)

9
Handout 4 • Relapse Prevention Group

Work and Recovery

Check which of the following statements
describe your situation:

______ 1. I am employed in a demanding job that makes

inpatient treatment impossible.

______ 2. I am working in an unsatisfactory job and thinking of making a change.

______ 3. I am working in a situation in which recovery will be difficult.

______ 4. I am working with a schedule that has to be changed to make treatment

work.

______ 5. I am unemployed and need to find a job.

•••

People in any of the above situations have to deal with certain problems that can
make treatment more difficult. Some of the problems are outlined below; the numbers
correspond to the list above.

1. People in this situation always have to look at priorities. Outpatient treatment

may have been selected because work is a number one priority. The problem is
that treatment won’t work unless it is given a 100 percent effort. That means that
for a while, treatment has to take priority over work. Once longer-term sobriety
has been achieved, the recovery can shift to maintenance intensity, and work can
again be a major focus.

2. It is a generally accepted fact that during recovery, major changes (in jobs, relation-
ships, and other areas) should be delayed for six months to one year whenever
possible. There are many reasons for this:

a. People in recovery go through large changes themselves and sometimes

change their views on personal situations.

b. Any change is stressful, and major stress is to be avoided as much as

possible during early recovery.

11 continued on other side

Handout 4 • Relapse Prevention Group Page 2 of 2

WORK AND RECOVERY continued from other side

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

a. Situations in which it is necessary to be with other people who are

drinking or using

b. Jobs that make large sums of cash money available at unpredictable times

4. Some jobs require long or unusual hours. Often, the very nature of the schedule
has contributed to the drug or alcohol problem in the first place. The first task, if
you have such a job, is to work with your therapist (and your boss or someone else
at your job) to make your schedule work for your recovery. Without this initial
intervention, your recovery will not stand a chance. Recovery is much too difficult
a process unless it is your number one priority while you are in treatment.

5. When people are out of work, treatment becomes more difficult:

a. Looking for work is often a necessary priority.

b. Without blocks of time spent at work, there is so much free time that it
is difficult to fill it and provide the structure that makes outpatient
treatment effective.

c. Resources are often more limited, making factors like transportation and
child care more of a problem.

•••

There are no easy solutions to these problems. It is important to be aware of the issues
so you can plan to make your recovery as strong as possible.

When people are out of work,

resources are often more limited,
making factors like transportation
and child care more of a problem.

12
Handout 5 • Relapse Prevention Group

Guilt and Shame

Guilt is feeling bad about what you have done.
(“I am sorry I spent so much time using/drinking
and not attending to my family.”)
•••

Shame is feeling bad about who you are.

(“I am hopeless and worthless.”)

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

__________________________________________________________________________________________________________

Feeling guilty is 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 get into
situations where they do things they feel guilty about. What is important is making
peace with yourself. Sometimes that means making up for things you’ve said and
done. Sometimes it means realizing you are feeling guilty unnecessarily.

Remember:

1. It’s all right to make mistakes.

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

3. 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(s)?

__________________________________________________________________________________________________________

13 continued on other side

Handout 5 • Relapse Prevention Group Page 2 of 2

GUILT AND SHAME continued from other side

Shame
Check the statements that apply to you:

______ I feel ashamed of being addicted.

______ I feel weak because I couldn’t or can’t stop drinking or using.

______ I feel stupid because of what I have done.

______ I feel like I am a bad person because I am involved with alcohol or drugs.

•••

No one knows all the reasons that some people can stop using once they decide to
and other people cannot. Research shows some of the reasons have to do with family
histories, genes, and individual physical differences in people. They do not have to do
with some people being bad, stupid, or weak. Addiction affects people differently.

What we do know is that you cannot recover by these means:

1. Trying to use willpower

2. Trying to be strong

3. Trying to be good

It takes two things to make recovery work:

1. Being smart

2. 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 just happen to you.

14
Handout 6 • Relapse Prevention Group

Staying Busy
Learning to schedule and to provide a structure of
activities to support your recovery is an important first step
in outpatient treatment. Staying busy doing things is
important for several reasons:

1. Often, relapses begin in the mind 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.

Has free time ever been a trigger for you? Explain.

______________________________________________________________________________________________________

How could you respond to prevent relapse if the trigger occurred again?

______________________________________________________________________________________________________

2. When drug and alcohol use gets severe enough, the user will often begin to isolate.
Being around other people is uncomfortable and annoying. Being alone results in
fewer hassles.

Did you isolate yourself when you used? Explain.

______________________________________________________________________________________________________

Does being alone now remind you of that experience? Explain.

______________________________________________________________________________________________________

15 continued on other side

Handout 6 • Relapse Prevention Group Page 2 of 2

STAYING BUSY continued from other side

3. Being involved with other people and doing things keep life more interesting.
Living a drug- and alcohol-free life can sometimes feel pretty tame. You begin to
think being sober is boring, and using is exciting and desirable. People have to
work at finding ways to make sobriety fun.

What have you done lately to have fun?

______________________________________________________________________________________________________

4. When people are involved in an addictive lifestyle, many of the 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 drug- and alcohol-free activities and people is critical to a
successful recovery.

How have you reconnected or built new activities and people into your life?

______________________________________________________________________________________________________

•••

Beginning to build a life around

drug- and alcohol-free activities
and people is critical to a
successful recovery.

16
Handout 7 • Relapse Prevention Group

Motivation for Recovery

Ask any group of people just starting recovery why
they want to stop drinking and 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 will if I use again.”
•••

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

•••

“I’ve been drinking for twenty years now; it’s time to change.”

Which of the people quoted above are most likely to be successful in recovering? It
seems logical to think that people who want to stop drinking and 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 have
little bearing on whether they will be able to successfully lead a drug- and alcohol-free
lifestyle.

What does make a difference is whether they can stay drug and alcohol free long
enough to appreciate the benefits of a different lifestyle. When debts are not over-
whelming, when relationships are rewarding, when work is going well, and when health
is good, the recovering addicted person wants to stay drug and alcohol free.

Fear will get people into treatment,

but fear alone is not enough to keep them in recovery.

17 continued on other side

Handout 7 • Relapse Prevention Group Page 2 of 2

MOTIVATION FOR RECOVERY continued from other side

1. List some of the specific reasons you first entered treatment (medical problems,
family pressure, job problems, depression, and so on).

______________________________________________________________________________________________________

2. List some of the specific reasons you are continuing to work on the recovery
process today.

______________________________________________________________________________________________________

3. Do you feel that your reasons for stopping drug and alcohol use initially are the
same as your reasons for staying sober today? Explain.

______________________________________________________________________________________________________

•••

18
Handout 8 • Relapse Prevention Group

Truthfulness
During Addiction
Not being truthful is part of addiction. It may be very hard
to meet the demands of daily living (in relationships, in families,
in jobs, and so on) and use drugs and alcohol regularly. As the addiction progresses,
so do the activities that are necessary to obtain, use, and recover from the drug or
alcohol use. It becomes more and more difficult to keep everything going smoothly, and
addicted people often find themselves doing and saying whatever is necessary to avoid
problems. Truthfulness is not always a consideration.

In what ways were you less than truthful during your addiction?

__________________________________________________________________________________________________________

During Recovery
Being honest with yourself and with others during the recovery process is critically
important. Sometimes being truthful is very difficult:
• You may not seem to be a “nice” person.

• Your therapist or group members may be unhappy with your behavior.

• You may be embarrassed.

• Other people’s feelings may be hurt.

Trying to be in recovery without being truthful will make you feel crazy. It will make
everything you are doing seem like a waste of time.

Has truthfulness been difficult for you in recovery? Explain.

__________________________________________________________________________________________________________

19 continued on other side

Handout 8 • Relapse Prevention Group Page 2 of 2

TRUTHFULNESS continued from other side

Being partly honest is not being truthful. Do you ever

• Decide to let someone believe a partial truth?

• Tell people what they want to hear?

• Tell people what you wish were true?

• Tell less than the whole truth?

Attending groups, attending meetings, going to a

hospital, or going to a therapist are all a waste of

time and money without truthfulness. Recovery from

addiction is impossible without truthfulness.

20
Handout 9 • Relapse Prevention Group

Total Abstinence
Have you ever found yourself saying any of the following?

“Having a beer (or glass of wine) is not really drinking.”

“I only drink when I choose to—my drinking is not out of control.”

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

“My problem is my drug use. Alcohol (or pot) is not a problem for me.”

If you entered the program to stop using a specific drug, you may have wondered why
you were asked to sign an agreement stating your willingness to also stop using other
drugs and alcohol. There are many reasons total abstinence is a necessary goal for
recovering people. A few of them are the following:

• Follow-up studies show that stimulant users are eight times more likely to relapse
if they continue using alcohol and three times more likely to relapse if they use
marijuana. You can greatly reduce your chances of relapsing by maintaining total
abstinence.

• Places and people associated with drinking are often the very places and people
that are triggers for drug use.

• When you’re learning to handle problems without resorting to drug or alcohol use,
using another drug or alcohol to numb the uncomfortable learning process
1. Blocks your chance to practice coping without running away.
2. Puts you at risk for becoming dependent on the alcohol or secondary drug.

• As one patient said, “When I invite one friend over (alcohol), they all want
to come.”

•••

Remember: You are committing to be totally drug and alcohol free only while you are
in treatment. If it’s more difficult than you expected, maybe you are more dependent
than you thought.

21
Handout 10 • Relapse Prevention Group

Sex and Recovery

Sexual activities can be divided into two categories:

Intimate Sex
This kind of sexual activity 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
Sexual activity in this category is a compulsive behavior. It can be used and abused
in the same way substances are used and abused. It is possible to become addicted to
impulsive sex. The partner in this type of sexual activity is usually irrelevant. There
may or may not be another person involved. If there is, the person is a vehicle for the
high. There is little, if any, relationship involvement.

1. Are you familiar with these two kinds of sex? Explain.

______________________________________________________________________________________________________

2. How is impulsive sex linked to your drug or alcohol use?

______________________________________________________________________________________________________

3. Have you ever had a healthy, intimate sexual relationship? Explain.

______________________________________________________________________________________________________

•••

Impulsive sex is not part of a healthy recovering lifestyle. It can be the first step in
the relapse process. Like secondary drug or alcohol use, impulsive sex can trigger a
relapse and result in use of the primary drug of choice.

23
Handout 11 • Relapse Prevention Group

Relapse Prevention
Why Is Relapse Prevention Important?
Recovery is more than not using drugs and alcohol.
The first step in treatment is stopping drug and alcohol use.
The next step is not starting again. This is very important, and the process for doing
it is called relapse prevention.

Addiction

➞
What Is Relapse?
Relapse is going back to drug
Treatment
or alcohol use and to all the

➞
behaviors and patterns that go
with that. Often the behaviors Sobriety
and patterns return before the

➞
actual drug or alcohol use.
Learning to recognize the Addictive behavior
Addictive thinking
beginning of a relapse can
Emotional buildup
help the recovering person
➞

stop the process before actual

➞
use begins.
Relapse prevention No relapse prevention
➞

➞
The choice is explained in the
chart on the right. Continued sobriety Readdiction

What Are Addictive Behaviors?

The things people do as part of drug or alcohol use are called addictive behaviors.
Often, these are things the addicted person does to get drugs or alcohol, to cover up
drinking or using, or as part of the use. Lying, stealing, being unreliable, and acting
compulsively are types of addictive behaviors. Describe yours:

__________________________________________________________________________________________________________

25 continued on other side

Handout 11 • Relapse Prevention Group Page 2 of 2

RELAPSE PREVENTION continued from other side

What Is Addictive Thinking?

In Twelve Step programs, these kinds of thoughts are called “stinking thinking.” They
are thoughts that make using or drinking seem okay. Some examples are “I can handle
just one drink,” “If they think I’m using, I might as well,” or “I have worked hard. I
need a break.” What might your brain say to you?

__________________________________________________________________________________________________________

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. The kinds of feelings that can build
are boredom, anxiety, sexual frustration, irritability, and depression. Are any of these
familiar to you now, or were they in the past? Explain.

__________________________________________________________________________________________________________

The important step is to take action as soon as you recognize the danger signs.
Check actions that might work for you:

______ Calling a therapist

______ Calling a Twelve Step friend

______ Going to a Twelve Step or other outside support meeting

______ Beginning to exercise

______ Taking a vacation

______ Talking to your spouse

______ Using time scheduling

Other ______________________________

26
Handout 12 • Relapse Prevention Group

Trust
1. Have drugs or alcohol affected the trust between
you and people you care about? Explain.

______________________________________________________________________________________________________

2. Does someone not trusting you ever make you feel like using? (“If you are going
to treat me like I’m using, I might as well use.”) Explain.

______________________________________________________________________________________________________

When an addicted person is using, it is very difficult for him or her to have an open,
honest relationship with any other person. Things are said and done that destroy the
trust and damage the relationship. The drug or alcohol use becomes as important or
more important to the user than other people.
When drug and alcohol use stops, the trust does not return right away. One or
both people may want the trust back, but trust is a feeling, and people cannot make
feelings happen. It takes time for feelings to change. To trust means to feel certain
you can rely on someone or something. People cannot be certain because they want
to be. Only time can make the difference.

Recovery is a long process. Learning to trust again

is part of that process. It may be one of the last changes to occur.

3. How do you deal with suspicions about drug and alcohol use?

______________________________________________________________________________________________________

27 continued on other side

Handout 12 • Relapse Prevention Group Page 2 of 2

TRUST continued from other side

4. How do you feel when you are not trusted?

______________________________________________________________________________________________________

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

______________________________________________________________________________________________________

•••

28
Handout 13 • Relapse Prevention Group

Be Smart, Not Strong

“I can be around drugs or alcohol. I am certain 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 and see if I can be
around friends who are using. It’s just a matter of willpower.”
•••

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

Staying drug and alcohol free does not depend on strength. People who are able to
maintain abstinence do it by being smart. They know that the key to not drinking
and not using is to keep far away from relapse situations. The closer you get, the more
likely a relapse becomes. If drugs or alcohol appears unexpectedly, and you are close
to them and to friends who are drinking and using, your chances of using are much
greater than if you weren’t in that situation. Smart people stay sober by avoiding
triggers for as long as possible.

DON’T BE STRONG. BE SMART.

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

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 drug and alcohol users 1 2 3 4

8. Avoiding drug and alcohol places 1 2 3 4

9. Exercising 1 2 3 4
10. Being truthful 1 2 3 4

11. Going to Twelve Step or other outside support meetings 1 2 3 4

Total Recovery IQ ________________________________________

29
Handout 14 • Relapse Prevention Group

Defining Spirituality
What does spirituality mean to you?
Check those definitions that seem to apply.

1. Spirituality is

______ A person’s relationship with God

______ The deepest level from which a human being operates

______ The philosophical context of a person’s life (values, rules, attitudes, and views)

______ The same as religion

The second and third definitions describe spirituality in a broad sense. Many people
believe that these broad definitions are the most useful way to think of spirituality.
They view being spiritual as something that has to do with a person’s spirit or soul,
as distinguished from the physical nature. Some people believe the level and degree
of spirituality in a person’s life will dictate the quality of life. In Finding Inner Peace
(1988), Earnie Larsen suggests you can assess the quality of your spirituality by
answering the following questions:*

2. How much is enough? (What do you want from life, and are you getting it?)

______________________________________________________________________________________________________

3. Upon what is my security based? (What would it take to destroy you?)

______________________________________________________________________________________________________

4. Who do I have to be before I approve of myself ? (What qualities are most important
to you?)

______________________________________________________________________________________________________

31 continued on other side

Handout 14 • Relapse Prevention Group Page 2 of 2

DEFINING SPIRITUALITY continued from other side

5. What does success mean to me? (What does “making it” mean?)

______________________________________________________________________________________________________

6. What would be the most comfortable and easy way for me to increase the spiritual
aspects of my own life, should I choose to do so?

______________________________________________________________________________________________________

•••

In order to have a drug- and alcohol-free life for a long period of

time, the recovering person has to be comfortable within himself
or herself. Gaining a sense of spirituality gives many people the
inner peace that makes using drugs and alcohol unnecessary.
The Twelve Step programs provide one way to gain or regain
a love of yourself and of life.

*Reprinted with permission from the author.

32
Handout 15 • Relapse Prevention Group

Taking Care of Business

and Managing Money
Maintaining a full-blown addiction takes lots of time and
energy. There may be very little time or thought given to normal responsibilities
during an addictive period. The lifestyle of an addicted person is usually one that
is obviously irresponsible.

Taking Care of Business

When recovery begins, forgotten and neglected responsibilities come flooding back.
It is sometimes overwhelming to think about all the things that need to be done. It
is also frustrating and time consuming to catch up on so many responsibilities.
Determine where you stand with regard to taking care of your business by thinking
about the following questions:

1. Do you have outstanding traffic tickets?

2. Have you filed all your tax returns to date?

3. Are there unpaid bills you need to make arrangements to pay?

4. What repair and maintenance needs of your house or apartment are necessary?

5. Does your car need to be serviced or repaired?

6. Do you have adequate insurance—health, home, car, and life insurance?

7. Do you have a checking account or some way to manage your finances?

8. Are you handling daily living chores (such as grocery shopping, laundry, and
cleaning)?

If you try to do all this at once, you may feel overwhelmed and hopeless. Take one or
two items each week and focus on clearing up one area at a time. Dealing with these
issues will help you regain a sense of control over your life.

1. The first item of business I need to take care of is

______________________________________________________________________________________________________

33 continued on other side

Handout 15 • Relapse Prevention Group Page 2 of 3

TAKING CARE OF BUSINESS AND MANAGING MONEY continued

2. I will start by

______________________________________________________________________________________________________

3. The second item of business I need to take care of is

______________________________________________________________________________________________________

4. I will start by

______________________________________________________________________________________________________

Managing Money
Being in control of your finances is being in control of your life.
5. When people with addictions are actively using, their out-of-control lifestyle is often
reflected in monetary ways. Check any of the following that have been true for you.

Any money over _______ is a trigger to buy drugs or alcohol.

______ I have used money secretly to buy drugs or alcohol.

______ I have to deal with large outstanding debts.

______ I have been negligent in paying taxes.

______ I owe money on traffic warrants.

______ I gamble with my money.

______ I spend compulsively when I feel bad.

______ I frequently argue about money with family members.

______ I have stolen money.

34
Handout 15 • Relapse Prevention Group Page 3 of 3

TAKING CARE OF BUSINESS AND MANAGING MONEY

Often, when patients first enter treatment, they choose to give control of their money
to someone they trust. Having another person handle your money will not work unless
it is done at your request. In making the decision, you are controlling your own finances
and asking the trusted person to act as your banker.
When you and your therapist decide you can safely handle money again, you can
begin working toward gaining financial maturity. You may choose to have some of the
following goals:
• Arrange to pay off large debts in small, regular payments.

• Budget your money in a way similar to scheduling your time.

• Arrange spending agreements with anyone who shares your finances.

• Use bank accounts to help you manage your money.

• Live within your means.

• Eventually, have a savings plan.

6. List any other financial goals you have.

______________________________________________________________________________________________________

____________________________________________________________________________

______________________________________________________________________________________________________

____________________________________________________________________________

•••

35
Handout 16 • Relapse Prevention Group

Relapse Justification I
Once a person decides not to use drugs and alcohol
anymore, how does he or she end up doing it again?
Does it happen completely by accident, or is there
some way of avoiding the relapse?

Relapse justification is a process that happens in people’s minds. If a decision has

been made to stop using and drinking, but the addiction still has strength, the game
gets tricky. The addicted part of the brain invents excuses that move the addicted
person close enough to relapse situations that accidents can and do happen. You may
remember times when you were planning to stay drug or alcohol free, and such a
situation happened before you used again.
Use the questions below to help you identify justifications your addicted brain
might use. You can then interrupt the relapse process.

Accidents or Other People’s Influence

Does your addicted brain ever try to convince you that you have no choice or that an
unexpected situation caught you off guard? Have you ever said one of the following
statements to yourself?
• It was offered to me. What could I do?

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

• I was cleaning my house and found drugs I’d forgotten about.

• 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? How would using drugs or alcohol improve the situation?
• My spouse left me. There’s no reason to stay clean.

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

• I just lost my job. Why not use?

• Other _______________________________

37 continued on other side

Handout 16 • Relapse Prevention Group Page 2 of 2

RELAPSE JUSTIFICATION I continued from other side

Specific Purposes
Has your addicted brain ever suggested that using a certain drug or alcohol is the
only way to accomplish something?
• I’m gaining weight and need stimulants to control how much I eat.

• I’m out of energy. I’ll function better if I’m using.

• 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?
Is it really?
• I’m depressed. What difference does it make if I use or not?

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

• I’m scared. I know how to make the feeling go away.

• If he or she thinks I’ve used, I might as well use.

• Other________________________________

What might you do when your addicted brain asks these questions?

__________________________________________________________________________________________________________

•••

38
Handout 17 • Relapse Prevention Group

Taking Care of Yourself

Addicted people often do not take care of themselves.
You may not have enough time or energy to attend to
health and grooming when you are using. How you look
becomes unimportant. Health is secondary to drug and alcohol use. Not caring for
oneself is a major factor in loss of self-esteem among people with an addiction. To
“esteem” something means you value it. You acknowledge its importance.
Recovering people need to recognize their own value. In recovery, your own health
and appearance become more important as you care more for yourself. Their importance
is part of starting to like and even respect yourself.
Attending to the following will strengthen your image of yourself as a healthy,
drug- and alcohol-free, recovering person:

1. Have you seen a doctor for a thorough checkup?

2. When is the last time you went to the dentist?

3. Have you considered getting a “new look” the next time you cut your hair?

4. Are you paying attention to what you are eating? Is it too much, too little,
or of adequate nutritional value?

5. Do you still wear the same clothes you wore during your using episodes?

6. Do you need to have your vision or hearing checked?

7. What exercise do you do regularly?

8. Is your caffeine or nicotine intake out of control?

If addressing all these things at once is too overwhelming, work on one or two items
each week. Decide which are the most important and do them 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

__________________________________________________________________________________________________________

•••

39
Handout 18 • Relapse Prevention Group

Dangerous Emotions
For many people, certain emotional states are
“red flag” feelings, often viewed by people in recovery
as “the reason I use.” It seems, to people in recovery, that if they could avoid ever
feeling lonely, angry, or deprived, they would never relapse. The emotional trigger
leads to automatic use.

The most common negative emotional triggers are the following:

Loneliness: It is difficult to give up friends and activities that are part of a drug- and
alcohol-using lifestyle. Being separated from friends and family leaves people feeling
lonely. Often, nonusing friends and family members are not ready to get together with
the addicted person. They are not ready to risk getting back into a relationship that
didn’t work earlier. The recovering person is stranded between groups of friends, and
the feeling of loneliness can become a driving force that moves him or her back to using.

Anger: The intense irritability experienced in the early stages of recovery can result
in floods of anger that are, for many people, instantly triggering. The rage comes
directly from the limbic area, the addicted brain. Once a person is into that frame of
mind, it is a short trip to drug or alcohol use and possibly a long trip back to the
rational state of mind.

Deprivation: Becoming drug and alcohol free is a real accomplishment. Usually,

recovering people feel very good and proud about what they have been able to do.
Recovery is a positive thing. Sometimes situations exist that make recovering people
feel like they have to give up “good times and good things.” Recovery becomes a negative
state. It becomes a sentence, something to be endured. Feeling that using behavior is
positive, and sober behavior is negative, 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
relapsing.

1. Have any of these emotional states been a trigger for you in the past? Expain.

______________________________________________________________________________________________________

41 continued on other side

Handout 18 • Relapse Prevention Group Page 2 of 2

DANGEROUS EMOTIONS continued from other side

2. Are there any other negative emotional states that are dangerous for you? Explain.

______________________________________________________________________________________________________

One of the goals during the recovery process is learning to separate thoughts, behaviors,
and emotions. Once you learn this, it is possible for you to control what you think and
how you behave. So that you are not always acting only on your feelings, it is important
to recognize and begin to try to understand your emotions.

Many people find writing to be a good tool for recognizing and understanding how
they feel and why they feel that way. It is not necessary to be a good writer to use this
tool. It is often used by people who do not like to write and who have never written
much in the past. Follow these simple instructions and try a new way of getting to
know yourself:
• Find a private, comfortable, quiet place just for writing, and try to write a little
each day.
• Begin by taking several deep breaths and relaxing.

• Write in response to a question that you have asked yourself about your feelings.
(“What am I feeling right now?” “Why am I angry?” “Why am I sad?”)
• If something is bothering you, and you can’t get started writing, ask yourself
the following:
– What is going on?
– Is there really a problem, or am I making the situation bigger than it is?
– How do I really feel about this?
– What can I do about this?
• Allow the words to flow; forget spelling or punctuating correctly.

Doing this can help prevent you from blaming other people and things for how you
feel. Any time you write about something, it becomes much clearer to you. It can also
help you avoid the emotional buildup process that often leads to relapse.

•••

42
Handout 19 • Relapse Prevention Group

Illness
Getting sick is a setup for relapse. “How can that be?” you
might wonder. “It’s not my fault that I get sick. I don’t have
control over getting the flu or getting colds. How is it a setup?”

There are a number of ways that people can be less than healthy:
• Getting a cold, the flu, or some other infection

• Having serious dental work done

• Having surgery

• Experiencing severe PMS or premenstrual cramping

These situations and others like them make you weaker than normal. When you
are physically weaker, you also have less mental energy. Fighting a substance abuse
problem requires a good deal of mental energy.

What are some of the things that happen when you are ill and have less energy?
• Visits to the clinic are canceled.

• AA, CA, or NA meetings, or other outside support group meetings, are missed.

• Exercise is impossible.

• Medication taking—or even abusing—can occur.

Imagine if all these things happened at once for any length of time, even if you were
feeling strong.

As a result of the above, many people report that when they are ill
• It is difficult to cope with hours or days of free time now that everything has
been canceled.
• The lack of structure is a trigger.

• Being in bed and not feeling well reminds them of “after-using time.”

• Being alone for long periods of time is a trigger.

In order to keep all the negative effects of illness from interfering with your recovery,
it is important to allow yourself as little “sick time” as possible. If you push to restart
recovery behaviors as soon as possible after an illness or difficult medical condition,
you will feel stronger and your recovery will be stronger.

•••

43
Handout 20 • Relapse Prevention Group

Recognizing Stress
Stress is what a person experiences as the result of difficult
or upsetting events, particularly those that continue for a
period of time.

Stress is the experience people have when the demands they make of themselves or
those placed upon them are greater than what they feel they can handle. Sometimes we
are unaware of this emotional state until the stress is producing physical symptoms.

Check any of the following problems you have experienced in the past thirty days:

______ Sleep problems

______ Difficulty falling asleep

• Waking up off and on during the night
• Having nightmares
• Waking up early and being unable to fall back to sleep

______ Headaches

______ Stomach problems

______ Chronic illness

______ Fatigue

______ Moodiness

______ Irritability

______ Difficulty concentrating

______ General dissatisfaction with life

______ Feeling overwhelmed

•••

If you have checked two or more of these items, you need to think about reducing
stress immediately. By becoming more aware of stress and learning ways to cope,
you can further ensure your continuing recovery.

45
Handout 21 • Relapse Prevention Group

Relapse Justification II
Once a person decides not to use drugs and alcohol
anymore, how does he or she end up doing it again?
Does it happen completely by accident, or is there
some way of avoiding the relapse?

Relapse justification is a process that happens in people’s minds. If a decision has

Addiction Is Cured
Does your addicted brain ever try to convince you that you can use just once or use
just a little?
• I’m back in control. I’ll be able to stop when I want to.

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

• This drug (or alcohol) was not my problem—another one was.

So I can use this and not relapse.
• Other _________________________________

Testing Yourself
Would your brain like to prove you could be stronger than drugs or alcohol? It’s very
easy to forget that being smart, not being strong, is the key to staying sober. Have you
ever had any of the following thoughts:
• I’m strong enough to be around drugs and alcohol now.

• I want to see if I can say no to drinking and using.

• I want to see if I can be around my old friends.

• I want to see how meth feels now that I’ve stopped.

• Other ____________________________

47 continued on other side

Handout 21 • Relapse Prevention Group Page 2 of 2

RELAPSE JUSTIFICATION II continued from other side

Celebrating
Both the addicted brain and other people may encourage you to fall for the following:
• I’m feeling really good. Using once won’t hurt.

• 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 ____________________________

•••

Does your addicted brain ever try to convince you that

you can use just once or use just a little?

48
Handout 22 • Relapse Prevention Group

Reducing Stress
The following questions should be answered as honestly
as possible to help 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. Your time, energy, and money are all you have to give. Are you investing them
in work that you enjoy and that satisfies you?

Yes _ No _

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 _

3. Do you appreciate things like music, reading, nature, and personal relationships?
(Or are you overly focused on having money and things?)

Yes _ No _

4. Are you forcing yourself to do things that increase your self-confidence?

Yes _ No _

5. Do you tackle large goals by breaking them into smaller, more manageable tasks?

Yes _ No _

6. Are you careful to make your environment peaceful?

Yes _ No _

7. Can you and do you say no when that is how you feel?

Yes _ No _

8. Do you know how to use self-relaxation techniques to relax your body, and do
you allow time in your day to do them?

Yes _ No _

49 continued on other side

Handout 22 • Relapse Prevention Group Page 2 of 2

REDUCING STRESS continued from other side

9. Are you careful to avoid large swings in body energy caused by taking in excess
sugar and caffeine?

Yes _ No _

10. Are there specific ways you deal with anger and get it out of your system physically?

Yes _ No _

•••

Learn how to use self-relaxation techniques to

relax your body, and allow time in your day to do them.

50
Handout 23 • Relapse Prevention Group

Managing Anger
Anger is an emotion that leads many
people to relapse. This is particularly true early in
treatment. Anger is frequently experienced as a slow, building process during which
you constantly think about the anger-producing issues. Sometimes it seems that the
issue causing the anger is the only important thing in life. Often, a sense of victimization
accompanies the anger. “Why do I get all the bad breaks?” “How come she doesn’t
understand my needs?” “Why won’t he just do what I want him to do?”

1. Does any of this seem familiar to you? Explain.

______________________________________________________________________________________________________

2. How do you recognize when you get angry?

______________________________________________________________________________________________________

3. How do you express anger?

• Do you hold it in and eventually explode?

• Do you become sarcastic and passive-aggressive?

______________________________________________________________________________________________________

Are there any positive ways to deal with anger? Consider these methods:
• Talk to the person you are angry with.

• Talk to a therapist, a Twelve 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.

• Take a break to change your frame of mind.

• Exercise.

• Other ________________________________

51
Handout 24 • Relapse Prevention Group

Acceptance
“Just say no” is good advice to help prevent experimentation
with drugs and alcohol. It is not an answer to addiction.
Overcoming addiction requires that you recognize the power
of addiction and accept the personal limitations that occur as
a result of it. Many people experience this acceptance when
they enter treatment. But entering treatment is just the
first act of acceptance. It cannot be the only one.

One of the biggest problems in staying drug and alcohol free, and one of the major
reasons for what is called “white-knuckle sobriety,” is the refusal to “let go” and accept
that a human being has limits. Accepting a substance abuse problem is not a statement
of weakness. Does having diabetes or a heart condition mean you are a weak person?

Accepting the idea that you have become a substance abuser does not mean you
cannot control your life. It means there are some things you cannot control, and one of
them is the use of drugs or alcohol. If you continue to struggle with trying to control
the addiction, you give it more power.

There is a paradox in this recovery process. People who accept the reality of
addiction to the greatest degree benefit the most in recovery. Those who don’t fight
with the idea of quitting are the ones who win the fight. The only way to win this
fight is to surrender. If you continue to fight, the addiction will slap you to your knees.
The longer you fight, the further you get slapped down.

You do not need to “hit bottom” to begin recovery.

1. I am addicted. Yes _ No _

2. I hope someday I can use and drink again. Yes _____ No _____

3. I need to work on acceptance of

______________________________________________________________________________________________________

•••

53
Handout 25 • Relapse Prevention Group

Making New Friends

A blessed thing it is for any man or woman 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

Nothing in the whole recovery process is more important than relationships. Friends
and family are mirrors that reflect who we are. 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:

1. Do you have any friends like the one described in the poem above? If yes, who
are they?

______________________________________________________________________________________________________

2. Have you become like the people around you? Explain.

______________________________________________________________________________________________________

3. What is the difference between a friend and an acquaintance?

______________________________________________________________________________________________________

4. Where can you make some new acquaintances that might become friends?

______________________________________________________________________________________________________

55 continued on other side

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MAKING NEW FRIENDS continued from other side

5. To whom are you a friend?

______________________________________________________________________________________________________

6. What behaviors do you need to change to be better able to have honest relationships?

______________________________________________________________________________________________________

•••

56
Handout 26 • Relapse Prevention Group

Repairing Relationships
During the course of a substance abuse problem, it is not
unusual for people to get hurt. Because the actively addicted
person often cannot take care of himself or herself, he or she
certainly cannot take care of others.
In recovery, it is often helpful to think about whom you have hurt during your
substance abuse and whether you need to do anything or say anything to repair the
relationships that are most important to you. In the Twelve Step programs, this
process is called “making amends.”

1. What are some of the past behaviors you might want to make amends for?

______________________________________________________________________________________________________

2. Are there things you neglected to do or say that need amending?

______________________________________________________________________________________________________

3. How are you planning to go about making the amends?

______________________________________________________________________________________________________

4. Do you feel that being in recovery and stopping the use of drugs and alcohol is
enough? Explain.

______________________________________________________________________________________________________

57 continued on other side

Handout 26 • Relapse Prevention Group Page 2 of 2

REPAIRING RELATIONSHIPS continued from other side

These repair actions do not have to be complicated. Some acknowledgment on your

part of the hurt caused by the abuse of drugs and alcohol will probably go a long way
to reduce conflict in your relationships. Not everyone will be ready to forgive, but an
important part of this process is beginning to forgive yourself. Another part of the
relationship repairing has to do with your forgiving others for things that happened
as part of the substance abuse process.

5. Whom do you need to forgive?

______________________________________________________________________________________________________

6. What resentments do you need to let go of?

______________________________________________________________________________________________________

•••

58
Handout 27 • Relapse Prevention Group

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.

1. What does the above saying mean to you?

______________________________________________________________________________________________________

2. What do you know you cannot change?

______________________________________________________________________________________________________

3. What have you changed already?

______________________________________________________________________________________________________

•••

59
Handout 28 • Relapse Prevention Group

Compulsive Behavior
Many addicted people enter treatment just to
stop using drugs and alcohol. 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 are living their lives. The lifestyle
changes recommended are focused on getting the recovering person back in control
of his or her life.

1. In what ways was your life out of control?

______________________________________________________________________________________________________

2. Have you noticed yourself behaving excessively in any of the following ways?
Check all that apply to you.

______ Working all the time

______ Using prescription medications

______ Abusing other illicit drugs

______ Drinking too much caffeine

______ Smoking more

______ Eating foods high in sugar

______ Exercising to the extreme

______ Compulsively masturbating

______ Gambling

______ Spending too much money

______ Engaging in compulsive sexual activities

Other _______________________

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Handout 28 • Relapse Prevention Group Page 2 of 4

COMPULSIVE BEHAVIOR continued

3. What changes have you tried to make so far?

______________________________________________________________________________________________________

Does the following sound familiar? “I stopped smoking, drinking, and drug use. 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 behavior is called the abstinence violation syndrome.

4. Do you have a similar story from the past? Explain.

______________________________________________________________________________________________________

5. Are you making major lifestyle changes in this recovery process? Explain.

______________________________________________________________________________________________________

6. Is it uncomfortable to make these changes?

Yes _ No _

7. Are you avoiding being uncomfortable by switching to other compulsive behaviors?

Explain.

______________________________________________________________________________________________________

62
Handout 28 • Relapse Prevention Group Page 3 of 4

COMPULSIVE BEHAVIOR continued

8. Are there changes you still need to make?

Yes _ No _

If so, what are they?

______________________________________________________________________________________________________

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 of things you can do in order to prevent
a relapse:

1. Prevent exposure to triggers.

Stay away from people, places, and activities that you associate with drug and
alcohol use.

2. Stop the thoughts that may lead to relapse.

There are many techniques that can be used to do this. Some examples of
thought-stopping techniques are
• Relaxation—take three slow, deep breaths.
• Snapping—wear a rubber band loosely on your wrist, and every time you
become aware of a triggering thought, snap the band and say “no!” to the thought.
• Visualization—imagine an on/off switch in your head. Turn it to “off” to stop the
triggering thoughts.

These techniques can be very effective in preventing a relapse. It helps to

have different pictures or thoughts ready to replace the triggering thoughts.
Try these techniques and use those that work best for you.

63
Handout 28 • Relapse Prevention Group Page 4 of 4

COMPULSIVE BEHAVIOR

3. Schedule your time.

Put structure into your day and fill blocks of free time with activities such as
spending time with nonrisky friends, exercising, or doing volunteer work.

4. Do something completely different.

Get out of town. Go to a movie or watch a video. Go to a meeting.

What are some other things you could do to prevent a relapse?

__________________________________________________________________________________________________________

What do you plan to do the next time you’re aware of being in a relapse situation?

__________________________________________________________________________________________________________

•••

64
Handout 29 • Relapse Prevention Group

Dealing with Feelings

and Depression
Feelings

Can you recognize your feelings?

Sometimes people don’t allow themselves to have certain emotions (for example, feeling
angry is not all right, or feeling good means trouble is coming). When you mislabel
emotions (saying “I am upset” but meaning “I am depressed” or “I am angry”) or deny
them, you cannot begin to deal with them.

Are you aware of outward signs of certain feelings?

Maybe you get an upset stomach when you are anxious, or you bite your fingernails
when you are stressed, or you yell when you are angry. Think about several emotions
that trouble you. Identify how they show physically, what you say to yourself when
you’re expressing them, and how you behave in response to them.

Can you identify the cause of the feelings?

Emotions can be caused by external events. They can also be caused by internal
messages. If you believe you should not feel angry, for instance, you might deny the
anger, and the feeling will build up inside you. If you find yourself blaming others for
how you feel, you need to recognize that you decide what to feel, and others cannot
make you feel any certain way. Be aware of feelings that might be primarily physio-
logical, such as PMS, biological depression, or the Wall.

How do you cope with your feelings now?

Another way of determining how you cope is to look at how your feelings affect you
and others around you. For instance, do your constant feelings of anger or depression
interfere with your relationships with others? Do people avoid dealing with you, try
to keep you from getting upset, or try to make you feel better? Focus on one or two
emotions you need to learn to cope with better.

65 continued on other side

Handout 29 • Relapse Prevention Group Page 2 of 3

DEALING WITH FEELINGS AND DEPRESSION continued

What are some new coping strategies?

Once you have identified what you feel, you may want to consider expressing it. You
can express feelings indirectly (to a trusted group, friend, or therapist), or you can
express feelings directly to the people about whom you have the feelings. You will
need to learn when direct expression is appropriate and when it is not. You can also
make changes in your thinking that can help diminish the feelings. You can change
“I am so angry she doesn’t agree with me, I feel like using or drinking” to “It’s all right
for someone not to agree with me, and using will not make anything better.” Changing
behavior and doing something different are other ways of coping with feelings.

The idea here is not to let out-of-control feelings drive you back to using. Learning
to deal (cope) with emotions means allowing yourself to feel and live life with a balance
of thinking and feeling, which then determines your behavior.

Depression

One feeling that typically needs to be dealt with in recovery is depression. Although
we know drug use, alcohol use, and depression are related, it is not yet known if this
relationship exists because depressed people use more or if drug and alcohol use causes
depression. Which came first, the chicken or the egg?

Most people report having problems with depression from time to time during
recovery. For some people this depression, left untreated, can result in relapse.
Therefore, it is important to be aware of signs of depression and to be prepared to
cope with the feelings.

1. Symptoms of depression include the following (check all that apply to you):

______ Having low energy

______ Overeating or not eating

______ Having sad thoughts

______ Losing interest in career or hobbies

______ Sleeping more than usual

______ Having a decreased sex drive

66
Handout 29 • Relapse Prevention Group Page 3 of 3

DEALING WITH FEELINGS AND DEPRESSION

______ Having increased thoughts of drinking

______ Having insomnia

______ Stopping Twelve Step attendance

______ Stopping an exercise program

______ Avoiding social activities

______ Having feelings of boredom, irritability, or anger

______ Having crying spells

______ Having suicidal thoughts or actions

______ Stopping normal activities such as work or cleaning house

2. List any other signs that you recognize as signaling the beginning of depression.

______________________________________________________________________________________________________

3. Healthy responses to depression may include the following:

Increasing exercise Talking to a spouse

Planning some new activities Talking to a friend

Talking to a therapist Considering evaluation

for medication

4. List any other ways you have of effectively coping with depression.

______________________________________________________________________________________________________

•••

67
Handout 30 • Relapse Prevention Group

Twelve Step Programs

(or Other Spiritual Groups)

What is AA?
Alcoholics Anonymous (AA) is a worldwide organization that has been in existence
since 1935. AA holds free, open meetings throughout the day and evening, seven days
per week, to help people who want to stop being controlled by compulsive disorders.

Are these meetings like treatment?

No. They are groups of recovering people helping each other stay sober.

Does a person need to enroll or make an appointment?

No, just show up. Times and places of meetings may be available in your treatment
program or by calling AA directly.

What are CA and NA?

CA stands for Cocaine Anonymous, and NA for Narcotics Anonymous. There are
also Gamblers Anonymous, Pills Anonymous, Marijuana Anonymous, Crystal Meth
Anonymous, Overeaters Anonymous, Emotions Anonymous, and more. The groups
are similar, although the specific focus may differ.
Spin-off support groups that use the Twelve Steps include Al-Anon, Adult Children
of Alcoholics (ACA), Codependents Anonymous (CODA), and Adult Children of
Dysfunctional Families. Often people go to more than one type of group. Most people
“shop around” for the type of group and the specific meetings they find most comfortable,
relevant, and useful.

What are the Twelve Steps?

The basis of the self-help groups are the Twelve Steps. These are beliefs and activities
designed to provide a program for sobriety. There is a strong spiritual aspect to both
the Steps and AA.

What if a person is not particularly religious?

One can benefit from AA without being religious or without working the Twelve
Steps, and many people in AA fall into the nonreligious category. These people think
of the Higher Power in the Steps as a bigger frame of reference or a bigger source of
knowledge, and not necessarily as “God.”

69 continued on other side

Handout 30 • Relapse Prevention Group Page 2 of 2

TWELVE STEP PROGRAMS (OR OTHER SPIRITUAL GROUPS) continued from other side

What does AA offer?

AA offers the following benefits:
• 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 AA, CA, or NA meetings while you are in
treatment. Ask other patients for help in choosing the best meeting for you, and sample
several different meetings. Try to be open to what you can get out of AA; it may offer
social, emotional, or spiritual support, or it may merely offer something to do.

70
Handout 31 • Relapse Prevention Group

Looking Forward:
Dealing with Downtime
Structure is important. Scheduling is important.
Balance is important. Downtime is important. So you’re making it work.
Recovery is working because you’re working at it. Now what? Do you feel like some-
thing is missing? Do you feel like you need to take a break from the routine and get
excited about something?

If you are in the Wall stage, you may not be able to feel much excitement about any-
thing. Some of the flat feeling in recovery may be a result of one of the following factors:
• The recovery process the body is going through prevents you from feeling strong
feelings of any kind.
• Normal life feels less exciting than life as an addicted person.

There is a trick people use to put a sense of anticipation and excitement into their
lives. It is possible to plan certain things and to look forward to them. Some people
think of this as building islands—islands of rest, recreation, or fun; islands to look
forward to so that the future doesn’t seem so endless and routine. The islands don’t
need to be big, extravagant things. They can be things like
• Going out of town for a three-day weekend • Visiting relatives

• Taking a day off work • Going out to eat

• Attending a baseball game • Visiting an old friend

The islands do need to be things you really look forward to doing. They also need to
be spaced closely enough so that you don’t get too stressed, tired, or bored in between,
thereby threatening your recovery.

List some past islands: What are some possible

islands for you now?

_________________________________ _________________________________
_________________________________ _________________________________
_________________________________ _________________________________
_________________________________ _________________________________

71 continued on other side

Handout 31 • Relapse Prevention Group Page 2 of 2

LOOKING FORWARD: DEALING WITH DOWNTIME continued from other side

Downtime

The Problem
Being in recovery means living responsibly. Deciding what to do, acting intelligently,
and constantly staying “with it” can be exhausting. It is easy to run out of energy and
become tired and negative. 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 anything or anyone
when your energy level is so low.

The Old Answer

Drugs and alcohol provide quick relief from the above state. Using or drinking is an
easy, fast way to get relief. All the reasons for not using chemicals are quickly forgotten
when the body and mind desperately need refueling.

The New Answer

Each person needs to decide what can provide a refreshing, satisfying break from the
daily grind. What works for you may not work for someone else. There are choices as
to what you can do in your downtime, but there is no choice as to whether it is neces-
sary to find a downtime activity that works. The more tired and beaten down you
become, the less energy there is to use in dealing with anything.
Notice how often you are feeling stressed, impatient, angry, or shut down emotionally.
These are signs of needing more downtime. Try some of the activities listed below:

Walking Bicycling Going to church

Taking a class Watching TV Cooking or eating
Going to the movies Listening to music Lying in the sun
Reading Painting or drawing Talking with nonusing friends
Playing sports Fishing Going to Twelve Step
Writing Playing with a pet meetings

Learning meditation/yoga Exercising Playing a musical instrument

Shopping

What will you do now on a day when you’re stressed and in the past might have said, “I
really need a drink” or “I need to get high today”? What will your downtime activity be?

__________________________________________________________________________________________________________

72
Handout 32 • Relapse Prevention Group

One Day at a Time

Recovering people do not usually relapse because they cannot
handle one particular day or one particular situation. Any
given day or any single event is usually manageable. Things
become unmanageable when the recovering person allows events
from the past or fears of the future to contaminate the present.
Beating yourself up with the past makes you less able to handle the present.
You are allowing the past to make your recovery more difficult when you find your
addicted brain saying things like
“I can never do anything right. I have always blown every opportunity.”
“If I try to do something difficult, I will fail. I always do.”
“I am always letting people down. I have always disappointed everyone.”

1. Can you think of a recent situation in which you allowed the past to make the
present more difficult? Explain.

______________________________________________________________________________________________________

Allowing what might happen to overwhelm you is projecting into the future. You
cannot deal with the unknown. You can only deal with what is happening right now,
today. You are filling yourself with fear when you begin telling yourself things like
“Tomorrow something will happen to ruin this.”
“That person is going to hate me for this.”
“I will never be able to make it.”

2. What are some things you tell yourself to produce fear of the future?

______________________________________________________________________________________________________

3. What are some other things you can tell yourself to bring you back to the present?

______________________________________________________________________________________________________

73
Handout 33 • Relapse Prevention Group

Recreational Activities (Optional)

Read this list of suggested activities and interests and
circle ones you might explore in the future:

Acting/dramatics Fishing Volleyball Weight lifting

Singing Marksmanship Boxing Badminton
Amateur radio Taking snapshots Go to movies Home decorating
Darkroom work Flower arranging Painting/drawing Rowing/boating
Archery Mechanics Volunteer work Woodworking
Designing clothes Talking on the phone Camping Scouts, PTA, coaching
Jogging Baseball/softball Go to the park Sailing
Skin diving Flying/gliding Playing cards Wrestling
Attending auctions Metalwork Walking Civic organizations
Dining out Tennis Canoeing Sculpture
Judo/karate Basketball Go to plays/lectures Writing poetry/songs
Squash/handball Folk dancing Playing a musical Collecting coins,
Attending concerts Model building instrument antiques, and so on

Driving Traveling Watching sports Horseback riding

Kite flying Bicycling Carpentry Sewing

Sunbathing Football Golf Writing letters

Attending swap meets Motorboating Political activities Cooking/baking

Electronics Video games Watching TV Horseshoes

Knitting/crocheting Billiards/pool Ceramics/pottery Shuffleboard

Surfing Fraternal organizations Green Peace Crossword puzzles

Auto racing Motorcycling Reading Hunting

Encounter groups Visiting friends Waterskiing Sierra Club

Leatherwork Bird-watching Checkers Dancing lessons

Swimming Gardening Gymnastics Ice-skating

Auto repairing Mountain climbing Religious activities Sightseeing

Fencing Visiting museums Weaving Social dancing

Listening to music Bowling Chess Jewelry making

Table tennis/Ping-Pong Go to garage/yard sales Hiking Child-related activities

Backpacking Needlework Roller-skating Skiing

75
Handout 34 • Relapse Prevention Group

Holidays and Recovery (Optional)

Holiday seasons are often a hard time
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:

______ More alcohol and drugs at parties

______ Money stress due to gift buying

______ Increased stress due to heavier traffic

______ Increased stress due to crowded shopping areas

______ Interruption of normal routine

______ Stopping exercise

______ Stopping spiritual meetings

______ Stopping therapy

______ Party atmosphere

______ More (or no) contact with family

______ Increased emotions from holiday memories

______ Increased anxiety regarding triggers and cravings

______ Stress from not having time to meet responsibilities

______ Dealing with New Year’s Eve and other party occasions

______ Extra free time with no structure

Other ____________________________________________

77 continued on other side

Handout 34 • Relapse Prevention Group Page 2 of 2

HOLIDAYS AND RECOVERY (OPTIONAL) continued from other side

Scoring:
Mild: If you checked one to three items, you are lucky. The holidays produce only a
slightly increased risk of relapse.
Moderate: If you checked four to six items, the holidays add lots of stress to your life.
Relapse risk is related to how well you cope with increased stress. Your score indi-
cates that you need to plan carefully for your recovery during the holidays.
Severe: Seven or more items checked indicates that 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 therapist. Use the tools that have
helped you in recovery to stay drug and alcohol free through this stressful time.

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