NOTE - this is a list of contents in the original document for clients in a drug addiction treatment program.

Selected sections are published here, on the Addiction Info site.

For the complete handbook, see the original 112 page PDF document:
 
Client's Handbook: Matrix Intensive Outpatient Treatment for People with Stimulant Use Disorder

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Individual/Conjoint Session Handouts
IC 1—Sample Service Agreement and Consent . .  .  . . . . . . 3
IC 2A—Recovery Checklist . . . . . . . . . . . . . . . . . . . 5
IC 2B—Relapse Analysis Chart . . . . . . . . . . . . . . . . . . . . 6
IC 3A—Treatment Evaluation. . .  . . .  . . . . . . . . . . . 7
IC 3B—Continuing Treatment Plan . . .  . . . . . . . . . . 9

Early Recovery Skills Handouts
SCH 1—The Importance of Scheduling . . .  . .  . . . . . . 11
SCH 2—Daily/Hourly Schedule . . . .   . . . . . . . 12
CAL 1—Marking Progress . . . .   . . . . . . . . . . . . . 13
CAL 2—Calendar . . . . . . . . .   . . . . . . . . . . . . 14

ERS 1A—Triggers . . . . . . . . . .  . . . . . . . . . . . . . . 15
ERS 1B—Trigger–Thought–Craving–Use . . . . . . . . . . . . 16
ERS 1C—Thought-Stopping Techniques . . . .  . . . . . . . . . . . 17
ERS 2A—External Trigger Questionnaire . .  . . . . . . . . . . . . . 19
ERS 2B—External Trigger Chart . . . . .  . . . . . . . . . . 20
ERS 3A—Internal Trigger Questionnaire . . . . . . . . 21
ERS 3B—Internal Trigger Chart. . . .   . . . . . . . . . . . . . . 22
ERS 4A—12-Step Introduction. . . . . .  . . . . . . . . . . 23
ERS 4B—The Serenity Prayer and the 12 Steps of Alcoholics Anonymous . . 28
ERS 5—Roadmap for Recovery .  . . . . . . . . . . . . . . . . . . . 29
ERS 6A—Five Common Challenges in Early Recovery . . .  . . . . 32
ERS 6B—Alcohol Arguments. . . . . . . .  . . . . . . . . . . . . . 34
ERS 7A—Thoughts, Emotions, and Behavior . .  . . . . . . . . . 35
ERS 7B—Addictive Behavior. . . . . . . . . . . . . . . . . 36
ERS 8—12-Step Sayings. . . . .   . . . . . . . . . . . . 37

Relapse Prevention Handouts
RP 1—Alcohol . . . . . . . . . . . . . .  . . . . . . . . . . . . . . . 39
RP 2—Boredom . . . . . . . . . .  . . . . . . . . . . . . . . . 41
RP 3A—Avoiding Relapse Drift . . . . .  . . . . . . . . . . . . . 43
RP 3B—Mooring Lines Recovery Chart . . . .  . . . . . . . . . . . 45
RP 4—Work and Recovery . . .  . . .  . . . . . . . . . . . . . . . . . . 46
RP 5—Guilt and Shame. . . . . . . . . . . . . . . . . . . . . 48
RP 6—Staying Busy. . . . . . . .  . . . . . . . . . . . . . . . . . . . . . . 50
RP 7—Motivation for Recovery . . .   . . . . . . . . . . . . . . . 52
RP 8—Truthfulness . . . . . . . . . . . . . . . . . . . . . . . . . . 54
RP 9—Total Abstinence . . . . . . .   . . . . . . . . . . . . . . . . . . . . 56
RP 10—Sex and Recovery . . . .  . . . . . . . . . . . . . . . . 57
RP 11—Anticipating and Preventing Relapse . .  . . . . 58
RP 12—Trust . . . . . . . . . .   . . . . . . . . . 61
RP 13—Be Smart, Not Strong . . . .   . . . . . . . . . . . . 62
RP 14—Defining Spirituality . . .   . . . . . . . . . . . 64
RP 15—Managing Life; Managing Money . .  . . . . . . . . . . . 66
RP 16—Relapse Justification I. . . .   . . . . . . . . . . . . . . . 68
RP 17—Taking Care of Yourself . .   . . . . . . . . . . . . . . . 70
RP 18—Emotional Triggers . . . . . .  . . . . . . . . . . . . . . . 71
RP 19—Illness . . . . . . . . . . .. . . .  . . . . . . . . . . . 73
RP 20—Recognizing Stress. . . .. . . . . .  . . . . . . . . . . . . 75
RP 21—Relapse Justification II . . .   . . . . . . . . . . . . . 76
RP 22—Reducing Stress . . . . . . .  . . . . . . . . . . . . . 78
RP 23—Managing Anger . . . . . . . . . . . . . . . . . . . 80
RP 24—Acceptance. . . . . .  . . . . . . . . . . . . . . . . . . . 81
RP 25—Making New Friends. .   . . . . . . . . . . . . . . . . . 82
RP 26—Repairing Relationships . . .   . . . . . . . . . . 83
RP 27—Serenity Prayer. . . . . .   . . . . . . . . . . . . . . . 84
RP 28—Compulsive Behaviors . . . . . .  . . . . . . . . . . . . . . 85
RP 29—Coping With Feelings and Depression. . . . .   . . . . . 88
RP 30—12-Step Programs. . . . . . . . . . . . . . . . . . . . . . . . . . 91
RP 31—Looking Forward; Managing Downtime . . . .  . . . . . . 95
RP 32—One Day at a Time . . . . . . . . . . . . . . . . . . . . 98
RP 33—Drug Dreams During Recovery . . .  . . . . . . . . 100
RP Elective A—Client Status Review. . . . . . . . . . . . 101
RP Elective B—Holidays and Recovery . .  . . . . . . . . . . . . 103
RP Elective C—Recreational Activities . . . .  . . . . . . . . . 105

Recovery is a lifelong process.

You can stop drug and alcohol use and begin a new lifestyle during the first 4 months of treatment.

Developing an awareness of what anchors your recovery is an important part of that process.

But this is only the beginning of your recovery. As you move forward with your recovery after treatment, you will need a lot of support.

And you may need different kinds of support than you did during treatment.

You and your counselor can use the information below to help you decide how best to support your recovery.

Group Work

You should participate in at least one regular recovery group every week after treatment. The program offers a Social Support group that meets once a week.

Other recovery groups are often available in the community.

Ask your counselor about local recovery groups.

Individual Therapy

Individual sessions with an addiction counselor might be helpful. When your current treatment ends, you have choices about continuing with therapy.

You may choose this time to enter therapy with another professional. You may want to return to therapy with the professional who referred you for the Matrix IOP method. Or you may choose to continue to see your current Matrix IOP counselor.

Couples Therapy

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

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

------

See original document for other chapters, diagrams, worksheets etc:

Client's Handbook: Matrix Intensive Outpatient Treatment for People with Stimulant Use Disorder (112 page PDF)

~ ~ ~

NOTE from AddictionInfo: Matrix IOP refers to Matrix Intensive Outpatient Treatment program.

For additional material on recovery and support groups, see:
What Are Your Recovery Options
AA Is Not The Only Way

Scheduling may be a difficult and boring task if you’re not used to it.

It is, however, an important part of the recovery process.

People with substance use disorders do not schedule their time.

Scheduling your time will help you achieve and maintain abstinence.

Why Is Scheduling Necessary?

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

Your schedule is your structure.

Do I Need To Write Down My Schedule?

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

What if I Am Not an Organized Person?

Learn to be organized. Buy a schedule book and work with your counselor.

Thorough scheduling of your activities is very important to treating your substance use disorder.

Remember, your rational brain plans the schedule. If you follow the schedule, you won’t use.

Your addicted brain wants to be out of control. If you go off the schedule, your addicted brain may be taking you back to using drugs or drinking.

Who Decides What I Schedule?

You do! You may consider suggestions made by your counselor or family members, but the final decision is yours.

Just be sure you do what you wrote down. Follow your schedule; try not to make any changes.

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

It is useful for both you and your counselor to know where you are in the recovery process at all times.

Marking a calendar as you go helps in several ways:

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

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

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

Make a mark to record on the calendar pages every day of abstinence you achieve.

You may decide to continue the exercise following the program. If you record your abstinent days regularly, this simple procedure will help you and your counselor see your progress.

---------

See original document for other chapters, diagrams, worksheets etc:
Client's Handbook: Matrix Intensive Outpatient Treatment for People with Stimulant Use Disorder (112 page PDF)

Triggers are people, places, objects, feelings, and times that cause cravings.

For example, if every Friday night someone cashes a paycheck, goes out with friends, and uses stimulants, the triggers might be

* Friday night 
* After work 
* Money
* Friends who use 
* A bar or club

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

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

1. Identify triggers.

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

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

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

What are some of the strongest triggers for you?

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

The Losing Argument

If you decide to stop drinking or using but at some point end up moving toward using substances, your brain has given you permission by using a process called relapse justification.

Thoughts about using start an argument inside your head—your rational self versus your substance-dependent self. You feel as though you are in a fight, and you must come up with many reasons to stay abstinent.

Your mind is looking for an excuse to use again. You are looking for a relapse justification.

The argument inside you is part of a series of events leading to substance use. How often in the past has your substance dependence lost this argument?

Thoughts Become Cravings

Craving does not always occur in a straightforward, easily recognized form.

Often the thought of using passes through your head with little or no effect. But it’s important to identify these thoughts and try to eliminate them. It takes effort to identify and stop a thought.

However, allowing yourself to continue thinking about substance use is choosing to relapse.

The further the thoughts are allowed to go, the more likely you are to relapse.

The “Automatic” Process 

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

Trigger –> Thought –> Craving –> Use

Thought Stopping

The only way to ensure that a thought won’t lead to a relapse is to stop the thought before it leads to craving. Stopping the thought when it first begins prevents it from building into an overpowering craving.

It is important to do it as soon as you realize you are thinking about using.

  

Thought-Stopping Techniques

A New Sequence

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

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

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

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

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

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

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

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

External Trigger Questionnaire

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

* Home alone  * Home with friends  * Friend’s home  * Parties
* Sporting events  * Movies  * Bars/clubs  * Beach
* Concerts  * With friends who use drugs  * When gaining weight
* Vacations/holidays  * When it’s raining  * Before a date
* During a date  * Before sexual activities  * During sexual activities
* After sexual activities  * Before work  * When carrying money
* After going past dealer’s residence  * Driving  * Liquor store
* During work  * Talking on the phone  * Recovery groups
* After payday  * Before going out to dinner  * Before breakfast
* At lunch break  * While at dinner  * After work
* After passing a particular street or exit  * School
* The park  * In the neighborhood  * Weekends
* With family members  * When in pain

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

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

List people you could be with and not use.

External Trigger Chart

Instructions: List people, places, objects, or situations below according to their degree of association with substance use, from 0% to 100% Chance of Using :

Never Use [These situations are “safe.”]

Almost Never Use [These situations are low risk, but caution is needed.]

Almost Always Use [These situations are high risk. Staying in these situations is extremely dangerous.]

Always Use [Involvement in these situations is deciding to stay addicted. Avoid totally.]

--------

Internal Trigger Questionnaire

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

* Afraid  * Frustrated  * Neglected
* Angry  * Guilty  * Nervous
* Confident  * Happy  * Passionate
* Criticized  * Inadequate  * Pressured
* Depressed  * Insecure  * Relaxed
* Embarrassed  * Irritated  * Sad
* Excited  * Jealous  * Bored
* Exhausted  * Lonely  * Envious
* Deprived  * Humiliated  * Anxious
* Aroused  * Revengeful  * Worried
* Grieving  * Resentful  * Overwhelmed
* Misunderstood  * Paranoid  * Hungry

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

Was your use in the weeks before entering treatment
_____ Tied primarily to emotional conditions?
_____ Routine and automatic without much emotional triggering?

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

Internal Trigger Chart

Instructions: List emotional states below according to their degree of association with substance use, from 0% to 100% Chance of Using:

Never Use [These emotions are “safe.”]

Almost Never Use [These emotions are low risk, but caution is needed.]

Almost Always Use [These emotions are high risk.]

Always Use [Persisting in these emotions is deciding to stay addicted. Avoid totally.]

~ ~ ~

See original document for other chapters, diagrams, worksheets etc:

Client's Handbook: Matrix Intensive Outpatient Treatment for People with Stimulant Use Disorder (112 page PDF)

There are alternatives to 12-Step groups, many of which are not based on the concept of a higher power.

Although the philosophies of these groups differ, most offer a mutual-help approach that focuses on personal responsibility, personal empowerment, and strength through an abstinent social network.

Here are a few notable alternatives to 12-Step groups:

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

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

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

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

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

Questions To Consider

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

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

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

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

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

---------

See original document for other chapters, diagrams, worksheets etc:

Client's Handbook: Matrix Intensive Outpatient Treatment for People with Stimulant Use Disorder (112 page PDF)

~~~~

NOTE from AddictionInfo -
Also see the section on Self Help Groups

      

Recovery from a substance use disorder is not a mysterious process. After the use of substances is stopped, the brain goes through a biological readjustment.

This readjustment process is essentially a “healing” of the chemical changes that were produced in the brain by substance use.

It is important for people in the beginning stages of recovery to understand why they may experience some physical and emotional difficulties.

The durations of the stages listed below are a rough guide of recovery, not a schedule.

The length of stages will vary from person to person. The substance used will affect the client’s progress through the stages, too.

Clients who had been using methamphetamine will tend to spend more time in each stage than clients who were using cocaine or other stimulants.

The Stages

Withdrawal Stage (1 to 2 weeks)

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

For people who use stimulants, withdrawal can be accompanied by drug craving, depression, low energy, difficulty sleeping or excessive sleep, increased appetite, and difficulty concentrating.

Although people who use stimulants do not experience the same degree of physical symptoms as do people who use alcohol, the psychological symptoms of craving and depression can be quite severe.

Clients may have trouble coping with stress and may be irritable.  People who drank alcohol in large amounts may have the most severe symptoms.

The symptoms can include nausea, low energy, anxiety, shakiness, depression, intense emotions, insomnia, irritability, difficulty concentrating, and memory problems.

These symptoms typically last 3 to 5 days but can last up to several weeks.

Some people must be hospitalized to detox safely. For people who used opioids or prescription drugs, the 7- to 10-day withdrawal period (or longer for people who use benzodiazepines) can be physically uncomfortable and may require hospitalization and medication.

It is essential to have a physician closely monitor withdrawal in people dependent on these substances.

Along with the physical discomfort, many people experience nervousness, trouble sleeping, depression, and difficulty concentrating.

Successfully completing withdrawal from these substances is a major achievement in early recovery.

Early Abstinence (4 weeks; follows Withdrawal)

For people who used stimulants, this 4-week period is called the Honeymoon.

Most people feel quite good during this period and often feel “cured.” As a result, clients may want to drop out of treatment or stop attending 12-Step meetings during the Honeymoon period.

Early abstinence should be used as an opportunity to establish a good foundation for recovery.

If clients can direct the energy, enthusiasm, and optimism felt during this period into recovery activities, they can lay the foundation for future success.

For people who used alcohol, this 4-week period is marked by the brain’s recovery. Although the physical withdrawal symptoms have ended, clients still are getting used to the absence of substances.

Thinking may be unclear, concentration may be poor, nervousness and anxiety may be troubling, sleep is often irregular, and, in many ways, life feels too intense. 

For those who used opioids or prescription drugs, there is essentially a gradual normalization during this period.

In many ways the process is similar to the alcohol recovery timetable.

Slow, gradual improvement in symptoms is evidence that the recovery is progressing.

Protracted Abstinence (3.5 months; follows Early Abstinence)

From 6 weeks to 5 months after clients stop using, they may experience a variety of annoying and troublesome symptoms.

These symptoms—difficulties with thoughts and feelings—are caused by the continuing healing process in the brain.

This period is called the Wall. It is important for clients to be aware that some of the feelings during this period are the result of changes in brain chemistry. If clients remain abstinent, the feelings will pass.

The most common symptoms are depression, irritability, difficulty concentrating, low energy, and a general lack of enthusiasm.

Clients also may experience strong cravings during protracted abstinence.

Relapse risk goes up during this period. Clients must stay focused on remaining abstinent one day at a time. Exercise helps tremendously during this period.

For most clients, completing this phase in recovery is a major achievement.

Readjustment (2 months; follows Protracted Abstinence)

After 5 months, the brain has recovered substantially. Now, the client’s main task is developing a life that has fulfilling activities that support continued recovery.

Although a difficult part of recovery is over, hard work is needed to improve the quality of life.

Because cravings occur less often and feel less intense 6 months into recovery, clients may be less aware of relapse risk and put themselves in high-risk situations and increase their relapse risk.

Everyone who attempts to stop using substances runs into situations that make it difficult to maintain abstinence.

Listed below are five of the most common situations that are encountered during the first few weeks of treatment.

Next to these problems are some suggested alternatives for handling these situations.

1  Challenges -
Friends and associates who use: You want to continue associations with old friends or friends who use.

New Approaches -
* Try to make new friends at 12-Step or mutual-help meetings.
* Participate in new activities or hobbies that will increase your chances of meeting abstinent people.
* Plan activities with abstinent friends or family members.
--------

2  Challenges -
Anger, irritability: Small events can create feelings of anger that seem to preoccupy your thoughts and can lead to relapse.

New Approaches -
* Remind yourself that recovery involves a healing of brain chemistry. Strong, unpredictable emotions are a natural part of recovery.
* Engage in exercise.
* Talk to a counselor or a supportive friend.
-------

3  Challenges -
Substances in the home: You have decided to stop using, but others in your house may still be using.

New Approaches -
* Get rid of all drugs and alcohol.
* Ask others to refrain from using and drinking at home.
* If you continue to have a problem, think about moving out for a while.
-------

4  Challenges -
Boredom, loneliness: Stopping substance use often means that activities you did for fun and the people with whom you did them must be avoided.

New Approaches -
* Put new activities in your schedule.
* Go back to activities you enjoyed before your addiction took over.
* Develop new friends at 12-Step or mutual-help meetings.
--------

5  Challenges -
Special occasions: Parties, dinners, business meetings, and holidays without substance use can be difficult.

New Approaches -
* Have a plan for answering questions about not using substances.
* Start your own abstinent celebrations and traditions.
* Have your own transportation to and from events.
* Leave if you get uncomfortable or start feeling deprived.

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

Which ones?

How will you handle them?

~~~~~~

See original document for other chapters, diagrams, worksheets etc:

Client's Handbook: Matrix Intensive Outpatient Treatment for People with Stimulant Use Disorder (112 page PDF)

Habitual substance use changes the way people think, how they feel, and how they behave.

How do these changes affect the recovery process?

Thoughts

Thoughts happen in the rational part of the brain. They are like pictures on the TV screen of the mind.

Thoughts can be controlled. As you become aware of your thoughts, you can learn to change channels in your brain.

Learning to turn off thoughts of substance use is a very important part of the recovery process.

It is not easy to become aware of your thinking and to learn to control the process. With practice it gets easier.

Emotions

Emotions are feelings. Happiness, sadness, anger, and fear are some basic emotions.

Feelings are the mind’s response to things that happen to you. Feelings cannot be controlled; they are neither good nor bad.

It is important to be aware of your feelings.

Talking to family members, friends, or a counselor can help you recognize how you feel.

People normally feel a range of emotions. Drugs can change your emotions by changing the way your brain works.

During recovery, emotions are often still mixed up.

Sometimes you feel irritated for no reason or great even though nothing wonderful has happened.

You cannot control or choose your feelings, but you can control what you do about them.

Behavior

What you do is behavior. Work is behavior. Play is behavior.

Going to treatment is behavior, and substance use is behavior.

Behavior can result from an emotion, from a thought, or from a combination of both. Repeated use of a substance changes your thoughts and pushes your emotions toward substance use.

This powerful, automatic process has to be brought back under control for recovery to occur.

Structuring time, attending 12-Step or mutual-help meetings, and engaging in new activities are all ways of regaining control.

The goal in recovery is to learn to combine your thinking and feeling self and behave in ways that are best for you and your life.

---------

Alcohol Arguments

Have you been able to stop using alcohol completely? At about 6 weeks into the recovery process, many people return to alcohol use.

Has your addicted brain played with the idea?

These are some of the most common arguments against stopping the use of alcohol and answers to the arguments.

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

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

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

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

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

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

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

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

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

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

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

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

--------

Addictive Behavior

People who abuse substances often feel that their lives are out of control. Maintaining control becomes harder and harder the longer they have been abusing substances.

People do desperate things to continue to appear normal. These desperate behaviors are called addictive behaviors—behaviors related to substance use.

Sometimes these addictive behaviors occur only when people are using or moving toward using.

Recognize when you begin to engage in these behaviors. That’s when you know to start fighting extra hard to move away from relapse.

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

* Lying

* Stealing

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

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

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

* Getting sloppy in housekeeping

* Behaving impulsively (without thinking)

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

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

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

* Isolating (staying by yourself much of the time)

* Missing or being late for treatment

* Using other drugs or alcohol

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

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See original document for other chapters, diagrams, worksheets etc:

Client's Handbook: Matrix Intensive Outpatient Treatment for People with Stimulant Use Disorder (112 page PDF)

      

It is often difficult for people to stop drinking when they enter treatment.

Some reasons for this follow.

Triggers for alcohol use are everywhere.

It is sometimes hard to do anything social without facing people who are drinking.

How can you get together with your friends without drinking?

Many people use alcohol in response to internal triggers. Depression and anxiety seem to go away when they have a drink.

It’s difficult for people to realize that sometimes the alcohol causes the depression.

What moods and feelings make you want to have a drink?

If a person is dependent on an illicit drug and uses alcohol less often, alcohol may not be viewed as a problem until the person tries to stop drinking.

What challenges have you faced in stopping drinking since you entered treatment?

Alcohol affects the rational, thinking part of the brain.

It is difficult to think reasonably about a substance that makes thinking clearly more difficult.

How does it feel to be sober at a party and watch people drink and act stupidly?

Alcohol dulls the rational brain. Alcohol lowers people’s inhibitions and can make people more sexually aggressive, less self-conscious, and more sociable.

People who use alcohol to decrease inhibitions and help them socialize may feel uncomfortable without it.

In what ways have you depended on alcohol? For sexual or social reasons?

Many of us grow up using alcohol to mark special occasions.

It is hard to learn how to celebrate those times without drinking. What special occasions did your family celebrate with alcohol?

How do you celebrate now?

In many families and social groups, drinking is a sign of strength or maturity.

Drinking often is seen as a way of being “one of the gang.” Do you feel less “with it” when you are not drinking?

If so, in what ways?

Drinking can become linked to certain activities. It can seem difficult during early recovery to do those things without a beer or other drink (for example, eating certain kinds of foods, going to sporting events).

What activities seem to go with drinking for you?

It is important to remember that everyone who stops drinking has these problems at first.

As you work through the difficult situations and spend more time sober, it does get easier.

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See original document for other chapters, diagrams, worksheets etc:

Client's Handbook: Matrix Intensive Outpatient Treatment for People with Stimulant Use Disorder (112 page PDF)

Often people who stop using drugs say life feels boring.

Some reasons for this feeling include the following:

* A structured, routine life feels different from a lifestyle built around substance use.

* Brain chemical changes during recovery can make people feel listless (or bored).

* People who use substances often have huge emotional swings (high to low and back to high). Normal emotions can feel flat by comparison.

People who have been abstinent a long time rarely complain of continual boredom.

The problem of boredom in recovery does improve. Meanwhile you should try some different activities to help remedy the problem of boredom in recovery.

List five recreational activities you want to pursue.

1. ___________________________________________________

2. ___________________________________________________

3. ___________________________________________________

4. ___________________________________________________

5. __________________________________________________

Have you started doing things that you enjoyed before using drugs?

Have you begun new activities that interest you? What are they?

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

How long has it been since you’ve taken a vacation? A vacation doesn’t have to involve travel—just time away from your regular routine.

What kind of break will you plan for yourself?

Here are some tips to reduce feelings of boredom:

* Recognize that a structured, routine life feels different from a lifestyle built around substance use.

* Make sure you are scheduling activities. Forcing yourself to write down daily activities helps you fit in more interesting experiences.

* Try not to become complacent in recovery. Do something that will further your growth. Sometimes boredom results from not challenging yourself enough in your daily living.

Which of the suggestions listed above might work for you?

It is important to try new ways of fighting boredom. Boredom can be a trigger that moves you toward relapse.

How Relapse Happens

Relapse does not happen without warning, and it does not happen quickly. The gradual movement from abstinence to relapse can be subtle and easily explained away or denied.

So a relapse often feels as if it happens suddenly. This slow movement away from abstinence can be compared to a ship gradually drifting away from where it was moored.

The drifting movement can be so slow that you don’t even notice it.

Interrupting Relapse Drift

During recovery people do specific things that keep them abstinent. These activities can be called “mooring lines.”

People need to understand what they are doing to keep themselves abstinent.

They need to list these mooring lines in a specific way so they are clear and measurable.

These activities are the “ropes” that hold recovery in place and prevent relapse drift from happening without being noticed.

Maintaining Recovery

Use the Mooring Lines Recovery Chart (below) to list and track the things that are holding your recovery in place.

Follow these guidelines when filling out the form:

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

* Include items such as exercise, therapist and group appointments, scheduling activities, 12-Step meetings, eating patterns.

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

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

You should complete your Mooring Lines Recovery Chart weekly. Place a checkmark next to each mooring line that you know is secure and record the date.

When two or more items cannot be checked, it means that relapse drift is happening.

Sometimes events interfere with your mooring lines. Emergencies and illnesses cannot be controlled.

The mooring lines disappear. Many people relapse during these times.

Use the chart to recognize when you are more likely to relapse, and decide what to do to keep this from happening.

(After 5 weeks when the chart is full, transfer the list of mooring lines to a journal or pages 12 and 13 of your Client’s Treatment Companion, and continue to check your mooring lines.)

You have learned new behaviors that keep you in recovery. These behaviors are the mooring lines that keep your recovery steady and in place.

It is important to chart the new behaviors and check every week to make sure the lines are secure.

Dropping one or more of the mooring lines allows you to drift toward relapse.

Use the chart below to list activities that are important to your continuing recovery.

If there are specific people or things you need to avoid, list those. Check your list each week to make sure you are continuing to stay anchored in your recovery.

RP 3B Mooring Lines Recovery Chart

Mooring Line Behaviors        Date Date Date Date Date
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I Am Avoiding                         Date Date Date Date Date
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See original document for other chapters, diagrams, worksheets etc:

Client's Handbook: Matrix Intensive Outpatient Treatment for People with Stimulant Use Disorder (112 page PDF)