Wisconsin Community Mental Health Counseling Centers, Inc.

The Mind
Lack of Self-Control
Uninhibited people who rarely utilize self-restraint in their lives are more likely to lack the ability to restrain their drug use as well.

Lack of Values that Constrain Drug Use
Certain religious tenets, a strong health ethic, or any core belief that values sobriety can limit drug use. Without them a person is vulnerable to addiction.

Low Self-Esteem/Feelings of Powerlessness
Heavy drug use may be more tempting to people who feel frustrated and defeated since drugs can grant feelings of power and self-importance.

Depression
People with anxiety and depression may be more susceptible to uncontrolled drug use because they have an underlying neurochemical imbalance that the drugs temporarily correct.

The Setting
Barren Environments
War zones, urban slums, and prisons are all more likely to foster heavy drug use than places that offer alternative adventures, pleasures, and opportunities.

Lack of supportive Social Group
Isolation or alienation from friends and family can encourage uncontrolled drug use.

Drug-Laden Environment
Being surrounded by people who use drugs heavily increases the likelihood that others will also use drugs heavily. Having access to plentiful, cheap drugs also tends to increase use.

Few Social Guidelines for Acceptable Use of a Drug
The use of illegal substances is outside the norm of socially respectable behavior so there are fewer social restraints; therefore people may be more likely to use to excess.

Denial appears in many different forms:

• Simple Denial - maintaining something is not so, that is in face so…insisting that something is not an alcohol-related problem despite the obvious evidence that it is. "I never have hangovers" is a common example of simple denial.

• Minimizing - admitting the alcohol-related problem to some degree but in such a way that it appears to be much less serious or significant than it actually is. "I was not that bad," " I had a few but I was okay to drive," or "I only had a couple" are frequently heard examples of minimizing.

• Rationalizing - offering alibis, excuses, justifications and explanations other than alcohol for behavior. "I hadn't eaten and I wasn't used to that much punch - it snuck up on me," " I usually don't drive after I drink but this friend needed a ride home - that's the last time I am the nice guy!" are some of the examples or rationalizing. The behavior is not denied but an inaccurate explanation of its cause is given.

• Intellectualizing - avoiding emotional, personal awareness of an alcohol-related problem by dealing with it on the level of generalization, intellectual analysis or theorizing. "Are those breath machines really reliable? I was reading just the other day about problems with them," "Lots of people have wine with meals, are they alcoholics?" "That's a bad corner-lots of accidents there. They should do something about it," are all examples of intellectualizing.

• Blaming - also called projecting. It is maintaining that the responsibility for the behavior lies with someone else. "You would drink too, if you were married to her!" "The cop was out to get me" or "There is something wrong with the front end of the car or the steering" are examples of blaming. The behavior is not denied, but its cause is placed 'out there', not within the person doing it.

• Diversion - changing the subject to avoid something that is felt to be threatening. Responding with a joke is a common example of diversion, such as "You wouldn't expect me to walk in that condition, would you?" Diversion is similar to intellectualizing. To avoid discussing behavior after drinking, the drinker might direct the discussion toward the merit of having good wine with meals. He might direct the discussion toward a category of people he perceives as really having a problem with booze.

• Hostility - occurs when the drinker becomes angry or unpleasantly irritable when the subject of his drinking behavior comes up. A classic example is the situation where the drinker asserts that his wife does not mention that he drinks too much. In fact, she used to mention it but not for years because every time she mentioned it in the past he got angry and they had a fight and therefore she no longer mentions it.

1. Abstinence (0-6 months)
a) Focus is on avoiding substance usage.
b) Tasks are specific and concrete-changes in behavior are readily observed.
c) Results are seen relatively quickly less crises in life.
d) Change in daily routine occupies most of one's attention.

2. Lifestyle Change (6-18 months)
a) Focus is on relapse prevention.
b) Tasks involve decisions about relationships, residence, leisure, job, and family.
c) Results take somewhat longer because these changes are more involved and may directly affect other people.
d) Building a long-term foundation occupies most of one's attention.

3. Self-Knowledge (greater than 18 months)
a) Focus is on long-term issues-trauma, psychological disorders, personality issues, unresolved conflicts.
b) Tasks are more involved and require much time, such as psychotherapy.
c) Results are less specific because they involve internal change.
d) Understanding one's life occupies most of one's attention.

4. Spirituality (lifetime)
a) Focus is on "Who am I?"-the meaning of life, purpose or mission in life, long-term goals, a sense of priorities, knowing one's place in the world, a sense of why one is here on earth.
b) Tasks are very involved-for some it may involve religion, for others it means finding a mentor, for all it means much self-reflection.
c) Results take a lifetime-these questions are ongoing.
d) Gaining a sense of identity occupies most of attention.

Remember:
1. These stages are not forced-you do not decide which stage you are in.
2. These stages are gradual-you may not notice that you are in a new stage until someone tells you.
3. Each stage builds on the last stage-you cannot jump ahead without building a good foundation.
4. Different people get "stuck" at different stages-you can learn from someone whose recovery is more advanced than yours.

Negative Emotions
Relapse sometimes occurs when you are feeling emotionally upset and you want to use drugs/alcohol to change the way you are feeling. You may want to drink/use drugs to cope with such feelings as frustration, anger, sadness, fear, anxiety, tension, boredom, depression, loneliness, grief, or guilt.

Negative Physical/Physiological States
Relapse sometimes occurs because of difficulty dealing with negative physical states and you want to use drugs/alcohol to change the way you feel physically. These negative physical states could be associated with prior alcohol use, like feeling shaky and sick, or having difficulty sleeping. Other negative physical states are independent of previous alcohol use, such as pain, illness, injury, fatigue, or headaches.

Enhancement of Positive Emotions
Relapse sometimes occurs when you are feeling good and you want to feel even better. You might drink to increase your feelings of pleasure, joy, freedom, sexual excitement, or celebration. These relapses are often connected to a special event like a birthday, a holiday, a vacation, or a trip away from home. It can be tempting to make a special exception and give yourself permission "just this one time."

Testing Personal Control
During a period of recovery, you may be tempted to test your recovery. You might begin to question whether you are really an alcoholic. You may decide to take one drink just to see if you are able to stop, or you might test your willpower by putting yourself in tempting situations.

Giving In to Temptation or Urges
Temptations or urges to drink often happen when you are in the presence of alcohol or in the presence of something that reminds you of drinking, like running across a hidden bottle, passing by a bar, or seeing an advertisement on the television or in a magazine for alcohol. There also might be times when you have urges to drink, which seem to come "out of the blue".

Coping with Conflict
Relapse sometimes occurs when you have difficulty coping with a conflict with another person, such as a significant other, friend, family member, or co-worker. You might experience feelings like frustration or anger stemming from an argument, disagreement, fight, or jealousy. This category also includes other emotional states which are directly connected to an interaction with another person, such as anxiety, tension, worry, concern, or fear.

Social Pressure
You may experience pressure to drink in social situations. Sometimes the pressure is direct, like when another person encourages you to drink using verbal persuasion. Other time that pressure more indirect, such as when you are in a situation where you are watching other people drink.

PRECONTEMPLATION or "Get off my back"
The first stage is called Precontemplation. In this stage, you have no intention of changing your substance use in the foreseeable future. You may be unaware or not fully aware of you substance abuse problem. You ask for help only when pressured by other people. Most precontemplators don't want to change themselves, just the people around them. Or, you may have had so many unsuccessful attempts to change that you feel to fatigued or uninterested to try again. An example of someone in precontemplation is the substance abuser who does not see himself as having a problem with drugs, but come to treatment because he has been told by his wife that if he doesn't get into treatment, and do so quickly, she will file for divorce.

CONTEMPLATION or "I want to stop feeling so stuck"
The next step towards change is Contemplation. If you are in this stage, you probably feel unsure about whether you want to stop using substances. You may feel quite "stuck", knowing you have a problem and that it should be worked out, but not really ready to make changes yet. An example of someone in contemplation is the woman substance abuser who is beginning to see that drugs are having a destructive effect in her life. However, there are many reasons she still wants to keep using drugs (all of her closest friends use drugs, drugs help her relax, etc.,).

PREPARATION or "I'll start tomorrow"
If you are in the Preparation stage, you have not yet stopped the substance use but are preparing to do so. You have pretty much decided that you want to stop, but have not yet taken the step of acting in a way that will make the change happen. If you are in this stage, you have committed tot take action in the very near future-usually within one month.

ACTION or "Here I go!"
You are in Action if you are actively moving toward taking change steps. These steps may not always lead to the desired change but you are interested in stopping your alcohol or drug use. You are clear about the direction that you want to go in and you have probably tried to stop using substances already. During this stage, you try to arrange your experiences and your environment to overcome the substance problem. This is the stage that requires the most commitment, time and energy.

MAINTENANCE or "Keep moving forward"
During Maintenance stage, you attempt to hold onto what you have achieved. This often takes great effort. Thus, the non-drinking alcoholic may feel a strong temptation in many circumstance where he or she would have used alcohol previously at parties, to relax, and so on). Your focus is on prevention relapse. This stage often begins 6 months after successful change. You may be in this stage for a long time.

There may be people, places, and situations that you should avoid so as not to put yourself at risk for relapse. There is no way to avoid all high-risk people or situations, but you can be aware of your personal triggers and avoid them as much as possible. Early recovery is not the time to "test" yourself by purposely putting yourself in risky situations. If you know ahead of time that you will be in a situation that might be risky, develop a plan so that you can cope with cravings if they develop.

• If you find yourself in a situation that is triggering a craving - LEAVE; you may have to make some polite excuse, but your recovery has to come first.
• Find someone supportive to talk to about how you feel - a sponsor or other friends in recovery. If you call someone and they are not available, keep calling until you reach someone. Always have phone numbers available in case of an emergency.
• Attend a self-help meeting, such as A.A., C.A., or N.A. You will not use drugs/alcohol during the time you are there.
• Distract yourself by doing something active-exercising, playing with your children, washing the dishes or the care, taking a shower, taking a drive in the country, mowing the lawn, reading a book. Or go somewhere where neither drugs or alcohol is available-a movie, museum, or a concert.
• Write down what you are feeling or thinking in a journal. Describe your craving and the situation in which it occurred. Track the outcome by reporting the coping strategies you used - this may help you see a pattern.
• Remember that cravings are ALWAYS temporary-they don't have to lead to using. Remember that none of your problems will be solved by using-remember the negative consequences of your drug/alcohol use.
• Powerful but infrequent triggers such as the loss of a loved one, can trigger old habits in an otherwise solid recovery. In times of crisis, use the recovery tools that have been working for you all along.
• Put off the decision to use drugs/alcohol, even for fifteen minutes at a time. Remember that urges are like waves - they crest and then recede - ride them out.
• Remove all alcohol, drugs, and paraphernalia from your home-they can keep craving alive.
• If you have a using/drinking dream, remind yourself that it is normal-they will eventually go away. Write it down and talk about; this takes away some of its power. Talking with another recovering person can help-you will find out you are not alone.
• Read recovery literature such as the A.A. Big Book-it can inspire you, give some practical suggestions, and may calm your anxieties.
• Being exposed to craving situations and not using, with the help of strong support and good planning, can help weaken or extinguish craving triggers.

What is protracted withdrawal?
Protracted withdrawal is a set of cognitive (brain) dysfunctions resulting from chronic use of alcohol and other drugs. About 64% of recovering alcoholics experience these dysfunctions. Following the first week of withdrawal, addicted people may fell better physically, but still have problems thinking clearly. These problems in thinking tend to last for weeks and even months, but improve as recovery progresses; this does not affect overall intellectual functioning. The addicted person should not assume that sobriety is causing these symptoms, but that they are a result of chronic use of substances. The older you are, the longer it takes to regain normal functioning.

What are the symptoms?
• Problems retaining new information.
• Difficulties in problem-solving.
• Decreased concentration.
• Emotional overreactions or numbness.
• Sleep problems (disturbing dreams, changes in sleep patterns).
• Poor physical coordination (poor balance, dizziness).
• Increased sensitivity to stress.
• Impaired abstract reasoning (difficulty picking up new concepts).
• Impaired eye-hand coordination.

How do I deal with protracted withdrawal?
• Verbalize feelings.
• Become educated about the symptoms.
• Write things down.
• Use your mind regularly-read books and newspapers, do puzzles.
• Identify stressors.
• Learn relaxation skills.
• Maintain good nutrition - avoid caffeine and concentrated sugar; eat three well balanced meals.
• Exercise regularly 3-4 times weekly to reduce tension.
• Develop spirituality to give life meaning.
• Balance work and play.
• Develop a healthy network of relationships.

What is the Abstinence Violation Effect?
The Abstinence Violation Effect (AVE) is a fancy name for something that we all experience after we give in to an urge. The urge may be aimed at alcohol, drugs, food, sex, etc. All it means is that we allow ourselves a "slip" and then become guilty or demean ourselves for giving in. This creates a vicious cycle-we begin thinking, "What's the use? I already gave in. Doing this again won't matter." This is obviously very dangerous thinking and needs to be addressed immediately, before a full-blown relapse occurs.
The AVE will be stronger if you believe that the slip occurred as a result of internal, unchangeable factors, like a lack of willpower. You may feel shame, guilt, or a deep fear that all is lost. If this occurs, you will be more likely to experience a full blown relapse.
If you believe that the cause of the lapse was an external, changeable factor, such as an unexpected offer of a drink or drug, you are more likely to feel some control over the slip (you may simply believe that you can stay safe by avoiding this situation in the future). In this case, you AVE would be less intense (assuming you are able to avoid the situation and not drink or use drugs).

How to Handle a Slip
1. GET OUT OF THE SITUATION. Staying in a high-risk situation will only cloud your judgment, encourage more substance usage, and prevent you from getting a clear look at the situation.

2. USE THE SLIP AS A LEARNING EXPERIENCE. The fact that the slip occurred means that you made a mistake or need information to avoid such risks in the future. Slipping does not mean that you are a failure - it means you need to learn more about yourself.

3. PLAY DETECTIVE. Take time to retrace your steps. Did you make any decisions prior to the slip that led to greater risk? Was there a pattern of negative thinking that preceded the slip? Has your lifestyle been supportive of recovery?

4. DO NOT KEEP THE SLIP A SECRET!

5. DISCUSS IT WITH SUPPORTIVE PEOPLE. Others may have noticed unhealthy patterns and can provide you with more insight into the slip.

6. DEVELOP A PLAN. Decide in advance what you would do in the event of a slip to reduce the chance of a full blown relapse.

SIDS are choices that seem unimportant at the time, but that may lead you back toward drinking/drug use. These ordinary decisions are made every day and appear to have nothing to do with drinking or drug use. Although they do not involve making a direct decision about whether to drink or use drugs, they may move you closer towards a situation where you will be confronted with that choice.

Making the Connection
You may have found yourself in high-risk situations in the past and not understood how you got into that predicament until it was too late. It is relatively easy to look back on the situation and see how you get yourself up for relapse but it is much more difficult to recognize when you are in the midst of the decision-making process. This is because many choices do not seem to involve drinking/drug use at the time. When drinking/drug use is not on your mind, it is hard to make the connection between drinking and a minor decision that seems fare removed from drinking.

Think Ahead
The best solution is to think about every choice you make, no matter how irrelevant to drinking/drug use the decision seems. By thinking about the possible options and outcomes ahead of time, you can anticipate dangerous situation so carefully, but after a while it will happen automatically, without much effort.

Low Risk vs High Risk Situations
When faced with a decision, you should generally choose the option that will put you at the lowest risk possible, to avoid putting yourself in a risky situation. It is usually easier to decide to avoid a high risk situation before you get too close to it than it is to resist temptation once you are already in the midst of it. If for some reason you decide on the higher risk option, plan out how to best protect yourself while in the high-risk situation.

What to Do When Making Decisions
• Consider all of your options.
• Think ahead to the possible outcomes of each option.
• Select the option that will minimize your relapse risk.

Some Examples of SID Situations
• Whether to keep liquor in the house for guests.
• Whether to go to old bars to see old drinking friends.
• Whether to go to a party where people are drinking.
• Where to purchase snacks (i.e., in a liquor store).
• What route to take when driving (i.e., past or detour around a favorite liquor store or bar).
• Making plans for the weekend.
• Whether to tell a friend that you have stopped drinking.
• Planning how to spend free time after work.

At some point in your recovery, you will be in social situations, such as parties, business lunches and other occasions, where there are people drinking. If possible, you should avoid these situations in early recovery, however you may have no choice but to attend. If that is the case, here are some suggestions for getting through it without drinking.

Evaluate Your Motivation
Why do you want to go? Are the reasons you give honest or are you still fantasizing about the good old days when you were drinking? Unless you have strong reasons for attending (e.g., it is you brother's wedding, It is your boss's twentieth anniversary party), avoid events where there will be drinking.

Evaluate Your Feelings
Are you overly nervous about going to an event where there will be drinking? Are you overly confident you can handle a drinking event? You are probably safest accepting an invitation if you are slightly hesitant about attending.

Forewarn the Host/Hostess
If the people hosting the party are not already aware, let them know in advance that you do not drink alcoholic beverages. Ask them if there will be other types of beverages available to drink.

Avoid "Non-Alcoholic" Beverages
Non-alcoholic beer and wine are not completely alcohol free and are not safe substitutes for someone in recovery.

Practice Refusing Drinks
Decide in advance how you will respond if someone offers you a drink.

Bring Support
Take along an AA friend or someone else who is supportive of your recovery. Keep phone numbers of supportive people handy.

Arrive Late and Leave Early
Although you have to make an appearance, this does not mean that you have to stay for the entire event. Arriving late and leaving early will mini8mize the amount of time you are in the presence of people drinking alcohol. By leaving early, you will also avoid the drunken revelry that invariable comes late in a party.

Serve Yourself
Upon arriving, serve yourself some juice or a soft drink. Keep that beverage in your hand for the rest of the social gathering. This should prevent you from having the continuously turn down offers of something to drink. If you set down your drink to dance or use the bathroom, get a new drink. Don't take a chance that your drink might have been switched with someone else's drink.

Avoid the Bar
Once you have your beverage, steer clear of the bar. Dance, talk with people, sit, but give yourself some space from the source of temptation.

Be Ready to Leave
If you begin to feel increasingly anxious or tempted to drink, leave the social event. Keep your car keys close.

Friendships
There will be a strong pull towards spending time with old friends who use alcohol and drugs. Making new friends is not easy, but necessary for protecting your recovery. Here are some suggestions for making new friends:
• Risk rejection by reaching out and making contact.
• Suggest that they join you in doing something casual like going out for a cup of coffee, joining other friends who are planning to do something together (beach, movies, hiking), or watching a sporting event on TV.
• Have realistic expectations. People will sometimes decline invitations. They may be available at another time or they may not be interested. Such events are part of a normal social life that one should learn to accept gracefully.

Ending Unhealthy Relationships
Ending close relationships is difficult and takes a great deal of courage. However, if your friends are abusing drugs and alcohol, they are unhealthy for you to be around. You may need to explain to them why the relationship cannot continue (which may also get them to look at their own alcohol/drug use). Prepare for this meeting in advance and make sure to meet in a safe place. Acknowledge to yourself that it might be a painful loss. If this is the case, get support.

Assess Your Motivation
You may have hidden reasons for continuing to be with people who drink/drug. It is important for your recovery to honestly examine your motivation.
• Are you showing off that you are clean and sober and doing well?
• Are you still longing for the excitement of the fast life?
• Are you trying to prove that you are an exception and are unaffected by the influence of old friends?
• Are you hoping that they will influence you because you want them to share in the blame for your getting high?

Likely Problem Situations
1. You are invited to a family event where several of your family members will be heavily drinking/using drugs.
Tips
• Consider not going.
• If you must attend, talk to the host in advance about not drinking.
• Arrive late and leave early.
• Bring support.
• Talk to supportive family members who will be present.

2. After a difficult week at work, your coworkers invite you out for a Friday night drink.
Tips
• Plan in advance what you will say when co-workers ask you to go out.
• Give reasonable excuses for why you cannot attend (your family is waiting for you at home, you have other plans for the evening)-eventually they will stop asking.
• Suggest another alternative (getting coffee in a café).

3. You live in an area where bars and drug dealers are prevalent.
Tips
• If possible, move.
• If it is not possible, seek out lots of positive people who live nearby and develop a strong network of friends.
• When you see other drug users in your neighborhood, be polite but move on quickly. Do not stay and chat.

4. A friend wants to get sober and wants your help.
Tips
• Be clear with him/her about what you are willing to do.
• Do not depend on his/her recovery for your own.
• Reduce your individual risk by enlisting the help of others.

5. You have friends who are social drinkers.
Tips
• Be clear with your friends about your needs for support-It is okay to ask them not to drink in front of you.
• Suggest activities where alcohol will not be involved.
• Assess the situation honestly-Can you enjoy each other's company without the involvement of alcohol?

1. Cocaine is safe-it has been used for many centuries; alcohol is safe - it is legal.
2. Cocaine is not addictive when it is sniffed; a person cannot get addicted to beer.
3. One cannot be considered addicted if the drug (or alcohol) is used once a week or once a month.
4. Cocaine (or alcohol) improves your ability to think clearly.
5. Cocaine (or alcohol) cures sexual problems.
6. Cocaine (or alcohol) improves physical performance (such as athletics or driving a car).
7. Cocaine (or alcohol) gives a person confidence in himself ("liquid courage").
8. Cocaine is a symbol of success - a "high status high;" drinking is glamorous - just look at the alcohol ads.
9. Cocaine (or alcohol) helps you when you are feeling down.
10. Cocaine improves your relationships by making them more exciting; alcohol helps you socialize.
11. Cocaine (or alcohol) use is okay because everyone is doing it.

1. Alcohol is both a stimulant and a depressant.
2. Alcohol abuse and alcoholism are much more significant problems than drug abuse.
3. Nonalcoholic beer should not be used as a means to deal with an alcohol problem.
4. Ninety percent of alcoholics smoke cigarettes, while thirty percent of the general population does.
5. Relapse is not a necessary sign of poor motivation-most alcoholics relapse.
6. One can predict which kids have a greater tendency to become alcohol abusers-as much as a year or two in advance.
7. One can still be in denial even if you agree that one has an alcohol problem-denial comes in many forms.
8. Just stopping drinking is an inadequate solution to a drinking problem-a lifestyle change is necessary.
9. Alcohol is a drug-it is mind altering and creates behavior similar to other drug use.
10. Drinking does not improve creativity, driving, or physical performance.

This section is for the people in your life who care about you and who want to be supportive of you sobriety.

Being supportive to the sober/clean substance user
The best way to support the clean and sober substance user is to find your own support. The substance use of one member of a family affects everyone in the family. Find out about your local Al-anon or Nar-anon support group meetings for family members of substance users.
• Learn the facts about addiction.
• Understand that addiction generally takes a long time to develop-recovery does not happen overnight.
• Don't expect everything to be perfect once the substance user stops using-the adjustment to sobriety will take time for the whole family, not just the user.
• Don't preach, nag or lecture.
• Be clear about what behavior is acceptable and what isn't-say what you mean and do what you say.
• Do not have alcohol in the home and do not drink in front of the alcoholic.

Identifying your need for support
Most people with a substance abuser in their lives need support. If you experience any of the following situations, you probably need more support than you are currently receiving.
• Physical symptoms such as sleep loss, a knot in you stomach, bitten fingernails.
• Many of you thoughts revolve around the substance user.
• You often feel alone, frustrated, worried or angry.
• You feel responsible and guilty for the person's substance use.
• You often try to conceal, deny, protect, or make excuses for the substance user.
• You try to control the person's substance use by exacting promises from them, hiding the substances from the, throwing the substances away.

If you suspect drinking/drug use
If you think that the substance abuser is actively using again.
• First and foremost, protect yourself-make sure you and your family are safe.
• If you choose to talk with the substance abuser about their substance use, approach the person only when he/she is clean and sober.
• Do not rescue them-they must face and assume the responsibility for the consequences of their substance use.
• Do no allow them to convince you that they can control their use "this time"-if they were no able to before, they won't be able to now.

Dealing with the children
Parents try their best to protect their children from the negative impact that substance use can have on a family. However, when there is a substance abuser in the home, children are often quite perceptive and know that something is not quite right. They may even blame themselves for the problems they see going on in the household.
• Be as honest with them as you can be about what is going on in the household.
• Tell them that their parent's drinking/drug use is not their fault.
• Explain the nature of addiction to the children.
• Don't use the children as tools or turn them against the substance user.
• Try to spare them from seeing the substance using parent extremely high/drunk.
• If the children are showing signs of emotional stress such as withdrawing, having trouble with authority figures or behaving rebelliously, they may need counseling. Participation in a support group of children of substance abusers may help them fell less alone.

• Intimidator - uses anger to drive people away.
• Intellectual - mistakes knowledge for understanding.
• Victim - blames negative events for addiction.
• Blamer - blames other people for addiction.
• Playing Dumb - "I don't understand."
• Avoider - tries to keep a low profile.
• Socialite - keeps a high profile, but is superficial.
• A.A. Expert - speaks in slogans, but doesn't get personal.
• Con Man - thinks he (or she) is fooling people.
• Close Minded - "I know what I have to do."
• Magic Bullet - "I know what caused my addiction."
• "Yeah, But" - "That's a good idea, but it won't work."
• Deflector - tries to focus attention away from self.
• Lip Service - agrees to follow through, but never does.
• Controller - tries to control the course of treatment.
• Rabble-Rouser - tries to turn patients against staff.
• Suspicious - "What will you do with this information?"

• You are asked to attend the wedding of a close drinking friend.
• A waitress asks you if you want a drink.
• Your dealer wants the money that you owe him.
• Your spouse asks you why you need to attend so many AA meetings.
• Your mother wonders how you got "this way."
• Your friends invite you to a bar saying that you can just drink a club soda.
• Your friends offer you marijuana, saying that your "real" problem is alcohol.
• You feel that you are missing out on "where the action is."
• You wonder how you will get to sleep without a substance.
• You wonder how you will deal with your sadness, loneliness, or anxiety without a substance.
• You wonder how you will be able to converse with people without a few drinks first.
• You wonder "what is normal."
• You are offered a dessert or a meal with alcohol in it.
• You want to see your family for the holidays but you know that they will be drinking.
• You wonder how you will handle physical pain without substances.
• A friend drops by with a case of beer.
• A family member ridicules you for being a "holy roller" because you attend AA meetings.
• You cannot figure out how you will walk down your street without running into people with drugs or alcohol.
• You feel lost because you have to give up activities connected to drinking such as playing pool, darts, or softball.
• You don't know how you will cope with your stressful job.
• A friend reminds you of the "good times."
• You feel guilty about stealing or conning people for money to get drugs or alcohol.
• You feel like a failure because of you past relapses.
• You wonder about your personality as a sober person.
• You have not had sex without chemicals in years - now what do you do.

01. I am angry, resentful and self-pitying that I can't return to "controlled" drug/alcohol use.
02. I have not severed ties with drug/alcohol abusing friends, lovers and acquaintances.
03. I am resistant to the idea of not drinking or smoking marijuana, even occasionally.
04. I am hold onto the phone numbers of my dealers because I think I might want to contact them again in the future.
05. I allow others to get high/drunk in my home.
06. I have not discarded all of my drug paraphernalia and supplies.
07. I am harboring a secret "stash" in my home, care, safe deposit box, friend's home, or other secret hiding place.
08. I feel self -pity about my addiction and repeatedly ask myself "why me"?
09. I tell others what they want to hear in an attempt to keep them off my back.
10. While some addicts need the "crutch" of AA, CA, or NA, I don't need to rely on others for help.
11. I continue to "romanticize" and glorify previous drug/alcohol experiences.
12. I tend to overact to stressful situations.
13. I believe the recovery is simply a matter of staying away from drugs and alcohol.
14. I am angry and disappointed because I have stopped using drugs/alcohol and my life hasn't significantly improved.
15. I am angry that the victims of my addiction have not granted me instant trust and forgiveness.
16. I am not actively working to build a strong social support network of people who do n ot abuse drugs or alcohol.
17. When I am not at work, I tend to isolate.
18. I do not have a specific action plan for dealing with cravings and urges.
19. I quietly resent being called an addict or alcoholic.
20. I have urges and cravings as a result of attending groups or 12-step meetings.
21. I blame my drug/alcohol use on a bad marriage, job stress, financial difficulties, or other problems in my life.
22. I am resentful and angry about the time and/or money I must devote to my recovery.
23. I am chronically irritable, short-tempered, or argumentative.
24. If something especially good happened to me, I would be tempted to drink/use drugs to celebrate.
25. I am not vigilant about watching for early warning signs of relapse.

Think about the benefits of not using
Thinking about the benefits of not using may help you maintain a clean and sober lifestyle. Some of these benefits include: better physical health, improved family life, greater job stability, more money available for recreation and bill paying and increased self-esteem.

List and recall unpleasant drinking/drugging situations
Remember the pain, fear, shame, guilt, embarrassment, and other negative feelings associated with using. Make a list of these experiences, including such situations as blackouts, hangovers, fistfights, arrests, withdrawal, liver problems, etc. Try to conjure up an image of a specific unpleasant experience.

Focus on the progress you are making
Do not dwell on what you seem to be giving up. Recalling the "partying" days of drinking and drug use will only increase your desire to use. Remember that if it were still fun to drink or drug, you would still be doing it and you would not have decided to stop. Instead, think of the good times to come - the many new things you can do clean and sober that you could not do when you were high.

Think about the potential negative consequences of using
While you have invariable experienced many negative consequences of alcohol/drug use, there may be consequences that you have not yet experienced. If you return to using, the following may be possible consequences: significant financial loss, overdose, job loss, loss of significant others, loss of current living situation, detox and jail.

Distractions
Think about something unrelated to drinking to stop thoughts about drinking. For example, think about pleasant enjoyable topics (loved ones, relaxation, enjoyable hobbies). Focusing on a task you want to accomplish is another constructive distraction.

Challenge your irrational beliefs
1. You Can Control Your Use
Remember what happened the last time you told yourself, "I am only going to have one."
2. You deserve a drink to unwind after work.
Remember that there are many other ways to relax and cope with stress. Make a list and keep it handy for times when you want to drink to relieve stress.
3. Why can't you have a good time like everyone else?
Remember that although it may seem like everyone in the world drinks/uses drugs, your perception of the world is probably skewed. In all likelihood, you spent most of your time with other people who drank and used drugs like you did so it seemed like everyone was using. This is, in fact, not true. Joining organizations that focus on health and fitness may help. Of course, you will meet others in recovery as well by joining A.A.

Our thinking is unrealistic if we consistently:

1. Exaggerate the Negative and Ignore the Positive
A negative event occurs and you assume it defines you or the situation, that it is true in all similar circumstances and you ignore any positive things that have occurred in the past.
For example, you do not get a job offer you were looking forward to and you assume you are not a good worker and overlook positive job evaluations you have received in the past. You have received in the past. You think to yourself, " I can never do anything right; this always happens to me."

2. Assume the Worst
A negative event occurs and you assume it is a sign, or the beginning of something horrible to come.
For example, you have a skin growth and you assume it is cancer, or your spouse forgets your Anniversary and you assume he or she is planning a divorce.

3. Personalize Things
A negative event occurs and, even if it was not entirely under your control, you assume you were in some way the cause of it and that if you were different-or you did something differently-it never would have happened.
For example, you blame your child's poor grades on the belief you are a bad parent, or your divorce on the belief you did not try hard enough in the marriage.

4. Jump to Incorrect Conclusions
A negative event occurs and from minimal or no facts you make a negative interpretation, assume it is true and sometimes predict it will continue to be true in the future.
For example, a friend does not respond when you say hello and you conclude he is ignoring you because he does not like you anymore.

There are many productive ways to relax, including exercise, meditation and doing something pleasurable. Below are two good breathing and muscle exercises:

A. Diaphragmatic Breathing
This is a brief exercise that can be done in almost any setting, at any time. Lie, sit, or stand still and notice your breathing pattern. When we are anxious, our breathing is often shallow and "from our throat." Now, focus on your naval and slowly breath so that your navel goes out when you inhale and in when you exhale. You are breathing from your gut, and you should notice a difference in the way you feel, especially in the upper chest.

B. Breathing and Muscle Relaxation
This exercise is longer, and for best results requires a quiet, comfortable place where you can sit or lie with your eyes closed. It uses the diaphragmatic breathing described above and combines it with counting, imagery, and muscle movements. The simplest method is to be in a comfortable spot and begin your diaphragmatic breathing. As you breathe in, count to seven slowly-pause-and then breathe out counting backwards from seven until your lungs are empty. Pause again, and imagine the stress flowing out of your muscles like water flowing in a babbling brook. Repeat two more times, noticing how different your body feels.
Another version of this exercise is to focus on some specific muscle groups that are tense, such as those in your neck. As you breathe in this time, tighten your neck muscles and hold them for a count of seven. Then, as you release them slowly for another count of seven, focus on the tension melting in these muscles. Repeat these steps for other muscle groups, all the time noticing how much more relaxed your body feels.
Another version is to repeat the steps above with every large muscle group in the body, working from head to toe, tightening or scrunching muscles, holding them and slowly releasing them, and noticing the tension melting and flowing out of your body.
It is important in all these exercises that you do not breathe too quickly. Doing so can cause hyperventilation - a condition that can cause you to get dizzy and feel faint. It is very useful to use imagery or ideas that you associate with these states of relaxation to help the relaxation response along. For example, in some situations, thinking of that "babbling brook" or repeating the word "relax" will help you feel calmer even more quickly. All these exercises take practice. Find the methods that work best for you.