Addicition Worksheets
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Drinking Patterns of U.S. Adults
Where Do You See Yourself?
Relapse Quiz
How Well Are You Preventing Relapse?
Treatment Attitudes Questionaire
Assessing Your Lifestyle
Feeling Skills
Feeling Management Ideas
Assertiveness Skills
Four Part Assertive Message
Learning to Say No
Downloads (PDF Format)
Drinking Patterns of U.S. Adults
Where Do You See Yourself?
Relapse Quiz
How Well Are You Preventing Relapse?
Treatment Attitudes Questionaire
Assessing Your Lifestyle
Feeling Skills
Feeling Management Ideas
Assertiveness Skills
Four Part Assertive Message
Learning to Say No
Drinking Patterns of U.S. Adults
What is a drink?
A DRINK means a can or bottle of beer, a glass of wine cooler, or a shot or hard liquor (like scotch, gin, vodka), including
a mixed drink.
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BEER
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WINE
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WINE COOLERS
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MIXED DRINK
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12 OZ
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4 OZ
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4 OZ
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WITH 1 SHOT
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Instructions:
1. Circle the average number of drinks you consume in a week.
PLEASE NOTE: 29% OF MEN AND 41% OF WOMEN DO NOT DRINK AT ALL!
2. Move across the row containing the circled number to find your score. If you are a man you will Move to the
second column; if you are a woman, you will move to the third column.
3. The number represents your percentile in terms of how much you drink. For example, a woman who drinks seven (7)
drinks per week drinks more than approximately 89% of U.S. adult women.
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Drinks per Week
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Men
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Women
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01
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46
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68
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02
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54
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77
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03
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57
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78
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04
|
61
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82
|
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05
|
67
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86
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06
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68
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87
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07
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70
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89
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08
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71
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89
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09
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73
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90
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10
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76
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91
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11
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76
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91
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12
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77
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92
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13
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77
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93
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14
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79
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94
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15
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80
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94
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16
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81
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94
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17
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82
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96
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18
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84
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96
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19
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86
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96
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20-25
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88
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97
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26-35
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91
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97
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36-48
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94
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99
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49-101
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97
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>99.5
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102-159
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99
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>99.9
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160+
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>99.6
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>99.9
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Where Do You See Yourself?
The first step towards change is knowing your stage of change. Although you may believe you already know what stage you
are in, a thorough self assessment is important for accuracy.
You can assess our own stage of change by choosing one of the following statements which best reflects your feelings about
your drinking/drug use:
I significantly reduced or stopped drinking/using drugs more than six months ago.
(Maintenance)
I significantly reduced or stopped drink/using drugs within the past six months.
(Action)
I have recently taken small steps to reduce or stop drinking/using drugs in the near future.
(Preparation)
I intend to significantly reduce or stop drinking/using drugs in the next few months.
(Contemplation)
I have no intention of changing my drinking/drug use pattern in the foreseeable future.
(Precontemplation)
Relapse Quiz
1. Relapse begins when you pick up a drink.
TRUE FALSE
2. People relapse because they fail to use willpower.
TRUE FALSE
3. The primary causes of relapse are negative events in the person's life.
TRUE FALSE
4. Relapse is sudden and unpredictable.
TRUE FALSE
5. All recovering persons experience equally strong tendencies toward relapse.
TRUE FALSE
6. Relapse involves a conscious and voluntary choice to drink.
TRUE FALSE
7. Alcohol withdrawal is complete within 5-10 days.
TRUE FALSE
8. The only way to help a chronic relapser is to hope for a spiritual awakening.
TRUE FALSE
9. The alcoholic with a long history of relapse will usually be unable to recover.
TRUE FALSE
10. People relapse because they haven't "hit bottom" yet.
TRUE FALSE
How Well Are You Preventing Relapse?
Have you set goals related to abstinence? What will abstinence allow you to accomplish?
1. Assess your drinking and/or drug practices:
a. What stimuli set you off? (Money, people, paraphernalia, etc.)
b. Who in your work/home/social environments use alcohol and/or drugs?
c. What is the availability of alcohol or drugs in your environment?
d. What is the availability of money to obtain alcohol or drugs? Will you be receiving any significant sum of money in
the near future?
2. Have you reviewed all of your high-risk situations with peers and staff?
3. Do you have plans for all anticipated high-risk situations?
4. Have you discussed the feelings of loss or deprivation that accompany getting straight or sober? Do you feel cheated because you can't drink or use drugs?
5. Are you aware of how you justify your drinking or use of drugs?
6. Are you aware of ways that you have tried to control your usage?
7. Are you prepared for the highs and lows of recovery?
8. Have you taken steps to limit the availability of alcohol or drugs?
9. Have you told all-important people in your life about your addictions(s)?
10. Do you expect treatment to be a "cure" or "magical" solution?
11. How do you "test" yourself in recovery?
12. How will you limit exposure to people who use drugs or drink?
13. Are you aware of how you make the "chain" of decisions that lead to drinking or using drugs?
14. How have you interpreted past relapses? Do you see them as mistakes, failures, or episodes of weakness?
15. What personality traits do you have that may interfere with recovery?
16. Do you feel entitled to use drugs or drink?
17. How well can you keep track of how you are feeling?
18. How well do you solve problems? Do you jump at the first apparent solution?
19. Do you assume that because you don't have craving in treatment that you won't have it after treatment?
20. Do you see craving as something that has a life of its own, something out of your control?
21. What lifestyle changes have you made? Do you need to change the way you structure things?
22. Do you seek out help or wait for it to come to you?
23. What are your plans to reduce complications or crises in your life?
Treatment Attitudes Questionaire
1. How many times have your received inpatient treatment for addiction?
If this is your first treatment, go to Question 6.
2. What was effective about past treatments?
3. What was ineffective about past treatments?
4. Which treatment suggestions did you follow?
5. Which treatment suggestions did you ignore?
6. Have you attended A.A. or N.A.?
If yes, what was effective about the meetings?
What was ineffective about the meetings?
7. Please answer the following questions True (T) or False (F):
I expect treatment to require much work on my part.
I get annoyed when people say that I need treatment.
I expect long-term benefit from treatment.
If I refused treatment, I would feel guilty.
I need support to help me remain sober and drug-free.
When I finish treatment, most of my problems will be solved.
I can handle my problems myself.
As long as I'm sober, everything should fall into place.
My addiction is caused by negative events in my life.
I don't see the benefit of talking about my problems.
I object to the idea of attending a lot of meetings.
Anyone faced with my problems would drink or use drugs.
My family and friends support my treatment.
I don't trust people enough to open up about myself.
I need to change my lifestyle to remain sober or drug-free.
I am willing to change my daily schedule to include aftercare.
I am willing to take direction from others with my recovery.
I tend to get defensive when people give me feedback.
Assessing Your Lifestyle
Living a balanced lifestyle can help raise your satisfaction with your life and reduce your risk for relapse. If the
imbalance is too great, and you become overwhelmed by obligations and pressures, you may be tempted to use drugs/alcohol
in order to escape. Although some areas may become temporarily out of balance, the important issue is to strive for a
balance that works for you.
Review the following questions to help you assess how balanced your life is currently. Take notice of any areas where you
have difficulty with moderation.
Physical
• Do you exercise regularly?
• Do you follow a reasonable diet?
• Do you take good care of your appearance?
• Do you get sufficient sleep?
• Do you get regular medical and dental checkups?
Mental/Emotional
• Do you have strategies for coping with stress?
• Do you worry too much or experience excessive stress?
• Are your significantly depressed or anxious?
Intellectual
• Are you able to satisfy your intellectual needs?
• Do you have enough interests to satisfy your intellectual curiosity?
Creative/Artistic
• Do you regularly practice your creativity/art?
• Do you have talents or abilities that are not being fully utilized?
Family
• Are you generally satisfied with family relationships?
• Do you spend enough time with your family?
• Can you rely on your family for help and support?
Personal relationships
• Are you generally satisfied with the quantity and quality of your personal relationships?
• Do you have friends you can depend on for help and support?
• Are you able to express your ideas, needs and feelings to others?
• Are there any specific relationships in which you have serious problems?
Spiritual
• Is there enough love in your life?
• Do you pay enough attention to you "inner" spiritual life?
• Do you feel a sense of inner peace?
Work/School
• Are you generally satisfied with your work/school situation?
• Do you spend too much time or effort working?
• Do you spend too little time or effort working?
Financial
• Do you have sufficient income to meet your expenses?
• Do you have any serious financial problems?
• Do you handle your money responsibly?
Feeling Skills
Facts About Feelings
1. We are all born with feelings and none of them are "good" or "bad". We learn from out families to hide certain
feelings; our families may also have taught us things like "nice people don't get mad." Think about some feelings
that were not okay in your family and write down an example:
Example:
__________________________________________
__________________________________________
__________________________________________
2. Feelings often do not make sense and they don't have to. It is okay that you cannot explain why you feel the way
you do, such as feeling lonely around a large group of people. Think of a feeling you have that does not make sense:
Example:
__________________________________________
__________________________________________
__________________________________________
3. Feelings can be strong causing some people to fear they are going "out of control". Write down an strong feeling you
have had:
Example:
__________________________________________
__________________________________________
__________________________________________
4. Feelings can be influenced by what and how we think about things that happen to us. If I think I am a "loser"
when criticized, I may hold in my hurt and angry feelings. I may then feel weak and look for ways to ease the pain, like
drinking, or to prove I am not weak, by criticizing someone else. Think of a pattern of feelings you have experienced
that lead to an unproductive behavior.
Example:
__________________________________________
__________________________________________
__________________________________________
5. Feelings can be our "friends." They are important messages to us that something has to be taken care of, such as
letting someone know they are annoying. If we "catch" (notice and label) our difficult feelings early and manage them
effectively, we will reduce our stress and feel better about ourselves. Think of an important message behind one of
your difficult feelings:
Example:
__________________________________________
__________________________________________
__________________________________________
Feeling Management Ideas
1. Getting Away Strategies:
a. Leave the room, or close the door.
b. Take a walk, or relaxing drive.
2. Physical Strategies:
a. Deep breathing
b. Relaxation exercises
c. Physical exercise (e.g., walking and running)
d. "Count to 10", slow down
e. Improve nutrition
f. Get enough sleep
3. Distraction Strategies:
a. Engage in pleasurable activities or hobbies
b. Re-focus on work at hand, structure day
c. Visualize pleasant events (e.g., walking on beach)
d. Listen to music, watch movie
4. People Strategies:
a. Call a friend to share feelings and ask for ideas
b. Develop an assertive strategy to productively confront
c. Schedule pleasant activity with a friend
d. Learn to say "No"
5. Thinking Strategies:
a. Remind yourself feelings pass
b. Notice your physical and emotional feelings and put words to them
c. Focus on one thing at a time
d. Use positive self-statements (e.g., I've handled this before, or I'm smart enough to figure this out)
e. Use the Feeling and Behavioral Skills Records to explore alternative ways to think about the events and to respond.
What do you think you could do to better manage your difficult feelings?
Assertiveness Skills
Assertive behavior means directly expressing your thoughts, feelings and needs to other people with respect and
without violating their rights.
Examples of assertive behavior:
1. Saying "No" to a pushy salesperson.
2. Telling someone they are important to you.
3. Ending a visit with an alcoholic parent when he or she starts to drink by saying, "You are not drinking so I am
leaving. "I'll call you later in the week"
Some people have trouble being assertive in all situations, some just with certain situations, or with certain people.
There are three general types of communication people use in different situations:
1. Passive: When a person is not expressing their true thoughts and feelings, they are being indirect and passive.
Usually the concern is, if they spoke up, they would hurt or anger someone else and be "attacked," or not liked.
They often feel others needs come first. It is not unusual for a passive person to have low self-esteem and feel
constantly stressed and used.
Example:
__________________________________________
__________________________________________
__________________________________________
2. Aggressive: When a person tries to get what they want to express their feelings by threatening, or "walking all over"
people, they are being aggressive. They violate the rights of others through intimidation, control and put-downs and
usually find others are defensive, angry and keep their distance. They often feel their wants and needs always come
first and sometimes their behavior is dangerous or gets them into trouble (e.g., fights or work warnings).
Example:
__________________________________________
__________________________________________
__________________________________________
3. Assertive: When a person is direct, as defined above, they are assertive. They do not put others down and they try
to make themselves understood, while trying to understand others. They usually feel better about themselves and less
stressed than those using the above styles and often they have more satisfying relationships.
Example:
__________________________________________
__________________________________________
__________________________________________
Four Part Assertive Message
People often try to be assertive and soon find themselves back into an old pattern of behavior. Sometimes they are
choosing the wrong time and place and the other person "can't" hear the message. Other times they are not clear enough
about the problem, or present too many problems. Sometimes people attempt to be assertive with the wrong person, such
as someone who is abusive or dangerous.
Once you have choose the right time and place to maximize listening, and are clear about what you want, the following
guidelines for developing a four part assertive message should be useful:
1. Describe the Behavior: Briefly describe a specific, observable behavior without judgments, sarcasm, exaggerations,
profanity, or reference to motives. "When you yell at me in public….," is better than, ":When you act
outrageously, trying ot make me angry and get me to give in….".
2. Describe your feelings: Briefly describe how you feel in response to the behavior, using accurate (e.g., don't say
concerned when you feel hurt) and nonjudgmental words (e.g., say angry rather than abused). Also, use "I"
statements, such as "I feel angry" rather than "You make me angry."
3. Describe the Tangible Effect: Briefly describe how the behavior and feelings affect your thinking and behavior.
This can give the other person a reason to change. Examples are"… and I get confused and withdraw" or"…and I get
tension headaches and often drink."
4. Describe your Request: Briefly and specifically describe what you want done differently. Rather than say "I would
like you to be more considerate," say "I would like you to return my calls within 24 hours."
Examples:
1. "When you yell at me in front of other people, I feel angry and embarrassed and want to hide and not be around you.
I want you to tell me what bothers you in private and not criticize or yell at me in public."
2.__________________________________________
__________________________________________
__________________________________________
3.__________________________________________
__________________________________________
__________________________________________
*Remember: BEING ASSERTIVE DOES NOT ALWAYS GET YOU WHAT YOU WANT, BUT YOU WILL GET MORE AND FEEL BETTER ABOUT YOURSELF.
Learning to Say No
An important aspect of being assertive is the ability to say "NO". This means you are able to respect your own rights
and limit what others demand from you when it interferes with you needs and wants.
Saying "NO" is particularly difficult for those who have developed strong patterns of behavior to please others, or fear
negative consequences. As with developing assertive statements, saying "NO" takes practice and support from others. The
following suggestions may be useful:
1. Take Time: Give yourself time to get the details and think about someone's request, so you can clarify what you want
to say. You might say, "Let me think about it and I'll call you later."
2. Don't Over-Apologize: This can give others the message that you are not sure and that your needs are not as important
as theirs. They may even "push harder."
3. Practice Saying "NO": Try saying it out loud, to yourself, in the mirror and even role play with a friend. The more
you "try it on" and learn to be brief and specific about what you are declining, the easier it will be. With some people,
you may have to be repeatedly firm and consistent.
4. Listen Reflectively: When you are concerned about someone's feelings, you can listen to them, feed back what you heard
them say and say NO, with a brief reason. You might also be able to direct them elsewhere. Like good customer service
representatives, this communicates that you listened and understood them.
5. Manage Guilt: Watch out that you don't try to make-up for saying "NO" by doing other things for the person.
Who do you have to learn to say "NO" to, and how will you do it?
__________________________________________
__________________________________________
__________________________________________
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