TRUST Patient Workbook

TRUST
PATIENT WORKBOOK
Name: Date:
______________________ ______________________
Version Date: March 15, 2021

TABLE OF CONTENTS
Introduction ............................................................................................................1
Drug Cessation Group (DCG) Worksheets ....................................................3
DCG 1 – Drugs-Drug Paraphernalia-Drug-using Friends.............................5
DCG 2 – Five Common Challenges in Stopping Drug Use .........................8
DCG 3 – Triggers/Thought-stopping ..............................................................10
Techniques for Thought-Stopping ..............................................................12
DCG 4 – Your Brain and Recovery ................................................................13
DCG Group A. Scheduling..............................................................................18
Recovery Skills Groups (RSG) Worksheets ................................................21
RSG 1 – Building a Recovery Support Program: Mooring Lines -----
Avoiding Recovery Drift ....................................................................................23
RSG 1a – Mooring Lines; Recovery Chart................................................26
RSG 2 – Internal Trigger Questionnaire ........................................................27
RSG 3 – External Trigger Questionnaire ......................................................29
RSG 2a-3a – Trigger Chart .........................................................................31
RSG 4 – Taking Care of Yourself ...................................................................32
RSG 5 – Be Smart; Not Strong .......................................................................35
RSG 6 – Drug Use Justification ......................................................................37
RSG 7 – Building a Recovery Support Program: Mooring Lines -----
Avoiding Recovery Drift ....................................................................................41
RSG 7a – Mooring Lines; Recovery Chart................................................44
RSG 8 – Addictive Behavior ............................................................................45
RSG 9 – Brain Tips ...........................................................................................47
RSG 10 – Onward and Upward: Career/School/Parenting ........................50
RSG 11 – Signs of Stress ................................................................................52
RSG 11a – Reducing Stress .......................................................................54
RSG 12 – Drug use Prevention ......................................................................56
Individual Coaching Session (ICS) Worksheets ....................................61
ICS A – Drug Use Analysis and Chart ...........................................................63
ICS 1 – Functional Analysis: The Five Ws ...................................................67
ICS 2– Exercise and Recovery .......................................................................69
ICS 3 – Drug Refusal Skills .............................................................................72
ICS 4 – Social Skills/Assertiveness Training ................................................75
ICS 5 – Recovery Checklist .............................................................................79
ICS 6 – Motivation for Recovery .....................................................................81
ICS 7 – Managing Anger ..................................................................................83
ICS 8 – Social/Recreational Counseling .......................................................85
ICS 8a – Leisure Interest Ideas ..................................................................89
ICS 9 – Stimulants and Sex-A Natural Connection .....................................90
ICS 10 – Recovery Checklist...........................................................................93
ICS 11 – Relationship Happiness Scale........................................................95
ICS 11a – Examples of Relationship-Related Activities .........................96
ICS 12 – Continuing Care Plan .......................................................................97
Introduction
Welcome
You have taken a big step by deciding to come into treatment. You should
be very proud of your decision to enter treatment and your commitment to
recovery.
This is your Patient Workbook. It contains the worksheets you will need for
your treatment. You will find worksheets for three types of sessions: Drug
Cessation Group, Recovery Skills Group and Individual Coaching.
Patient Worksheets
The patient worksheets will help you get the most out of your treatment.
Some worksheets ask questions and have spaces for your answers. Other
worksheets ask you to read and think about a subject or an idea, or they
contain suggestions or reminders about recovery. It is a good idea to keep
and review the worksheets after you have used them. They provide
information that will help you throughout the course of your recovery.
During each treatment session, your therapist will ask you to follow along
on the worksheet while they review it with the group. The therapist will give
you time to think about what it says and write your answers to questions it
may ask. The group will then discuss the worksheet. You should share your
thoughts and ask questions during this time. If you still have questions,
there will be more time to ask questions during the last part of each
session.
TRUST Workbook: Version Date – March 15, 2021 1

Making the most of sessions
The more work you put into the treatment sessions, the more benefit you
will receive from it. Part of the work you should be doing is reading and
considering how you can use the information in the worksheets and
applying it to your recovery. Other ways to get the most from treatment:
 Attend every scheduled session.
 Arrive for sessions on time or a little early.
 Listen carefully and respectfully to the therapist and the other
patients.
 Be supportive of other patients. If you disagree with someone, be
polite when you speak to them. Do not attack people personally.
 Do not talk about other patients’ personal information outside group.
Patients must be able to trust one another if they are to feel
comfortable sharing their thoughts.
 Ask questions when you do not understand something.
 Participate in group discussions.
 Do not dominate the conversation. Allow time for other patients to
participate.
 Be truthful.
 After the session is over, try to apply what you learned to your
recovery.
 Work on the homework assignments that the therapist gives you.

Drug Cessation Group (DCG) Worksheets

DCG 1 – Drugs-Drug Paraphernalia-Drug-using
Friends
Drugs
It is critical to throw away any drugs
you still have. Over time, you may
have stashed drugs in many places,
some you do not even remember.
Your home, your car, and the places
you go need to be as safe as you can
make them.
Keeping some meth, speed, or pot around, or a few beers in the
refrigerator, to prove to yourself they are not a problem is not smart. These
drugs are triggers that very well could lead you to drug use.
1. Which rooms have stashes of drugs/paraphernalia?

_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
2. Where specifically would you likely find drugs/alcohol in your house?

_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
3. How safe is your car?
____________________________________________________________
____________________________________________________________
____________________________________________________________
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Drug Paraphernalia
Paraphernalia are items used for, or related to, your drug use.
Paraphernalia can trigger intense cravings. It is important to separate
yourself from all paraphernalia as early in your recovery as possible.
Research by the National Institute of Drug Abuse, using sophisticated brain
imaging techniques, shows that the brains of recovering individuals who
use stimulants continue to register powerful brain activity at the sight of
stimulant paraphernalia long after the last use of stimulant (triggers).
People without substance dependencies viewing the same images of
stimulant paraphernalia show no extra brain activity. Removing triggers
from your surroundings will help with recovery.
Use the following checklist to remind yourself of items that you need to get
rid of and add any that might not be listed.
__Vials
__Pipes
__Straws
__Chemicals
__Lighters/Torches
__Spoons
__Phone Numbers
__Needles/Syringes
__ ______________

Drug-using Friends
Friends and acquaintances who use drugs
present an extreme risk. The risk is not
related to who they are, whether they are
close friends or casual acquaintances, or
whether or not they support your recovery.
The risk is that they are “triggers” for your
use.
 If you can avoid these people do so.

 If you expect to run into them, you need to be clear and direct. “I’m
not using anymore.” “Nothing personal, but I can’t be around you. It’s
not that I don’t trust you, I don’t trust me.” Then immediately GO.
 If someone unexpectedly shows up at your place, be clear and direct
and do not invite them inside.
Who are people you need to avoid? (first names and initial)
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
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What will you say to these people?

____________________________________________________________
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DCG 2 – Five Common Challenges in Stopping Drug
Use
Everyone who attempts to stop using stimulants 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.
Challenges New Approaches
1. Friends and acquaintances  Try to make friends at 12-step
who use: you want to or other community support
continue associations with old meetings.
friends who use.  Participate in new activities
that increase chances of
meeting abstinent people.
 Plan activities with abstinent
friends and family members.
2. Anger, irritability: Small  Remind yourself that you are

events can create feelings of experiencing a healing of the
anger that seem to preoccupy brain and strong
your thoughts and can lead to unpredictable emotions are a
relapse. natural part of recovery.
 Exercise.
 Talk to a therapist or
supportive friend.
3. Drugs and alcohol in the  Get rid of all drugs and

house: You have decided to alcohol.
stop using, but others in your  Ask others not to drink or use
house may still be using. at home.
 If the problem continues,
consider moving out.

4. Boredom, loneliness:  Put new activities on your
Stopping substance use often schedule.
means that activities you did  Go back to activities you
for fun can be a problem. enjoyed before your drug use
took over.
 Try to find new friends at
community support meetings.
5. Special Occasions: Parties,  Have a plan for answering

dinners, holidays, questions about drug or
celebrations alcohol use (or not using).
 Start your own drug-free
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 a problem for you in the next few
weeks? Which ones?
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
How will you handle them?

____________________________________________________________
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DCG 3 – Triggers/Thought-stopping
The Losing Argument

 If you decide to stop drinking or using and end up moving toward drugs,
sometimes your brain tries to give you permission to use through a
process we call “drug use justification.”
 Thoughts about stimulant use start an argument inside your mind, your
“rational brain” versus your “addicted brain.” You feel as though you are
in a fight and you must come up with many reasons to stay away from
drugs.
 Your addiction is just looking for the excuse, a drug use justification. The
argument inside you can be part of a series of events leading to drug
use.
Thoughts Become Cravings
If you allow yourself to focus on the thought and
think about details and next steps (eg. get cash,
call a user friend), without your awareness, you
are making a choice to use drugs. The longer
time period that you allow the thoughts to go on,
the more likely you are to develop powerful
cravings and subsequently use drugs.
The "Automatic" Process

During addiction, triggers, thoughts, cravings and use all seem to run together.
However, the usual sequence goes like this:
TRIGGER  THOUGHT  CRAVING  USE

Thought-Stopping
 The key to success is stopping the thought before
it becomes a craving.
 It is important to respond to the thought as soon as
you recognize it occurring.
 Effective thought-stopping can prevent a craving
from occurring. Once a craving occurs, there is a
powerful biological push toward use. It becomes
much harder to stop this process.
A New Sequence
In order to get recovery started it is necessary to change the trigger - use
sequence. Thought - stopping provides a tool for breaking the process. The
choice is:
Thought-stopping
Techniques
Trigger Thought
Continued Cravings Use

Thoughts
You make a choice. It is not automatic.

Techniques for Thought-Stopping
Try the techniques described and use those that work best for you.
VISUALIZATION -There are many ways to use your imagination to substitute
a new thought in place of the drug thought. Some include:
 Picture a switch or a lever in your mind. Imagine yourself actually

moving it from ON to OFF to stop the drug thoughts.
 Focus on a positive memory/scene from your life that is something

you enjoy thinking about. A great view from a mountain when you
went on a hike. The face of your child or a parent. Any thought
that has a strong positive effect.
SNAPPING - Wear a rubber band on your wrist loosely. Each time you
become aware of drug thoughts snap the band and say "NO!" to the thoughts
as you make yourself think about another subject. Have a subject ready that
is something meaningful and interesting to you.
RELAXATION/MEDITATION - Thoughts can be avoided or replaced by taking

a deep breath and then focusing on your normal breathing.

DCG 4 – Your Brain and Recovery
In understanding and dealing with addiction it

is important to think about your brain regarding
two very powerful and different parts:
1. The higher, rational brain. This is the

decision-making part of your brain.
2. The lower, emotional centers in the

brain. This is your pleasure center.
Decisions to use drugs or alcohol start in the higher brain. You weigh the
positives and negatives associated with using, and when you use, the
pleasurable experiences happen in the lower brain.
After a time, as the negative consequences of use mount, you have
probably decided at times to stop using but you are not able to stop. You
decide in your higher brain, but the decision to stop is overpowered by your
lower brain.
What happens?
Most people describe cravings that overpower the rational decision to
stop using.
Why does this happen?
1. After a period of regular substance use, the people, places, and
circumstances that have been associated with the drug use have the
power to trigger a response in the lower, “addicted,” brain.
2. When this happens, you feel a craving and your thinking changes
making it seem OK to use, “one more time,” or “just a little bit,” etc.
Why is this important?

1. The triggered reaction in the lower brain cannot be directly controlled.
This automatic reaction is like a reflex.
2. No amount of good intentions, promises, or commitments will reduce
the strength of the cravings.
3. If you are around people, in places, or in situations where you have
used in the past, the chances are great that you will use again even if
you have a sincere desire to stop using.
4. If you understand substance dependence you can begin to effectively
deal with it.
What can you do about this?

1. Change your behavior so that you avoid the things that will trigger
cravings.
2. Start doing new, healthy, alternative behaviors.
3. Reassume higher brain control of what you do by planning your day
and scheduling you time.
Understanding the brain and addiction makes sense out of your behavior
up until now and provides the key to beginning your first steps in recovery.
1. Have you tried to stop in the past and failed? What happened?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
2. What could you have done differently in light of what you know now
about the brain?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________

Brain Changes by Drug Use.
The brain has neurons that release and receive dopamine. Dopamine is a
brain chemical that allows us to feel pleasure, happiness, and positive
emotions. As people use meth and cocaine, the brain becomes addicted,
one of the major parts of the biology of addiction is the result of how
methamphetamine and cocaine change the dopamine system. The good
news is that the brain recovers with time and no stimulant use. In a sense
the brain “heals.” Understanding this aspect of addiction is important for
people to understand so they can see hope for the future when stimulant
use is stopped.
Video Clip 1. Normal dopamine function

Press play below, or access the video online here:
https://vimeo.com/418131516

Video Clip 2. Dopamine system changes from the use of
methamphetamine

Video Clip 3: Dopamine recovery with abstinence from
methamphetamine.

DCG Group A. Scheduling
What is scheduling?
A schedule is a plan you make for yourself.
You will need to schedule recreation and rest
as well as work and appointments.
Scheduling will leave less room for impulsive,
possibly high risk, behavior which may result
in your using drugs. Scheduling helps you
change your behavior in line with a new,
drug-free, lifestyle.
Why should I schedule?

If you begin your recovery in a residential
setting, you have the structure of the program
and the building to help you stop using. As an
outpatient, you must build that structure
around yourself as you continue functioning in
the world. Your schedule is your structure.
Moving from addiction is like getting out of a
mine field. You need to be very careful where
you are going and where you are stepping.
Initially, how you got to where you are is not
important; getting out is.
Do I need to write it down?

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

Daily/Hourly Schedule
Date Date Date
7:00 7:00 7:00
8:00 8:00 8:00
9:00 9:00 9:00
10:00 10:00 10:00
11:00 11:00 11:00
12:00 12:00 12:00
1:00 1:00 1:00
2:00 2:00 2:00
3:00 3:00 3:00
4:00 4:00 4:00
5:00 5:00 5:00
6:00 6:00 6:00
7:00 7:00 7:00
8:00 8:00 8:00
9:00 9:00 9:00
10:00 10:00 10:00
11:00 11:00 11:00
12:00 12:00 12:00
Notes/reminders:______________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

Recovery Skills Groups (RSG) Worksheets

RSG 1 – Building a Recovery Support Program:
Mooring Lines ----- Avoiding Recovery Drift
Mooring line – Ropes or cables that hold a boat from drifting away from its
dock/pier.
Recovery from stimulants doesn’t “just happen”. You build the recovery
with your behavior. You add new behaviors to your life. These might
include: Attendance at treatment sessions, 12 Step meetings, exercise,
scheduling your time, meditation, spending time with drug-free friends, yard
work, etc.
These recovery behaviors become your “mooring lines”. These activities
keep you from moving toward drug use.
How It Happens
 Drug use does not suddenly occur. It does not happen without
warning and it does not happen quickly.
 The slow movement away from sobriety can be compared to a
ship gradually drifting away from where it was moored. The drifting
movement can be so slow that you don't even notice it.
Interrupting the Process
 During recovery, each person does specific things that work to

keep them sober.
 These "mooring lines" need to be clearly stated and listed in a very
specific way so they are clear and measurable.
 These are the ropes that hold the recovery in place and prevent
drift back to drug use from happening without being noticed.

Maintaining a Recovery
Use the Mooring Lines Recovery Chart to list and track the things that
are holding your recovery in place. Follow these guidelines when filling
out the form:
1. Identify 4 or 5 specific things that are now helping you stay

sober. (e.g., working-out for 20 min., 3 times per week).
2. Include items such as exercise, therapist and group

appointments, scheduling, 12-Step meetings, eating patterns,
etc.
3. Do not list attitudes. They are not as easy to measure as

behaviors.
4. Note specific people or places that are known triggers and

need to be avoided during the recovery.

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

RSG 1a – Mooring Lines; Recovery Chart
 In becoming sober you have had to learn to do certain new behaviors -

behaviors that work for you in keeping you sober.
 Charting the new behaviors and checking occasionally to make sure the
lines are secure can be very useful.
Use the chart below to list those activities that are very important to your
continuing recovery. If there are specific people or things you need to avoid,
list those. Look back at your list regularly to check yourself and make sure you
are continuing to stay moored in your recovery.
Mooring Line Date () Date () Date () Date () Date ()
Behaviors
1.
2.
3.
4.
5.
I am Date () Date () Date () Date () Date ()
Avoiding
1.
2.
3.
4.
5.

RSG 2 – Internal Trigger Questionnaire
During recovery there are often certain feelings or

emotions that trigger the brain to think about using
drugs. Read the following list of emotions and indicate
which of them might trigger (or used to trigger) thoughts
of using for you:
_____ Afraid _____ Frustrated _____ Neglected

_____ Angry _____ Guilty _____ Nervous
_____ Confident _____ Happy _____ Sexy
_____ Criticized _____ Inadequate _____ Pressured
_____ Depressed _____ Insecure _____ Relaxed
_____ Embarrassed _____ Irritated _____ Sad
_____ Excited _____ Jealous _____ Bored
_____ Exhausted _____ Lonely _____ Tired
A. Check √ the above emotional states or feelings that have triggered your
use of drugs recently.
B. Has your use in recent weeks/months been:
_____ 1. Primarily tied to emotional conditions
_____ 2. Routine and automatic without much emotional triggering.

C. Are there any times in the recent past in which you were attempting to
not use and a specific change in your mood clearly resulted in your
using? (For example, You got in an argument with someone and used
in response to getting angry.) Yes _____ No _____
If yes, describe: __________________________________________

________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
D. Go back to the trigger chart and enter these triggers if you haven’t
already.

RSG 3 – External Trigger Questionnaire
1. Place a check mark next to activities or situations in which you

frequently used stimulants. Place a zero (O) next to activities or
situations in which you never have used stimulants.
__When home alone __Before a date __After Payday
__At home with friends __During a date __Before going out to

dinner
__At a friend’s home __Before sexual __Before breakfast

activities
__At parties __During sexual activities __At lunch break
__While at dinner __After sexual activities __At sporting events
__At movies __Before work __After work
__At bars/clubs __When carrying money __Driving near some

streets
__At concerts __After going past a __At a school residence

dealer’s place
__In the park __With drug using friends __When driving
__When I gain weight __At or near a liquor store __When internet browsing
__In certain __Texting certain people __Calling friends who use

neighborhoods
__Travelling (airports, __After medical visits __At a pharmacy

hotels, planes)

2. List any other settings or activities where you frequently use.
____________________________________________________________
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3. List activities or situations in which you would not use drugs or

alcohol.
____________________________________________________________
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4. List people you could be with and not use drugs or alcohol.
____________________________________________________________
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RSG 2a-3a – Trigger Chart
Name:________________________________________
Date:_________________________________________
Instructions: List people, places, objects, situations, and emotions below according to how likely they would trigger drug or alcohol use.
0% 100%
Chance of Using Chance of Using
Never Use Almost Never Use Almost Always Use Always Use
_________________
_________________
_________________
_________________
_________________
_________________
_________________
These are "safe" These are low risk, but These situations are high Involvement in these
situations. caution is needed. risk. Staying in these is situations is deciding
dangerous. to stay involved with
drug use. Avoid totally.

RSG 4 – Taking Care of Yourself
During periods of drug use people often do not take care of themselves.
There is often not enough time or energy to attend to health and grooming
when you are using. How you look becomes unimportant. Health is
secondary to drug use.
 Not caring for yourself is a major factor in losing self-esteem.

 This is a time to recognize your own value. In recovery, your own
health and appearance become more important as you care more for
yourself.
 It is part of starting to like and respect yourself.

Attending to the following will strengthen your image of yourself as a
healthy, drug-free, person.
1. Have you seen a doctor for a thorough
check-up?
________________________________
________________________________
2. When is the last time you went to the

dentist?
________________________________
________________________________
3. Have you considered getting a "new

look" next time you cut your hair?
_______________________
What kind of changes might you like to try?

___________________________________
___________________________________
___________________________________
4. Are you paying attention to what you are

eating? Is it too much, too little or of
adequate nutritional value? How many
meals a day do you eat?
________________________________
________________________________
________________________________
5. Do you still wear the same clothes you

wore during your using episodes?
________________________________
________________________________
________________________________

6. Do you need to have your vision or
hearing checked?
_______________________________
_______________________________
_______________________________
7. What exercise do you do regularly?

_______________________________
_______________________________
_______________________________
8. Is your caffeine or nicotine intake out of

control?
_______________________________
_______________________________
_______________________________
 If doing all these things at once is too overwhelming, work on one or

two items each week.
 Decide which are the most important and do those first.
 You will begin to see a person you like and respect.
The first thing I need to do to take care of myself is:
__________________________________________________________________

RSG 5 – Be Smart; Not Strong
"I can be around drugs/alcohol. I am certain I don't want to use and

once I make up my mind, I'm very strong."
"I have been doing well and I think it's time to test myself and see
if I can be around friends who are using. It's just a matter of
willpower."
"I think I can have a drink or smoke a joint and not use stimulants.
I never had a problem with alcohol anyway."
Staying drug/alcohol-free takes more than just strength or will power. People
who can maintain abstinence do it by being smart. They know that the key
to not drinking and not using is to keep far away from drug use situations.
The closer you get, the more likely you are to use. If drugs appear
unexpectedly and/or you are close to friends who are drinking and using,
your chances of using are much greater than if you weren't in that situation.
Smart people stay sober by avoiding triggers for as long as possible.
DON’T BE STRONG.
BE SMART.

How smart are you being? Rate how well you are doing in avoiding
relapse:
Poor Fair Good Excellent
1. Practicing Thought-Stopping 1 2 3 4
2. Scheduling 1 2 3 4
3. Keeping Appointments 1 2 3 4
4. Avoiding Triggers 1 2 3 4
5. Not Using Alcohol 1 2 3 4
6. Not Using Drugs 1 2 3 4
7. Avoiding Individuals who
use Drugs/Alcohol 1 2 3 4
8. Avoiding Drug/Alcohol Places 1 2 3 4
9. Exercising 1 2 3 4
10. Being Truthful 1 2 3 4
11. Going to 12-Step
or other support meetings 1 2 3 4
Which area(s) you want to improve?

____________________________________________________________
____________________________________________________________
____________________________________________________________
How do you plan to do that?

____________________________________________________________
____________________________________________________________
____________________________________________________________

RSG 6 – Drug Use Justification
Once a person decides not to use drugs anymore, how does it happen again?
Is there some way of avoiding the return to drug use?
Drug use justification is a process that happens in people's minds. The

addicted part of the brain invents excuses that move the person close enough
to drug use situations so that “accidents” can and do happen. You may
remember times when you were planning to stay drug free and the mental
justification process happened before you used again.
Use the questions below to help you identify justifications your addicted brain
might use and interrupt the process with thought-stopping.
Accidentally or Other People

Does your addicted brain ever try to convince you that you have no choice
when an unexpected situation catches you off-guard? Have you ever said any
of the following to yourself?
1. It was offered to me. What could I do?

2. An old friend called, and we decided to get together.
3. I was cleaning my house and found drugs I'd forgotten about.
4. I had friends come for dinner and they brought me some wine.
5. I was in a bar and someone offered me a beer.
6. Other .

Catastrophic Events
Is there one unlikely, major event that is the only reason you would use? What
might such an event be for you? How would using drugs improve the situation?
1. My spouse left me. There's no reason to stay drug free.

2. I just got injured. It's ruined all of my plans. I might as well use.
3. I just lost my job. Why not?
4. Other .
For a Specific Purpose

Has your addicted brain ever suggested that using a certain drug or alcohol is
the only way to accomplish something?
1. I'm gaining weight and need stimulants to control my weight.

2. I'm out of energy. I'll function better.
3. I need drugs to meet people more easily.
4. I can't enjoy sex without using.
5. Other .

Depression, Anger, Loneliness, and Fear
Does feeling depressed, angry, lonely or afraid make using seem like the
answer? Is it really? What might you do when your addicted brain says the
following to you?
1. I'm depressed. What difference does it make if I use or not?

2. When I get mad enough I can't control what I do.
3. I'm scared. I know how to make the feeling go away.
4. If they think I've used, I might as well use.
5. Other .
My Addiction is Cured
Everyone struggles with the fact that addiction and recovery are on-going
processes. Does your addicted brain ever try to convince you that you can
use just once or just a little?
1. I’m back in control. I’ll be able to stop when I want to.

2. I’ve learned … I’ll only use small amounts and only once in a
while.
3. This drug (or alcohol) was not my problem – the other one
was. So I can use this and not use the other.

Testing Yourself
Would your brain like to prove you can be stronger than drugs/alcohol? It’s
very easy to forget that being smart is the key to staying sober; not being
strong. Have you ever thought:
1. I’m strong enough to be around it now.

2. I want to see if I can say “no” to drinking/using.
3. I want to see if I can be around my old friends.
4. I want to see how stimulants feel now that I’ve stopped.
Celebrating
Both the addicted brain and other people may encourage you to fall for the
following:
1. I’m feeling really good. One time won’t hurt.

2. I’m doing so well. Things are going great. I owe myself a
reward.
3. This is such a special event and there’s only one way to
celebrate.

RSG 7 – Building a Recovery Support Program:
Mooring Lines ----- Avoiding Recovery Drift
Mooring line – Ropes or cables that hold a boat from drifting away from its
dock/pier.
Recovery from stimulants doesn’t “just happen”. You build the recovery
with your behavior. You add new behaviors to your life. These might
include: Attendance at treatment sessions, 12 Step meetings, exercise,
scheduling your time, meditation, spending time with drug-free friends, yard
work, etc.
These recovery behaviors become your “mooring lines”. These activities
keep you from moving toward drug use.
How It Happens
 Drug use does not suddenly occur. It does not happen without
warning and it does not happen quickly.
 The slow movement away from sobriety can be compared to a
ship gradually drifting away from where it was moored. The drifting
movement can be so slow that you don't even notice it.
Interrupting the Process
 During recovery, each person does specific things that work to

keep them sober.
 These "mooring lines" need to be clearly stated and listed in a very
specific way so they are clear and measurable.
 These are the ropes that hold the recovery in place and prevent
drift back to drug use from happening without being noticed.

Maintaining a Recovery
Use the Mooring Lines Recovery Chart to list and track the things that
are holding your recovery in place. Follow these guidelines when filling
out the form:
1. Identify 4 or 5 specific things that are now helping you stay

sober. (e.g., working-out for 20 min., 3 times per week).
2. Include items such as exercise, therapist and group

appointments, scheduling, 12-Step meetings, eating patterns,
etc.
3. Do not list attitudes. They are not as easy to measure as

behaviors.

4. Note specific people or places that are known triggers and need
to be avoided during the recovery.
The checklist should be completed regularly (probably weekly). When

two or more items cannot be checked, it means that recovery drift is
happening. Sometimes things weaken your mooring lines. Vacation,
illnesses and holidays sometimes cannot be controlled. The mooring
lines loosen up. Many people return to drugs during these times. Use
the chart to recognize when you are more likely to use and decide what
to do to keep this from happening

RSG 7a – Mooring Lines; Recovery Chart
 In becoming sober you have had to learn to do certain new behaviors -

behaviors that work for you in keeping you sober.
 Charting the new behaviors and checking occasionally to make sure the
lines are secure can be very useful.
Use the chart below to list those activities that are very important to your
continuing recovery. If there are specific people or things you need to avoid,
list those. Look back at your list regularly to check yourself and make sure you
are continuing to stay moored in your recovery.
Mooring Line Date () Date () Date () Date () Date ()
Behaviors
1.
2.
3.
4.
5.
I am Date () Date () Date () Date () Date ()
Avoiding
1.
2.
3.
4.
5.

RSG 8 – Addictive Behavior
As drug use increases, it becomes more and more difficult to maintain the
appearance of normalcy. Finally, the individual does desperate things to
try to continue to appear normal. They are the things people do related to
their drug use and their re-emergence in recovery can precede a return to
drug use. Learning to recognize when one or more of these begin
happening will help you know when to start fighting extra hard to move
away from using drugs.
Which of these behaviors do you think are related to your

drug/alcohol use?
Lying
Stealing
Being irresponsible (not meeting family/work commitments)
Being unreliable (late for appointments, breaking promises, etc.)
Being careless about health and grooming (wearing “using”

clothes, stopping exercise, poor diet, messy appearance,
etc.)
Housekeeping gets sloppy
Behaving impulsively (without thinking)

Behaving compulsively (too much eating, working, sex, etc.)
Changing work habits (working more, less, not at all, new

job, change in hours, etc.)
Losing interest in things (recreational activities, family life, etc.)
Isolating (staying by yourself much of the time)
Missing or being late for treatment
Using substances other than that which brought you to treatment
Increasing, decreasing, or stopping prescribed medication on

your own

RSG 9 – Brain Tips

RSG 10 – Onward and Upward:
Career/School/Parenting
The focus of recovery changes and expands over time.

The early goals may be:
 Not using stimulants for a day, a weekend, a week, a month and so
on.
 Working on heathy eating and exercising.
 Attending all of your treatment appointments.
 Shedding relationships with drug users and establishing a new group
of sober friends.
When you make changes in your life that establish a break from drug use,
you reach a new starting point in recovery. Goals need to be more focused
on personal growth and a new lifestyle beyond just being drug-free.
These goals may be:
 Returning to school or a training program (for example, the trades,
computers, or a high school or college degree).
 Applying for jobs and returning to work.
 Contributing financially to your household and family.
 Being a full-time parent and being responsible for children
These goals are not only a way to move farther away from the drug use life
but bring a feeling of self-esteem. This is critical for the continuation of
recovery. It puts you in a world where you are more than simply drug-free,
but a new and positive place where you can experience the satisfaction of
being a contributing member of society.

What are some things you could do to achieve these “bigger picture”
goals?
Goal_________________________ When_______________
Initial steps___________________________________________
Goal_________________________ When_______________
Initial steps___________________________________________
Goal_________________________ When_______________
Initial steps___________________________________________

RSG 11 – Signs of Stress
Stress is what a person experiences as the result of difficult or upsetting

events, particularly those which continue for a period of time. Stress is a
major cause of a return to drug use.
Stress is the experience people have when the demands they make of
themselves or those placed upon them are greater than what they feel they
can handle. Sometimes we are unaware of this emotional state until the
stress is producing physical symptoms. Check off any of the following
problems you have experienced in the past 30 days:
__________ 1. Sleep problems

a. Difficulty falling asleep
b. Waking up off and on during the night
c. Nightmares
d. Waking up early and being unable to fall back to
sleep

__________ 2. Headaches
__________ 3. Stomach problems
__________ 4. Chronic Illness
__________ 5. Fatigue
__________ 6. Moodiness
__________ 7. Irritability
__________ 8. Difficulty concentrating
__________ 9. General dissatisfaction with life
__________ 10. Feeling overwhelmed
If you have checked some of these items, you might want to think about
ways to reduce stress. By becoming more aware of stress and learning
ways to cope, you can further ensure your continuing recovery and improve
your physical and mental health.

RSG 11a – Reducing Stress
The following questions should be answered as honestly as possible to

help identify which parts of your daily living are most stressful. Take steps
to correct these areas and you will reduce stress in your life.
Do you enjoy your work, does it satisfy you?

Yes________ No________
Focusing on the present means giving your attention

to the task at hand without past and future fears
crippling you. Are you usually able to stay in the
here and now?
Yes________ No________
Do you appreciate things like music, reading, nature,

and personal relationships? (Or are you focused on
having money and things?)
Yes_______ No_______
Are you forcing yourself to do things that increase

your self-confidence?
Yes________ No_________

Do you tackle large goals by breaking them into
smaller, more manageable tasks?
Yes________ No________
Are you careful to make your environment

peaceful?
Yes_______ No________
Can you and do you say "NO" when that is how you
feel?
Yes______ No______
Do you know how to use self-relaxation/ meditation/

yoga techniques to relax your body and do you
allow time in your day to do it?
Yes_______ No________
Are you careful to avoid large swings in body

energy caused by taking in excess caffeine or
nicotine?
Yes________ No________
Are there specific ways you deal with anger and get
it out of your system physically?
Yes________ No________

RSG 12 – Drug use Prevention
Why is drug use prevention important?

Recovery is more than not using drugs/alcohol. The first step in treatment is
stopping drug/alcohol use. The next step is not starting again. This is very
important and the process for doing it is called DRUG USE PREVENTION.
What is relapse?
Relapse is going back to drug/alcohol use and to all the behaviors and patterns
that go with that. Often the behaviors and patterns return before the actual
drug/alcohol use. Learning to recognize movement towards drug use can help
the recovering person stop the process before actual drug/alcohol use begins.
The choice looks like this:

Addiction

Treatment

Sobriety

Substance Use Behavior

Drug use Justifications
Emotional Building

Drug Use Prevention No Prevention
 
 
Continued Sobriety Drug use

What is Substance use Behavior?
The things people do as part of using

drugs or alcohol are called “using
behaviors.” Often these are things the
individual does to get drugs or alcohol, to
cover-up drinking/using or as part of the
use. Lying, stealing, being unreliable, and
acting compulsively are types of these
behaviors. Describe yours:
What is Emotional Building?
Feelings that don't seem to go away and

just keep getting stronger cause emotional
building. Sometimes the feelings seem
unbearable. The kinds of feelings that can
build are boredom, anxiety, sexual
frustration, irritability, and depression. Are
any of these familiar to you now or in the
past?
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

What is Drug use Justification Thinking?
In AA these kinds of thoughts are called

"stinking thinking." They are thoughts that
make using or drinking seem O.K. Some
examples are, "I can handle just one drink", "If
they think I'm using, I might as well", or "I have
worked hard. I need a break." What might
your brain say to you?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
The important step is to TAKE ACTION as soon as you recognize the danger
signs. Which actions might work for you?
Calling a therapist Have sober fun
Calling a sober friend Talking to your family
Going to a support meeting ___ Talk to your spouse
Exercise Using time scheduling
Other

Individual Coaching Session (ICS)
Worksheets

ICS A – Drug Use Analysis and Chart
When does a return to drug use begin?
If drug use happens, it is important to analyze the events surrounding it. By

doing this, you can make necessary changes to avoid future drug use.
Prior to the actual substance use there are usually signs and changes in
behavior days or even weeks ahead of the final punctuation mark of drug
taking.
Use the drug use analysis chart to help zero in on the causes of drug use
recently, currently, or in the future.
Look at events over the 1 – 4-week period preceding drug use. Note every
change or stressor even if it doesn’t seem relevant. Areas to look at are:
1. Work Events – events or change in status relative to a job.
2. Personal Events – events or a change in the status of relationships with

family/friends as well as other events or situations unrelated to any
other category.
3. Treatment Events – events or a change in status of the regular

treatment plans as well as transition from one phase of treatment to
another.
4. Drug/Alcohol Related Behaviors – behaviors directly related to drug and

alcohol consumption (e.g., drinking, going to bars, visiting a dealer)
5. Behavior Patterns – new or resumed behaviors that are part of

addiction (e.g., lying, stealing, behaving compulsively, isolating, etc.)

6. Drug use Cognitions- thought that seem to condone or justify drug use,
even if they were brief and seemed minor. Being aware at any point
that a return to drug use might be in progress. Fantasies about using or
the behaviors above that go with using. Dreams about drugs and drug
use.
7. Health Habits Status-events or a change in status or routine of normal

eating, sleeping, exercise, or grooming behaviors. Illness or injuries are
particularly pertinent.
It is not likely that there will be significant events in every single category. It is
important to get a picture of overall vulnerability before the actual drug use
occurred.

Drug Use Analysis Chart
Name:________________________________________________
Date of Drug Use:________________________________________
An episode of drug use does not begin when drug ingestion occurs. Frequently there are pre-use events that
occur, which are indicative of a return to drug use. Identifying your individual pre-use patterns will allow you to
interrupt the process of a return to drug use. Using the chart below, note events occurring during the week
immediately preceding the drug use being analyzed.
WORK PERSONAL TREATMENT DRUG/ BEHAVIORAL DRUG USE HEALTH

RELATED PATTERNS THOUGHTS HABITS STATUS
EVENTS EVENTS
BEHAVIORS

THOUGHTS OR FEELINGS RELATIVE TO ABOVE EVENTS

ICS 1 – Functional Analysis: The Five Ws
 Your drug use isn’t random. It doesn’t happen accidentally.

 If you have been using stimulants on a regular basis, then there are
probably some patterns to your use (e.g., places, times of day, with
certain people).
 If you understand how methamphetamine/cocaine are entangled in
your life, then you can work on reducing or eliminating your use.
To gain an understanding of how drug use has become involved in your
life, it is useful to do a “Functional Analysis.” This analysis helps you see a
clear picture of the factors that influence your drug use or simply, “The five
Ws.”
The Five Ws
 When: The time periods when you use stimulants
 Where: The places where you use and buy stimulants
 Why: The external cues and internal emotional states that trigger
craving and use of stimulants (why)
 Who: The people who you use drugs with or the people who you buy
drugs from.
 What: What effects do you experience (good and bad) when you use
stimulants (what happened)

When are the days of the week/ times of day that you most often use
cocaine or methamphetamine:
____________________________________________________________
____________________________________________________________
____________________________________________________________
Where are the places you most often use and buy meth/cocaine:
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Why does use happen? What are the events or things around you or the
emotional feelings (triggers) that you have that often occur right before you
buy and use meth/cocaine:
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Who are the people you frequently use stimulants with, or buy stimulants
from?
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
What happens when you use methamphetamine/cocaine? Good and Bad.

____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

ICS 2– Exercise and Recovery
 People who exercise on a regular basis in stimulant treatment do

better than those who don’t.
 Research has been done that shows exercise can reduce anxiety,
depression, weight gain and help reduce craving.
 Any exercise that increases heart rate (aerobic) and can be done for
20 minutes, 3 times per week can make a huge benefit on the health
and mental health of people recovering from stimulant dependence.
 And exercise provides a new set of behaviors to use your time in a
non-drug related activity.
Making a plan for exercise, one day at a time, is a really valuable

way to increase your chances of success in stimulant recovery.

There are simple things you can do alone without expense or equipment
(e.g., jogging, sit-ups, etc.) or there are group activities that can provide
you with support and new non-drug using friends (yoga, joining a gym,
aerobics classes) There are also many apps for smart phones, tablets and
computers that you can use to support your exercise efforts.
1. What are some exercises that you are willing to add to your recovery
plan?___________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
2. List any medical or physical problems that could be obstacles to

exercise?_______________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
3. What is the name of your doctor who could clear you for exercise?
_______________________________________________________
4. Do you exercise now? ____ Have you exercised in the past? ____
Describe your exercise experiences:
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________

5. What exercise plan would work for you? Think about:
 Is there someone you could exercise with?
 Do you have any equipment (e.g., a bike, hand weights, basketball)?
 When could you block out a half hour for exercise? 3 x week?
 What exercise program has worked for you in the past?
 What kinds of things do you like to do physically?
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
______________________________________________________
Start slowly, don’t overdo it, some is better than none.

Be consistent-do a little but do it consistently

ICS 3 – Drug Refusal Skills
Refusing Methamphetamine and Cocaine
Some Important Things to Know:

 Remember that those persons who offer you drugs or alcohol are not
thinking of your best interests. They may be your friends, but once you
have decided to quit, it is important for you to consider anyone who asks
you to use to be a danger. They must be discouraged - politely, if
possible, but firmly.
 Saying “no” is the first and most important part of your refusal response.
There are different ways of saying “no” that are appropriate in different
situations. Different people say “no” in different ways. It is important to
feel comfortable, which means that you have to develop your own style.

Components of Effective Refusal
When creating your own refusal style, a few basic components of your
refusal responses will increase the likelihood that they will be effective.
1. “No” should be the first thing you say.

a. No, thank you.
b. No, I’m not using anymore; it’s causing me too many problems.
c. No, I’ve got a meth problem, so I’m not using anymore
2. Tell the person offering you drugs not to ask you now or in the future.
3. Saying things like:
a. “maybe later,” “I have to get home,” or “I’m on medication” just

make it likely that they will ask again. This “no” means “no, not
now but yes at another time.”
4. Body language is important. You want to communicate sureness and
inflexibility.
5. Making good eye contact is important; look directly at the person
when you answer.
6. Your expression and tone should clearly indicate that you are serious.
7. Change the subject to a new topic of conversation but don’t prolong
being in the presence of the person.
COMPONENTS OF AN EFFECTIVE REFUSAL
 “NO” SHOULD BE THE FIRST THING YOU SAY.

 TELL THE PERSON NOT TO ASK YOU NOW OR IN THE FUTURE IF
YOU WANT TO USE DRUGS.
 USE APPROPRIATE BODY LANGUAGE:

 MAKE GOOD EYE CONTACT; LOOK DIRECTLY AT THE PERSON

Practice Refusal Skills
 It is necessary to practice refusal skills. Practice prepares you with
words and a plan.
 Think about situations where you have used drugs. Examples of

such situations are friends stopping by with drugs, friends calling or
texting, running into friends while shopping or leaving work, and
attending parties or celebrations.
 What are at least three typical scenarios in which you have had, or
may have difficulty refusing drugs? Choose a specific situation,
include specific people, the time of day, the place, and the activity.
 Role-play two or three of these situations. Before starting, review the

components of effective refusal and the goals for the situation (see
box with components)
 After each trial, constructive feedback is given referring to the above

components. Following the feedback, the role-play is repeated.
 If you experience a lot of trouble, the therapist may reverse roles with
you and model an effective response.
Homework
The most important thing in developing effective refusal skills is practice.
Identify high-risk situations and practice these scenes between sessions. If
you have a partner to practice with, this can be scheduled either during or
outside of the session. If you do not have anyone to practice with, you can
either practice aloud in front of a mirror or write down a refusal scenario
with responses and bring it to the next session for practice.

ICS 4 – Social Skills/Assertiveness Training
What is assertiveness?
Assertiveness means to behave in a confident, forceful, yet respectful way. Being
assertive helps you to stand up for yourself and stick to your beliefs.
Why is assertiveness training relevant to treatment for drug use?

Assertiveness training can help with improving interpersonal relations.
Poor interpersonal skills can give rise to emotional states such as anger,
frustration, resentment, depression, or anxiety and decrease the quality of
life and increase the risk of drug use.
Assertiveness training is particularly appropriate if you tend to be either too
passive or too aggressive in social situations.

What is passive behavior?
Do you deny yourself or your rights? ___Yes ___No ___Sometimes
Do you avoid expressing feelings? ___Yes ___No ___Sometimes
Do you feel hurt and anxious? ___Yes ___No ___Sometimes
Do you allow others to choose for you? ___Yes ___No ___Sometimes

_
Do you fail to achieve your goals? ___Yes ___No ___Sometimes
What is aggressive behavior?

Do you accomplish goals without ___Yes ___No ___Sometimes
concern of bad feelings and resentment
in others?
Do you express feelings and promote ___Yes ___No ___Sometimes
yourself, but usually hurt others in the
process?
Do you minimize others’ worth and put ___Yes ___No ___Sometimes
them down?
Do you make choices for others, and ___Yes ___No ___Sometimes
deny them their rights?
What is assertive behavior?

 Assertive behavior enables you to express your feelings honestly.
 Assertive behavior allows you to achieve your personal goals.
 Assertive behavior respects the feelings of others.
In summary:
• Passive: You are hurt by not getting what you want.
• Aggressive: The other person is hurt and may seek revenge.
• Assertive: Neither person is hurt, and both get what they want.

Some tips on how to be assertive.
Rate yourself on each item from 0 to 10,
0 meaning “I need to work on this”
10 meaning “I’m as good as I can be with this.”
 I clearly express my needs (what you want). Rating: _____
 I balance the negative with the positive when I give others feedback. For
example, if telling someone that you want them to stop nagging at you,
you might say, “I know you have really tried to be supportive and
understanding of my problem in the past, but lately I feel like you have
been on my case constantly.” Rating: _____
 I use “I” statements when expressing my feelings or needs.( For

example, you could say “I am angry because I feel like nobody cares
about my feelings,” instead of “You make me feel awful.”) Rating: _____
 I speak loudly and firmly (Your message should be said with authority
but not hostility. You want to convey that you mean business but are
respectful). Rating: _____
 I respond promptly. (This lets the other person know that you have
thought about this and are sure of yourself). Rating: _____
 I make good eye contact when speaking. I look at the other person when
I speak and when I listen. (Again, this promotes the impression that you
are serious about your message). Rating: _____
 My body gestures and facial expressions are consistent with my

message. (For example, don’t smile if you are angry.) Rating: _____

Practice
What are some situations where you feel you might have been too passive
or too aggressive? For example, at home, at work, with friends, with
neighbors. Pick one to act out with your therapist.
____________________________________________________________
____________________________________________________________
____________________________________________________________

ICS 5 – Recovery Checklist
Outpatient treatment requires a lot of hard work and a great deal of

commitment. To get the most from treatment, it is necessary to change many
old habits and replace them with new behaviors.
Check all the things that you do (or have done) since entering treatment:
_____ Schedule on a daily basis
_____ Avoid triggers (when possible)
_____ Visit physician for check-up
_____ Use thought-stopping for cravings
_____ Eliminate all paraphernalia
_____ Avoid individuals who use alcohol
_____ Avoid individuals who use drugs
_____ Attend treatment groups
_____ Attend 12-Step/other support meetings
_____ Avoid bars and clubs
_____ Stop using alcohol
_____ Get a sponsor or sober support
_____ Stop using all drugs
_____ Exercise every day

_____ Pay financial obligations promptly
_____ Discuss your thoughts, feelings, and behaviors honestly with your
therapist
____ Avoid triggering websites
_____ Delete triggering contacts from your phone/computer
_____ Identify behaviors associated with drug or alcohol use
Which of the above are easiest for you to do?
_____________________________________________________________
_____________________________________________________________
Which of the above take the most effort for you to do?
_____________________________________________________________
_____________________________________________________________
Which have you not done yet? Why not?
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

ICS 6 – Motivation for Recovery
Ask any group of people just starting into recovery WHY they want to stop
using right now and you will get many different answers:
 "I was arrested and it's either this or jail."

 "My wife says if I don't stop, we are finished."
 "Last time I used I thought I was going to die; I know I will if I use
again."
 "They are going to take the children from us unless we stop."
 "I've been using for 20 years now; it's time to change."
Which of the people quoted are most likely to be

successful in recovering? It seems logical to think that
people who want to stop using for themselves and not
because someone else wants them to, are more likely
to do well in treatment. However, that may not be true.
Research shows that the reasons people stop using
have little bearing on whether they will be able to
successfully lead a drug-free life.
What does make a difference is whether they can stay drug-free long enough
to appreciate the benefits of a different lifestyle. Life becomes less
complicated and more enjoyable. When debts are not overwhelming, when
relationships are rewarding, when work is going well, and health is good, the
recovering person WANTS to stay drug free.
FEAR WILL GET SOMEONE INTO TREATMENT BUT

FEAR ALONE IS NOT ENOUGH TO KEEP THEM IN RECOVERY.

1. List some of the specific reasons you first entered treatment. (e.g., medical
problems, family pressure, job problems, depression, etc.)
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
2. List some of the specific reasons you are continuing to work on the recovery
process today:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
3. Do you feel that your reasons for stopping drug use initially are the same
as your reasons for staying off drugs today? Explain why or why not.
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

ICS 7 – Managing Anger
Anger is an emotion that leads many people to r elapse.
This is particularly true early in

treatment. Frequently, anger
slowly builds on itself as you
may constantly think about the
people and events that make you
angry. Sometimes it seems like
the issues causing the anger are
the only important things in life.
Often, a sense of victimization
accompanies the anger.
Do you ever think these things?
 “Why do I get all the bad breaks?”

 “How come they don’t understand my needs?”
 “Why won’t they just do what I want them to do?”
1. Does any of this seem familiar to you?______ Explain.

____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
2. How do you recognize when you are angry? Does your behavior
change? For example, pacing, clenching your jaw, feeling restless?
How or where do you feel or notice it?
______________________________________________________
______________________________________________________
______________________________________________________

3. How do you express anger?
• Do you hold it in and eventually explode?
• Do you become sarcastic or passive-aggressive?
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
There are positive ways to deal with anger. Consider these

methods:
• Talk to the person with whom you are angry (unless this is
dangerous or might make the situation worse).
• Talk to a therapist, a Twelve Step sponsor, or another
trusted, rational person who can give you guidance.
• Talk about the anger in a Twelve Step or community support
group meeting.
• Don’t lose sight of where you are in your recovery.
• Write about your feelings of anger.
• Take a break to change your frame of mind.
• Exercise.
• Other (Remember things that might have worked for you in the
past):_____________________________________________
________________________________________________
Which of these would you try?
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________

ICS 8 – Social/Recreational Counseling
This session focuses on developing interest and participation in

recreational and social activities that are pleasurable and do not involve
drug use. The goal is to increase your participation in social activities that
may serve as alternatives drug use.
Why this is important?

Social and recreational activities provide a source of enjoyment that can be
looked forward to after a stressful day. They are a way to decrease
boredom and to feel physically healthy. They are a way to develop a skill
that makes you feel good about yourself, and an opportunity to be with new
people and to develop friendships.
These activities can play a very important part in becoming and staying
drug free. When you give up using drugs, you must do something else
during the times you were using. If the things you do are not satisfying or
enjoyable, or you don’t do anything but sit around and feel lonely or bored,
you are more likely to use drugs.

List Activities and People
The first step is to develop a list of activities that you are interested in
pursuing. (See the Leisure Interest Checklist for ideas.)
 What are some current activities you enjoy?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
 What are some activities you enjoyed in the past?

_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
 What are some activities you have always wanted to do, but have
never done?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________

 Of these activities which are the most realistic with regard to: your
amount of interest, cost, others’ involvement, time commitment, your
likelihood of engaging in the activity?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
 List some non-drug-using people who might participate in these

activities with you?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
______________________________________________________

Set Goals
 What activities could you take part in over the next week?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
 What activities could you take part in over the next month?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
 Who could take part in these activities with you?

_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________

ICS 8a – Leisure Interest Ideas
Read these suggested activities and circle ones you might try in the future:
Acting/Dramatics Gardening Political activities

Attending concerts Garage/yard sale Reading
Attending swap meet Go to movies Religious activities
Auto repairing Go to park Roller skating
Backpacking Go to plays/lectures Rowing/Boating
Badminton Golf Scouts, PTA, coaching,
Baseball/Softball Gymnastics Sculpture
Basketball Hiking/Walking Sewing
Bicycling Home decorating Singing
Bird watching Horseback riding Skiing
Bowling Horseshoes Surfing
Camping Ice-skating Swimming
Canoeing Jogging Tennis
Carpentry Judo/Karate Video games
Ceramics/Pottery Kite flying Visiting museum
Checkers Knitting/Crocheting Volleyball
Chess Leatherwork Volunteer work
Child-related activities Model building Walking
Civic organizations Motorcycling Watching sports
Cooking/Baking Mountain climbing Weaving
Dining out Needlework Weight lifting
Electronics Painting/Drawing Woodworking
Fishing Ping Pong Writing poetry/songs
Flower arranging Playing a musical
Folk dancing instrument
Football Playing cards

ICS 9 – Stimulants and Sex-A Natural Connection
Stimulants affect the same part of the brain that controls both sexual
behavior and sexual pleasure. Were any of these true for you?
In the Beginning
Stimulants increased sexual pleasure ____yes ____no
Stimulants helped sex last longer ____yes ____no
Stimulants allowed me to do things I might not ____yes ____no
otherwise do
Stimulants helped me meet people ____yes ____no
Stimulants made me less anxious in new sexual ____yes ____no
encounters
Stimulants added excitement to an existing ____yes ____no
relationship
It is not unusual for people to experience some of the above effects from
stimulant use in the beginning. As the addiction gets worse, less pleasant
things often begin to happen. Did you experience any of the following?

Near the End
Continued ability to prolong sexual activity with ____yes ____no
decrease in pleasure from the experience
Increased, more unusual sex (looking for ____yes ____no
pleasure)
Thinking about sex and drugs became more ____yes ____no
exciting than the real thing
Difficulty achieving erection (males) or orgasm ____yes ____no
(females)
Using stimulants replaced sex ____yes ____no
All these things are commonly experienced when people use stimulants in
connection with sex. They also move people away from sexual pleasure
faster.
Many people notice that thinking about sex is a trigger for drug use. If that
is true for you, be aware that you will need to avoid both the drugs and the
sexual triggers, at least for a while. Use the checklist below to identify
situations that may still be dangerous for you.
Are you getting triggered from any of the following?
Porn: Looking at porn internet sites or cruising through areas of

prostitution can result in arousal and then cravings. It is difficult to fight this
1-2 punch from your addicted brain.
Bars/Clubs: Many people miss the social scene that goes along with
using and try to return to the same places where stimulants and sex were
used together. A menu for drug use.

Extra-relationship Sex: Forbidden sex can be a trigger during recovery.
One of the reasons for this is that such activity may involve lying, cheating,
etc. All of these are addictive behaviors.
Dysfunction: It takes a while after stopping drug or alcohol use to
experience pleasurable, normal sex again. There are times it is not unusual
to lose all interest in sex. For some people it’s difficult not to get anxious
about this.
Over time, with abstinence, normal sexual functioning will return. Some
people may be faced with drug-free sex for the first time since adolescence
– or ever! It’s important not to rush back to sex. The triggering will occur
less often and with less power over time. Let your triggers (or the lack of
them) be your guide for your return to sexuality.
1. In what ways does your sexual functioning interact with your

recovery?

ICS 10 – Recovery Checklist
Outpatient treatment requires a lot of hard work and a great deal of

commitment. To get the most from treatment, it is necessary to change many
old habits and replace them with new behaviors.
Check all the things that you do (or have done) since entering treatment:
_____ Schedule on a daily basis
_____ Avoid triggers (when possible)
_____ Visit physician for check-up
_____ Use thought-stopping for cravings
_____ Eliminate all paraphernalia
_____ Avoid individuals who use alcohol
_____ Avoid individuals who use drugs
_____ Attend treatment groups
_____ Attend 12-Step/other support meetings
_____ Avoid bars and clubs
_____ Stop using alcohol
_____ Get a sponsor or sober support
_____ Stop using all drugs
_____ Exercise every day

_____ Pay financial obligations promptly
_____ Discuss your thoughts, feelings, and behaviors honestly with your
therapist
____ Avoid triggering websites
_____ Delete triggering contacts from your phone/computer
_____ Identify behaviors associated with drug or alcohol use
Which of these is the easiest for you to do?

_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Which of the above take the most effort for you to do?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Which have you not done yet? Why not?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________

ICS 11 – Relationship Happiness Scale
This scale is intended to estimate your current happiness with your
relationship in each of the 10 areas listed below. Ask yourself the following
question as you rate each area:
How happy am I with my partner today in this area? Then circle the
number that applies.
Numbers toward the left indicate some degree of unhappiness: numbers
toward the right reflect some degree of happiness. By using the proper
number you can show just how happy you are with that relationship area.
Remember: You are indicating your current happiness, that is, how you
feel today. Also do not let your feelings in one area influence your rating in
another area.
Completely Completely
unhappy happy
Household Responsibilities 1 2 3 4 5 6 7 8 9 10
Rearing of Children 1 2 3 4 5 6 7 8 9 10
Social Activities 1 2 3 4 5 6 7 8 9 10
Money 1 2 3 4 5 6 7 8 9 10
Communication 1 2 3 4 5 6 7 8 9 10
Sex and Affection 1 2 3 4 5 6 7 8 9 10
Academic/Occupational Progress 1 2 3 4 5 6 7 8 9 10
Personal Independence 1 2 3 4 5 6 7 8 9 10
Partner’s Independence 1 2 3 4 5 6 7 8 9 10
General Happiness 1 2 3 4 5 6 7 8 9 10

ICS 11a – Examples of Relationship-Related Activities
Social Activities Academic/Occupational

 Going together to: Progress
 the movies  Spends too much or too little
 out to dinner time on it
 Visiting friends, going for  Too much procrastination
walks  Constant complaining about
 Participating in or watching job
sports  Poor job location
Rearing of Children Personal Independence

 Preparing their meals  Has day or night off alone
 Bathing/dressing the children  Allowed to drive by myself
 Disciplining the children  Allowed to learn to drive
 Watching the children  Attends social events alone
 Playing with the children  Feels free to ask partner’s
 Helping with homework advice
 Can make decisions w/o
asking
Money Partner’s Independence
 Paying bills  Partner relies on you to make
 Budgeting money household decisions
 Buying/receiving presents  Partner goes out without you
 Saving too much or too little  Partner will not go out without
 Buying clothes or necessities you
Communication  Partner is too possessive
 Planned discussion periods  Partner is not possessive
 Frequent discussion periods’ enough
 Frequent arguments  Partner lacks friends
 Using tactful statements  Partner has no personal
 Misinterpreting things said interests
 Solving problems through  Partner does not drive
discussion

ICS 12 – Continuing Care Plan
Chronic health problems require ongoing attention. The intensity of care can
be less as time goes by, but there must be some regular monitoring and
adjustments to keep things on track. The Continuing Care group provides a
weekly opportunity to help maintain the progress to date. It is important to
begin the Continuing Care group right away. Taking a “vacation” from
treatment often results in the end of care.
What to expect from the group:
 It is a drug use prevention group. Every group of recovering people is a
drug use prevention group. The group fortifies your new, healthy
lifestyle and can help get you back on track if you stray from your plan.
 It is a support group. A group of people who are dealing with the
common problem of stimulant use have an invaluable understanding
and empathy for each other. The people in the group provide support
for progress and help during rough times.
 It is a place to review the status of your continuing care plan. The
Mooring Lines handout will be reviewed regularly with attention to
changes in behavior that may reflect some slippage.
Other plans:
 Are you attending or planning to attend 12-Step or other community
support groups? If so, which ones, where, and when?
________________________________________________________
________________________________________________________
 Are you attending or planning to attend counseling for personal or

relationship issues? If so, where and when?
_______________________________________________________
________________________________________________________
 What are your regular social/recreational healthy activities? How often do

you take part in these?
________________________________________________________
________________________________________________________

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TRUST

Version Date: March 15, 2021

TRUST Workbook: Version Date – March 15, 2021 1

TRUST Workbook: Version Date – March 15, 2021 2

TRUST Workbook: Version Date – March 15, 2021 3

1. Which rooms have stashes of drugs/paraphernalia?

2. Where specifically would you likely find drugs/alcohol in your house?

TRUST Workbook: Version Date – March 15, 2021 5

TRUST Workbook: Version Date – March 15, 2021 6

 If you can avoid these people do so.

What will you say to these people?

TRUST Workbook: Version Date – March 15, 2021 7

2. Anger, irritability: Small  Remind yourself that you are

3. Drugs and alcohol in the  Get rid of all drugs and

TRUST Workbook: Version Date – March 15, 2021 8

5. Special Occasions: Parties,  Have a plan for answering

How will you handle them?

TRUST Workbook: Version Date – March 15, 2021 9

The Losing Argument

The "Automatic" Process

TRIGGER  THOUGHT  CRAVING  USE

TRUST Workbook: Version Date – March 15, 2021 10

Continued Cravings Use

You make a choice. It is not automatic.

TRUST Workbook: Version Date – March 15, 2021 11

 Picture a switch or a lever in your mind. Imagine yourself actually

 Focus on a positive memory/scene from your life that is something

RELAXATION/MEDITATION - Thoughts can be avoided or replaced by taking

TRUST Workbook: Version Date – March 15, 2021 12

In understanding and dealing with addiction it

1. The higher, rational brain. This is the

2. The lower, emotional centers in the

Why is this important?

What can you do about this?

TRUST Workbook: Version Date – March 15, 2021 14

Video Clip 1. Normal dopamine function

TRUST Workbook: Version Date – March 15, 2021 15

TRUST Workbook: Version Date – March 15, 2021 16

TRUST Workbook: Version Date – March 15, 2021 17

Why should I schedule?

Do I need to write it down?

TRUST Workbook: Version Date – March 15, 2021 18

TRUST Workbook: Version Date – March 15, 2021 19

TRUST Workbook: Version Date – March 15, 2021 21

Interrupting the Process

 During recovery, each person does specific things that work to

TRUST Workbook: Version Date – March 15, 2021 23

1. Identify 4 or 5 specific things that are now helping you stay

2. Include items such as exercise, therapist and group

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

4. Note specific people or places that are known triggers and

TRUST Workbook: Version Date – March 15, 2021 24

TRUST Workbook: Version Date – March 15, 2021 25

 In becoming sober you have had to learn to do certain new behaviors -

TRUST Workbook: Version Date – March 15, 2021 26

During recovery there are often certain feelings or

_____ Afraid _____ Frustrated _____ Neglected

B. Has your use in recent weeks/months been:

_____ 1. Primarily tied to emotional conditions

___ Afraid _ Frustrated ___ Neglected

At home with friends During a date __Before going out to

At a friend’s home Before sexual __Before breakfast

At parties During sexual activities __At lunch break

While at dinner After sexual activities __At sporting events

At movies Before work __After work

At bars/clubs When carrying money __Driving near some

At concerts After going past a __At a school residence

In the park With drug using friends __When driving

In certain Texting certain people __Calling friends who use

Travelling (airports, After medical visits __At a pharmacy