IAC Patient Workbook
IAC Patient Workbook
Be sure to ask your IAC counselor any questions you have about how this works. Do this at your next session!
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MODULE #1: TREATMENT INITIATION: Your relationship with drugs and alcohol HANDOUT #2
You have a relationship with drugs and alcohol. Like many relationships, this may have started out good, and then over time turned into something different or even not so good. You may have mixed feelings about your relationship with drugs or alcohol. A part of you may want to end it, another part of you is drawn to it. Some substances may not seem as problematic to you as others. For example, you may think that heroin is your main problem, because it gets you into trouble with the law, it makes you sick, or gets you fired from jobs. On the other hand, you may feel that marijuana has not really done any of these things to you and may even help you to relax. Understanding these relationships is critical for you to recover. With the help of your counselor, fill in the sections below. What is the name of the substance? How old were you when you first met? What kind of trouble has this substance caused you? What are the good What kind of things that relationship do this substance you want with this does for you? substance now?
Denial
Denial is defined as refusing to believe the reality about ones life circumstances. It may be refusing to believe that one is addicted or refusing to acknowledge that the losses one has suffered as a result of the addiction are significant. People often enter treatment with some denial about their addiction. In spite of evidence to the contrary, you may believe you still can control your chemical use. Maybe you do not believe that they have the disease of addiction, and they frequently are ambivalent about giving up their drugs or alcohol. ARE ANY OF THESE EXAMPLES OF DENIAL TRUE FOR YOU?
1. Refusal to believe that you are addicted. 2. Thinking that you can solve the problem by cutting down on substance use, rather than eliminating it totally. You may also say that you want to get your substance use back under control. 3. Refusal to believe that a secondary drug (alcohol, for example) is a problem, as well as your primary drug of choice (cocaine, for example). 4. Refusal to believe that Alcoholics Anonymous or Narcotics Anonymous will be helpful, because you are not like the people there, or perhaps because their drug problems are worse. 5. Insisting on continuing to spend time with friends who enable your use by agreeing that drugs are not a problem.
Ambivalence
People usually enter treatment with some ambivalence about staying sober or making a commitment to treatment. We should examine your motivation together. ARE ANY OF THESE EXAMPLES OF AMBIVALENCE TRUE FOR YOU?
1. You associate your substance use with some positive emotional change. 2. You see your use as a coping strategy for solving problems, and you do not yet know of a better coping strategy. 3. You feel too weak or helpless to break the powerful cycle of addiction. Motivation
Motivation refers to how much you are impelled to act on the desire to become sober. A person may enter treatment already somewhat motivated because he or she recently hit bottom in some way. Such a bottom may be losing ones job or ones spouse, draining ones bank account, or getting arrested. Although these events may help to motivate you, they may not be sufficient. How strong is your desire to get clean and sober?
ON A 0 TO 10 SCALE, HOW MOTIVATED ARE YOU TO ABSTAIN FROM DRUGS AND ALCOHOL? Not at All 0 1 2 3 4 5 6 7 8 9 10 Totally Motivated
ON A 0 TO 10 SCALE, HOW CONFIDENT ARE YOU THAT YOU WILL BE ABLE TO ACHIEVE THIS GOAL? Not at All 0 1 2 3 4 5 6 7 8 9 10 Totally Confident
MODULE #1: TREATMENT INITIATION: Your experiences with treatment and 12-step groups HANDOUT #4
This section is to help your counselor understand what kind of help you have had and how it worked or did not work for you. Your counselor will explain that treatment for addiction is kind of like treatment for chronic diseases such as hypertension, diabetes or asthma. Treatment may at times have bee intense, like in a hospital setting if you relapsed or if you were going thru severe withdrawal. Treatment may also have been less intense like when you were stable and in a maintenance stage.
My prior treatment for addiction What kind of setting? Inpatient/Hospital What year? What was helpful about this? What was not helpful?
Outpatient DrugFree
Methadone Maintenance
My prior experience with 12-step recovery: TYPE Year and average number of meetings per week Did you have a sponsor? What was helpful about this 12-step program? What was not helpful about this 12-step program?
Alcoholics Anonymous
Narcotics Anonymous
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MODULE #1: TREATMENT INITIATION: Relapse and Crisis Prevention Plan HANDOUT #5
A. The early warning signs that I may be about to relapse to alcohol or drugs are: 1. _____________________________________________________________ 2. _____________________________________________________________ 3. _____________________________________________________________ (Examples: going to places where I used drugs or drank alcohol; hanging out with people I used or drank with; cravings; coping with negative feelings such as fear, anger, sadness; problems sleeping; isolation; needing to feel comfortable dealing with people)
B. Feelings I experience when I want to start using are: 1. _____________________________________________________________ 2. _____________________________________________________________ 3. _____________________________________________________________ (Examples: Anger, sadness, boredom, nervous, guilty, ashamed, excited, overwhelmed, selfconfident, afraid of people, confused, lonely, resentful, despair, fatigue)
C. The plan to be implemented when these early warning signs or feelings appear: 1. _____________________________________________________________ 2. _____________________________________________________________ 3. _____________________________________________________________ (Examples: Call my doctor, call my counselor, call a person who supports my recovery, go to a self-help meeting, or call my sponsor)
D. Names and numbers of supports: Doctors Name: _______________________________________ # _____________ Counselors Name: ____________________________________ # _____________ Support persons Name: _______________________________ Support persons Name: _______________________________ # _____________ # _____________
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PEOPLE
PLACES
WHERE?
WHERE?
THINGS
WHAT?
WHAT/
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If you can complete the daily schedule, or if your schedule changes from day to day, complete the Weekly Schedule with your counselor:
Monday 7 am Tuesday 7 am My Weekly Schedule Wednesday Thursday Friday 7 am 7 am 7 am Saturday 7 am Sunday 7 am
Noon
Noon
Noon
Noon
Noon
Noon
Noon
11 pm
11 pm
11 pm
11 pm
11 pm
11 pm
11 pm
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If these situations cannot be avoided, how do you plan to deal with each one? Discuss these plans with your counselor? Are these plans realistic? Are you underestimating how difficult it will be for you? 1.______________________________________________________________ ________________________________________________________________ ________________________________________________________________ 2.______________________________________________________________ ________________________________________________________________ ________________________________________________________________ 3.______________________________________________________________ ________________________________________________________________ ________________________________________________________________
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___ Anxiety ___ Depression ___ Sleep problems ___ Short-term memory problems ___ Lack of pleasure in things ___ Trouble concentrating ___ Sexual problems
Many people with a history of substance use experience these symptoms for weeks after they stop using. These may not be disorders but are symptoms of post-acute withdrawal. Your counselor may want to know if you ever had these symptoms before you started using, only had a problem with using, or if you had these symptoms during periods of abstinence, or if anyone in your family had these symptoms or was diagnosed with a psychiatric problem.
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MODULE #2: EARLY ABSTINENCE Other Drugs & Alcohol HANDOUT #13
Many people feel that they have a problem with one drug or substance but that others are not a problem. They would prefer to abstain from the substance that has given them the most trouble, but wish to be able to continue to use other substances. Talk with your counselor about your thoughts on this subject, and how you think best to approach these other substances. Your counselor may suggest that you abstain from all substances as the best ultimate goal. This is a conservative and less risky approach. It also takes into account the fact that most people who have tried to abstain from one drug and continue with others eventually relapse. Others develop an addiction to the new drug and then it eventually gets them into the same or even more trouble as the original one.
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MODULE #2: EARLY ABSTINENCE Twelve-Step Programs HANDOUT #14 Attending twelve-step recovery programs and actively participating increases your chances of staying clean and sober. In the space below, please list the pros and cons of attending twelve-step recovery meetings. Discuss these with your counselor. What are the Pros for What are the Cons for attending twelve-step recovery attending twelve-step recovery meetings? meetings?
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MODULE #3: MAINTAINING ABSTINENCE Relationships HANDOUT #16 In addition to the power of the disease of addiction itself, relationships may be the single most important relapse trigger. Discuss with your counselor what relationships and what emotions that get stirred up in these relationships may be relapse triggers for you.
Relationship Emotions How do you cope with these emotions?
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How do your beliefs in this regard make it easy or hard to get into twelvestep meetings or the literature from this program?
Sometimes things do not go your way in life. Say for example, someone close to you dies, or perhaps not getting a promotion at work that you feel you deserve. What do you say to yourself about why these things happen?
Sometimes you are in situations where you feel powerless. For example, perhaps you have had an illness that you could not shake. Or less serious, perhaps you were stuck in traffic or standing in a line that was really long and did not seem to move. How did you feel during these times? What kinds of things did you say to yourself?
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B. How does my addiction affect those around meat home, at work, financially, in social situations, as a role model for children, with regard to the safety of myself and others, and so on?
C. What character defects in me feed the addictioninsecurities, fears, anxieties, poor self-image, lack of confidence, excessive pride, controlling behavior, anger, and others?
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MODULE #3: MAINTAINING ABSTINENCE Character Defects and Assets HANDOUT #20
Working the program of twelve-step recovery typically involves taking a fearless and searching inventory of ones self and life. A part of this inventory is taking an honest assessment of character defects or things about your self that have gotten you into trouble, and have hurt others. In addition to defects, each of us also has assets to our character. These are qualities and our ways of dealing with others that we feel good about, and that are constructive.
Common Character Defects Inappropriate Anger Self-Centeredness Lust Impatience Over criticalness Low Self-Esteem Exploitativeness Overconfidence Dishonesty Common Character Assets Kindness Generosity Loving Patience Understanding and non-judgmental Healthy self-esteem and confidence Offering service/help to others Courage Honesty
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HOW TO WORK ON CHARACTER DEFECTS A. Identify problematic qualities in your self, such as inappropriate anger, impatience, and overconfidence. B. Decide what qualities to change by assessing how much control you have over the undesirable trait and by determining whether it is in your best interest to change. C. Make a commitment to work on changing the quality. D. Seek the help of others such as your counselor, or sponsor. E. Follow through. Remember, progress not perfection!
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MODULE #3: MAINTAINING ABSTINENCE Anger HANDOUT #21 What things cause you to get angry?
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MODULE #3: MAINTAINING ABSTINENCE Relaxation and Leisure Time HANDOUT #22 Please complete the three sections below. List the activities you did for fun or relaxation before your relationship with drugs and/or alcohol began, what you did for fun or relaxation while you were using drugs and/or alcohol and then what you would like do to for fun or relaxation now. Activities for fun or relaxation before I used alcohol or drugs Activities for fun or relaxation while I was using alcohol or drugs Activities for fun or relaxation that I would like to do NOW.
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MODULE #3: MAINTAINING ABSTINENCE Compulsive Behaviors HANDOUT #23 People recovering from addiction often transfer compulsive and addictive behaviors to other things, and may not recognize this pattern as such. They may become compulsively involved in other things like overeating, sex, work or exercise. Although some of these behaviors may be trading up from compulsively using drugs or alcohol, they still may not allow you to any free choice. It may not be alcohol or drug use, but it is compulsive behavior nevertheless and may not seem within your control. Compulsive behavior is behavior that is excessive, repetitive, takes time away from people or responsibilities, and feels either slightly or very much out of control. The replacement of ones addiction with another compulsive behavioral pattern will not lead to true recovery in the long run. Check the behaviors that you wonder if you are engaging in compulsively, and discuss these with your counselor. ___ Overeating ___ Sex (masturbation or with another or others) ___ Exercise ___ Work ___ Gambling ___ Shopping ___ Biting finger nails, pulling out hair, bathing, other bodyrelated behaviors ___ Other
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MODULE #4: RECOVERY HANDOUT #24 What do you look forward to being different about your life in recovery?
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MODULE #4: RECOVERY HANDOUT #25 Professional treatment Please check the type of professional treatment you will continue to receive for your alcohol or drug problem. Also write out where you will be receiving this treatment. Type of Treatment
Outpatient treatment
Location
Mental health outpatient treatment Medications for my addiction or mental health issues Residential rehab program
Halfway house
Methadone maintenance
12-Step Groups
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Attending 12-Step groups is associated with successful long-term recovery and happiness. Please fill in the space below, the steps you will be taking to stay connected with 12-Step Groups. Discuss your participation with your counselor.
Activity How many meetings will you attend per month? Per week? If you go to meetings, at what percent of the meetings do you speak or share? Do you or will you obtain a sponsor? Do you intend to or have you already begun to work the steps? If you have begun to work the steps, at what step do you feel you are presently? Do you expect to have or do you already have a job at a meeting? (Such as a coffee maker, greeter, GSR, treasurer, or clean-up)
Plan
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How are you feeling now compared to when you began the program?
How are you feeling about your ability to manage your life without using drugs and alcohol?
What stands out for you as having been the most helpful part of the counseling?
How would you recommend we improve IAC for future patients in your situation?
Adapted from DE Mercer and GE Woody. Therapy Manuals for Drug Addiction Series: Individual Drug Counseling. U.S. Department of Health & Human Services, National Institutes 33
of Health, National Institute on Drug Abuse, Division of Clinical and Services Research 6001 Executive Boulevard Rockville, Maryland 20892. NIH Pub. No. 994380 Printed September 1999. Support for this research and adaptation of this manual is funded by the National Institute on Drug Abuse (McGovern, PI). Correspondence: Mark P. McGovern, Department of Psychiatry, Dartmouth Medical School, 85 Mechanic Street, Suite B4-1 Lebanon, New Hampshire 03766. Email: [email protected]
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