New-Foundation-Aod-1

New Foundation

12 Week Drug and Alcohol Program

Clinician Manual

Summit Psychological Associates, Inc. "Help is at the Summit"

Akron Center: - 37 North Broadway Street Akron, Ohio 44308 (330) 535-8181 (

Canton Center:

Belden Village Tower 4450 Belden Village Street NW, Suite 701 Canton, Ohio 44718 (330) 493-2554

Ravenna Center:

North Chestnut Medical Arts Building 6693 North Chestnut Street, Suite 235 Ravenna, Ohio 44308 (330) 296-3700 ODADAS - Adult Group - 12 week New Foundation (NF) - AoD Client Requirements At Intake

1. If client is mandated to attend treatment, complete ROI in Care Logic to/from Probation (or employer, etc.) with the box about treatment checked 2. Client completes New Foundation Pretest (pp. 2-3 in Client Manual) 3. Show Client in his/her Manual a. 4 Disease Handouts (TB, Hepatitis B, Hepatitis C, HIV) (pp. 11-18 in Client Manual) b. Confidentiality 42CFR (p. 19 in Client Manual) c. Program Rules (p. 20 in Client Manual) 4. Have client sign Program Checklist of Forms in Care Logic 5. Client completes Outcome Framework Survey-Adult Individual - "Entry'' - send to Quality Assurance Coordinator (p. 6 in Client Manual) 6. Complete ISP - AoD tab of ISP/ISP Review for Comprehensive (AoD and/or MH) Treatment Form i11 Care Logic to address AoD issues. Clinician must also complete the MH tab on the ISP/ISP Review for Comprehensive (AoD and/or MH) Treatment Form for other problems, e.g. depression, anxiety 7. Review Contract (pp. 21-22 in Client Manual) and then have client sign Program Contact in Care Logic 8. If Court Referred or Work-Mandated (Management Referral), must attend 1 AA meeting per week and bring proof. Give 12-Step Verification Form. If not mandated, encourage AA attendance. (p. 23 in Client Manual) 9. Clinician must complete OHBH Enrollment Form, the OHBH Data Admission/Discharge Form, and the OHBH Residency Form in Care Logic ifclient has Medicaid or is in the STARKMHAR SMART Program 10. Clinician must complete ODADAS Fee Agreement in Care Logic (unless support staff already completed it with client). Client and Clinician both sign. 11. As with all clients, clinician must complete Client Orientation Checklist in Care Logic with client.

At "Midpoint," defined as having ~ 3 weeks to go 1. Client completes Outcome Framework Survey-Adult Individual - "Midway" - send to Quality Assurance Coordinator (p. 7 in Client Manual) 2. If client was Court Referred, clinician and client together complete the Criminal Justice Pre Discharge Plan in Care Logic

At Discharge 1. Client completes Outcome Framework Survey-Adult Individual - "Graduation" - send to Quality Assurance Coordinator (p. 8 in Client Manual) 2. As with all discharges, administer SPA Satisfaction Survey (p. 10 in Client Manual), and Self Appraisal Form (p. 9 in Client Manual). The clinician reviews Self-Appraisal form and notes on Progress Note: Administered and reviewed Self-Appraisal Fonn. 3. If client was court-ordered, Client completes New Foundation Posttest (pp. 4-5 in Client Manual) 4. Clinician completes Transfer/Discharge Summary in Care Logic 5. Clinician must complete OHBH Discharge form in Care Logic ifclient has Medicaid or is in the STARKMHAR SMART Program

1/29/2020 - Curriculum

Lesson 1: Substance use and your offense. (Pages 25-31 of Client's Manual)

Lesson 2: Is there a problem? (Pages 32-33 of Client's Manual)

Lesson 3: Common traits of substance addiction. (Page 34 of Client's Manual)

Lesson 4: Why does addiction occur? (Page 35 of Client's Manual)

Lesson 5: Negative effects of alcohol and other drugs. (Page 36 of Client's Manual)

Lesson 6: What is recovery? (Pages 37-38 of Client's Manual)

Lesson 7: Identification of high risk situations. (Page 39 of Client's Manual)

Lesson 8: Coping with cravings and urges to use. (Pages 40-41 of Client's Manual)

Lesson 9: Dealing with emotions. (Page 42 of Client's Manual)

Lesson 10: Self-defeating beliefs and behaviors. (Page 43 of Client's Manual)

Lesson 11: Avoiding a relapse. (Pages 44-45 of Client's Manual)

Lesson 12: Taking good care of ourselves. (Page 46 of Client's Manual) NEW FOUNDATION 12-WEEK DRUG AND ALCOHOL PROGRAM CONTRACT

A. General Conditions:

1. I have signed release(s) of information to permit Summit Psychological Associates (S.P .A.) staff and other significant parties ( e.g. Municipal Court, probation/parole office) to communicate freely about my case. I understand that I must sign new release(s) one year from signature date. S.P.A. staff will be in contact with these parties on a regular basis and when they believe it is necessary to protect any third party at risk for injury or when I have violated this contract.

2. I will never be without the S.P.A. telephone number. I will call the group leader when I recognize that I am in immediate danger or if there is danger to another individual or any other mental health emergencies.

- 3. I will attend one 12-step meeting each week and bring proof of attendance to each group session. Failure to do so will result in an unexcused absence from group for that day.

4. Throughout the duration of my attendance in this group, I will not spend time with other group members outside group meetings.

5. Throughout the duration of my attendance in this group, I will remain drug and alcohol free.

6. I will make the group leader aware of any additional legal offenses incurred during my enrollment in this group.

7. I must present and turn in a Relapse Prevention Plan in order to successfully graduate from this program.

8. I may have to submit to a urine drug screen in order to successfully graduate from group. B. Group Behavior:

1. I will attend 12 required sessions and I will attend on time. If I am more than five minutes late, it may be considered a violation of the contract and treated as a missed appointment. I may not be pennitted to enter the group if I am more than five minutes late.

2. J will actively participate in group, including talking about myself and my behavior, confronting others, completing any assignments, and engaging in general group discussions.

3. I will be completely honest and assume full responsibility for all of my offenses, and my behavior. This includes not giving false infonnation as well as not leaving out important information.

4. I will only use first names when referring to other members in the group.

5. I will not attend any groups while under the influence of alcohol or other non prescribed medications or drugs.

6. I will not disclose the identity of, or any information regarding, another group member to anyone outside the group.

7. If I have more than one unexcused absence I may be expelled from the group.

8. If I miss a group session for any reason without canceling 24 hours in advance, I will pay $5 for that missed session when I return the following week.

9. I will bring the full payment amount owed to each session, or else that session will count as an unexcused absence.

I 0. I will not receive my certificate of completion until all financial responsibilities have been met.

C. Violating the Contract:

1. J agree to contact the group leader immediately ifl violate any condition of this contract. Violations of this contract may result in the imposition of sanctions by S.P.A.

2. I understand that my probation/parole officer and/or municipal court will be notified - immediately of any violation of this contract determined to be of a serious nature. 3. Any violation of the conditions of this contract may be grounds for suspension or termination from the group. The group leader may also terminate my treatment for any other behavior not outlined in this contract and they may add new conditions at any time. Worksheets, Homeworks, Relapse Prevention Plan Sections and References New Foundation 12 week Worksheet Lesson 1:

Substance Abuse

1. Yes No

2. Yes No

3. Yes No

4. Yes No

Substance Dependence/ Addiction

1. Yes No

2. Yes No

3. Yes No

4. Yes No

5. Yes No

6. Yes No

7. Yes No New Foundation 12 week Lesson 1 Homework

Name: ------Date: ------1. Repeatedly driving a car or operating a machine while drunk or high is a sign of:

2. Tolerance and withdrawal are signs of: New Foundation 12 week Worksheet Lesson 2: -- Consequences of my substance use

I. Yes No

2. Yes No

3. Yes No

4. Yes No

5. Yes No

6. Yes No

7. Yes No

8. Yes No

9. Yes No

10. Yes No

11. Yes No

12. Yes No - New Foundation 12 week Lesson 2 Homework Name: ------Date: ------Name 2 consequences of your substance abuse: !. ______

2. ______

- New Foundation 12 week Lesson 3 Homework

Name: ______Date: ------Name the 3 main characteristics of addiction: New Foundation 12 week Lesson 4 Homework Name: ------Date: ------Labe I each of these statements as truth or fiction:

1. Addiction is a sign of weakness.

Truth Fiction

2. Addiction has a genetic component.

Truth Fiction

3. Anyone should be able to stop using on their own.

Truth Fiction

4. All a person needs to quit is willpower.

Truth Fiction

5. The process of addiction takes place in the limbic system in the brain.

Truth Fiction

6. Addiction is a progressive disease that can lead to death.

Truth Fiction

- New Foundation 12 week Lesson 5 Homework Name: ------Date: ------

1. Waking up and not remembering parts of a night of drinking is called having a

2. Heavy alcohol use causes the brain to: (Circle one)

Shrink Grow

3. One symptom of marijuana withdrawal is: ______

4. Smoking crack once can result in a deadly heart attack. (Circle one)

True False Name: ------Date: ---- New Foundation 12 week Worksheet Lesson 6: Taking Steps Toward Recovery

1. List 3 examples of times when you missed appointments with friends or family due to your drug or alcohol use:

2. How does your behavior change when you use drugs or alcohol?

3. Identify 3 times when you tried to control your use of drugs or alcohol and ended up using more than you had planned:

4. When have people commented on your use of drugs or alcohol?

5. How many times were your problems caused by your drug or aJcohol use? New Foundation 12 week Lesson 6 Homework

Name: ------Date: ------Why is it important to ask others for help? New Foundation 12 week Relapse Prevention Plan - part 1 Lesson 7

Name: ------Date: ------HIGH RISK SITUATIONS

HIGH RISK SITUATIONS - List 5 situations that are dangerous for my recovery. Consider your jobs, friends, family, social activities, etc.

1. ------

2. ------3. ______

4. ------

5. ------

COPING SKILLS - How I will cope with each of the high risk situations listed above:

1. ------

2. ------3. ------

4. ------~------

5. ------New Foundation 12 week Lesson 8 Homework

Name: ------Date: ------Challenging Magical Thinking

Magical thinking says that you could use again and things would be okay, and that you could somehow control your chemical use. But, you know better!

Play the tape to the end, and write down what would really happen if you started to use again.

If I used DRUGS ALCOHOL (circle one or both) again ...

The first bad thing that would happen would be

Then, the next bad thing that would happen would be ______.-

And, after that, the next bad thing that would happen would be ______

Complete part 2 of your Relapse Prevention Plan. (- New Foundation 12 week Relapse Prevention Plan - part 2 Lesson 8 Name: ------Date: ------ACTION PLAN FOR WHEN I GET CRAVINGS AND URGES TO DRINK OR USE DRUGS

PEOPLE I CAN CALL WHEN I GET A CRAVING TO USE List the names and phone numbers of 5 people I can call the minute I get a craving or urge to drink or use drugs (Include names and phone numbers):

1. ------2. ------3. ------4. ------5. ______

THINGS I CAN DO WHEN I GET A CRAVING TO USE List 5 things I can do to get my mind off of drinking or using drugs:

l . ______

2. ______3. ______

4. ______

5. ______New Foundation 12 week Lesson 9 Homework Name: ------Date: ------1s anger always a negative thing? Yes No

Explain your answer: ______

What are 2 ways to express anger appropriately?

1. ------2. ______New Foundation 12 week Lesson 10 Homework - Name: ------Date: ______Here are 10 common self-defeating beliefs: 1. I should never be uncomfortable, physically or emotionally. 2. I should never have to be inconvenienced. 3. Life should be fair! 4. I know best. I should be in control all the time. 5. I should never have to ask anyone for help. 6. Rules are for other people, not for me. 7. Other people, places, and things are responsible when I feel bad. 8. My self-worth is based on my job, clothes, car, bank account, etc. 9. Everyone should respect me and approve of me. 10. I can avoid responsibility. I should always take the easy way out.

From the above list of self-defeating beliefs, or from other self-defeating beliefs that you have had, select two that you can relate to: Belief 1. ______

Explain how this belief is self-defeating: ______

What were the payoffs that you experienced from having this self-defeating belief that kept you thinking this way in the past? (There had to be payoffs or you wouldn't have had the belie£) ______

How can you start to change this way of thinking? ______

Beliefl. ______

Explain how this belief is self-defeating: ______

What were the payoffs that you experienced from having this self-defeating belief that kept you thinking this way in the past? (There bad to be payoffs or you wouldn't have bad the beliefJ ______

How can you start to change this way of thinking? ______New Foundation 12 week Relapse Prevention Plan - part3 Lesson 11

Name: Date: ------DON'T LET A RELAPSE TAKE YOU BY SURPRISE!

CIRCLE ANY OF THESE WARNING SIGNS THAT YOU SHOULD LOOK FOR:

Avoiding problems Lying about activities Missing meetings and aftercare Hanging out with friends who use Dreaming of the "good old days" Thinking you are cured Not communicating Missing appointments Keeping a stash just in case Getting too hungry Dwelling on mistakes Staying too lonely Keeping secrets Quit reading recovery literature Feeling depressed Problems sleeping Quitting treatment Blaming other people Excess anger Feeling overwhelmed Being too tired

Worrying too much about the future

Bored most of the time

Stopping prescribed medications

ADDITIONAL WARNING SIGNS: Visiting clubs and bars

Not taking action

Thinking, I can handle it on my own Holding onto resentments New Foundation 12 week Relapse Prevention Plan - part 4 Lesson 11 Name: ------Date: ------MY BIGGEST. PERSONAL WARNING SIGNS OF A POSSIBLE RELAPSE COMING

From the list on the page 3, I have learned that these are the warning signs and relapse factors that I need to watch out for the most:

! . ______

2. ------3. ______

4. ------

5. ------

ACTION PLAN IF I RELAPSE - PEOPLE I NEED TO TELL If I should use drugs or alcohol in the future, these are the people I need to tell about it: }. ______

2. ------3. ______

PREVENTION OF ANY MORE RELAPSES These are the things I need to do to make sure I don't relapse again:

!. ______

2. ______

3. ------

4. ------5. ______( New Foundation 12 week Relapse Prevention Plan - part 5 Lesson 12

Name: ------Date: ----- SUBSTANCE-FREE ACTIVITIES AND HEALTHY HABITS

10 things I can do that are good for me are:

1. ------2. ______

3. ______

4. ______

5. ------

6. ------

7. ------

8. ------

9. ------10. ______( References

Stop the Chaos: How to get Control of your Life by Beating Alcohol and Drugs, by Allen A. Tighe, 1998

U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration SAMHSA Health Information Network website

U.S. Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism No. 53 July 2001 Alcohol Alert

U.S. Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism, Number 63, October 2004 ALCOHOL'S DAMAGING EFFECTS ON THE BRAIN

Me d l i Il e r> I t1 S . A service of the U.S NATIONAL LIBRARY OF MEDICINE Trusted Health Information for You ano the NATIONAL INSTITUTES OF HEALTH

Medical Encyclopedia: Alcohol withdrawal

URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/000764.htm

http://www.saskatoonhealthregion.ca/your health/calder documents/MAPforFamilyMembers Apr02rev1 .pdf

http://www.tgorski.com/gorski articles/developing a relapse prevention plan.htm

Dual Recovery Anonymous: http://draonline.org/relapse_relax.html

.}- Summit Psychological Associates, Inc. New Foundation 12 week Program

NAME: ______As a condition for the participation in the New Foundation 12 week Program, you are required to attend 1 AA meeting per week.

DATE Time Time Meeting Signature In Out ...,uv. urouo Name: I .L. WCCK. 1...,.cw ruuuuuuuu .a.••··-· Client's Name: Instant Offense: P.O. Name: Pertinent legal history: (include previous OVI's, DUl's and OWi's, etc.): P.O. County: (if needed): P.O. phone number (if needed): P.O. fax number{ifneeded): At Beginning (Enter dates): PRETEST At Discharge (Enter dates): POSTTEST ODADAS OUTCOMES FRAMEWORK SURVEY GIVEN All Homeworks turned in? ODADAS ISP COMPLETED OUTCOMES FRAMEWORK SURVEY ADMINISTERED PROGRAM CHECKLIST OF FORMS SIGNED UDS results negative? CONTRACT SIGNED IF MEDICAlD, OHIO BEHAVIORAL HEALTH DISCHARGE FORM GIVEN IF MEDICAID, OHIO BEHAVIORAL HEALTH ADMISSION FORM SATISFACTION SURVEY ADMINISTERED SELF-APPRAISAL ADMINISTERED After 9 sessions: (Enter dates) DISCHARGE SUMMARY COMPLETED ODADAS OUTCOMES FRAMEWORK. SURVEY GIVEN CRIMINAL JUSTICE PRE-DISCHARGE PLAN COMPLETED REMEMBER TO SEND MONTHLY REPORTS TO PROBATION/PAROLE UDS Fax sheet sent to Probation?

10 12 Lesson# 1 2 3 4 5 6 7 8 9 ll Date(s) Attended (and session #'s). Use 2°d row if repeats a lesson Proof of 1 AA Meetim!? Date Absent: Excused? YIN Reason?

Homework turned in?

Client terminated from group on: _ _ Class successfully completed on: ______Sanctions imposed on ______. Specify: ------

If client restarts, also begin new Tracking sheet.

6/9/2017 Summit Psychological Associates, Inc. ODADAS Outcomes Framework Adult Client Survey

Completing this survey will assist us in our ability to be most helpful to you. Please feel free to be honest in completing it.

D 26-Week Group D 12-Week Group D Individual Treatment

Client Name:______Date: ______Clinician Name: ------Point in Program at SPA: Entry Midway Graduation

1. Do you believe that your alcohol or other drug use bas negatively impacted your life'! D Yes D No D Not Sure

2. Are you cu.-rently attending 12 step meetings (e.g. AA) each week? □ Yes □ No

3. Are you currently abstinent from all alcohol and other drug use? □ Yes D No

4. Have you learned skills to manage your triggers or high-risk situations, in order to avoid using alcohol or other drugs? D Yes □ No

5. Is your goal to remain abstinent from all alcohol and other drug use, even after you complete treatment at SPA? □ Yes □ No □ Not Sure

6. Have you met with a case manager at Summit Psychological Associates, Inc.? □ Yes* □ No □ Not Sure *If yes, please answer the following two questions:

Has the case manager assisted you in obtaining stable housing? D Yes D No O N/ A (already have stable housing) Has the case manager assisted you in obtaining stable employment or another source of regular income, such as disability payments, retirement benefits, a pension, or social security? D Yes □ No D N/A (already have stable employment or another source of income)

7. May we contact you in the future to conduct a follow up survey? □ Yes* □ No *If yes, please prnvide us with your email address or another method of communication:

1/30/2020 SUMMIT PSYCHOLOGICAL ASSOCIATES, INC. An Association of Mental Health Professionals

ODADAS PROGRAM RULES

1. The program at Summit Psychological Associates, Inc. is an abstinence based program, meaning that our goal will be to assist you in eliminating drug and/or alcohol use.

2. You may not attend any appointments at Summit Psychological Associates, Inc. while under the influence. of alcohol or other drugs.

3. Please be sure to give us 24 hours' notice if you must change or cancel an appointment. A pattern of missed or canceled appointments may result in your discharge from our program.

4. We may require you to attend 12 step meetings and provide proof of attendance.

5. We may require you to sign release of information forms for us to coordinate with other involved agencies or treatment providers and inform them of your progress, completion of the program or discharge from the program.

6. We expect you to be an active participant in your treatment. You will need to participate fully in sessions and complete any assignments given. You will need to be completely honest and assume full responsibility for your behavior. This includes not giving false information as well as not leaving out important information.

7. You are not permitted to bring guns, knives or weapons of any kind onto our premises.

8. You are not permitted to bring any illegal drugs onto our premises.

9. You may not linger around Summit Psychological Associates, Inc. ' s property either before or after your appointments. Please arrive on time and depart promptly.

10. Physical assault of an agency employee, another client, or anyone on the property of Summit Psychological Associates, Inc. will result in immediate discharge from our program.

11. The staff at Summit Psychological Associates, Inc. may terminate your treatment for any other behavior not outlined above and may add new conditions at any time. Summit Psychological Associates, Inc. Confidentiality of Alcohol and Drug Abuse Client Records 42 CFR Part 2

The confidentiality of alcohol and drug abuse patient records maintained by this program is protected by Federal law and regulations. Generally, the program may not say to a person outside the program that a patient attends the program, or disclose any information identifying a patient as an alcohol or drug abuser Unless: (I) The patient consents in writing; (2) The disclosure is allowed by a court order; or (3) The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation.

Violation of the Federal law and regulations by a program is a crime. Suspected violations may be reported to appropriate authorities in accordance with Federal regulations. Federal law and regulations do not protect any information about a crime committed by a patient either at the program or against any person who works for the program or about any threat to commit such a crime. Federal laws and regulations do not protect any informational about suspected child abuse or neglect from being reported under State law to appropriate State or local authorities.

(See 42 U.S.C. 290dd-3 and 42 U.S.C. 290ee-3 for Federal laws and 42 CFR part 2 for Federal regulations.)

(Approved by the Office of Management and Budget under control number 0930-0099). Tuberculosis Facts - Center for Disease Control and Prevention

What is TB? TB is short for a disease called tuberculosis. TB is spread through the air from one person to another. TB germs are passed through the air when someone who is sick with TB disease of the lungs or throat coughs, speaks, laughs, sings, or sneezes. Anyone near the sick person can breathe TB germs into their lungs. TB germs can live in your body without making you sick. This is called latent TB infection. This means you have only inactive {sleeping) TB germs in your body. The inactive germs cannot be passed on to anyone else. However, if these germs wake up or become active in your body and multiply, you will get sick with TB disease. When TB germs are active (multiplying in your body), this is called TB disease. These germs usually attack the lungs. They can also attack other parts of the body, such as, the kidneys, brain, or spine. TB disease will make you sick. People with TB disease may spread the germs to people they spend time with every day.

How do I know if I have been infected with TB germs? If you have been around someone who has TB disease, you should go to your doctor or your local health department for tests. There are two tests that can be used to help detect TB infection: a skin test or special TB blood test. The skin test is used most often. A small needle is used to put some testing material, called tuberculin, under the skin. In 2-3 days, you return to the health care worker who will check to see if there is a reaction to the test. In some cases, a special TB blood test is given to test for TB infection. This blood test measures how a person's immune system reacts to the germs that cause TB. To tell if someone has TB disease, other tests such as chest x-ray and a sample of sputum may be needed.

What should I do if I have TB? If you have latent TB infection, you may need medicine to prevent getting TB disease later. Usually, only one drug is needed to treat latent TB infection. It is important that you take your medicine exactly as you are told. TB disease can also be treated by taking medicine. It is very important that people who have TB disease finish the medicine, and take the drugs exactly as they are told. If they stop taking the drugs too soon, they can become sick again. If they do not take the drugs correctly, the germs that are still alive may become difficult to treat with those drugs. It takes at least six months to one year to kill all the TB germs. Remember, you will always have TB germs in your body unless you kill them with the right medicine.

People who are more likely to get sick from TB disease include: • people with HIV infection (the virus that causes AIDS); • people who have been recently infected with TB ( in the last two years) • people who inject illegal drugs; • babies and young children; • elderly people; • people who were not treated correctly for TB in the past; and • people with certain medical conditions such as diabetes, certain types of cancer, and being underweight. These things make your body weaker. When your body is weaker, it is difficult to fight TB germs. What is HIV/AIDS? HIV - the human immunodeficiency virus - is a virus that kills your body's "CD4 cells." CD4 cells (also called T-helper cells) help your body fight off infection and disease. HIV can be passed from person to person if someone with HIV infection has sex with or shares drug injection needles with another person. It also can be passed from a mother to her baby when she is pregnant, when she delivers the baby, or if she breastfeeds her baby.

AIDS - the acquired immunodeficiency syndrome - is a disease you get when HIV destroys your body's immune system. Normally, your immune system helps you fight off illness. When your immune system fails you can become very sick and can die.

What do I need to know about HIV? The first cases of AIDS were identified in the United States in 1981 , but AIDS most likely existed here and in other parts of the world for many years before that time. In 1984 scientists proved that HIV causes AIDS. Anyone can get HIV. The most important thing to know is how you can get the virus. You can get HIV:

• By having unprotected sex- sex without a condom-with someone who has HIV. The virus can be in an infected person's blood, semen, or vaginal secretions and can enter your body through tiny cuts or sores in your skin, or in the lining of your vagina, penis, rectum, or mouth. • By sharing a needle and syringe to inject drugs or sharing drug equipment used to prepare drugs for injection with someone who has HIV.

• From a blood transfusion or blood clotting factor that you got before 1985. (But today it is unlikely you could get infected that way because all blood in the United States has been tested for HIV since 1985.)

• Babies born to women with HIV also can become infected during pregnancy, birth, or breast feeding.

You cannot get HIV: • By working with or being around someone who has HIV. • From sweat, spit, tears, clothes, drinking fountains, phones, toilet seats, or through everyday things like sharing a meal. • From insect bites or stings. • From donating blood.

• From a closed-mouth kiss (but there is a very small chance of getting it from open-mouthed or "French" kissing with an infected person because of possible blood contact).

How can I protect myself?

• Don't share needles and syringes used to inject drugs, steroids, vitamins, or for tattooing or body piercing. Also, don't share equipment ("works") used to prepare drugs to be injected. Many people have been infected with HIV, hepatitis, and other germs this way. Germs from an infected person can stay in a needle and then be injected directly into the next person who uses the needle. • The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual intercourse, or to be in a longterm mutually monogamous relationship with a partner who has been tested and you know is uninfected.

• For persons whose sexual behaviors place them at risk for STDs, correct and consistent use of the male latex condom can reduce the risk of STD transmission. However, no protective method is 100 percent effective, and condom use cannot guarantee absolute protection against any STD. The more sex partners you have, the greater your chances are of getting HIV or other diseases passed through sex.

• Condoms used with a lubricant are less likely to break. However, condoms with the spermicide nonoxynol-9 are not recommended for STD/HIV prevention. Condoms must be used correctly and consistently to be effective and protective. Incorrect use can lead to condom slippage or breakage, thus diminishing the protective effect. Inconsistent use, e.g., failure to use condoms with every act of intercourse, can result in STD transmission because transmission can occur with a single act of intercourse. • Don't share razors or toothbrushes because of they may have the blood of another person on them.

• If you are pregnant or think you might be soon, talk to a doctor or your local health department about being tested for HIV. If you share HIV, drug treatments are available to help you and they can reduce the chance of passing HIV to your baby.

How do I know if I have HIV or AIDS? You might have HIV and still feel perfectly healthy. The only way to know for sure if you are infected or not is to be tested. Talk with a knowledgeable health care provider or counselor both before and after you are tested. You can go to your doctor or health department for testing. To find out where to go in your area for HIV counseling and testing, call your local health department or the CDC INFO, at 1-800-CDC INFO (232-4636). Your doctor or health care provider can give you a confidential HIV test. The information on your HIV test and test results are confidential, as is your other medical information. This means it can be shared only with people authorized to see your medical records. You can ask your doctor, health care provider, or HIV counselor at the place you are tested to explain who can obtain this information. For example, you may want to ask whether your insurance company could find out your HIV status if you make a claim for health insurance benefits or apply for life insurance or disability insurance. CDC recommends that everyone know their HIV status. How often you should an HIV test depends on your circumstances. If you have never been tested for HIV, you should be tested. CDC recommends being tested at least once a year if you do things that can transmit HIV infection, such as: • injecting drugs or steroids with used injection equipment • having sex for money or drugs • having sex with an HIV infected person • having more than one sex partner since your HIV test • having a sex partner who has had other sex partners since your last HIV test. In many states, you can be tested anonymously. These tests are usually given at special places known as anonymous testing sites. When you get an anonymous HIV test, the testing site records only a number or code with the test result, not your name. A counselor gives you this number at the time your blood, saliva, or urine is taken for the test, then you return to the testing site (or perhaps call the testing site, e.g. with home collection kits) and give them your number or code to learn the results of your test. If you have been tested for HIV and the result is negative and you never do things that might transmit HIV infection, then you and your health care provider can decide whether you need to get tested again. You are more likely to test positive for (be infected with) HIV if you: • Have ever shared injection drug needles and syringes or "works." • Have ever had sex without a condom with someone who had HIV. • Have ever had a sexually transmitted disease, like chlamydia or gonorrhea.

• Received a blood transfusion or a blood clotting factor between 1978 and 1985. • Have ever had sex with someone who has done any of those things

What can I do if the test shows I have HIV? Although HIV is a very serious infection, many people with HIV and AIDS are living longer, healthier lives today, thanks to new and effective treatments. It is very important to make sure you have a doctor who knows how to treat HIV. If you don't know which doctor to use, talk with a health care professional or trained HIV counselor. If you are pregnant or are planning to become pregnant, this is especially important. There also are other things you can do for yourself to stay healthy. Here are a few • Follow your doctor's instructions. Keep your appointments. Your doctor may prescribe medicine for you. Take the medicine just the way he or she tells you to because taking only some of your medicine gives your HIV infection more chance to grow.

• Get immunizations (shots) to prevent infections such as pneumonia and flu. Your doctor will tell you when to get these shots. • If you smoke or if you use drugs not prescribed by your doctor, quit. • Eat healthy foods. This will help keep you strong, keep your energy and weight up, and help your body protect itself.

• Exercise regularly to stay strong and fit. • Get enough sleep and rest.

How can I find out more about HIV and AIDS? You can call CDC-INFO at 1-800-CDC-INFO (232-4636); TTY access 1-888-232-6348. CDC-INFO is staffed with people trained to answer your questions about HIV and AIDS in a prompt and confidential manner in English or Spanish, 24 hours per day. Staff at CDC-INFO can offer you a wide variety of written materials and put you in touch with organizations in your area that deal with HIV and AIDS. On the Internet, you can get information on HIV and AIDS from www.AIDS.gov or www.cdc.gov/hiv. HEPATITIS C Hepatitis C is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness that attacks the liver. It results from infection with the hepatitis C virus (HCV), which is spread primarily through contact with the blood of an infected person. It can be either "acute" or "chronic."

Acute hepatitis C virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the hepatitis C virus. For most people, acute infection •-~ds to chronic infection.

Chronic hepatitis C virus infection is a long-term illness that occurs when the hepatitis C virus remains in a person's body. Hepatitis C virus infection can last a lifetime and lead to serious liver problems, including cirrhosis (scarring of the liver) or liver cancer.

Statistics: How common is acute hepatitis C in the United States? In 2006, there were an estimated 19,000 new hepatitis C virus infections in the U.S. However, the official number of reported hepatitis C cases is much lower. Many people who are infected never have symptoms and never come to the attention of medical or public health officials.

How common is chronic hepatitis C in the United States? An estimated 32 million persons in the United States have chronic hepatitis C virus infection. Most people do not know they are infected because they don't look or feel sick.

How likely is it that acute hepatitis C will become chronic? Approximately 75%- 85% of people who become infected with hepatitis C virus develop chronic infection.

Transmission I Exposure: How is hepatitis C spread? Hepatitis C is spread when blood from a person infected with the hepatitis C virus enters the body of someone who is not infected. Today, most people become infected with the hepatitis C virus by sharing needles or other equipment to inject drugs. Before 1992, when widespread screening of the blood supply began in the United States, hepatitis C was also commonly spread through blood transfusions and organ transplants. People can become infected with the hepatitis C virus during such activities as

• Sharing needles, syringes, or other equipment to inject drugs • Needle stick injuries in healthcare settings • Being born to a mother who has hepatitis C

Less commonly, a person can also get hepatitis C virus infection through sharing personal care items that may have come in contact with another person's blood, such as razors or toothbrushes or having sexual contact with a person infected with the hepatitis C virus

Can hepatitis C be spread through sexual contact? Yes, but the risk of transmission from sexual contact is believed to be low. The risk increases for those who have multiple sex partners, have a sexually transmitted disease, engage in rough sex, or are infected with HIV. More research is needed to better understand how and when hepatitis C can be spread through sexual contact.

Can you get hepatitis C by getting a tattoo or piercing? A few major research studies have not shown hepatitis C to be spread through licensed, commercial tattooing facilities. u"wever, transmission of hepatitis C (and other infectious diseases) is possible when poor infection-control practices are used during tattooing or piercing. Body art is becoming :asingly popular in the United States, and unregulated tattooing and piercing are known to occur in prisons and other informal or unregulated settings. Further research is .....;ded to determine if these types of settings and exposures are responsible for hepatitis C virus transmission.

Can hepatitis C be spread within a household? Yes, but this does not occur very often. If hepatitis C virus is spread within a household, it is most likely a result of direct, through-the-skin exposure to the blood of an infected household member.

What are ways hepatitis C is not spread? Hepatitis C virus is not spread by sharing eating utensils, breastfeeding, hugging, kissing, holding hands, coughing, or sneezing. It is also not spread through food or water.

Who is at risk for hepatitis C? Some people are at increased risk for hepatitis C, including • Current injection drug users (currently the most common way hepatitis C virus is spread in the United States) • Past injection drug users, including those who injected only one time or many years ago • Recipients of donated blood, blood products, and organs ( once a common means oftransmission but now rare in the United States since blood screening became available in 1992) • People who received a blood product for clotting problems made before 1987 • Hemodialysis patients or persons who spent many years on dialysis for kidney failure • People who received body piercing or tattoos done with non-sterile instruments • People with known exposures to the hepatitis C virus, such as o Healthcare workers injured by needlesticks o Recipients of blood or organs from a donor who tested positive for the hepatitis C virus • HIV-infected persons • Children born to mothers infected with the hepatitis C virus

Less common risks include: • Having sexual contact with a person who is infected with the hepatitis C virus • Sharing personal care items, such as razors or toothbrushes, that may have come in contact with the blood of an infected person

What is the risk of a pregnant woman passing hepatitis C to her baby? Hepatitis C is rarely passed from a pregnant woman to her baby. About 4 of every 100 infants born to mothers with hepatitis C become infected with the virus. However. the risk becomes greater if the mother has both HIV infection and hepatitis C.

a person get hepatitis C from a mosquito or other insect bite? Hepatitis C virus has not been shown to be transmitted by mosquitoes or other insects.

Can I donate blood, organs, or semen if I have hepatitis C? No, if you ever tested positive for the hepatitis C virus (or hepatitis B virus), experts recommend never donating blood, organs, or semen because this can spread the infection to the recipient. Symptoms: What are the symptoms of acute hepatitis C? Approximately 70o/cr-80% of people with acute hepatitis C do not have any symptoms. Some people, however, can have mild to severe symptoms soon after being infected, including • Fever • Vomiting • Clay-colored bowel movements • Fatigue • Abdominal pain • Joint pain • Loss of appetite • Jaundice (yellow color in the skin or • Dark urine • Nausea eyes) How soon after exposure to hepatitis C do symptoms appear? If symptoms occur, the average time is 6-7 weeks after exposure, but this can range from 2 weeks to 6 months. However, many people infected with the hepatitis C virus do 1101 develop symptoms.

Can a person spread hepatitis C without having symptoms? Yes, even if a person with hepatitis Chas no symptoms, he or she can still spread the virus to others.

ls it possible to have hepatitis C and not know it? Yes, many people who are infected with the Hep C virus don't know they are infected because they do not look or feel sick.

What are the symptoms of chronic hepatitis C? Most people with chronic hepatitis C do not have any symptoms. However, if a person· has been infected for many years, his or her liver may be damaged. In many cases, there are no symptoms of the disease until liver problems have developed. In persons without symptoms, hepatitis C is often detected during routine blood tests to measure liver function and liver enzyme (protein produced by the liver) level. How serious is chronic hepatitis C? ·

Chronic hepatitis C is a serious disease that can result in long-term health problems, including liver damage, liver failure, liver cancer, or even death. It is the leading cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the U.S. Approximately 8-10,000 people die every year from Hep C related liver disease.

What are the long-term effects of hepatitis C? Of e~·ery 100 people infected with the hepatitis C virus, about

• 7~5 people will develop chronic hepatitis C virus infection; of those, • 60-70 people will go on to develop chronic liver disease • 5-20 people will go on to develop cirrhosis over a period of20-30 years • 1-5 people will die from cirrhosis or liver cancer

Tests: Can a person have normal liver enzyme (e.g., ALT) results and still have hepatitis C? Yes. It is common for persons with chronic hepatitis C to have a liver enzyme level that goes up and down, with periodic returns to normal or near normal. Some infected persons have liver enzyme levels that are normal for over a year even though they have chronic liver disease. If the liver enzyme level is normal, persons should have their enzyme level re-checked several times over a 6-12 month period. If the liver enzyme level remains normal, the doctor may check it less frequently, such as once a year.

Who should get tested for hepatitis C? Talk to your doctor about being tested for hepatitis C if any of the following are true:

• You are a current or former injection drug user, even if you injected only one time or many years ago. • You were treated for a blood clotting problem before I 987. • You received a blood transfusion or organ transplant before July 1992. • You are on long-term hemodialysis treatment. • You have abnonnal liver tests or liver disease. • You work in healthcare or public safety and were exposed to blood through a needlestick or other sharp object injury. • You are infected with HIV.

lfyou are pregnant, should you be tested for hepatitis C? No, getting tested for hepatitis C is not part of routine prenatal care. However, ifa pregnant woman has risk factors for hepatitis C virus infection, she should speak with her doctor about getting tested.

What blood tests are used to test for hepatitis C? Several different blood tests are used to test for hepatitis C. A doctor may order just one or a combination of these tests. Typically, a person will first get a screening test that will show whether he or she has developed antibodies to the hepatitis C virus. (An antibody is a substance found in the blood that the body produces in response to a virus.) Having a positive antibody test means that a person was exposed to the virus at some time in his or her life. If the antibody test is positive, a doctor will most likely order a second test to confirm whether the virus is still present in the person's bloodstream.

Treatment: How is acute hepatitis C treated? No medication is available to treat acute hepatitis C infection Doctors usually recommend rest, adequate nutrition, and fluids.

How is chronic hepatitis C treated? Each person should discuss treatment options with a doctor who specializes in treating hepatitis. This can include some internists, family practitioners, infectious disease doctors, or hepatologists (liver specialists). People with chronic hepatitis C should be monitored regularly for signs of liver disease and evaluated for treatment. The treatment most often used for hepatitis C is a combination of two medicines, interferon and ribavirin. However, not every person with chronic hepatitis C needs or will benefit from treatment. In addition, the drugs may cause serious side effects in some patients.

1s it possible to get over hepatitis C? Yes, approximately l So/cr-25% of people who get hepatitis C will clear the virus from their bodies without treatment and will not develop chronic infection. Experts do not fully understand why this happens for some people.

What can a person with chronic hepatitis C do to take care of his or her liver? People with chronic hepatitis C should be monitored regularly by an experienced doctor. They should avoid alcohol because it can cause additional liver damage. They also should check with a health professional before taking any prescription pills, supplements, or over-the-counter medications, as these can potentially damage the liver. If liver damage is present, a person should check with his or her doctor about getting vaccinated against hepatitis A and hepatitis B.

Vaccination: Is there a vaccine that can prevent hepatitis C? Not yet. Vaccines are available only for hepatitis A & B. Research is being done.

Miscellaneous : Should a person infected with the hepatitis C virus be restricted from working in certain jobs or settings? CDC's recommendations for prevention and control of the hepatitis C virus infection state that people should not be excluded from work, school, play, child care, or other settings because they have hepatitis C. There is no evidence that people can get hepatitis C from food handlers, teachers, or other service providers without blood-to-blood contact. What I need to know about Hepatitis B - National Digestive Diseases Information Clearinghouse (NDDIC)

Hepatitis Bis a liver disease. Hepatitis (HEP-ah-TY-tis) makes your liver swell and stops it from working right. You need a healthy liver. The liver does many things to keep you alive. The liver fights infections and stops bleeding. It removes drugs and other poisons from your blood. The liver also stores energy for when you need it.

What causes hepatitis B? Hepatitis Bis caused by a virus. A virus is a germ that causes sickness. (For example, the flu is caused by a virus.) People can pass viruses to each other. The virus that causes hepatitis B is called the hepatitis B virus.

Hepatitis B spreads by contact with an infected person's blood, semen, or other body fluid. You could get hepatitis B by .

• having sex with an infected person without using a condom • sharing drug needles • having a tattoo or body piercing done with dirty tools used on someone else • getting pricked with a needle that has infected blood on it (health care workers can get hepatitis B this way) • living with someone who has hepatitis B • sharing a toothbrush or razor with an infected person • traveling to countries where hepatitis 8 is common • An infected woman can give hepatitis B to her baby at birth.

You can NOT get hepatitis B by

• shaking hands with an infected person • hugging an infected person • sitting next to an infected person

What are the symptoms?

Hepatitis B can make you feel like. you have the flu. You might feel tired, feel sick to your stomach, have a fever, not want to eat, have stomach pain, or have diarrhea. Some people have dark yellow urine, light-colored stools, or yellowish eyes and skin. Some people don't have any symptoms. If you have symptoms or think you might have hepatitis B, go to a doctor.

What are the tests for hepatitis B?

To check for hepatitis B, the doctor will test your blood. These tests show if you have hepatitis B and how serious it is. The doctor will take some blood to check for hepatitis B. The doctor may also do a liver biopsy. How is hepatitis B treated?

Treatment for hepatitis B may involve

• A drug called interferon (in-ter-FEAR-on). It is given through shots. Most people are treated for 4 months. • A drug called lamivudine (la-MIV-you-deen). You take it by mouth once a day. Treatment is usually for one year. Hepatitis Bis treated through shots of medicine. • A drug called adefovir dipivoxil (uh-DEH-foh-veer dih-pih-VOX-ill). You take it by mouth once a day. Treatment is usually for one year. • Surgery. Over time, hepatitis 8 may cause your liver to stop working. If that happens, you will need a new liver. The surgery is called a liver transplant. It involves taking out the old, damaged liver and putting in a new, healthy one from a donor.

How can I protect myself?

You can get the hepatitis B vaccine. A vaccine is a drug that you take when you are healthy that keeps you from getting sick. Vaccines teach your body to attack certain viruses, like the hepatitis 8 virus. The hepatitis B vaccine is given through three shots. All babies should get the vaccine. Infants get the first shot within 12 hours after birth. They get the second shot at age 1 to 2 months and the third shot between ages 6 and 18 months. Older children and adults can get the vaccine, too. They get three shots over 6 months. Children who have not had the vaccine should get it. You need all of the shots to be protected. If you are traveling to other countries, make sure you get all the shots before you go. If you miss a shot, call your doctor or clinic right away to set up a new appointment. Vaccines protect you from getting hepatitis B.

You can also protect yourself and others from hepatitis B if you • People who touch blood at work should wear gloves to protect themselves from hepatitis B. • use a condom when you have sex • don't share drug needles with anyone • wear gloves if you have to touch anyone's blood • don't use an infected person's toothbrush, razor, or anything that could have blood on it • make sure any tattooing or body piercing is done with clean tools

For More Information

Hepatitis B Foundation 700 East Butler Avenue Doylestown, PA 18901-2697 Phone:215-489-4900 Fax:215--489-4920 Email: [email protected] Internet: www.hepb.org 1. Substance use and your offense.

Do New member paperwork, if any new members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Introductions: Have clients introduce themselves, saying first name only, what legal charges are, and how drug or alcohol use was related to that. Why do you think you were recommended to complete this program, even if your charge wasn't a drug or alcohol charge? Do Midpoint paperwork, if any group members are at their 9th week (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader' s Manual) Do Graduation paperwork, if any graduating members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader' s Manual) Complete Tracking Form, including whether attended AA Do Group check-in Briefly review homework from Lesson 12, if applicable [part 5 of the Relapse Prevention Plan SUBSTANCE-FREE ACTMTIES AND HEALTHY HABITS (P. 46 of Client's Manual).]

The Role of Substance Abuse in crime: - • 60-70% of all crime involves alcohol and/or other intoxicating drugs. • Almost 50% of all violent crimes involve alcohol. • Twenty-four percent of Federal inmates and 49% of State inmates reported that they were under the influence of alcohol or illicit drugs at the time of their current offense. 36.3% were under the influence of alcohol alone. • Federal research also shows that more than 40% of convicted murderers being held in jail or State prison, had alcohol as a factor in their crime. • Extensive data is available to show the relationship between violent crime and alcohol. • In the United Kingdom, the British Medical Association, advised the Parliament that alcohol is a factor in: o 60-70% of homicides o 75% of stabbings o 70% of beatings o 50% of fights and domestic assaults. • According to the Seventh Special Report to the U.S Congress on Alcohol and Health, "In both animal and human studies, alcohol more than any other drug, has been linked with a high incidence of violence and aggression." Now let's talk about drinking and driving. Raise your hands if you have ever been charged with a DUI or and OVI. Let's talk about how much alcohol a person has to drink to be impaired in their driving.

Why did they pick these numbers as the legal limit? As little as two beers or drinks can impair coordination and thinking

Group Leader: Have clients take out the Alcohol Impairment Chart, using the Men's chart (Page 25 in Client's Manual) and/or the Women's chart(s) (Page 26 in Client's Manual), and review.

- CONNECTICUT «t-wheeler Clearinghouse a p-qvam of the Comecticut Cente for """"'"tion, Wellness and Recolle

800.232.4424 (Voice/ITV) 860.793.9813 (Fax) www.ctclearlnghouse.org Chart

A Ubrary and Resource Cenhlr on Alcohol, Tobacco, other Drugs, Mental Heallh and Welness

Alcohol affects individuals differently. Your blood alcohol level may be affected by your age, gender, physical condition, amount of food consumed, and any drugs or medication. In addition, different drinks may contain different amounts of alcohol, so it Is important to know how much and the concentration of alcohol you consume.

For the purposes of this guide:

"One drink" Is equal to 1.5 oz. of 80 proof llquor, 12 oz. of regular beer, or 5 oz. of table wine. A woman drinking an equal amount of alcohol in the same period of time as a man of an equivalent weight may have a higher blood alcohol level than that man. Women should refer to the Alcohol Impairment Chart for Women.

Connecticut has set .08% Blood Alcohol Concentration (BAC} as the legal llmlt for Driving Under the Influence.

For commercial drivers, a BAC of .04% can result in a DUI conviction nationwide.

Alcohol Impairment Chart for Men

MEN Approximate Blood Alcohol Percentage

Drinks Body Weight In Pounds

.03 .03 .09 .08 .05 .05 Driving Skills Signlflcantly Affected 4 .15 .12 .11 .09 .08 .08 .07 .06 5 .19 .16 .13 .12 .11 .09 .09 .08 Possible Crlmlnal Penalties 6 .23 .19 .16 .14 .13 .11 .10 .09 7 .26 .22 .19 .16 .15 .13 .12 .11 8 .30 .25 .21 .19 .17 .15 .14 .13 Legally Intoxicated 9 .34 .28 .24 .21 .19 .17 .15 .14 10 .38 .31 .27 .23 .21 .19 .17 .16 Criminal Penalties

One drink is 1.5 oz. of 80 proof liquor, 12 oz. of beer, or 5 oz. of table wine

This chart Is Intended as a guide, not a guarantee. (over) -

Alcohol Impairment Chart for Women

WOMEN Approximate Blood Alcohol Percentage

Drinks Body Weight In Pounds

2 3 .15 .14 .11 06 Driving Skills Significantly Affected 4 .20 .18 .15 .11 .10 .09 .08 .08 Possible Criminal Penalties 5 .25 .23 .19 .16 .14 .13 .11 .10 .09 6 .30 .27 .23 .19 .17 .15 .14 .12 .11 7 .35 .32 .27 .23 .20 .18 .16 .14 .13 Legally Intoxicated 8 .40 .36 .30 .26 .23 .20 .18 .17 .15 9 .45 .41 .34 .29 .26 .23 .20 .19 .17 Criminal Penalties 10 .51 .45 .38 .32 .28 .25 .23 .21 .19

One drink is 1.5 oz. of 80 proof liquor, 12 oz. of beer, or 5 oz. of table wine.

This chart Is intended as a guide, not a guarantee.

Impairment Begins With Your First Drink.

Never Drive After Drinking!

Information Provided by: National Clearinghouse for Alcohol & Drug Information Pennsylvania Liquor Control Board

AlcohollmpairmentChart (revised 062304) - 1. Substance use and your offense.

Do New member paperwork, if any new members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Introductions: Have clients introduce themselves, saying first name only, what legal charges are, and how drug or alcohol use was related to that. Why do you think you were recommended to complete this program, even if your charge wasn't a drug or alcohol charge? Do Midpoint paperwork, if any group members are at their 9th week (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Do Graduation paperwork, if any graduating members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader' s Manual) Complete Tracking Form, including whether attended AA Do Group check-in Briefly review homework from Lesson 12, if applicable [part S of the Relapse Prevention Plan SUBSTANCE-FREE ACTIVITIES AND HEALTHY HABITS (P. 46 of Client's Manual).]

The Role of Substance Abuse in crime: • 60-70% of all crime involves alcohol and/or other intoxicating drugs. • Almost 50% of all violent crimes involve alcohol. • Twenty-four percent of Federal inmates and 49% of State inmates reported that they were under the influence of alcohoi or illicit drugs at the time of their current offense. 36.3% were under the influence of alcohol alone. • Federal research also shows that more than 40% of convicted murderers being held in jail or State prison, had alcohol as a factor in their crime. • Extensive data is available to show the relationship between violent crime and alcohol. • In the United Kingdom, the British Medical Association, advised the Parliament that alcohol is a factor in:

o 60-70% of homicides o 75% of stabbings

o 70% of beatings o 50% of fights and domestic assaults. • According to the Seventh Special Report to the U.S Congress on Alcohol and Health, "In both animal and human studies, alcohol more than any other drug, has been linked with a high incidence of violence and aggression." Now let's talk about drinking and driving. Raise your hands if you have ever been charged with a DUI or and OVI. Let's talk about how much alcohol a person has to drink to be impaired in their driving.

Why did they pick these numbers as the legal limit? As little as two beers or drinks can impair coordination and thinking

Group Leader: Have clients take out the Alcohol Impairment Chart, using the Men's chart (Page 25 in Client's Manual) and/or the Women's chart(s) (Page 26 in Client's Manual), and review. CONNECTICUT Clearinghouse -«twheeler a program of the Comectlcut Center fo, Prevention, Wellne,o ond Recovery Alcohol Impairment

800.232.4424 (Voice/TTY) 860.793.9813 (Fax) WWW. cfcleorlnghouse.org Chart

A Library and 1.-ce Cent.. on Alcohol, Tobac:co, OW- Drug$, Mental Heallh and W.. ness

A woman drinking an equal amount of alcohol in the same period of time as a man of an equivalent weight may have a higher blood alcohol level than that man. Women should refer to the Alcohol Impairment Chart for Women.

Connecticut has set .08% Blood Alcohol Concentration (BAC) as the legal limit for Driving Under the Influence.

For commercial drivers, a BAC of .04% can result in a DUI conviction nationwide.

Alcohol Impairment Chart for Men

MEN Approximate Blood Alcohol Percentage

Drinks Body Weight in Pounds

.08 .03 .03 3 .11 .09 .08 .05 .05 Driving Skills Slgnlflcantly Affected 4 .15 .12 .11 .08 .07 .06 5 .19 .16 .13 .12 .11 .09 .09 .08 Possible Criminal Penalties 6 .23 .19 .16 .14 .13 .11 .10 .09 7 .26 .22 .19 .16 .15 .13 .12 .11 8 .30 .25 .21 .19 .17 .15 .14 .13 Legally Intoxicated 9 .34 .28 .24 .21 .19 .17 .15 .14 10 .38 .31 .27 .23 .21 .19 .17 .16 Criminal Penalties

One drink is 1.5 oz. of 80 proof liquor, 12 oz. of beer, or 5 oz. of table wine

This chart is intended as a guide, not a guarantee. J (over) Alcohol Impairment Chart for Women

WOMEN Approximate Blood Alcohol Percentage

Drinks Body Weight In Pounds

.08 .07 .05 .04 .04 Driving Skills Significantly Affected 3 .15 .14 .11 .10 .09 .08 .07 .06 .06 4 .20 .18 .15 .13 .11 .10 .09 .08 .08 Possible Criminal Penalties 5 .25 .23 .19 .16 .14 .13 .11 .10 .09 6 .30 .27 .23 .19 .17 .15 .14 .12 .11 7 .35 .32 .27 .23 .20 .18 .16 .14 .13 Legally Intoxicated 8 .40 .36 .30 .26 .23 .20 .18 .17 .15 Criminal Penalties 9 .45 .41 .34 .29 .26 .23 .20 .19 .17 10 .51 .45 .38 .32 .28 .25 .23 .21 .19 One drink is 1.5 oz. of 80 proof liquor, 12 oz. of beer, or 5 oz. of table wine.

This chart Is intended as a guide, not a guarantee.

Impairment Begins With Your First Drink.

Never Drive After Drinking!

Information Provided by: National Clearinghouse for Alcohol & Drug lnfonnation Pennsylvania Liquor Control Board

AlcohollmpairmentChart (revised 062304) H!lv@ eli@nt~ t!lk.@out New Foundation 12 week Worksheet Lesson 1: (Page 27 in Client's Manual)

J Handout Symptoms and Phases of Alcoholism in Men (Jellinek Chart for Men)

Have you ever experienced: I Yes Prodromal Phase I. Increased tolerance (need to drink more to get the same effect)? □ 2. Temporary loss of memory (blackouts, times you couldn't remember what you did)? □ 3. Sneaking a drink when no one was looking? □ 4. Preoccupation with drinking (thinking about drinking while working, etc.)? □ 5. Hurried drinking ("chasing a high")? □ 6. A voiding talking about your drinking because it made you uncomfortable? □ 7. Loss of memory {can't remember thin_gs you said, what you were supposed to do)? □ Crucial (basic) Phase 8. Loss of control (unable to predict how much you'll drink)? □ 9. Justifying (making excuses for drinking)? □ I 0. Disapproval from others about your drinking? □ 11. Being extravagant with money? □ 12. Aggression (verbal or physical)? □ 13. Remorse (or guilt or depression about drinking)? □ 14. Periods of abstinence (times when you tried to stop drinking)? □ 15. Changes in your pattern of use (switching types or brands of alcohol)? □ 16. Losing friends (or having fights with them) on account of your drinking? D 17. Losing a job or getting into trouble at work on account of drinking? □ - 18. Giving up old hobbies or activities in order to spend time drinking? D 19. Having to get treatment of some form for your drinking? D 20. Feeling resentful a lot toward others? D 21. Escape (moving or changing friends in an effort to get a "fresh start")? D . .22• ....&otecting-¥nur..suppl~ ~(hid ing.a.stash of alcohol)?- . . . -· . . . □ . 23. Drinking in the morning (or before work)? D Chronic Phase 24. Drinking more or less continuously for at least 18 hours (a "binge")? □ 25. Doing things that violate your-own ethical or moral standards? □ 26. Inappropriate (or confused) thinking, such as hearing voices or not knowing where D you are? 27. Decreased tolerance (feeling and acting drunk after just one drink)? D 28. Vague fears or anxiety? □ 29. Tremors (shaky hands)? D 30. Feeling hooeless or suicidal? □

Source: Adapted from Jellinek, E. M. (1964). A chart of alcohol addiction and recovery. Journal ofthe Iowa Medical Society. March. as cited in N1ttional Institution on Alcohol Abuse and Alcoholism. ( I 995). Twelve-step facilitation therapy manual . (Volume I: Project MATCH Series). Rockville, MD: Author. Chart is reprinted with permission from the Journal of the Iowa Medical Society.

J 31 Symptoms and Phases of Alcoholism in Women Handout (Jellinek Chart for Women)

Have you ever experienced: I Yes Prodromal Phase 1. Increased tolerance (need to drink more to get the same effect? □ 2. Unwillingness to discuss drinking? □ 3. Feelings that women who drink excessively are worse than men? □ 4. Personality changes when drinking? □ 5. Drinking more just before your menstrual period? □ 6. Feeling more intelligent and capable when drinking? □ 7. Being "supersensitive"? □ Early Stage 8. Periods of abstinence (times when you've tried to stop drinking)? □ 9. Disapproval from others about your drinking? □ I 0. Rationalizing (making excuses for) drinking? □ l I. Temporary losses of memory (blackouts, times you couldn't remember what you did) □ when drinking? 12. Unexplained bruises or injuries? □ 13. Drinking before facing a new situation? □ Middle Stage 14. Neglecting eating? □ 15. Protecting your supply (hiding a "stash" of alcohol)? □ 16. Self-pity (feeling sorry for yourself)? □ 17. Feeling resentful toward others? □ 18. Being permissive or lax with your children because of guilty feelings about drinking? □ 19. Drinking to feel happier but finding yourself feeling more depressed? □ 20. Being told by others that you "couldn't be an alcoholic"? □ _2J__ '..'...Er.edrinkin~=-drinking..befor.e.a-dr.i.nking .occasion;.or-~postdr-inking~• --continuing □ to drink after a drinking occasion? 22. Feeling guilty about drinking? □ 23. Drinking more or less continuously for a period of at least 18 hours? □ Chronic Phase 24. Starting the day with a drink? □ 25. Tremors (shaky hands)? □ 26. Decreased tolerance (feeling and acting drunk after just one drink)? □ 27. Sneaking drinks? □ 28. Gulping drinks? □ 29. Persistent remorse? □ 30. Devaluing personal relationships? □ 31 . Carrying liquor in your purse? D Source: Adapted from James, J. E. (1975). Symptoms of alcoholism in women: A preliminary survey of AA members. Journal ofStudies on A /coho/ 36(11 ): 1564-1569, as cited in National Institution on Alcohol Abuse and Alcoholism. (1995). Twelve-step facilitation therapy mamial. (Volume I: PTQject MATCH Series). Rocl-.-ville, MD: Author. Reprinted with pennission from Journal ofSt udies on Alcohol, vol. 36, pp. 1564-1 569, 1975. Copyright hy Journal of Studies on Alcohol Inc. . Rutgers Center of Alcohol Studies, Piscataway, NJ 08854.

J 30 OCCASIC:ltaLAEUeF DRINKING

Addictionand Recovery ENUGMTENEDAND INTEReSTING- WAYOF ~OPENS~~~O TheJellinek Curve

DECREASEOF MIILITY TO 8TOP DRINMING'MIEN ona& DOSO

GRANDIOSEAND AGGRESSIVE IEHAVIOR

FAMILYANO fRIEND8 I NEW1NTSIESTS DEVEL.PP LOSS:=.!...,~-==.:.-:..APPREDA'TErPfORTS NA'MW.R!S1' NfO Sl!IP~ADJUSl"Ml:NT TO FAMI\.YNEEDS --M0NEY11ICIJIIID'\{---RrALISTIClfflf«ING 71. DUIIIETO f.SCAPEGOES REGUlARNOURISHMENT ,, / FfE.T1JPMOFSELF ESTEEM NEGLECTOF FOOD~ , LOSSo, ORDINARYW1.L POWER TAICEN DIMINISHINGFfARS OFlH! UNMN0WN FU1URE

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( - New Foundation 12 week Worksheet Lesson 1:

Substance Abuse

1. Yes No

2. Yes No

3. Yes No

4. Yes No

Substance Dependence/Addiction - 1. Yes No 2. Yes No

3. Yes No

4. Yes No

5. Yes No

6. Yes No

7. Yes No

27 No one can make another person stop doing something. The only times that any of us changes our habits is ifwe decide we want to change them. So, one of the goals of the New Foundation 12 week Program is to have each of you make a decision for yourself about whether your substance use is something you want to change. Because, unless you decide that you want to change what you've been doing up until now, nothing that anyone will say to you will make you change.

So, the first step is to see if you have a problem with drugs or alcohol or you don't. I'm going to begin by telling you about how we figure out if someone has a substance use problem.

Think about the substance that you have used the most. It could be alcohol, marijuana, crack, meth, prescription drugs that you're taking to get high, or any other drugs.

In order to say that someone has a problem with substance abuse, we look for several things. On your paper, it says abuse, and then the numbers I through 4. I'll read you what those are, and I want you to put a check mark by the ones that apply to you. When you give your answers, don't talk about now, while you're in jail. Think about before you were in jail. And, be honest. We can only be helpful to you if you're honest with us.

Abuse- (1) Repeatedly failing to fulfill major obligations at work or school (a) Can include repeated absences from work or poor work performance (b) Can include substance-related absences, suspensions or expulsions from school ( c) Can include neglect of children or household (2) Repeatedly using the substance when it could be physically dangerous to yourself or other people (a) Can include driving an automobile or operating a machine while high (3) Repeated substance-related legal problems (a) Can include arrests for substance-related disorderly conduct (4) Continued substance use despite repeated problems in relationships (a) Can include arguments with spouse and physical fights

You meet the definition of substance abuse if you had any of those four.

J Now, let's discuss the definition of substance dependence. That one is more serious than substance abuse. It's the same thing as the term addiction. Addiction = Substance Dependence On your handout, you'll see the words Substance Dependence/Addiction, and then the numbers I through 7. Again, be honest. And again, we're looking at your behavior before you were in jail. Group leader: simplify terminology and give more examples when going through the following: (I) Tolerance (a) Defined by either of the following: (i) You need a lot more of the substance to feel the way you used to when you used a lot less (ii) Using your usual amount gets you much less high (2) Withdrawal - symptoms that may occur when a person who has been drinking too much of a substance every day suddenly stops using that substance or significantly decreases their use (a) Defined by either of the following: (i) The development of a pattern of symptoms due to stopping ( or reducing) substance use that has been heavy and prolonged (ii) The same substance or a closely related substance is taken to relieve or avoid the withdrawal symptoms (b) Note that the specific withdrawal symptoms vary between substances (3) The substance is often taken in larger amounts or over a longer period than was intended (4) You've tried to stop using but you couldn't (5) A great deal of time is spent in activities necessary to obtain the substance, or recover from its effects (a) Visiting multiple doctors, driving long distances (b) Binge using (6) Important social, occupational, or recreational activities are given up or reduced because of substance use (7) The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (a) E.g. Current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption (b) E.g. other people have talked to you about your alcohol or drug use J If you had 3 or more of those, you are considered to be dependent on or addicted to substances. Group discussion about results. Assign Homework (Page 31 in Client's Manual)

J - 2. Is there a problem?

Do New member paperwork, if any new members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Introductions: Have clients introduce themselves, saying first name only, what legal charges are, and how drug or alcohol use was related to that. Why do you think you were recommended to complete this program, even if your charge wasn't a drug or alcohol charge? Do Midpoint paperwork, if any group members are at their 9th week (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Do Graduation paperwork, if any graduating members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Complete Tracking Form, including whether attended AA Do Group check-in Briefly review homework from Lesson 1 (Page 31 in Client's Manual)

GO TO NEXT PAGE -

ongratula-tions on deciding to expl re chemical abuse and ?,i ~~ ,, ,;" addiction. If ~r~ reading this book, u probably have many ' ,_ ,_ , questions cancer~ alcohol and other d use. Many people first become concerned about their alcohol or other drug use or that of another person because of some negative consequence. Legal difficulties resulting from driving while intoxicated, assault, or domestic violence may bring attention to a chemical problem. Loss of employment or broken relationships may also lead us or others to question our use of chemicals. Frequently a family member, friend, or employer may say something about the amount of our drinking or drugging. These are signs for us to take a closer look at our chemical use.

<< 1 >> STOP THE CHAOS

Alcohol and other drug use is part of·our culture. Many people in the United States use alcohol or other drugs socially. Many others don't use alcohol or other drugs at all. They just don't seem interested. In the United States 1. about one-third of the population abstains from (does not use) alcohol and other drugs; I We;JS 2. about one-third uses occasionally on a social basis;

Example 1. College fraternity members may drink heavily on Can / Take It or Leave It? a regular basis .. A keg in the Some of us question whether we really have a problem with alcohol frat house may be customary. and other drugs or are just "social users." Social users rarely have con These members frequently become intoxicated and rowdy. sequences associated with alcohol or other drug use. They have little They may be labeled as "real desire to use alcohol or other drugs to intoxication. They may say, "Oh, drunks. " They may even have I hate that feeling of being out of control." They may leave a drink half some consequences from their finished. Their lives do not revolve around chemical use. The people chemical use. Yet, when they they associate with are unlikely to be heavy abusers or addicts. Alcohol graduate from college, they get and other drugs simply are not an issue in their lives. married, have children, and stop or moderate their use at drugs or alcohol.

<< 2 >> AM I AN ADDICT OR ALCOHOLIC?

Not All "Drunks" Are Alcoholics

Not all people with alcohol or other drug problems are alcoholics or addicts. Some people may consume large amounts of drugs or alcohol, appear intoxicated on many occasions, but may not be dependent on Example 2. Ben spent his weekends smoking marijuana. those chemicals. They lack the spiritual, emotional, psychological, or He seemed to see few of his old physical dependence associated with addiction. friends. On several occasions, his wife had made plans for ~ [see example 1J the family, but Ben never felt Everyone has heard of people who drank, drugged, or smoked like participating. He missed cigarettes excessively and then one day, out of the clear blue, decided out on his children 's school to stop. They seemed to have no problem quitting. For them, quitting and athletic activities. Ben's was a matter of willpower and determination. These people hadn't wife told him he seemed to prefer "a joint" to his family. crossed the line into addiction. Ben shrugged his shoulders and Chemical abusers are just that-people who use chemicals in an thought, "No wonder I smoke abusive manner. If abusers start to experience negative consequences with all the complaining because of their chemical use, they can decide to moderate or stop. around here." Programs are available to help them make those decisions. Example 3. Brenda's mother There are ways to help us determine whether we're abusing _chemi commented that Brenda seemed cals. One important way is to listen to what others say to us about our to be drinking a lot more now alcohol and other drug use. Often, those close to us see our situation than she had previously. Brenda more clearly than we do. said there was a lot more stress in her life now and she needed [see examples 2 and 3} ~ to relax. She believed her mother wasn't being sympathetic to her problems.

Check the appropriate box in response to the question. If you answer yes to any of the questions, consider taking a close look at your chemical use.

YES NO i ·(v e- ( 0~-1.\ _v 1. Has a friend or family member expressed concern about your use? I I I va -.\" 2. Has your social life changed or have you switched friends? I I I a~~ l 3. Have you experienced a negative consequence from your use? \tJ\.. /\0 -- Legal? 'Emotional? Physical? I 4. Do you find that your behavior changes when you use chemicals? I

J 5. Are you using chemicals to become more outgoing or to overcome fears? I

6. Do you go against your values or morals when you use alcohol or other drugs? I STOP THE CHAOS ·-ri"l \u et d:J t( ,(\+tlJ

We need to take some time to consider the serious and life-changing consequences of continuing to abuse chemicals. Abuse, left unchecked, could progress into addiction. We can decide to HRl!.t at:ti=OT stop our chemical use. It becomes our choice. We @tift go€ help b:, se~g.:a c-b.emwa.h,ab~:tl •~Gi~e-~ -~PJHg p@ople moderate theil--aloohol and drug nse.--

Crossing the Line into Addiction Addiction is a complex disease with psychological, environmental, social, spiritual, and physiological components. How do we know if we have crossed the line into addiction? Do we identify with having prob lems with alcohol or other drugs? Remember this important point: We don't willingly choose to be addicted. Most people don't want that label or the lifestyle. Because of the stigma, we're not anxious to admit to having any kind of problem with drugs or alcohol. Addiction knows no age or gender restrictions. Rich or poor, old or young, regardless of intelligence level, everyone is susceptible. Many alcoholics and addicts started out as social users. They progressed to abusive users. Their level of abuse increased. Somewhere along the way they "crossed the line" into addiction. Some became addicted early into their use, perhaps almost immediately. Others used for years before experiencing problems. They wonder how they could have used for so long without consequences and then suddenly spiraled downward. Where are we along that sequence? Have we tried to convince ourselves that we are social users? Do we really have a problem with alcohol or other drugs? There is no laboratory test for addiction . We look instead at our behavior and thinking. If we are concerned about addiction, we need J to be rigorously honest .

<< 4 '>'> We're going to again take a look at how much you have been using alcohol or other drugs.

Have clients take out Sober Success Worksheet Lesson 2: f ~ C /~ /:: On your paper, you see numbers 1 through 12. Please answer each of these questions as -r{/ C/fl VIA./ honestly as possible. C, G (\ s <:: t V\ ·({\ '-t )" \\ F ,('{) ~ s \It \:, s--f-Cf{\ ~ <.A .t{__

YES NO

1. Have other people talked to you about your alcohol and other drug use?

2. Have you experienced legal, work, family, or relationship problems because of your use?

3. Have you quit using for a month or a week to prove you could and then started again?

4. Does it seem that you need more or use more chemicals now than you used to?

- 5. Have you ever experienced a loss of memory while using? For example, maybe you can't remember driving home after drinking or what you said or did at a party.

6. Do you spend a lot of time thinking about using drugs or alcohol during the day?

7. Have you tried to stop using but couldn't?

8. Have you lied to others a~out your drinking or drugging or tried to hide your use? "'

9. Have you ever regretted what you've done while using?

10. Have you started to withdraw from others to protect your chemical use?

11. Do you use drugs or alcohol to cope with life?

12. Has your chemical use ever put yourself or others in danger?

Answering yes to three or more of the questions in exercise lb indicate that you are addicted to chemirqls. · J

- /Y1 /'/7 r"l 1./7 £\. / We're going to again take a look at how much you have been using alcohol or other drugs.

Have clients take out New Foundation 12 week Worksheet Lesson 2: (Page 32 in Client's Manual)

On your paper, you see numbers 1 through 12. Please answer each of these questions as honestly as possible.

J - New Foundation 12 week Worksheet Lesson 2: Consequences of my substance use

1. Yes No

2. Yes No

3. Yes No

4. Yes No

5. Yes No

6. Yes No

7. Yes No

8. Yes No

9. Yes No

10. Yes No

11. Yes No

12. Yes No

J ' 32 - 3. Common Traits of Substance Addiction

Do New member paperwork, if any new members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Introductions: Have clients introduce themselves, saying first name only, what legal charges are, and how drug or alcohol use was related to that. Why do you think you were recommended to complete this program, even if your charge wasn't a drug or alcohol charge? Do Midpoint paperwork, if any gr9up members are at their 9th week (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Do Graduation paperwork, if any graduating members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Complete Tracking Form, including whether attended AA Do Group check-in Briefly review homework from Lesson 2 (Page 33 in Client's Manual) - GOTO NEXT PAGE

J :I t j STOP THE CHAOS

- · In talking t'o.? professional, we need to be rigo ously honest about our alcohol and of r drug use. If we try to minimiz ur use or deny our consequences, we y hurt ourselves. Professional ave talked to many people like us; ey are there to help, not to cri · ize or judge. They themselves may be · recovery from drugs and alco ol and truly understand what we are go through.

Common Traits of Addiction Addiction has three main characteristics: loss of control, denial, and preoccupation.

Loss of Control Those of us addicted to mood-altering chemicals don't have the luxury of making a choice about our chemical use. The biggest difference between abuse and dependency is that, as alcoholics and addicts, we have lost the ability to control our chemical use. We say that we are powerless over alcohol and other drugs. Powerlessness means being unable to predict or to control when we use or how much we may use at any given time. • We cannot foresee the outcome when we start to use drugs or alcohol. • We cannot predict how much we will use. A pledge to just "stop for a minute at the local bar" or to just "have a couple" turns into an entire night of drinking or drugging. • We find ourselves needing to use more and more-a condition called tolerance. • We have vowed to quit our use on several occasions but have been able to stop only for a short period or not at all. We tell ourselves that if we can stop for three months, we are not an addict or alcoholic. If we accomplish our goal, we immediately go back to drinking or drugging. • We find that when we drink or drug, our behavior becomes unpredictable. We may violate our social or moral values. We do things that we would not consider doing while sober.

<< 6 >> AM I AN ADDICT OR ALCOHOLIC?

Denial A major obstacle to recognizing our addiction is denial. We tend to minimize or deny the effect our dependency has on others or ourselves. We minimize or lie about the amount of our chemical use. This behavi(?r allows us to protect and continue our alcohol and other drug use while preventing us from looking at the seriousness of our problem. We make excuses, explain away consequences, or blame others for our chemical use. We end up being the last to know how severe our alcohol and other drug use has become. Denial can be

1. refusing to accept that we're alcoholics and addicts. We still Example 4. "I've been stopped see chemical use as an option. for DUI on three occasions, but 2. minimizing the severity of our dependency and what we need I hod a good lawyer each time. " Raoul may have had o good to do to stop our use. We try to control our use. lawyer; but he does not face the 3. ignoring the problems we've created because of our use. fact that he is drinking to intoxi 4. focusing on other people's faults rather than on our own. cation and driving. He thinks if 5. refusing to acknowledge people, situations, and events that he "beats the rap, " he can con• tinue his dangerous behavior. cause us stress. We may deny the need to take action to resolve He denies that his drinlcing is a - problems. problem because he hos avoided 6. b~Jieving that we can live with some dishonesty in our lives. legal consequences. Secrets or lying by keeping silent become habits for addicts and-aleoholics-:-· ------·· - ·--·- - - - ·--- --·--·--- -···-txamp1~·s:·"SfJre~Thave a - drink once in a while, but I never [see :examples 4 and SJ iGF' have more than a couple drinks and never during the week. " Raoul and Susan each have a belief system that minimizes or In reality, Susan is frightened and being dishonest. She drinks denies the real scope of their alcohol and other drug use. Addiction almost every day and her to is progressive. If these individuals do not get help, they will begin amount is rising rapidly. She suffer severe consequences. Yet, their denial holds them captive. They tries to act normal when her may have to suffer major consequences before acknowledging they children come home from school. have a problem. Denial prevents us from taking an honest look at She worries that if her husband _ our probl~ms with drugs and alcohol. or family finds ou~ she might end up divo~ed and separated from her children. She's thinking that because she cannot seem to quit, there is something morally wrong with her. Her refusal to acknowledge the problem is based on fear.

J STOP THE CHAOS

Preoccupation Another factor in addiction is the preoccupation that alcoholics and addicts have with their chemicals. Preoccupation means that we spend a great deal of time ~ticipating, planning, and protecting our chemical use. Thoughts of using fill our minds constantly. Example 6. At work, Woody found himself concentrating Anticipation of pleasure is combined with the fear that somehow on going to the bar for happy our plans will go astray. How, when, and where can I use next? How hour that day. His boss had can I avoid trouble? Do I have enough of my drug of choice or should I commented on his lock of focus be getting more? This type of thjnlcing illustrates what our priorities on his work: Woody was count• really are. Our performance on the job or our interactions with friends ing the hours. He thought about but don't want anything to interfere with our use of how long it would be before he may suffer, we could drink again. As the a~er alcohol or other drugs. Chemicals take priority over our families and noon went on, his anxiety grew. our health. Our drug and alcohol use come first. He projected how exciting this ~ [see examples 6 and 7) evening would be. He could hardly wait to leave the office Preoccupation includes obsessing and planning our chemical use and rush to his car. while attempting to protect our next "high." We want to make sure that we're able to do what we want to do when we want to do it. - Example 7. Betsy knew that her roommate was leavirig for the weekend. It was the perfect Not Every Alcoholic Is a Falling-Down Drunk ------opporfiin7ffroil!e-dremicals-·------..--~ ___ . . . h . . Sh h d Some of us concluaetbat we-can'tbe-an--aleoholie-a'l"--addict.. becau.s.e wit out mterrupt,on. e a spent a week planning for this we don't believe we have had any consequences of our chemical use. time. She had made sure to We don't seem to fit our own image of what an alcoholic or addict is. have enough cocaine. She had • We may hold responsible jobs. We may even be quite successful. hidden her drugs with care so work. her roommate wouldn't find • We always show up for them. She had lied to several • We are well liked by other employees. friends about her plans for the • We have no legal problems. ("I can't be an alcoholic! I've never weekend so she could be alone. had a DUI.") Betsy tingled with anticipation • We say, ~I never drink before noon." as she said good-bye to her roommate. The above statements are typical of functional alcoholics or addicts. If we are functional alcoholics or addicts, we are able to get along in society while continuing addictive use of chemicals. We have not yet experienced the heavy consequences of our use. We are on borrowed time. The progression of our illness will ultimately bring us down. Some of us drink or drug periodically. We abstain for various amounts of time and then go out on a "binge." When we start our use, J we experience loss of control. We drink or drug for the purpose of intoxication. We cannot predict the outcome of our use, and we may • AM I AN ADDICT OR ALCOHOLIC?

suffer consequences frequently. We may say, "I can't be an alcoholic; I don't drink every day." Nevertheless, we are truly addicted. Not all of us l..ook like the stereotypical addict or alcoholic. Whether we're chronic users with severe lifestyle consequences, binge users who plan our using experiences, or functional alcoholics or addicts whose friends and co-workers may be unaware of our using, the same principles apply. We all have the terminal, progressive illness of addiction. Our consequences will become increasingly more severe and our emotional, spiritual, and physical health will deteriorate. We will not be able to regain the ability to drink or drug normally again. We cannot overcome our addiction by ourselves. Willpower and strength of character will not play a role. We have lost control of our chemical use. We have become powerless over our addiction.

-----·------· ------

)i ,n c /1 f(l f 'J- 4. Why does addiction occur?

Do New member paperwork, if any new members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Introductions: Have clients introduce themselves, saying first name only, what legal charges are, and how drug or alcohol use was related to that. Why do you think you were recommended to complete this program, even if your charge wasn't a drug or alcohol charge? Do Midpoint paperwork, if any group members are at their 9th week (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Do Graduation paperwork, if any graduating members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Complete Tracking Form, including whether attended AA Do Group check-in Briefly review homework from Lesson 3 (Page 34 in Client's Manual)

GO TO NEXT PAGE l

'-la V ) ~ 0 n- [ "> i- l r"'. -n ---n,-·

I ~, • ~: ~.:,: ~ c9epting that we're dependent on drugs or alcohol is hard.

1 • ~;~-',•,·,.., We find we don't fit our idea of an addict or alcoholic. Old :,~ • !_, family values, cultural beliefs, movies, and television shows have given us inaccurate pictures of alcoholics or addicts. These images have influenced our thinking. We may see people who are chemically dependent as losers or failures, or as people in the gutter of life, which is certainly not the way we want people to see us.

<< 11 >> .,, ...... ·- ...... ·""',_,~

Dispelling Old Myths The terms addiction, addict, and alcoholic carry a stigma, or feeling c shame. Many people believe that 1. addiction is a weakness (if we were just morally or emotionally stronger, we could "licit" this problem); 2. we should he able to stop using on our own; 3. we just don't have enough willpower (if we were more disciplined, we'd be able to drink or drug in moderation). Don't buy into these myths. People who've never encountered the true nature of addiction can't conceive of what we're going through. They've never experienced the inability to stop chemical use. They jq.st don't understand. The response of our loved ones and close friends can be particularly hurtful. We may see our addiction as unfair. No one ever said to us, "Hey you! Stand in this line if you'd like to become addicted to alcohol or drugs and ruin your life." We weren't given that choice. We ask, "How did I end up this way? Why am I the one who has to be like this?" We see dependency as a curse in which we had no say. Somehow, we became dependent-but bow? To answer these questions, we need to understand the addiction process. Its origin is deeper than poor control of our ~pulses.______...... __ .. _ .... ··-·· --·····-----·• How Did I Get Addicted? Addiction to drugs or alcohol is a complex illness. It is progressive and can be life threatening. 1n addition, it has social, physiological, and psycho]ogica] com,ponents. Several factors increase the risk for addiction. • Drug availability. The more available drugs and alcohol are, the more likely we are to take them. Even if mood-altering chemicals aren't readily available, we'll find them if we really want them. • Purity and route of administration. The purity of the drug and the route of administration (how we take it) determine the level of euphoria and how quickly we can reach it. Chemicals that give us a quick and powerful high .are more likely to be rapidly addicting. Purity of.the drug includes t~e amount of alcohol -- (proof) in a beverage.

... ; .. •.;. •-· .. << 12 >> WHAT IS CHEMICAL ADDICTION?

,-. Inhaling and injecting quickly transmit the chemical to the brain, producing almost instant euphoria. Swallowing drugs and drinking are slower to produce the high. The quicker the eupho ria, the more likely we are to repeat our drinking and drugging.

• Dose, frequency, and duration of use. This factor has to do with the amount of drugs we take, how often we do them, and over what length of time. Some drugs are more quickly addicting than others. While we may avoid the quick dependency to crack cocaine, using alcohol and other drugs over a sustained period can lead to addiction. • Genetic factors. Certain groups of people and certain families seem to have higher levels of addiction than others. In some families almost all members may be chemically dependent. Genetic makeup seems to influence susceptibility to addiction. • Developmental factors. As we grow up, we develop our own attitudes about drug and alcohol use by observing chemical use in our families, in society, and in our peer groups. • Mental health disord.er.s or chronic pain. Those of us afflicted with certain mental health conditions have a higher rate of J · addiction than the ~eneral population. People who have chronic -- --- :pain-may-abuse -pain-medications-in an--effort-t.o-i'eel-better-and-- - may .eventually become addict.ed to these medications. • Psychosocial factors. When people have meaningful alternatives to chemical use, the incidence of abuse and addiction is lower. Having sober places to socialize and a variety of drug-free entertainment options seem particularly important for teens and preteens. You hive No/DEA The .Brain Chemistry of Addictio~ oftlJe mf.sferir:s - When we put mood-altering drugs (which includes alcohol) into our I Ao/J. bodies, our bloodstream quickly carries these intoxicating chemicals to our brains. In the brain, drugs set off complex chemical reactions and activities that can distort our sense of reality. We know this altered state as being intoxicated, or getting "high." Some of us find this feeling pleasurable and worth repeating. Other people find getting high an unpleasant experience and, as a result, will seldom use alcohol and other drugs. r I •

Addiction is not about willpower or weakness. Research has shown that the addiction process is connected to how our brains are "wire~ " 1 I' Powerful chemicals called neurotransmitters control brain activitieb. These neurotransmitters carry messages from one brain neuron to another. The levels of these neurotransmitters can vary depending on how much and how often we use alcohol and other drugs.

Figure 1: The Brain

The cerebrum is the thinking area of the brain: NI know I will never take another drink or drug. I know I'm strong enough to be around

drugs or alcohol. H

The brain stem, or pr;11'\J~. brain, is home to the limbic ·- - -·system ano is the automatic .. --- --·------area of the brain. The limbic system contains the compo nents of our addictive natun

The process of addiction takes place in the limbic system, which is located in the brain stem (see figure 1). The limbic system stimulates our sense of smell, motivation, sex drive, and complex -emotional responses. It also plays a role in regulating basic bodily functions and other actions that are automatic-actions that occur without thought. The automatic nature of the limbic system sets up the addiction process. Let's look at the following: the pleasure center, automatic recall of emotions and memories, and thinking versus the limbic system.

<< 14 >> WHAT IS CHEMICAL ADDICTION?

The Pleasure Center To understand addiction, we need to understand the pleasure center. Located in the limbic system, the pleasure center responds to p1easurable stimulation and 1earns to repeat it. Neurotransmitters, including endorphins and dopamine, activate the pleasure ~enter. Alcohol and other drugs increase the activity of neurotransmitters, resulting in the high-our feelings of euphoria. As shown in figure 2, we set up a cycle.

Figure 2: The Pleasure Center Cycle

.,.

------

_- We learn to repeat this pattern. If some is good, more must be better. As we continue using our chemicals, our desire to repeat this pattern develops into a need to repeat the pattern. Our bodies become accustomed to having drugs and alcohol present. Our brains stop producing neurotransmitters on .their own; they come to rely on alcohol and other drugs to produce the "feel-good" chemicals. Without our drugs, we feel lower than low. ·Our brains are waiting for the drugs and a1coho1 to do the work, and we're waiting for our brains to do their job. Our bodies are out of balance. We experience cravings for our chemicals as we go through psychological and physi cal withdrawal. Our need to use alcoho1 and other drugs becomes - more powerful than our thinking processes that say we shouldn't. I STOP THE CHAOS I l - Crossing the Line into Addiction We may have heard others say that·they ~ank or drugged for years without harmful consequences of their use. Then one day they somehow "crossed over the line"-they became unable to control their chemical use. Crossing the line is when our brains adapt to our chemical use and override our rational, or reasonable, thought processes. The chemical use-reward sequence that leads to the euphoria in the pleasure center becomes "hardwired," or imprinted, into our brains. Once this occurs, normal drinking and social drug use are impossible. We've crossed the line into addiction. We're no longer able to control our use.

Cross-Addiction People who are chemically dependent do not crave particular drugs, but rather they crave the euphoria that a drug produces. While each of us may have our favorite drug, we're actually addicted t.o the feeling of intoxication. This means that we can become easily addicted to any mood-altering drug. If we find ourselves addicted t.o one chemical, we will not be able to replace it with controlled use of another chemical. ..-.. Example 8. Elaine had been in a When we decide to stop using, we must decide t.o stop using a/.l mood .chemical dependency treatment altering chemicals. center for addiction to cocaine. She had never experienced con ~ [see example BJ sequences from alcohol use so, after she got out of treatment, Elaine found that she was susceptible to other mood-altering - she began to drink periodically. drugs. It would not be unusual to learn that alcohol use led Elaine Within a short amount of time, back to her ~ of choice-cocaine. Chemicals lower our inhibiti~ns. she noticed that her drinking One of our inhibitions is to avoid our drug of choice. had escalated. She soon found that she could not control her Progression alcohol use. Elaine recognized that she had now become Addition is ~ progressive, terminal disease. Left unchecked our dependent on alcohol. addiction can take our lives-either through accident or from physical complication5. AB we start to look at our drug and alcohol use, we believe it's unlikely that we could ever get that bad. What we may overlook is the progressive nature of our illness. Our alcohol and drug use becomes progressively worse over time. As we build up· a tolerance to alcohol and drugs, we have to use more chemicals to get our high. The higher the level of toxic mood-altering chemicals in our body, - the more damage that is done to our organs and nervous system. Our liver, for example, has a harder time detoxifying our chemicals. We no longer function in a normal manner. Our health starts to deteriorate. I·· WHAT IS CHEMICAL ADDICTION?

Though we try to control our use, our consumption rises. Even if we stop using for a period, we quickly end up back where we left off. Some of us who return to using find we're worse off than when we stopped. It's as if the disease kept progressing even though we had stopped our using. Progression makes our addiction that much more dangerous.

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-- 5. Negative effects of alcohol and drugs.

Do New member paperwork, if any new members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Introductions: Have clients introduce themselves, saying first name only, what legal charges are, and how drug or alcohol use was related to that. Why do you think you were recommended to complete this program, even if your charge wasn't a drug or alcohol charge? Do Midpoint paperwork, if any group members are at their 9th week (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Do Graduation paperwork, if any graduating members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Complete Tracking Form, including whether attended AA Do Group check-in Briefly review homework from Lesson 4 (Page 35 in Client's Manual)

Alcohol

- • Alcohol use impairs judgment • Alcohol can produce noticeable impairment in memory after only a few drinks and, as the amount of alcohol increases, so does the degree of impairment. • "Have you ever awoken after a night of drinking not able to remember things that you did or places that you went?" That's called a blackout. Blackouts come from drinking too much and too quickly, especially on an empty stomach. They are dangerous because people do things in blackouts that are potentially dangerous. • Drinking during pregnancy can lead to a range of physical, learning, and behavioral effects in the developing brain, the most serious of which is a collection of symptoms known as fetal alcohol syndrome (FAS). Discuss if group is interested. Children with FAS may have distinct facial features (skin folds at the comer of the eyes, low nasal bridge, short nose, indistinct philtrum - the groove between the upper lip and the nose, small head circumference, small eye opening, small midface, thin upper lip). FAS infants also are markedly smaller than average. Their brains may have less volume (i.e., microencephaly). And they may have fewer numbers of brain cells (i.e., neurons) or fewer neurons that are able to function correctly, leading to long-term problems in learning and behavior. • Alcohol can damage every organ in the body, including the brain • Brain damage is a common and potentially severe consequence of long-term, heavy alcohol use. Alcohol causes the brain to shrink. • A person who drinks heavily over a long period of time may have brain deficits that persist well after he or she achieves sobriety. • A small but significant number of the heaviest drinkers may develop devastating, irreversible brain-damage syndromes, such as Wemicke-Korsakoff syndrome, a disorder in which the patient is incapable of remembering new information for more than a few seconds. • Most people realize that heavy, long-term drinking can damage the liver, the organ chiefly responsible for breaking down alcohol into harmless byproducts and clearing it from the body. But people may not be aware that prolonged liver dysfunction, such as liver cirrhosis resulting from excessive alcohol consumption, can harm the brain, leading to a serious and potentially fatal brain disorder known as hepatic encephalopathy • Alcoholic cardiomyopathy is a disorder in which drinking too much alcohol over a long period of time weakens the heart muscle so that it cannot pump blood efficiently. This can lead to heart failure. • The good news is that most alcoholics with cognitive impairment show at least some improvement in brain structure and functioning within a year of abstinence, though some people take much longer

Alcohol Withdrawal - Causes, incidence, and risk factors

Alcohol withdrawal usually occurs in adults, but it may happen in teenagers or children as well. It can occur when a person who uses alcohol excessively suddenly stops drinking alcohol. The withdrawal usually occurs within 5 - l Ohours after the last drink, but it may occur up to 7 - 10 days later.

Excessive alcohol use is generally considered the equivalent of 2 - 6 pints of beer (or 4 oz. of "hard" alcohol) per day for 1 week, or habitual use of alcohol that disrupts a person's life and routines.

The more heavily a person had been drinking every day, the more likely that person will develop alcohol withdrawal symptoms when they stop. The likelihood of developing severe withdrawal symptoms also increases if a person has other medical problems.

Symptoms

Mild-to-moderate psychological symptoms:

• Jumpiness or nervousness • Shakiness • Anxiety • Irritability or easy excitability • Rapid emotional changes • Depression • Fatigue • Difficulty thinking clearly • Bad dreams

Mild-to-moderate physical symptoms:

• Headache -- general, pulsating - • Sweating -- especially the palms of the hands or the face • Nausea and vomiting • Loss of appetite • Insomnia (sleeping difficulty) • Pallor • Rapid heart rate • Eye pupils enlarged(dilated pupils) • Clammy skin • Tremor of the hands • Involuntary, abnormal movements of the eyelids

Severe symptoms:

• Delirium tremens- DT's -- a state of confusion and visual hallucinations • Agitation • Fever • Convulsions/seizures • Death

Marijuana = Cannabis/Weed

• Marijuana may cause impaired short-term memory, a shortened attention span and delayed reflexes. • During pregnancy, marijuana may cause birth defects. • Marijuana may cause a fast heart rate and pulse. • Repeated use of marijuana may cause breathing problems. • Marijuana may cause relaxed inhibitions, disoriented behavior. • The parts of the brain that control emotions, memory, and judgment are affected by marijuana • Blocks information from entering into long-term memory • Weakens problem solving ability • The effect on the lungs is the same or worse than tobacco, since marijuana smokers inhale more deeply and hold smoke in lungs longer

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J Marijuana withdrawal symptoms. Insomnia, anxiety, - iritability, headache... 89

By recovering addict

Marijauna

Marijuana is not heroin ... but neither is it the same marijuana that it was 20 or even 1O years ago, and as the potency has risen almost 1O fold over the decades, so to have the risks of addiction, the risks of developing a tolerance and experiencing withdrawal symptoms with marijuana cessation.

Marijuana detox and withdrawal is not dangerous but it can be very uncomfortable, and it can be difficult to overcome the cravings back to use and abuse. Many people can t:1se marijuana recreationally without developing dependency issues, but many hundreds of thousands cannot, and it is not at all ridiculous to seek professional assistance if you are having difficulty overcoming an addiction to marijuana.

The risks of marijuana addiction

Long term marijuana use can have a negative effect on health and well being. Marijuana use promotes cancer, and it also increases the probability of experiencing certain psychiatric conditions such as anxiety, psychosis and depression. It is also linked to memory loss and cognitive deficits, as well as a sense of lethargy that can pervade all waking hours.

Marijuana use, even heavy marijuana use is very unlikely to kill you; but it can lessen your quality of life, make you a little bit duller, and increase the risks of psychological deficits. If you are using marijuana everyday, you may want to seriously consider taking a break from regular intoxication.

Marijuana withdrawal symptoms

Withdrawal symptoms to marijuana can be somewhat characterized ·as the opposite to the intoxicating effects of the drug ... instead of hunger, a loss of appetite, and instead of drowsiness, an inability to sleep.

Some additional symptoms of marijuana withdrawal can include headache, nausea, anxiety (common) paranoia and even irritability or aggression.

These sensations will endure with some intensity for several days before gradually. subsidi~g, and it is during this period that the cravings to use are strongest, and there is the greatest risk of re apse.

httn://huhnaizes.com/hub/Mariiuana-withdrawal-svmntoms-Tnsomnia--anxietv--iritabilitv-... 04/07/2009 Cocaine:

• Cocaine use may cause severe mood swings and irritability. • You need more and more cocaine each time you want a "high." • Cocaine increases your blood pressure and heart rate - particularly dangerous if you have a heart condition. • One use can cause death! • Both powder and crack are extremely addictive stimulants • Causes feelings of paranoia • Causes anxiety • Reduces ability to feel pleasure • Cocaine withdrawal can include fatigue, vivid and unpleasant dreams, increased appetite, etc. • Cocaine overdose can cause seizures, heart attack, stroke

Crack

Also known as: Crack, "Crack cocaine", Freebase rocks, Rock - You probably know why crack is abused - • Quick high • Power • Euphoria

But did you know that -

• Crack is almost instantly addictive. • One use could cause a fatal heart attack. • Repeated use may cause insomnia, hallucinations, seizures, paranoia. • The euphoric effects of crack last only a few minutes. • There are more hospitalizations per year resulting from crack and cocaine use than any other illicit substance.

Group Leader: Pick and choose among the following substances depending on the substance use history of the group members

Stimulants Amphetamines- e.g. Ritalin, inhalants (We'll discuss meth below)

You probably know why stimulants are abused-

• Increase alertness • Euphoria J • Relieve fatigue • Feel stronger

But did you know that -

• Withdrawal from stimulants can cause apathy, irritability, depression, disorientation, long periods of sleep • Symptoms of overdose include agitation, increase in body temperature, hallucinations, convulsions, death

Methamphetamine

Also known as: Crystal Meth, Crank, Meth, Ice

You probably know why meth is abused-

• Temporary mood elevation • Exhilaration (high) • Increased mental alertness • It's an upper and increases wakefulness

But did you know that -

• Meth is extremely addictive - sometimes with just one use! • Meth causes many of the same physiological effects as cocaine, but with much slower metabolic elimination from the body than cocaine • Meth can cause convulsions, heart irregularities, high blood pressure, depression, restlessness, tremors, severe fatigue. • An overdose can cause coma and death • When you stop using meth you may experience a deep depression. • Meth causes a very jittery high, along with anxiety, insomnia, sometimes paranoia.

Narcotics Heroin, methodone, oxycontin, vicodin, opium, morphine, codeine.

You probably know why narcotics are abused -

• Immediate "rush" • Feeling of euphoria • Relieve pain

But did you know that - - • Very high potential for abuse • Narcotics withdrawal can include watery eyes, mnny nose, yawning, cramps, loss of appetite, irritability, nausea, tremors, panic, chills, sweating. • Symptoms of overdose include slow, shallow breathing, clammy skin, convulsions, coma and possible death

Inhalants

Butyl nitrite, Amyl nitrite (Gas in aerosol cans), Gasoline and Toluene vapors (Correction fluid, glue, marking pens)

You probably know why inhalants are abused -

• Cheap High • Quick buzz • Fun

But did you know that inhalants may cause -

• Loss of muscle control • Slurred speech • Drowsiness or loss of consciousness • Excessive secretions from the nose and watery eyes • Brain damage and damage to.lung cells

Hallucinogens

Types:

• MDMA = Ecstacy • LSD (Acid, Red/Green Dragon) • PCP (Angel Dust, Loveboat) • Mescaline • Psilocybin - Magic Mushrooms

You probably know why hallucinogens are abused -

• Fun feeling for the user: changes in perception of time, smell, touch, etc. • Stimulation or depression • Behavioral changes

But did you know that

• Rapidly changing feelings, immediately and long after use • Chronic use may cause persistent problems, depression, violent behavior, anxiety, distorted perception of time • Large doses may cause convulsions, coma, heart/lung failure, ruptured blood vessels in - the brain • Can lead to increased heart rate, blood pressure and blood sugar • May cause hallucinations, illusions, dizziness, confusion, suspicion, anxiety, loss of control • Delayed effects - "flashbacks" may occur long after use • Designer drugs (e.g. Ecstasy)- one use may cause irreversible brain damage • A single exposure to MDMA (Ecstasy) at high does or prolonged use at low doses destroys up to 50% of the brain cells that use dopamine (a neurotransmitter or chemical compound that occurs in the brain) • Many hallucinogens cause unpleasant and potentially dangerous "flashbacks," long after the drug was used. • With aging or exposure to other toxic agents, symptoms similar to Parkinson ' s disease may emerge. These symptoms begin with lack of coordination and tremors, and may eventually result in a form of paralysis • Symptoms of overdose: longer, more intense "trip" episodes, psychosis, coma, death

Depressants Benzodiazepines (valium, Librium, ativan), barbiturates

You probably know why depressants are abused

• Produce state of intoxication similar to that of alcohol • Relieve anxiety, irritability, tension

But did y ou know that -

• Very high potential for abuse and development of tolerance • Withdrawal from depressants can cause anxiety, insomnia, muscle tremors, loss of appetite. • Abruptly stopping may cause convulsions, delirium, death. • Symptoms of overdose include shallow respiration, clammy skin, dilated pupils, weak and rapid pulse, coma, death

Steroids

Drugs that are closely related to the male sex hormone, testosterone.

You probably know why steroids are abused--

• Increase strength and athletic performance • Increase muscle size • Increase physical endurance • Help muscles recover

But did you know that abuse ofsteroids may cause-

• Severe acne, rashes, stunted growth • Sexual function problems • Behavioral changes, aggressiveness ("roid rages") • Long-term effects, such as cholesterol increases, heart disease, liver tumors, cancer, cataracts and death • Withdrawal from steroids can include significant weight loss, depression, behavioral changes, trembling. • Symptoms of overdose: Quick weight and muscle gains, extremely aggressive behavior, severe skin rashes, impotence, whithered testicles. In females, irreversible masculine traits, e.g. become very hairy

......

C 6. What is recovery?

Do New member paperwork, if any new members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Introductions: Have clients introduce themselves, saying first name only, what legal charges are, and how drug or alcohol use was related to that. Why do you think you were recommended to complete this program, even if your charge wasn't a drug or alcohol charge? Do Midpoint paperwork, if any group members are at their 9th week (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Do Graduation paperwork, if any graduating members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Complete Tracking Form, including whether attended AA Do Group check-in Briefly review homework from Lesson 5 (Page 36 in Client's Manual)

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( ,, ', ,,, •:~ :,, , ~: ~\ ow do we know if we're ready to "recover"? We may have '_,-, , .. -~\'. agonized over whether to stop using alcohol and other • l ~ - drugs, but stopping our chemical use is not the hardest part. Like the smoker who says, "Quitting is no big deal; I've quit

. hundreds of times," the person addicted to alcohol or other drugs :;{ . has the most difficulty staying off mood-altering chemicals. Main ',, taining our abstinence requires serious personal changes.

<< 19 » b Wr-.. , STOP THE CHAOS

What Does Recovery Mean? For our purposes, to recover means to restore ourselves to a healthy emotional, physical, and spiritual condition-free of alcohol and other mood-altering drugs. We seek to reclaim the life we've lost through our addiction. Recovery is the process of returning to a healthy and Wh1cX1 (e tove(\J fulfilling lifestyle. Recovery is not a destination but a lifelong journey. 6t-(ilio us h °' "'I 2 Recovery from addiction encompasses 1. stopping our chemical use completely UDU lJ"s-c:0 : 2. admitting we're powerless over our addiction -:I 3. understanding we have a chronic illness r Jr . i Cr1 wvW-ii ~BLl__ 4. making the necessary changes in our lifestyle ~- --i-o GWN'~ 5. asking others for help 6. being patient _c1J_l_:_,,yi..QY O( fru ?i(f_) I Stopping Chemical Use After we've decided to recover, the first step is to stop using all mood altering chemicals, including alcohol. When we stop using, we begin detoxifying our bodies. As the body gets rid of toxins, or poisonous chemicals, and begins to rebalance itself, we experience uncomfortable mthdr.a:w.al.sY-IDP,toms. ------. ------•---- Our experiences during withdrawal depend on the drug we're with drawing from and on how much we're used to taking. Withdrawal from Now that I kn~w all , certain chemicals can be mild and hardly noticeable. Withdrawal can these thin:JS, and /Jon't also create severe, life-threatening reactions. u.re anymote, I Mu.sr BE CV RED! We need time to adjust to the absence of chemicals. This detoxifi cation period can be only a few days, as with alcohol, or much longer, as with drugs such as benzodiazepines (Valium, Xanax, Klonopin). If we're taking a prescribed medication, we can check with our doctor to determine whether it's mood altering. It's important not to stop the use ofprescribed medications without the approval of a physician. We should never try to detoxify alone. Alcoholics and addicts can die during withdrawal. The wisest course of action is to seek profes sional care from a treatment facility or a physician who is familiar with detoxification from mood-altering chemicals. We may need medications to prevent seizures or to slowly detoxify our bodies. A medically supervised withdrawal is the best way to ensure safety and to avoid suffering from unnecessary symptoms. Once we are stable, we can embark on our journey.

<< 20 >> AM I READY FOR RECOVERY?

dmitting We're Powerless ' .Jver Our Addiction It's difficult to accept that we've encountered something we can't control. This admission is crucial. Until we can accept on a daily basis that we can't control our drug and alcohol use, we're doomed to repeat failed attempts at controlled use. When we don't accept our condition, we deny or minimize the amount of effort needed to maintain our recovery. We invite trouble by using intellectual processes to analyze and to understand our addiction. We assume that our newly found knowledge will overcome our old thinking and behavior. When we stop chemical use, our lives and our thinking are still programmed to enable alcohol and other drug use. These old patterns are not erased easily and can return automatically.

Understanding We Have a Chronic Illness Addiction is forever. It's neither a moral weakness nor a matter ofwill wer. Addiction is about brain neurochemistry and adaptations our

.Jies make to our chemical use. The illness of addiction is chronic-it's Example 9. Alicia had made ongoing and with us for life. Just hoping it will go away doesn't work. a commitment to her counselor - ----em-m:lditti-onims"lrbtologtc-aiiraID.~me~-aaatction1rs"1r-·- ·· to stop her alcofio/ use. Slie disease or illness. Just as diabetics have to monitor their chronic con- quickly found, however, that dition on a daily basis to avoid a reoccurrence of diabetic symptoms, many of her social activities revolved around drinking. Alicia the alcoholic and addict need to monitor their chronic condition on a decided to continue socializing daily basis. If we ignore our addiction, we will once again experience with her old friends and just not the symptoms of chemical use-irrational thinking and behavior. use alcohol or other drugs. After A return to chemical use can follow quickly. all, she had made the promise to her counselor and knew that her.chemical use had brought Making the Necessary Changes her nothing but problems. Soon We'd prefer to stop our chemical use without having to make many after, while attending a party, lifestyle changes. We picture ourselves going back to a "normal" life Alicia began to listen to friends who tried to persuade her that style. We forget that the lifestyle we were leading was anything but she was not really an alcoholic. normal. Lifestyle changes may be the most difficult part of recovery. She decided that she would have only a few drinks. That [see example 9] ~ night Alicia ended up arrested - for driving while intoxicated. STOP THE CHAOS

- Alicia believed that she could safely continue her contact with people who abused drugs and alcohol. She believed that she could choose whether to drink. All of us in recovery need to change the direction of our lives. Our old lifestyle won't keep us sober. We need to find new outlets for our time and activities that don't include mood-altering chemicals. Necessary changes may involve 1. staying out of bars, clubs, and liquor stores 2. staying away from old using friends and others who abuse alcohol and other drugs 3. not contacting our drug source for any reason (Tb.row those telephone numbers away! ) 4. keeping away from areas where we know drugs are available 5. not keeping alcohol or other mood-altering drugs around the home or office

Asking Others for Help When we were using drugs and alcohol, we frequently thought we - knew all the answers. We believed we were in control of our lives. In early recovery, we realize that our chemical use dictated our lifestyle. We used chemicals to get through life. We discover we're___ _ lacking basic coping skills and the knowledge needed to get through this period. We have difficulty dealing with normal life issues, much less with the wreckage of our addiction. Our insides shout that somehow we must accomplish our recovery by ourselves. We see asking for help or discussing feelings as an admission of weakness. We soon discover, however, that we can't stay sober alone. We need to acknowledge the importance of getting strength and guidance from others in recovery-we need to acknowledge that they know more about recovery than we do. Recovering people become the most power ful tool we have in recovery. We can use this tool in important ways. • We can share our thoughts and feelings with other recovering people. Still having using urges is normal and does not reflect on our seriousness to stay straight. We can talk about our urges with people who've been there. • We can admit that others know more than we do about recovery. We don't know all the answers. • We can listen to others' stories about their recovery and learn from their experiences. AM I READY FOR RECOVERY?

Being Patient We often have great expectations of others and ourselves in early recovery. We're convinced that our lives will quickly change for the better. We want to get on with our lives and prove ourselves to others. We view the time spent in our addiction as wasted and wish to put the past behind us. We need to make up for lost time. People in recovery need to remember that everything happens in its own time. Recovery is a process. AB addicts and alcoholics, we have a tendency to try to force the square peg into the round hole. When it doesn't fit, rather than search for a more rational solution, we simply get a bigger hammer. By trying to move too fast, we create frustration and resentment because things don't go our way or happen at our pace. These feelings and our lack of perceived progress can lead us back to chemical use. Developing an attitude of patience and acceptance enables us to deal with these stressors.

How Do I Know If I'm Ready to Recover? 3ome of us are pressured into abstinence when legal or family conse quences become too severe. We may not see the role that drugs and alcohol have played in ourJiyes....an_d_hav_e_no..reaLintention-of-quitting ------We comply to avoid further conflict or consequences. Some of us see that our lives are becoming increasingly chaotic and unmanageable. We're aware that something is wrong. We're willing to stop chemical use to see if our lives improve. It's of little consequence how we get to the point of considering stopping our chemical use. The important part is that we're willing to take a look at our use. Most of us are not completely convinced that recovery is the answer. We hear ourselves making statements such as the following: • I'm not sure I'm really that bad. I'm not like those other people. • Do I want to do this? What if I try to quit and fail? • Drugs and alcohol are my best friend. How will I cope without them? • I don't need to abstain. I can just drink and drug less often . • Isn't there an easier way to do this? • I don't want to be an alcoholic or addict. STOP THE CHAOS

- Few of us are willing to accept overnight that we are addicted to alcohol or other drugs. Most of us are willing to admit that we might have some type of problem with drugs or alcohol. The evidence is usually there. What we don't understand is the severity of our problem. Even if we firmly believe that others are wrong about our chemical use, we need to listen to what they're saying and to continue to gain knowledge about alcohol and other drug addiction. There is no magic. A willingness to listen and to explore our chemi cal use is the essential part of starting recovery. We must keep an open mind. If we find we are addicted to drugs and alcohol, we're ready to do whatever it takes to stay sober. V,- " l · 1 f lt"l ~-Ks"\ "\((-+- -4(I{ \\ t.. <\., l, \. ' . l e..5s-~ ~1 ~ . ,vJ~"- rd. ;- \.' ~ M ~\· ·n.,, '1. .5 -l- ifJ k '('€. c\J ve.r,7 On a separate sheet of paper, write a personal history of the consequences ofyou:r chemical use. p. )1 'rfI"{ ..-----__;~------',.,<:....l.:--,---,,r-1'f7"9-,.,.,v ou missed appointments with friends, family, or clients.

2. How does your behavi change when you use chemicals?

3. Identify times when you've ied to control your use and ended up using more than you planned. Be h est.

4. How many times were your proble s caused by chemicals?

5. When have people commented on you~

Get friends and family to help. Exploring your chemical use will

-- ..., ... - .. Name: ------Date: ---- New Foundation 12 week Worksheet Lesson 6: Taking Steps Toward Recovery

1. List 3 examples of times when you missed appointments with friends or family due to your drug or alcohol use:

1. 2.

2. How does your behavior change when you use drugs or alcohol?

3. Identify 3 times when you tried to control your use of drugs or alcohol and ended up using more than you had planned:

4. When have people commented on your use of drugs or alcohol?

5. How many times were your problems caused by your drug or alcohol use?

37 7. Identification of High Risk Situations. i Do New member paperwork, if any new members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader' s Manual) Introductions: Have clients introduce themselves, saying first name only, what legal charges are, and how drug or alcohol use was related to that. Why do you think you were recommended to complete this program, even if your charge wasn't a drug or alcohol charge? Do Midpoint paperwork, if any group members are at their 9th week (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader' s Manual) Do Graduation paperwork, if any graduating members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Complete Tracking Form, including whether attended AA Do Group check-in Briefly review homework from Lesson 6 (Page 38 in Client's Manual)

GOTO NEXT PAGE elapse to chemical use is especially common in early recovery. We lack a lifestyle that supports abstinence. We've had little experience at remaining sober. We haven't developed activities or coping skills to help us through situations that could threaten our sobriety. High-risk situations can be described as 1. any person, place, or situation connected with using drugs or alcohol 2. any time we're around alcohol or drugs - 3. any place or situation that is associated with high stress J ,•. <<: 53 » ..11.L.. - STOP THE CHAOS

As recovering people, we're faced with deciding how to avoid high. risk situations on a daily basis. Some of these will be easy decisions. We'll probably choose not to attend the "Let's Get Acquainted, All You Can Drink or Use for $5 Block Party" being sponsored by the local liquor distributor and the friendly representatives of a Colombian drug cartel. But what about situations involving family, friends, or job responsibilities? Is there danger in these seemingly safe situations? Many people return to chemical use in situations where they believe they are safe. We try to be attentive to high-risk circumstances. It's unlikely that we would knowingly put ourselves in a position that would lead us back to chemical use. The problem is that we're usually not aware of what actually makes up a high-risk situation. This lack of awareness can be dangerous.

Defining High-Risk Situations Three simple criteria can guide us in recognizing threats to our sobriety.

Example 22. John had finished 1. Any person, place, or situation connected with using drugs or an outpatient substance abuse alcohol. For some of us, this includes just about everywhere. program. In the past, he spent We know that using friends or using situations can bring on his leisure time at a local sports urges, some of which can be severe. This phenomenon is un bar with his friends. He understood that this could be a prob predictable. If we're in a place wherewe've used before, we can lem but thought that he was never be sure that we won't be overwhelmed by sudden urges. strong enough to handle it. Old thoughts and emotions can come back in a moment. Our Besides, his friends knew that brains have many automatic, unhealthy responses just waiting he'd quit drinking and drugging. to be triggered. It felt very comfortable to him to return to his old hangout. The ~ [see example 22] smell, the noise, the people, the atmosphere were aJ/ the same. John thought he would be able to handle using urges. He knew He found that the only thing he was dependent on drugs and alcohol but believed he would be missing was a drink. One of his "strong enough to handle it." He assumed his friends would support friends offered to buy him a his recovery. beer, saying, "Just have one, When we rely on logic and willpower to handle our chemical use, man, you're not an alcoholic. we dismiss the power and unpredictability of our addiction. We can't You just did too many drugs." The next morning, John called depend on nonrecovering people to understand what we need. They in sick to work. He still had haven't experienced addiction. They most likely don't understand some drugs left from the night addiction or the lengths that we need to go to remain sober. before, and he was planning another trip to the liquor store. J He was immediately back into his addiction. IDENTIFYING HIGH-RISK SITUATIONS

~ .ny time we're around alcohol or drugs. Be cautious. If drugs 'ld alcohol are around, there's always a chance that we could use them even if we firmly believe we won't. We can't predict how we'll react in the presence of chemicals. Example 23. Dana had six [see example 2 3) U@f months of abstinence from drugs. His company was having Our ability to resist drugs and alcohol is unpredictable. The belief a holiday party, and he felt ! "I don't feel like using so I'm okay " is just not valid! We can't obligated to go. He knew that 5e our commitment to sobriety based on what we're thinking there would be alcohol in the eeling at any given moment. Dana's experience shows that past restaurant, but Dana reasoned -gers can change our thinking in seconds. When we encounter that he was a heroin addict and seldom had any desire 1ations where chemicals are present, we must exercise caution . for alcohol. He felt safe in his 3. Any place or situation that is associated with high stress. Some dedsion to attend this function. For the first two hours, Dana of us forget that stress builds up. Rather than being triggered had a wonderful time with no by a single catastrophic event, stress may result from a number using urges. Then, Dana's ex of different areas in our lives. Poor financial conditions, relation wife came in with another man. ships, and work situations can build collectively to create an Within seconds, the old resent _overwhelming level of stress. ments and anger were back, and all he could think about S. ,os plays an important role in our ability to handle high-risk was having a drink. He left .lS. When overly stressed, we tend to make irrational decisions. immediately but was baffled .want to relieve the stress as quickly as possible. If the stress by the idea that when his old omes too intense, we may choose to use chemicals t9 cope with rrre5ti~gmd;-~ discomfort. sought help from whatever chemical was around, not just {see example 24] ~ his chemical of choice, He was amazed at how fast his thinking Carolyn had placed herself in an extremely stressful situation changed. It had taken only a bout having thought about the possible consequences. Any place few seconds. t has the potential for "bad news"-such as a doctor appointment, ,urt proceeding, or a meeting with someone who has "pushed our Example 24. Carolyn went tons" in the past-can be a problem. We do not yet have the skills to her physician for the results of her biopsy. As she sat in Land.le high-stress situations safely. the waiting room, her fear was Avoiding people or places that have caused or could cause emotion mounting. She hcid never rauma is also important. Attending a funeral, visiting a cemetery, experienced this type of :racting with form.er lovers, and confronting past failures all have anxiety without reducing it ability to trigger traumatic memories. These emotions can create with chemicals. She thought that if the results showed 1g urges to suppress the resulting emotional hurt. We revert to old cancer, she deserved a drink. Lk:- .,. and behaviors to deal with the pain. If she didn 't have cancer, it seemed right to celebrate......

STOP THE CHAOS

Looking for Solutions In each of the previous examples, people put themselves in a high-risk situation without realizing or preparing for it. Some of us may think we can't go anywhere without risking our sobriety! Remember that we're focusing on identification. If recovering alcoholics and addicts frequently relapse in situations where they are unaware and un prepared, then it's important for us to be able to identify dangerous situations. This gives us choices. One choice we always have is to not put ourselves in a high-risk situation. If we're undecided, we can turn to others in recovery for guidance. We may not see potentially dangerous situations ourselves. If we determine that we cannot avoid a high-risk situation, we can take the following steps:. 1. We can take someone with us who is in recovery or who under stands addiction. We need support in a high-risk situation. Most people are not knowledgeable about addiction. We may hear them say, "I know you went to treatment. Here, have a - beer. Just don't get drunk." Many times people who know about our dependency will choose not to intervene even when they see us using for fear of saying or doing the wrong_thing. Having someone who understands us and our fears and urges is important. It keeps us accountable. 2. We can give ourselves permission to leave an uncomfortable situation. We don't need to test ourselves in the presence of drugs or alcohol. We've taken that test before and failed. Some times an event that we believe will be relatively safe can turn on us. This is the unpredictable part of our addiction. We can give ourselves permission to leave before we attend an event.

Example 25. Jean and Bill ~ [see example 25] attended a social function for Bill's company. Jean told Bill Letting others know ahead of time that we may choose to leave before the event that she had makes it easier for us to make that decision later. We won't feel as concerns about how she might though we're letting others down. Remember that our recovery comes react to the liquor that was sure first. It's far more important than any approval we may get by staying to be there. They discussed this in a dangerous situation. and decided they would drive separately so Jean could leave if she needed to. IDENTIFYING HIGH-RISK SITUATIONS

g_ We can have a reli.a.ble way to leave should we choose to do so. When we give ourselves permission to leave an uncomfortable situation, we need a reliable way to leave. Some of us may not have driving privileges as a consequence of our chemical use, but we can avoid being "trapped" at an event with no way to leave. We can plan beforehand to have a sponsor or friend pick usup.

WJ..,ts haffE'JJir,g How would you have handled the situations of John, Dana, and tig/·J NERE, ,;1/2t Now, Carolyn? What would you have done in their positions to protect yourself? AT T/1/S MOMfNr?

John

-1------Dana

Carolyn 7. Identification of High Risk Situations. ( Do New member paperwork, if any new members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Introductions: Have clients introduce themselves, saying first name only, what legal charges are, and how drug or alcohol use was related to that. Why do you think you were recommended to complete this program, even if your charge wasn't a drug or alcohol charge? Do Midpoint paperwork, if any group members are at their 9th week (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Do Graduation paperwork, if any graduating members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Complete Tracking Form, including whether attended AA Do Group check-in Briefly review homework from Lesson 6 (Page 38 in Client's Manual)

GO TO NEXT PAGE ,?:,:~, elapse to chemical use is especially common in early recovery. ~-~'• '..': We lack a lifestyle that supports abstinence. We've had little • I• ·' ' · · · experience at remaining sober. We haven't developed activities or coping skills to help us through situations that could threaten our sobriety. High-risk situations can be described as 1. any person, place, or situation connected with using drugs or alcohol 2. any time we're around alcohol or drugs 3. any place or situation that is associated with high stress

« 53 >> - STOP THE CHAOS

As recovering people, we're faced with deciding how to avoid high. risk situations on a daily basis. Some of these will be easy decisions. We'll probably choose not to attend the "Let's Get Acquainted, All You Can Drink or Use for $5 Block Party'' being sponsored by the local liquor distributor and the friendly representatives of a Colombian drug cartel. But what about situations involving family, friends, or job responsibilities? Is there danger in these seemingly safe situations? Many people return to chemical use in situations where they believe they are safe. We try to be attentive to high-risk circumstances. It's unlikely that we would knowingly put ourselves in a position that would lead us back to chemical use. The problem is that we're usually not aware of what actually makes up a high-risk situation. This lack of awareness can be dangerous.

Defining High-Risk Situations Three simple criteria can guide us in recognizing threats to our sobriety.

Example 22. John had finished l. Any person, place, or situation connected with using drugs or an outpatient substance abuse alcohol. For some of us, this includes just about everywhere. program. In the past, he spent We know that using friends or using situations can bring on his leisure time at a local sports urges, some of which can be severe. This phenomenon is un bar with his friends. He understood that this could be a prob prefuctaEle. ll we're in a place where we've used before, we can lem but thought that he was never be sure that we won't be overwhelmed by sudden urges. strong enough to handle it. Old thoughts and emotions can come back in a moment. Our Besides, his friends knew that brains have many automatic, unhealthy responses jll$t waiting he'd quit drinking and drugging. to be triggered. it felt very comfortable to him to return to his old hangout. The ~ [see example 22] smell, the noise, the people, the atmosphere were all the same. John thought he would be able to handle using urges. He knew He found that the only thing he was dependent on drugs and alcohol but believed he would be missing was a drink. One of his "strong enough to handle it." He assumed his friends would support friends offered to buy him a his recovery. beer, saying, "Just have one, When we rely on logic and willpower to handle our chemical use, man, you're not an alcoholic. we dismiss the power and unpredictability of our addiction. We can't You just did too many drugs. " The next morning, John coiled depend on nonrecovering people to understand what we need. They in sick to work. He still had haven't experienced addiction. They most likely don't understand some drugs left from the night addiction or the lengths that we need to go to remain sober. before, and he was planning another trip to the liquor store. He was immediately back into his addiction. IDENTIFYING HIGH-RISK SITUATIONS

~- .ny time we're around alcohol or drugs. Be cautious. If drugs ".ld alcohol are around, there's always a chance that we could use them even if we firmly believe we won't. We can't predict how we'll react in the presence of chemicals. Example 23. Dana had six [see example 2 3) ~ months of abstinence from drugs. His company was having Our ability to resist drugs and alcohol is unpredictable. The belief a holiday party, and he felt ! "I don't feel like using so I'm okay" is just not valid! We can't obligated to 90. He knew that 5e our commitment to sobriety based on what we're thinking there would be alcohol in the eeling at any given moment. Dana's experience shows that past restaurant, but Dana reasoned ·gers can change our thinking in seconds. When we encounter that he was a heroin addict and seldom had any desire 1ations where chemicals are present, we must exercise caution. for alcohol. He felt safe in his 3. Any place or situation that is associated with high stress. Some decision to attend this function. For the first two hours, Dana of us forget that stress builds up. Rather than being triggered had a wonderful time with no by a single catastrophic event, stress may result from a number using urges. Then, Dana's ex of different areas in our lives. Poor financial conditions, relation wife came in with another man. ships, and work situations can build collectively to create an Within seconds, the old resent overwhelming level of stress. ments and anger were back, and all he could think about s. -ss plays an important role in our ability to handle high-risk was having a drink. He left .18. When overly stressed, we tend to make irrational decisions. immediately but was baffled

.want to relieve the stress as quickly as possible. If the stress by the idea that when his old r.~i. omes too intense, we may choose to use chemicals tQ cope with - -errrott

Looking for Solutions In each of the previous examples, people put themselves in a high-risk situation without realizing or preparing for it. Some of us may think we can't go anywhere without risking our sobriety! Remember that we're focusing on identification. If recovering alcoholics and addicts frequently relapse in situations where they are unaware and un prepared, then it's important for us to be able to identify dangerous situations. This gives us choices. One choice we always have is to not put ourselves in a high-risk situation. If we're undecided, .we can turn to others in recovery for guidance. We may not see potentially dangerous situations ourselves. Ifwe determine that we cannot avoid a high-risk situation, we can take the following steps:. 1. We can take someone with us who is in recovery or who under stands addiction. We need support in a high-risk situation. Most people are not knowledgeable about addiction. We may hear them say, "I know you went to treatment. Here, have a -- beer. Just don't get drunk." Many times people who know about our dependency will choose not to intervene even when they see us using for fear of saying or doing the wrong_thing. avmg someone who understands us and our fears and urges is important. It keeps us accountable. 2. We can giue ourselves permission to leaue an uncomfortable situation. We don't need to test ourselves in the presence of drugs or alcohol. We've taken that test before and failed. Some times an event that we believe will be relatively safe can tum on us. This is the unpredictable part of our addiction. We can give ourselves permission to leave before we attend an event.

Example 25. Jean and Bill ~ [see example 25) attended a social function for Bill's company. Jean told Bill Letting others know ahead of time that we may choose to leave before the event that she had makes it easier for us to make that decision later. We won't feel as concerns about how she might though we're letting others down. Remember that our recovery comes react to the liquor that was sure first. It's far more important than any approval we may get by staying to be there. They discussed this in a dangerous situation. and decided they would drive separately so Jean could leave if she needed to. IDENTIFYING HIGH-RISK SITUATIONS

3. We can have a reliable way to leave should we choose to do so. When we give ourselves permission to leave an uncomfortable situation, we need a reliable way to leave. Some of us may not have driving privileges as a consequence of our chemical use, but we can avoid being "trapped" at an event with no way to leave. We can plan beforehand to have a sponsor or friend pick us up.

How would you have hand.led the situations of John, Dana, and Carolyn? What would you have done in their positions to protect yourself?

John

Dana

Carolyn Assign and explain homework for lesson 7: part 1 of Relapse Prevention Plan: High Risk Situations. (Page 39 in Client's Manual) 8. Coping with Cravings and Urges to Use.

Do New member paperwork, if any new members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Introductions: Have clients introduce themselves, saying first name only, what legal charges are, and how drug or alcohol use was related to that. Why do you think you were recommended to complete this program, even if your charge wasn't a drug or alcohol charge? Do Midpoint paperwork, if any group members are at their 9th week ( see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Do Graduation paperwork, if any graduating members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader' s Manual) Complete Tracking Form, including whether attended AA Do Group check-in Briefly review homework for lesson 7: part 1 of Relapse Prevention Plan: High Risk Situations. (Page 39 in Client's Manual)

GO TO NEXT PAGE , ... , . \ ,, , , -; ,:., :, n urge or craving to use alcohol or other drugs is a normal \ I I I ~~;-~ ~ ',_', ~-. physical and emotional reaction to stopping alcohol and :< ',_, other drug use. Our bodies and minds have adapted to receiving a regular supply of chemicals. When we stop taking our chemicals, our bodies and minds still want them. When we have a craving, we may experience physical symptoms. Our hearts may beat faster or we may salivate when watching a beer commercial. We can enco:unter cravings without warning or by some trigger, such as seeing our drug of choice or driving past our dealer's house.

« 59 >> ,:..J 7 .... , f V ', CMON. 1014 _ c 'fh l,~'-'ej11s - I ONt /iff lt1,

I "' , ., \ ✓ I I -; ,:,, :, n urge or craving to use alcohol or other drugs is a normal \ I I I :~;-~, ',_', :,, physical and emotional reaction to stopping alcohol and .,. \ I I , ~ '- - other drug use. Our bodies and minds have adapted to receiving a regular supply of chemicals. When we stop taking our chemicals, our bodies and minds still want them.

When we have a craving, we may experience physical symptoms. Our hearts may beat faster or we may salivate when watching a beer commercial. We can encounter cravings without warning or by some --... trigger, such as seeing our drug of choice or driving past our dealer's house.

<< 59 >> ,.,J . , STOP THE CHAOS

When we stop our chemical use, urges to use our drugs can be fre quent and intense. As we focus on developing a lifestyle free of alcohol and other drugs and based on personal growth, cravings become fewer and farther between but can still occur. Most urges are short-lived and last no longer than a few minutes. This means that easy access to drugs or alcohol can be dangerous. It only takes a moment to walk to the refrigerator, open a beer, and start to drink again. With an impulsive act, our dependency has been reignited, and we find ourselves deeply into our addiction again. But, if we don't have drugs or alcohol nearby, the urge may pass before we can get to the liquor store or have a chance to contact our drug dealer. Careful planning is the key. If we have a plan outlining how we'll handle these situations, we can save our recovery.

How Could I Talk Myself into Using Again? When life becomes stressful or if something triggers our emotions and memories, we may return to chemical use. Euphoric recall and magical thinking are methods we use to rationalize, or excuse, a - return to using.

Euphoric Recall Euphoric recall refers to "romancing" our past use.

Example: "It sure was great at Bob's party that night. I really got wasted. Gosh, those were great days. I sure haven't had that much fun since I stopped drugging. Sobriety is boring."

Euphoric recall is· the process of thinking favorably about our past using experiences. Our memory becomes very selective. We think about how good it was to use, and we forget or minimize the consequences of our actions. We miss the excitement of the "old days."

Magical Thinking Magical, or delusional, thinking is planning for controlled future use.

Example: Barbara's husband is going to be gone for a week on business. She remembers the many times she secretly drank while he was gone. She starts to plan how she could drink again and stop before he returns. COPING WITH USING URGES

Magical thinking is when we believe that social using or controlling ur use might be an option. We question whether we're dependent on __J.emicals. We start to believe that we may be able to use "one more time" and then quit before suffering any consequences. We may be so caught up in the thought of using again that we forget about the past consequences of our use. We delude, or fool, ourselves into believing we can control our chemical use. We deny our powerlessness over our addiction.

Challenging Euphoric Recall and Magical Thinking One problem in dealing with urges is mistakenly making the situation worse rather than better. If an urge lasts longer than a few minutes, we may be doing something to prolong its effect. We intensify our urges by focusing on euphoric recall or magical thinking or by putting ourselves in high-risk situations (see~that,J;rigger more intense thoughts. 9.S7 \ dV\ 1 I Example 26. Bev had to work We need to challenge euphoric recall and magical thinking late again. She left the office immediately. Early intervention is the key. When we have an urge tired and angry. A memory from her old using days flashed , use, we can take the following steps: in her mind. She remembered _ L ._TI;y. -to.~or..te.cir..cuit!:..the-tkinking-by-challe-nging--the-using-- - -t-hat-5-topping-by-her...favorite------ thoughts. Within the first ten seconds, we should think about bar for a few drinks had always what would happen if we were to follow through and use again. made her feel better. The urge was so strong she could taste We can plan for these occasions by creating a thought sequence the drink. that describes the worst circumstance _or consequence of past Bev knew how to handle the chemical use. urge. She carried a card in How did we feel emotionally? Physically? What was it like her purse that described what to face our families? Our employers? This is called "thinking the happened the last time she drink or drug through" or "playing the tape through to the end." had a drink. She read through it It puts us back into contact with the reality of the consequences and remembered thot the lost time she'd gone to that bar, she of our use. It contradicts addictive thinking. lost control of her drinking and [see example 26) ~ ended up in jail for DUI. She thought of how embarrassed she was when her mother had to bail her out. Bev didn't want her name in the paper again. She decided to go home. STOP THE CHAOS

2. Remove ourselves from any person, place, or situation that may have triggered the using thoughts. We can know what our triggers are! We don't have to be afraid to leave an uncomfort able situation. We can't be concerned about what others may think. Our sobriety comes first.

3. Contact someone and talk about how we're feeling. Using Thinking can thoughts are normal and not a sign of weakness. Calling some be our biggest one and talking about what we've encountered can relax/dilute obstacle to soften or end the urge. Other people with chemical dependency recovery. have been there and know exactly what we're experiencing. They know that we're not weak. They understand the need for talking about these intense feelings.

The object is to l.essen the severity of the urge so that we can copE with it. It may not go away completely. If it reoccurs, we need to rela start at the beginning, and calmly challenge the thought again.

\){J _ ___ 1. To challenge euphoric recall, or positive using memories from the ------,-~ -U\:::,J ___ 7'.q- ~ T' ····- -past,ereate-a--speei.fi:c-thought-sequence-about··specifi:c-past-events. \i \j\'\ I' Jj rt ½ , - Describe the most severe consequences of your past use. This includi:. \1-, ( ~r/ \~J L-\. events, devastating feelings, people you hurt, legal problems, or ., r,r[\r, (}°\ ~ relationship issues. When challenging euphoric recall, you need to 1 ,/'-\_'V . completely honest. Write down what really happened when you USEt f\ \J "

- ., COPING WITH USING URGES l

.agical thinking says that you could use one more time-that you .Juld somehow control your chemical use. When you start to have .;is type of thinking, consider how using again would play out in reality. You might imagine that using again would be okay, but what would really happen? Think the drink or drug through or play the tape through to the end. Wioi-te down a sequenee of wh-e:t-wottlrl h :,Pen if you s

First, I would

What would happen next?

..--.... ------

What would happen next?

And next?

'W:1:-i.en we start to think about using, we can play out the sequence of .,at has happened in the past and what would happen in the future. - need to live in the honesty and reality of what our lives were _.,,_e when we used chemicals.

<< 63 >> Assign and explain homework for lesson 8: (Pp. 40 and 41 of Client's Manual) This includes part 2 of Relapse Prevention Plan: Action Plan for When I Get Cravings and Urges to Drink or Use Drugs. Summit Psychological Associates, Inc. ODADAS Outcomes Framework Adult Client Survey

Completing this survey will assist us in our ability to be most helpful to you. Please feel free to be honest in completing it. D 26-Week Group D 12-Wcek Group D Individual Treatment

Client Name: ______Date: ______Clinician Name: ------Point in Program at SPA: Entry Midway Graduation

1. Do you believe that your alcohol or other drug use has negatively impacted your life? □ Yes □ No □ Not Sure

2. Are you currently attending 12 step meetings (e.g. AA) each week? □ Yes □ No

3. Are you currently abstinent from all alcohol and other drug use? □ Yes □ No

4. Have you learned skills to manage your triggers or high-risk situations, in order to avoid using alcohol or other drugs? □ Yes D No

5. Is your goal to remain abstinent from all alcohol and other drug use, even after you complete treatment at SPA? D Yes O No □ Not Sure

6. Have you met with a case manager at Summit Psychological Associates, Inc.? D Yes* D No D Not Sure *If yes, please answer the following two questions:

Has the case manager assisted you in obtaining stable housing? D Yes D No D N/A (already have stable housing) Has the case manager assisted you in obtaining stable employment or another source of regular income, such as disability payments, retirement benefits, a pension, or social security? □ Yes □ No D N/A (already have stable employment or another source of income)

7. May we contact you in the future to conduct a follow up survey? □ Yes* D No *If yes, please provide us with your email address or another method of communication:

1/30/2020 9. Dealing with emotions.

Do New member paperwork, if any new members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Introductions: Have clients introduce themselves, saying first name only, what legal charges are, and how drug or alcohol use was related to that. Why do you think you were recommended to complete this program, even if your charge wasn't a drug or alcohol charge? Do Midpoint paperwork, if any group members are at their 9th week (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Do Graduation paperwork, if any graduating members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Complete Tracking Form, including whether attended AA Do Group check-in Briefly review homework from Lesson 12 Review homework for lesson 8: (Pp. 40 and 41 of Client's Manual) This includes part 2 of Relapse Prevention Plan: Action Plan for When I Get Cravings and Urges to Drink or Use Drugs.

GO TO NEXT PAGE Riqht now/m l•,..,, ..., w •Uo4 •u.u ~ ~ ac,..,w.. CAM l,1wA 111 .. , "4,..-. fEELIN6 '1S ----- fhou9h ... -

I "' , • ~~ , :_: .\ s addicts and alcoholics, we're notorious for not wanting to talk ..,..,;_.,,,_.,:, ' I , I about what's bothering us. When we were using, we couldn't .. \ I \ ~) ' - talk about our problems for fear someone would discover how severe our addiction was. We may have learned early in life that problems were not to be discussed openly. We may believe that to "open up" about how we feel leaves us vulnerable to manipulation or rejection by others. Many of us used alcohol and other drugs for years to cope with the normal emotions of everyday life. It seemed that we were extremely - sensitive to stress and to "bad" feelings. Whether by choice or by chance, we lacked the ability to deal with our feelings in a responsible manner.

<< 77 >> 9. Dealing with emotions.

Do New member paperwork, if any new members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Introductions: Have clients introduce themselves, saying first name only, what legal charges are, and how drug or alcohol use was related to that. Why do you think you were recommended to complete this program, even if your charge wasn't a drug or alcohol charge? Do Midpoint paperwork, if any group members are at their 9th week (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Do Graduation paperwork, if any graduating members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader' s Manual) Complete Tracking Form, including whether attended AA Do Group check-in Briefly review homework from Lesson 12 Review homework for lesson 8: (Pp. 40 and 41 of Client's Manual) This includes part 2 of Relapse Prevention Plan: Action Plan for When I Get Cravings and Urges to Drink or Use Drugs.

GO TO NEXT PAGE

- (

Riq 1-J now .. llh,a 1,ll 11,,,M K\141 I'm U, tt.( ~

~ ~ ,, • ..t,,t ,,, ._, ~ ...... ~.c...,...._ fEfLlN6 '1> thou~ ...

, ' , - ~~ ,~~ .', s addicts and alcoholics, we're notorious for not wanting to talk . -.,;_. ' .. I,,_.,:, t I about what's bothering us. When we were using, we couldn't .. \ I ' ~) ' · talk about our problems for fear someone would discover how severe our addiction was. We may have learned early in life that problems were not to be discussed openly We may believe that to "open up" about how we feel leaves us vulnerable to manipulation or rejection by others. Many of us used alcohol and other drugs for years to cope with the normal emotions of everyday life. It seemed that we were extremely sensitive to stress and to "bad" feelings. Whether by choice or by chance, we lacked the ability to deal with our feelings in a responsible manner. STOP THE CHAOS

Learning to talk about feelings is a critical part of recovery. To remain sober, we must learn the skills t o deal with our emotions. Failure to do so leads us back to chemical use. When we are troubled, we need to discuss our feelings with other people in recovery. When we share our feelings of anger, shame, or fear, we take a load off our shoulders, and we usually get some worth while feedback, which can be comforting, reassuring, and even inspirational. We need to remember the saying "My head is a dangerous neigh borhood to be in alone." Getting out with other people and keeping ourselves busy with positive recovery activities will leave little time for thinking about our troubles. We may have to discuss our feelings frequently and with different people to reduce the level of anger, fear, or shame. We also need to listen to what others are saying to us. Feedback helps us see another perspective. Talking to one person about a troubling issue is seldom enough. Not everyone understands how addicts and alcoholics think. When dealing with troublesome emotions, we need to use coping skills, communicate with others, and make changes.

Use Coping S_~_il_~s • Learn to express feelings and concerns. • Keep realistic expectations of the world and ourselves. • Be honest with ourselves and others. We should keep no secrets and tell no lies. • Seek professional help. If certain emotions are disrupting our lives, a psycholog1.st or therapist who is experienced in dealing with recovering people can help us develop the skills we need to feel better.

Communicate with Others • Ask for help. This is crucial. We should never try to go through recovery alone. We're inexperienced with emotions. We need constructive guidance. • Build a support system of recovering people . They have the knowledge and the experience to help. J • Set u p regular meetings with people who share similar problems. A variety of self-help and recovery groups exists. - DEALING WITH EMOTIONS .. ~ake Changes • Identify the problems in our lives that need to be dealt with and make the necessary changes. We should discuss these changes with other recovering people first. Newly recovering addicts and alcoholics frequently act without thinking things through. • Avoid procrastination. If we get stuck, we can use others to hold us accountable for taking action.

Certain feelings seem to be a persistent problem in the early recovery period. Anger, fear, shame, and grief are the most trouble some emotions.

Anger and Resentments Anger plays a major role in addiction. Unresolved anger, or resentment, can disrupt our lives. Yet, anger is a normal human emotion that every one experiences. Anger is an emotional response to situations in which -wQ feel threatened, treated unfairly, or violated. Anger is not the issue. The real problem is unresolved anger. 7:ien we resolve our anger, we can move on. Unresolved anger is a major cause of relapse to chemical use. We ~an'~ ~o~d__ !:,o ~e r.~s-~~~- ~~~!1:~~~nt_!8 ~e_op__po~~~ of forg~:Y~!1.e_ss_: Resentment keeps us stuck at the point of pain. We may be filled with anger toward someone who doesn't even remember the event that made us angry or toward someone who's already died. We are the ones who suffer by holding on. Most of us believe that other people, places, and things make us angry. We think that these external factors cause our feelings. We indulge ourselves in "righteous anger." Blaming others enables us to hold on to resentments and to avoid having to change ourselves. It lets us operate from a morally superior position: I'm good, you're bad. Our work with emotions in chapter 8 taught us that our belief system is responsible for how we feel-not other people, places, and things. We can keep this in mind as we explore how we use anger. STOP THE CHAOS

Anger as a Positive Force Anger can be a positive motivator. We have energy when we feel angry. Anger is part of the body's automatic survival response. Rather than yell, scream, or throw things, we can direct energy from anger into a positive action. A woman whose child died in a car accident started a national group that works to promote safer driving. Her anger pro Example 32. Tina had promised duced a lifesaving organization. How can we use anger constructively? herself yesterday that she would not drink or drug. This morning §tlI [see example 32) she found herself in bed with her clothes on and hung over. Tina was angry because she could not control her chemical use. She had become intoxicated She used that anger constructively to get help. Her anger became a again. Tina was furious with lifesaving tool. herself. How could she have We can use our anger.to make important changes. We may become been so stupid? This was the last straw. She called a local angry about our job, an abusive relationship, or our lack of schooling. addiction treatment center to Our anger can energize us to make changes that will better ~ur lives. get information and an assess If we are mistreated, our anger can provide the courage to assert our ment for addiction. She would needs. - not let drugs and alcohol ruin her life. Anger as a Negative Force Alcoholics and addicts look at life in a fairly self-centered way. We resent what we-can't control and want life at our· convenience. Many of us use anger in unhealthy ways. The following list gives reasons for and effects of our anger.

• Anger from lack of control. We are constantly angry with some one or something. Things never happen quickly enough. We encounter tremendous frustration when life doesn't happen according to our plan. The world seems to be against us. People in recovery refer to this way of thinking and acting as the king baby complex: "I want what I want when I want it, and I want it now." • Anger as a defense. Sometimes we intimidate others with our anger to keep them at a safe distance. Others may give in to our wishes rather than risk an angry scene. Using anger as a defense enables us to remain isolated so others don't get close enough to see all our faults. Sometimes the best defense is a.n angry offense. • Anger as a mask. Anger can cover grief, hurt, loss, or fear. An angry exterior keeps people from finding out what we're really feeling. The other emotions are much too sen~it.ivP t.n '1"'" l .,..,.;fh DEALING WITH EMOTIONS - • Being uncomfortable with feelings of anger. We may feel that it's wrong to be angyy. When we were younger, we may have been told, "Don't get angry at your baby sister" or ''You keep that tem per under control." These old tapes reinforce the idea that anger must be a negative thing and that we must never show we're angry. Such ideas keep us from learning to resolve anger. • Being overwhelmed by others' anger. While we may have difficulty dealing with our own anger, some of us also don't know how to deal with other people's anger. We feel powerless and intimidated by other people's anger. Because we're not sure how to handle it, we quickly withdraw or avoid situations where we might en counter it. We would rather lose out on something than chance someone getting angry with us. We feel powerless, manipulated, and victimized. To us, anger is a weapon that others can use against us.

Our inability to cope with anger in a constructive way makes .chemical use attractive for relief of the distress.

The Anger Cycle Expressing our anger improperly creates harmful consequences. As fi~~ 1 sl.iQ~~,.~~J@. .~ -~--a. ~yc~e ~f !~SE~11.~~-~_ ;3:1:~~-1-c~_e,p_s us st~c~.

Figure 4: Unfust Treatment or Loss of Control

NOT FAIR NOT IN CONTROL OBSESS

q__ET EVEN, ---1• )E' EELINGS JSt: 1..rlEMICALS STOP THE CHAOS

The anger cycle begins when we perceive that we are being treated unjustly or when we experience a lack of control. We need to identify our anger and resolve it. If we are skilled at handling our emotions, we can stop the process. Left unchecked, our anger becomes resentment. As our resentments build, we try to deal with the discomfort in one of three ways: 1. We deny that the anger still affects us. We stuff it into our "emotional backpack" and believe that we have dealt with it. As we continue to stuff emotions into our "backpack," we reach the breaking point, and our anger spills out onto others. We can also turn that anger inward. Inward-directed anger can result in depression. 2. We attempt to "get even." We perceive that we can even things up or right the injustice through some type of retribution, or pay back. We may take an outwardly aggressive stance or quietly get our revenge in a roundabout way. We want to "win." 3. We use chemicals to relieve the discomfort.

The problem with these responses is that they do not resolve the anger. We continue to roll angry thoughts over and over in our minds. Rather than relieve our anger, we increase our sense of injustice and - fuel -tlre-cyci~:· -Our b'i.lrhing -angef'·creates·a -Fieavy spiritual birrdeii~ · When we experience anger, it has a direction. In the early stages of recovery, we may direct our anger at one or more of the following: • The world in general because we can no longer use chemicals. We have to deal with our feelings without the use of drugs and alcohol. • Family or friends because they intervened to stop our use or they don't understand what we're going through. • Ourselves for having wasted part of our lives using. Somehow, we should have known better. • God, or our Higher Power, for making us an addict or alcoholic. ''Why me?" DEALING WITH EMOTIONS

Expressing Anger Appropriately ( Vhen we're angry, we need to look closely at the reason. How old is our anger? At whom is our anger directed? Are we angry because someone is not doing something our way? We need to zero in on the specific cause. 1. If our anger results from an irrational belief, that belief needs to be challenged. Chapter 8 gave us ideas for dealing with irrational beliefs. 2. If our anger has a rational basis, we can, if appropriate, let the other person know how we feel. We can calmly use assertive statements such as, ''When you behave that way, I feel angry." We don't raise our voices or assume a threatening posture. We want to avoid a verbal contest of who can shout the loudest. 3. If the anger is about a current situation, we can resolve the issue or get out of the situation. 4. We can talk about our feelings with other people. Venting about anger dissipates some of its strength. - 5. Forgiving others is a powerful tool for freeing ourselves of resentments. 6. Sometimes there may be no way to right the injustice. It's out . ..of .our..control Then we must .exer.cise -acoeptanoe.-Ws--called

letting go: the understB:nding that we're powerless to change Example 33. An angry the situation. The worst thing we can do is worry about some customer came into Tony1 past everit that we can't change. store and complained about a product she had purchased [see example 3 3} EE there. Her tirade got his own anger rising. Tony quickly Tony had learned skills associated with Rational Emotive Behavior identified his reaction and Therapy to work through anger issues. He found he did not have to saw that his beliefs- that no react to others in an angry fashion. He also remembered that it took one should ever criticize him, a lot of practice before he could quickly handle these situations. that he must never be wrong caused his anger. He challenged his beliefs and accepted the customer's complaint as va lid. He was able to refrain from an angry response and resolve the problem without emotional distress. J f J - 10. Self-defeating beliefs and behaviors. {

Do New member paperwork, if any new members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Introductions: Have clients introduce themselves, saying first name only, what legal charges are, and how drug or alcohol use was related to that. Why do you think you were recommended to complete this program, even if your charge wasn't a drug or alcohol charge? Do Midpoint paperwork, if any group members are at their 9th week (see 12 Week New Foundation.AoD Client Requirements on page 2 of Leader's Manual) Do Graduation paperwork, if any graduating members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Complete Tracking Form, including whether attended AA Do Group check-in Briefly review homework from Lesson 9 (Page 42 of Client's Manual)

In the last lesson, we talked about emotions and feelings. Today we're going to talk about our thoughts and beliefs.

There's a direct connection between our thoughts and our feelings, and here's what it is: It's not the situations that we're in that cause our feelings. It's our thoughts.

Here's an example: Imagine that Bob is driving in his car on the highway and someone cuts him off. Let's say Bob's immediate thought is, "What a jerk! That guy did that on purpose! He thinks he's the only one on the road!" If he think that way, what will Bob's feeling be? (Ask the class)That's right. Anger.

Now imagine that Sue's driving down the highway and a guy cuts her off. Let's say that Sue's immediate thought is, "Oh no. I almost hit that guy. What if someone else cuts me off and I can't get out of the way on time and I get into an accident? What if I get really hurt or killed?" If she think that way, what will Sue's feeling be? (Ask the class) That's right. Fear.

This time imagine that Joe's driving and someone cuts him off. Let's say that Joe's immediate thought is, "I'm ok. It's no big deal. I accidentally cut someone off last week. I'm sure the guy did it accidentally." If he think that way, what will Joe's feeling be? (Ask the class) That's right. He'll be feeling happy or fine.

These thoughts that we have in the moment that a situation occurs are called "Automatic Thoughts." So, you see, the same situation, with 3 very different automatic thoughts, lead to 3 very different feelings. Taking this a step further, it's important to realize that each person tends to have the same ( type of automatic thoughts no matter what the situation is.

Let's go back to Bob, who thinks the guy who cut him off is a jerk and did it on purpose. Bob is going to tend to think similarly in other situations. Ifhis boss tells him he's not doing his job well, Bob's probably going to think what? (Ask the class) That's right. He's probably going to think his boss is a jerk and that his own work performance is fine. And he'll probably feel what? Angry. Mad.

On the other hand, Sue, who felt afraid of getting into an accident just because she got cut off, is going to have a ~otally different set of thoughts if she gets negative feedback from her boss. (Ask the class) That's right. She's probably going to think, "Uh oh. My boss realizes I'm really bad at my job. What ifhe fires me?" And, just like in the other example, she'll probably feel what? Afraid. Anxious.

So, what we're saying is that each person tends to have the same type of automatic thoughts across different situations. That explains why some people have problems with anger. They always think that other people did bad things to them on purpose. It also explains why some people tend to have problems with depression or anxiety. If a person always thinks they did something wrong, that leads to what? Depression. If a person - always thinks something bad will happen to them, that leads to what? Anxiety. We call these negative automatic thoughts "self-defeating" thoughts because having them works against us. That's because self-defeating thoughts and beliefs lead to unpleasant emotions, like anger or anxiety. Why is that a problem? Because those unpleasant emotions lead to negative behaviors, also known as "self-defeating behaviors." Again, they're "self defeating" because they work against us. They make us make bad choices.

Back to Bob, who's mad that some guy cut him off on purpose. What negative behaviors could that lead to? Maybe giving the finger or tailgating the guy, or even a full-blown road rage episode. Then, what could happen? (Ask the class) That's right. Maybe an accident or a fight or even being arrested.

How do self-defeating beliefs and behaviors relate to substance abuse?

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u {-~-\ :·:~ ::·.:' e've made a choice for recovery. We find life is getting I , .,,, "' I / .., ...1,, '1 ·c<,::,;';:, better with our abstinence from chemicals. We haven't t,! ~-: ,, ·· '' experienced urges to use alcohol or other drugs. We don't see why we would want to go back to chemical use. In spite of this positive outlook, some of us do return to chemical use. We acknowledge that life is better without alcohol and other drugs, but we find ourselves slipping back into our old ways.

« 137 » STOP THE CHAOS

~ [see example SO]

Arlene's discomfort comes from self-defeating beliefs. To her, this Example 50. Arlene is checking incident is just another thing going wrong in her life today. She's start out at the supermarket. The man in front of her has twelve ing to feel as though the world is out to inconvenience her. The same items but is in the ten-item-or type of thinking led to her chemical use in the past. Arlene is reverting /ess line. Now that his total is to her old thinking. She's starting to take the same track again. rung up, he takes out his check book and slowly begins to write The Role of Self-Defeating Behaviors the check. He spends additional time filling in the check register Stopping chemical use doesn't change negative attitudes and un before handing the check to healthy behavior. These ways of thinking and behaving have over the clerk. Arlene is angry and time become subconscious habits. They are learned traits and defense impatient. Why couldn't he have mechanisms we've used-to deal with uncomfortable people and gone in the proper line? Why couldn't he have started filling situations. These negative traits help us to avoid responsibility or out the check sooner? Why ore to escape unpleasant emotional feelings. people so stupid? Anyone who As addicts and alcoholics, we are known for doing the same thing has to put up with these idiots over and over, expecting different results. We call this addictive has a right to use chemicals. insanity. Continuing to use or returning to past self-defeating think ing and behavior is a perfect example of addictive insanity. This mind-set can derail our recovery. We find ourselves justifying a return to chemical use. Discomfort with personal responsibility or dealing with unpleasant emotions is not new to us. It's one of the reasons we turned to alcohol and other drugs. In recovery, we may find ourselves automatically reacting or behaving negatively to familiar situations, such as being behind a slow driver or having to wait in line when everyone should know we're in a hurry. We may be unaware of how our behavior influences us. These auto matic reactions are powerful, and we're apt to see them as simply part of us. We may believe that they are unchangeable, but changing these beliefs is possible. Not only is it doable, it's a vital part of recovery. In chapter 8 we saw that our belief system is responsible for our feelings and behavior. If our beliefs are in error, the serenity we seek evades us. We need to change our actions and our thinking. This can be a long process. We will need to practice healthy actions and responses frequently before our deep-seated beliefs start to change. SELF-DEFEATING BELIEFS AND BEHAVIORS

Common Self-Defeating Beliefs f ct') &\~ Here is a list of the more common self-defeating beliefs. ~:LCD\ 1. I should never be uncomfortable-physically or emotionally. Life should be painfree. I must never feel angry, anxious, or depressed. Pain is unacceptable and should be suppressed as quickly as possible.

This kind of thinking is common for us. Quick relief from pain used to come in the form of alcohol and other drugs. We need to accept that life is full of uncomfortable situations. If we don't, we're constantly angry and blaming others for our problems. We feel we're being treated poorly or unfairly. This prompts us to use chemicals to change how we feel.

2. I must never be inconvenienced. I can't tolerate being inconvenienced by other people. No one should ever make a mistalie. Everyone should take my feelings - into consideration. I must have things my own way! As stated in chapter 9, this is referred to as the king-baby complex: l want what I want when I want it, and I want it now." Our egos get in the way. We start to believe that we're special. We deny the reality that life is frequently inconvenient. We're filled with anger and become impatient and resentful when others don't do things the way we believe they should. We're unforgiving of mistakes. We've lost our serenity.

3. Life should be fair! Fair is defined as·things happening "my way." If I win the lottery, that's fair. Ifyou win the lottery, that's not fair. Good things should always happen to me. Unrealistic expectations of life set us up for disappointment. Life becomes about getting what we want. We become jealous of what others have. But let's think about it. If life were fair, we would have been caught every time we drove intoxicated, every time we bought illegal drugs, and every time we lied to someone. Life is unpredictable. It doesn't always play by our rules. STOP THE CHAOS

4. I know best. I should be in control. Other people make me angry and frustrate me when they do things I know are wrong. People should see things my way. If they do not, then I need to change them. You should behave in a manner that is comfortable for me. Sometimes my fear may require me to try to control everything around me just to feel safe. We need to admit that we don't know everything. When we try to exert control over others, we set ourselves up for failure and feelings of anger. Part of recovery is concluding that we can control what we do, not what others do. If we're arrogant enough to believe we should control others we're arrogant enough to believe we can control our chemical use. '

5. I should never have to ask for help. I should be able to handle situations by myself Asking for help may mean that I am weak or inadequate. I should never look bad to others. I should be competent, even perfect, in everything I do. If I am not good at something immediately, I feel inadequate. If I can avoid taking risks, I can avoid looking at my perceived inadequacies and feel safe. Our fear of looking stupid or failing keeps us stuck. If we believe we should never ask for help, we're invariably disappointed in ourselves when we can't solve our problems. We feel overburdened. We lose confidence in our ability, and our self-esteem decreases. In time, we become resentful that others aren't helping us. They should know how we feel and what we need. Our anger level increases. If we're feeling inadequate, we're probably just inexperienced. We can learn.

6. Rules are for others. It depends on whether I can get away with it. I should not be inconvenienced. No one should tell me what to do. I should be able to run my life the way I want to. If we resist following the rules, one of the rules we inevitably end up breaking is the need to stay sober. Our rebelliousness places us in trouble with others. We're out for our own good regardless of the effect on others. Our life lacks the harmony and peace we seek. SELF-DEFEATING BELIEFS AND BEHAVIORS

I 7. Other people, places, and things govern how I feel. Others are responsible for making my life miserable. You make me angry and upset. Therefore, you must change-not me. By blaming others for how we feel, we're relieved of the responsibility to change ourselves. As long as they behave the same way, we can react the same way. We remain stuck and resist change. We give the power to control our lives to others. This encourages self-pity and resentment. We are unable to grow until we take responsibility for our actions and our place in life. Some of us take responsibility for how others feel: when you are unhappy, I am unhappy; if you have problems, I must fix them; your needs come before mine. I am responsible for how you feel. Our job becomes fixing others. If they're sad, it is our job to make them happy. Because others are responsible for how they feel, our attempts prove futile and we think we've failed. Our efforts to change others will invariably be unsuccessful. It's their job to change.

8. I focus on external things to feel good. My self-worth is determined by my job, my clothes, my car, how much money I have (or don't have), the woman or man I'm with, where I live, what I look like, etc. If I don't possess material things, I don't feel good. If I achieve and still don't feel good, I strive for mor~. When our efforts and successes still don't bring us happiness, we try to achieve even more. Material things and job titles may be short lived and unpredictable, yet we're willing to base our happiness on these external factors. When this proves unsuccessful, we learn that happi ness comes from inside ourselves, not from external sources. We learn that we always have our self. 'lb honor and love our self is a worth while investment. STOP THE CHAOS

9. Everyone should respect me and approve ofme. A negative statement from even one person can ruin my day. It means I'm no good. I have a great fear of rejection. I personalize comments that others make. My worth as a person is continually on the line. No one should ever criticize me.

We give a lecture to one hundred people. Ninety-nine people think we did wonderfully, but one hates our presentation. Do we spend the night thinking about what we could have done to turn that one person around? Sometimes this quest for approval is a sign of our own insecurity. We spend our time trying to please everyone else while our own needs go unattended. It keeps us stuck since we'll never get unanimous approval from everyone. Our fragile egos cannot take rejection and we may respond with anger to any challenge. We forget that respect is earned.

10. I can avoid responsibility. I boast about how clever I am for taking the easy way out. It's too uncomfortable to deal with many of life's difficulti,es and responsibiliti£s. It's easi-er to avoid them and blame someone else for my problems. Self-discipline and self-responsibility are too hard for me so I procrastinate. If I whine and act helpless, I find someone else takes care of my responsibilities. Our fears or our failure to take responsibility for where we are in life keeps us from moving ahead. It's easier to blame others than it is to look at ourselves. It's easier to "disappear" than it is to be where we're needed. We become a victim. Though we never achieve happiness, we never risk failure. By deciding to be safe, we prevent personal growth and achievement.

Attached to all of these beliefs is an obsession with other people or situations. We let others "rent space" in our heads. Rather than deal with the present, we ruminate about our past mistakes or project about future problems. We spend too much time thinking about people - and situations we can't change. The past is out of our control, and the future is unpredictable. We spend the present in frustration and fear. I SELF-DEFEATING BELIEFS AND BEHAVIORS Ifwe continue the same self-defeating behavior over and over again, ) we must be receiving some kind of reward or payoff. While the payoffs may not be healthy, they are positive enough to keep us putting forth great energy in the wrong places. Example 51. Although Jim hos six months of sobriety, he con [see example 51 J ~ tinues to feel miserable. He What are Jim's self-defeating behaviors? What could be some of the blames his drinking and drug use on his ex-wife. He blames payoffs for continuing to blame others for his troubles? his lack of money on his divorce, Jim has chosen to blame others for his perceived misfortune. He is although he has no~ yet found engaging in behavior 7-believing others are responsible for how he the "time" to search for work. feels. He also is exhibiting behavior 10-taking the victim stance and Friends have offered him work, avoiding responsibility for his behavior. but he rejects their offers by What are the payoffs for this type of behavior? believing that the job is not up to his standards. He feels that to • By blaming others, Jim doesn't have look at his own behavior. other people are constantly He doesn't have to change his behavior because the fault lies badgering him about his life with others. He avoids the discomfort of taking responsibility for and making him angry. He his behavior. can't even drive down the • He can find a measure of contentment with self-righteous anger. street without some jerk driving him crazy. Jim feels like he's He can tell himself that he's right and that others are bad for stuck in Nfe with no solution. making him miserable. • Jim can get attention and sympathy as he tells his tale of woe to those around him. • He can avoid taking any risks involved with making changes and avoid being wrong or a failure. • He avoids facing reality.

Jim's beliefs and behavior create a safe, stable situation for him in a perverse way. By playing the victim, Jim may find someone to come along and save him. This may be a way that Jim solicits relationships. AB a victim, he attracts a partner who feels comfortable taking care of and fixing others. We have two unhealthy people in an unhealthy relationship. Each feels as though they have found the perfect person. STOP THE CHAOS

1iXERCISE[iJJt.

Identify some of your self-defeating behaviors. What are the payoffs? Ask others in recovery to help you identify your behaviors and payoffs

Pick two self-defeatin·g behaviors you most closely identify with. ,. ------a. Give an example of how using this thinking or behavior is self-defeating.

b. What are the payoffs for continuing to use this method of thinking or behavior?

c. How can you start to change this thinking or behavior pattern? Ask others in recovery for help in making a plan. lean ______

2. ------

a. Give an example of how using this thinking or behavior is self-defeating.

b. What are the payoffs for continuing to use this method of thinking or behavior?

c. How can you start to change this thinking or behavior pattern? Ask others in recovery for help in making a plan. I can ______r SELF-DEFEATING BELIEFS AND BEHAVIORS Once we've identified our self-defeating behaviors, shouldn't we be able to stop them easily? Many of these behaviors are deeply ingrained into who we are. It's difficult to see them ourselves. We're unaware that we're even engaging in them. We need to tell others about the behaviors we've identified and ask for their help in pointing them out to us. This can be uncomfortable at times. We must also permit others to point out the self-defeating behaviors we haven't identified but that they see in us. We need to accept their observations as part of a learning process. We need to practice healthy behaviors and thinking.

Remember: • We must make changes in our behavior and thinking. Stopping our chemical use is not enough. • Some self-defeating beliefs and behaviors may predate our chemical use. Others may result from trying to protect our chemical use. • Many of us continue self-defeating behaviors without knowing it. • When we repeat behaviors that distress us, there may be a payoff of some type for continuing that behavior. Payoffs for our self-defeating behavior keep us stuck. • We shouldn't be discouraged. Everyone, addicted or not, has self-defeating behaviors. • Once we've identified self-defeating beliefs and behaviors, we need to plan how to change them. Self-defeating behaviors are difficult to resolve alone. We need to ask others for assistance.

c; I 11. Avoiding a relapse.

Do New member paperwork, if any new members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Introductions: Have clients introduce themselves, saying first name only, what legal charges are, and how drug or alcohol use was related to that. Why do you think you were recommended to complete this program, even if your charge wasn't a drug or alcohol charge? Do Midpoint paperwork, if any group members are at their 9 th week (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Do Graduation paperwork, if any graduating members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Complete Tracking Form, including whether attended AA Do Group check-in Briefly review homework from Lesson 10 (Page 43 of Client's Manual)

GO TO NEXT PAGE he medical definition of a relapse is a return of the signs and symptoms of a particular disease. In addiction, people equate the term relapse with starting to drink and drug again. This is inaccurate. Relapse starts long before that point. Relapse is a process that begins with slight and often unseen changes in our thinking, attitude, and behavior. Over a period of time-weeks to years--our attitudes, beliefs, and emotions change to the point where we are convinced, consciously or unconsciously, that a return to chemical use makes sense.

« 147 >> STOP THE CHAOS . . ' f When we reach this point, it's unlikely that we will think about preventive measures when confronted with a using opportunity. Our attitude has already changed. We find that we have little or no defense ~-.~ against the first drink or hit. • Relapse starts with a subtle change in attitude and thinking. • Relapse ends when we start using chemicals again. r Relapse prevention explores the changes in attitudes, emotions, i~ and behaviors that we would exhibit prior to returning to chemical i', I, use or to becoming emotionally unstable. Addiction is a chronic disease with a tendency for relapse to chemical use. We are susceptible to relapse whether we have many years of sobriety or only a few weeks.

Susceptibility in Early Recovery

'r . ~I Many of us on the recovery road really believe that we won't drink or .. drug again, yet a large number ofus (40 to 60 percent) will return to •·:• I alcohol and/or other drug use in the first year. We are especially susceptible to relapse in early recovery. Our stress levels are high as our bodies and minds go through intense emotional and physical changes. We have not had time to develop reliable coping______-· - -. ------Elkffiii for dealing with the ~;~ti;-nal roller ~;~~;~Tllie. We ~ be easily overwhelmed. Our brains are still clouded by years of intoxication. On the other hand, it's easy to become complacent. We start to feel good about our abstinence from alcohol and other drugs. We minimize the severity of our addiction and the effort needed to stay in recovery. We gradually forget that addiction is an illness that is hardwired into our brains. We believe in the notion that because we know we can't use, we will be able to make intellig~nt decisions about our use. We find that it doesn't take much to push us back to using again. In early recovery, many relapses result from our not taking our addiction seriously. We are not convinced that we are addicted. We understand that we've had negative consequences from our chemical use, but we're not yet willing to admit to being powerless. We hang on to a belief that if we understand our addiction, we can master it. Because we think we have some control, we mistakenly put ourselves - at risk.

b. u AVOIDING A RELAPSE TO CHEMICAL USE

Identifying dangerous situations is crucial. We need to be able to 7 uickly identify high-risk situations when we encounter them ~ c~. A high-risk situation is 1. any person, place, feeling, or situation connected with using drugs or alcohol or experiencing emotional trauma 2. any time that we are around alcohol or other drugs 3. any place or situation we associate with high stress The following list shows thinking and behaviors that are "red flags" in early recovery. We need to take these seriously. They are steps on our way back to alcohol and other drug use and must be dealt with immediately. • Slippery people and places. Slippery people and places can grease our slide back to chemical use. People in recovery say, "If you keep going to the barbershop, sooner or later you'll wind up with a haircut." Going back to our old lifestyle involving using people and using places ultimately leads to our return to drugs and alcohol. • Dishonesty. Dishonesty is the way we lived while we were using. We would have said or done anything to prolong our chemical use. Secrets provide a basis for further dishonesty. Being honest Witnother!faiia ourselves-is a -sigfilficant-partof recovery.rlonesty .. 1 holds us accountabl_e and we willingly take responsibility for our behavior. • Control. We have to accept that we can't control other people, places, and tirings. Anger and resentments block love and serenity from our lives. To maintain recovery, we must do a thorough housecleaning of our resentments and shortcomings. • &lationships. Very few things can spur emotional upheaval more quickly than romantic relationships. Our relationship with a spouse or significant other can send us to terrific heights or incredible emotional lows. Both extremes can be dangerous in early sobriety. • Isolation. Isolation gives us an opportunity to engage in self pity or to construct irrational thoughts. We need to break out of isolation. STOP THE CHAOS

• Impatience. Many ofus are anxious to move ahead and get on with our lives. We set our expectations too high. When we can't reach our goals, we believe we have failed. We can remember that our serenity is usually inversely proportional to our expectations of others and ourselves; that is, the higher our expectations of others and ourselves, the less serene we seem to be and vice versa. • Emotional distress. Emotional triggers can be especially dangerous since they can seem overwhelming. When feeling overwhelmed, we seek a quick, reliable solution. • HALT-Hungry, Angry, Lonely, Tired. The concept of moderation is sometimes foreign to us. Our addictive thinking and compulsive behavior make it difficult for us to "take it easy" or "keep it simple." We drive ourselves until we become hungry, angry, lonely, and tired, arid our self-care deteriorates. • Thinking we know it all. This kind of attitude plays down the effort needed to stay in recovery. We thi?k that "half measures" are adequate to maintain our sobriety. We display reckless - behavior by placing ourselves in situations where our sobriety might be compromised. • The unexpected. Life can serve up unexpected problems that - createlarge amountsof stress for us-accidents; wvorce, deaths, - · financial problems, depression, anxiety attacks, family issues, sickness, job instability. We are seldom prepared for these traumas in early recovery.

Explore behaviors that could change your attitudes and return you to chemical use. What negative attitudes do you see in yourself? Think about your answers to the following questions.

• Are you cocky? Angry? Fearful? • Do you find it easy to feel inadequate and shameful or would you rather be seen as a "know-it-all"? • Do you worry about getting approval from other people? • Are you dishonest with others to avoid consequences or to look better in their eyes? AVOIDING A RELAPSE TO CHEMICAL USE

· Are you likely to let others know when you're in trouble and to ask for help? • Do you believe that you should never make a mistake? • Are you easily overwhelmed? • Do you like to be in control? • Are you impatient with others?

Do you understand why the above behaviors are dangerous? List your attitudes and behaviors that could be signs of .slipping into a relapse.

What slippery situations ·ght you encounter? Try to identify as many people or places as possibl . Look at your social activities, jobs, friends, and family. Are any of these associated with drug or alcohol use? The more you can identify as dan erous, the safer you'll be.

\ \ .- \

' ' ''-· STOP THE CHAOS - What Do I Do If I Relapse to Chemical Use? Regardless of our best intentions, some of us may return to chemical use. We may be taken completely by surprise. We need to set aside feelings of failure and take action to stop our chemical use. There are steps we can take to keep ourselves as safe as possible if relapse to chemical use occurs. • If we've just started our use, we must STOP! • If we've been using for a while, we may need professional help for withdrawal. An unsupervised detoxification can be dangerous. We may experience seizures or hallucinations. • We may be disoriented or confused because of the toxic effect of the chemicals on the brain. We need to work on stabilizing our selves and remaining safe. Our chance of continuing our chemical use at this time is high. Safety from continuing our chemical use is the first priority.

• We can turn to our support system immediately-recovery group or friends, aftercare group, counselor or therapist-and let them know what's going on. There is no shame in a relapse to chemical use. A relapse is +- - - -not a-mor.al issue.--a-sign of-weakness, ol! a-failure,_Ws-impor-taat - to be honest about what has happened. The people around us will appreciate our honesty and support our need to return to recovery. We can't keep secrets in a program based on rigorous honesty and expect to stay sober. • We work to get past any feelings of failure, anger, guilt, shame, blaming, or self-pity for relapsing. Thoughts of "I should have known better!" can keep us from the help we need. Talking openly about our feelings with other recovering people will make it ea5ier for us to cope.

If we have a pattern of relapsing, we can't take chances. We need to seek professional help. Several different levels of care are available to the person struggling to stay sober. Our medical insurance may cover treatment. If we don't have insurance, we can check with city, county, or state social service organizations. We should never try to handle a relapse to chemical use alone. We need to ask for help and get others involved. Failing to do so can lead to continued use and to severe consequences. It's easiest to quit immediately. Assign and explain homework for lesson 11: parts 3 & 4 of Relapse Prevention Plan: Don't ( Let a Relapse Take You by Surprise. (Pp. 44 - 45 of Client's Manual) 12. The importance of taking good care of yourself. (

Do New member paperwork, if any new members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Introductions: Have clients introduce themselves, saying first name only, what legal charges are, and how drug or alcohol use was related to that. Why do you think you were recommended to complete this program, even if your charge wasn't a drug or alcohol charge? Do Midpoint paperwork, if any group members are at their 9th week (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Do Graduation paperwork, if any graduating members (see 12 Week New Foundation AoD Client Requirements on page 2 of Leader's Manual) Complete Tracking Form, including whether attended AA Do Group check-in Briefly review homework for lesson 11: parts 3 & 4 of Relapse Prevention Plan: Don't Let a Relapse Take You by Surprise. (Pp. 44 - 45 of Client's Manual)

Have group members take out part 5 of the Relapse Prevention Plan SUBSTANCE-FREE ACTIVITIES AND HEALTHY HABITS (P. 46 of Client's Manual). Explain that during today's group meeting, they will be filling out that f"mal page. Review the instructions.

Attending Meetings: Attending meetings regularly will add structure to your life. Meetings are a social group where you can get hope and practical suggestions for recovery. Attending meetings helps with feelings of loneliness and isolation. We connect with other people who understand what we are going through - people who accept us just as we are. They understand us because many of them have gone through similar experiences and feelings. Meetings are the best way to share our experience, strength and hope.

Remind group members that in their packet is a list of the AA meetings in Portage County.

Stress Management: One way to reduce stress is to use relaxation techniques. The reason is that you can't be relaxed and stressed at the same time. So, if you can get good at getting relaxed, your level of stress will drop. I'm going to teach you 2 relaxation techniques. Quieting Reflex: 1. Close your eyes. 2. Inhale deeply through your nose. Think the words, "I am ... " 3. Hold it for a few seconds. 4. Exhale deeply through your mouth. Think the words, " ...relaxed. " Visualization of a Peaceful Scene: Beach Visualization: Imagine that you are sitting alone on a beach, in a beautiful, safe, and peaceful location. You are facing the water and are slowly breathing in and out while you immerse yourself in the setting. As you continue to breathe gently, imagine the smell of the sea and let it fill your lungs. And tune into the sounds of the waves as they ebb and flow, slowly rolling in and breaking over each other and then slowly flowing back out again. Picture the sky in your mind ... blue and clear, with just a few small white clouds moving slowly across the sky. Feel the sunlight gently warming you ... the mild breeze passing over you and stirring your hair ... the texture of the sand beneath your feet. Take a few moments to continue to enjoy your time here, paying attention to what you are hearing, seeing, touching, smelling, or even tasting from this scene. Now, continue to breathe in and out slowly while you open your eyes.

Eat Well-balanced meals: Many people have neglected their nutritional needs. Maintaining a healthy and balanced diet allows the body and brain to heal. Our bodies need a regular source of goo quality fuel to work efficiently. If we skip meals and eat a lot ofjunk food, we are not giving our bodies and brined the high quality fuels they need to heal and function at their best. Eating balanced meals on a regular schedule is a self-loving act and is beneficial to our overall recovery.

Exercise regularly: Moderate exercise helps reduce stress, speeds healing, and can aid sleep. We don't have to take up weight training or memberships in fancy gyms. Walking is a great way to get our blood circulating and the muscles moving. It can also be a great stress reliever.

Sleep and Rest: It is healthy and helpful to our recovery to be on a regular schedule for bedtime and awakening. Our bodies and brains need a certain amount of quality sleep to operate correctly. It helps to refrain from drinking coffee or consuming large quantities of snacks and sweets in the late evening. We don't need to charge up our systems with extra energy (calories/sugars) or stimulants (caffeine) just to geo to bed.

Find/keep Employment: Being productive and staying busy help a person feel good about him or herself. Avoiding too much free time will reduce the urge to use. Earning money will reduce stress. It's important if you don't have a job lined up to devote a lot of time and energy to find one.

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iving a lifestyle· of recovery asks us to improve all areas of our lives, not just to stop our chemical use. We're asked to develop moderation-a strange concept for the alcoholic and addict. Usually our living style has been an all-or-none proposition-living on the edge or ignoring everything. Now we look for balance in our lives. We focus on self-care as part of - the solution for keeping us sober. This is a difficult process. We become impatient and want quick results. We need to remember that recovery is a journey, a process that does not happen overnight. STOP THE CHAOS - Many of us have neglected our own health needs for years because of our chemical use. Our chemical use may have influenced our eating and sleeping patterns or reduced our physical activity. We postponed or made excuses to avoid health care appointments. We avoided such appointments for fear of hearing bad news, Our focus remained on our alcohol and other drug use, not on our well-being. Use of alcohol and other drugs can take a heavy toll on psychologi cal and physical health. We need to assess the damage we've done. We need to listen to what others have to say and follow through. We may feel afraid or rebellious. We continue to want to accomplish recovery by ourselves and to not have to ask for help. It's necessary to once again remember our saying, 'We need to make our lifestyle fit our recovery, not our recovery fit our lifestyle."

Physical Examinations It's a good idea to have a comprehensive physical examination after we've gotten sober. In early recovery, we may find ourselves plagued by pains and aches that we never noticed before. Our chemical use may have hidden existing medical conditions or caused new illnesses. A physical examination can identify diabetes, high blood pressure, or other illnesses that may get worse if left witreated. We can't forget to let the physician know that we're chemically dependent to all mood-altering drugs. Sometimes even if we mention that we're alcoholic, a physician may unknowingly prescribe mood altering prescription drugs. He or she may be unaware of the reality of cross-addiction or of the severity of our dependency. We can't be afraid to ask questions..

Dental Exam When using, most likely we overlooked dental care. Dental pain may have been another excuse to continue chemical use, or our drug may have masked the pain. When we get sober, these conditions need to be addressed quickly. Severe dental pain can trigger a relapse to chemicals when we decide to use to moderate the discomfort. We want to consider what type of anesthetic the dentist will be using. Novocaine and other local anesthetics for numbing the teeth and gums should present no addictive problems for the addict and alcoholic. Nitrous oxide, or ''laughing gas," is a mood-altering chemical and should be avoided. AVOIDING A RELAPSE TO CHEMICALt]SE

As,others had predicted, Chu lost his family an job. His addic- ion fooled him into thinking, "It never happen to e." He believed that heh~ control over his chemical e and would stop· things got "really bad." we accept the power of o further losses in ur lives. We may have ask ourselves, "What ar my priorities? letting my job, fami recovery program?"

The Role of Stress in Relapse Stress can be a critical factor in setting up a return to chemical use. Stress can take a situation that we could normally handle and turn it into a sobriety-threatening nightmare. Many of us are unaware of the level of stress in our lives. We frequently ignore stress as something we don't have time to deal with. Left unattended, stress can create an unmanageable situation.

Stress Is Cumulative We may find it difficult to identify long-standing stressors in our lives. 1f we live downwind from a sewage plant, after a time, the smell becomes normal. In other words, we've known stress for so long, we don't have anything to compare it to. Examples of stress-inducing situations include • any time or situation where there is a change-negative or positive (stress is an inherent factor in.all change) • any time we're feeling physically ill or dealing with chronic pain • any time we're feeling hungry, angry, lonely, or tired (HALT) • any time we're feeling powerless or out of control • any time we're feeling shameful or inadequate • any time we're feeling alone and/or hopeless • any time we're feeling angry and resentful • any time we're trying to avoid conflict • any time we're living in fear • any time we're feeling pressure from others (directly or indirectly) to perform in some preconceived manner l STOP THE CHAOS 1- ! Many of us tend to stuff feelings into our emotional backpack. When we have stuffed too many unresolved emotions into our back pack, its seams rip open and the emotions explode outward at our selves and others.

What are high-stress areas in your life? List situations or people that make you feel stressed. (Examples of stressful situations are attending funerals, going through divorce settlements, meeting with an ex spouse, or appearing for sentencing in a court case.)

If we must be in a high-stress situation, we need to plan for it. We can't tell ourselves, "I'll be okay" or "I haven't felt like using so I'll be able to handle it." We're setting ourselves up. A plan to handle a high-stress situation includes the following: • Prior to the situation. We can attend extra support meetings ahead of time; set up a list of people we can call before, during, or after the situation; plan to bring someone supportive with us; pla..-ri to bring recovery readings; let everyone know about the event-no secrets. People say, "If I get into trouble, I'll call someone." This is an answer given by someone who doesn't yet understand the power of the disease. If we get into trouble away from our support system, we may not call anyone. We need to commit to calling people at specific times. I AVOIDING A RELAPSE TO CHEMICAL USE J--- • During the situation. What problems might we encounter during the situation? How can we respond to these problems in a healthy way? What are our resources for support? If we are going out of town, we can take recovery reading with us and make sure we know where recovery meetings are held. We can make calls to recovering friends to help stabilize us during emotional encounters.

• After the situation. We may not allow ourselves to experience the emotional consequences of a stressful situation until we've gotten through it. Plan to contact recovering friends or stay in a safe place immediately after a stressful situation. Our emotional responses may be stronger than we anticipate.

These procedures are not limited to those who are in early sobriety. Regardless of how much recovery time we ha e, we are in danger of drinking, \ ging, or collapsing emotionally · high-stress situations.

- What If I' Exhibiting Signs of and Behavi r Change?

If someone points ou a change in our attitude, it's imp rta.nt for us to listen and get specific ormation. We need to remembe that others may see changes that don't. We need to talk about thi information with a mentor or sponsor· recovery and with experience recovering friends. • We need to step back d take time to review where we Are we becoming compla ent? • We can ask for help from o ers in recovery in dealing witH dry-drunk behaviors. • We may need to increase our p icipation in recovery activiti and interactions with other reco ring people. • We may choose to get more educati non a particular issue in our lives or to get away and relax for few days. • We can look at our recovery plan. Are trying to do too much? Are our expectations too high? • It may be time to look at old, unresolved emotional issues. We can seek professional care. Summit Psychological Associates, Inc. ODADAS Outcomes Framework Adult Client Survey

Completing this survey will assist us in our ability to be most helpful to you. Please feel free to be honest in completing it. D 26-Week Group D 12-Weck Group D Individual Treatment

Client Name: ______Date: ______

Clinician Name: ______

Point in Program at SPA: Entry Midway Graduation

1. Do you believe that your alcohol or other drug use has negatively impacted your life? D Yes D No D Not Sure

2. Are you currently attending 12 step meetings (e.g. AA) each week? □ Yes □ No

3. Are you currently abstinent from all alcohol and other drug use? □ Yes □ No

4. Have you learned skills to manage your triggers or high-risk situations, in order to avoid using alcohol or other drugs? D Yes D No

5. Is your goal to remain abstinent from all alcohol and other drug use, even after you complete treatment at SPA? □ Yes □ No □ Not Sure

6. Have you met with a case manager at Summit Psychological Associates, Inc.'! □ Yes* □ No D Not Sure *If yes, please answer the following two questions:

Has the case manager assisted you in obtaining stable housing? □ Yes □ No □ N/A (already have stable housing) Has the case manager assisted you in obtaining stable employment or another source of regular income, such as disability payments, retirement benefits, a pension, or social security? □ Yes □ No D N/A (already have stable employment or another source of income)

7. May we contact you in the future to conduct a follow up survey? □ Yes* □ No *If yes, please provide us with your email address or another method of communication:

1/30/2020 New Foundation 12 week Program Summit Psychological Associates, Inc.

Pretest Post-test

Name: ------Date: ------1) "In both animal and huma~ studies, alcohol, more than any other drug, has been linked with a high incidence of violence and aggression." This statement is: A) True B) False

2) "Stopping heavy marijuana use can lead to withdrawal symptoms." This statement is: A) True B) False

3) Recovery requires: A) Stopping substance use completely B) Admitting being powerless over the addiction C) Asking other people for help D) Understanding that addiction is a chronic illness E) All of the above

4) "You can't be an alcoholic if you have a job, never drink before noon, and have never gotten a DUI." This statement is: A) True B) False

5) Which of the following is true about how substance addiction occurs: A) It can involve genetic factors B) It involves the limbic system in the brain C) It gets worse over time D) All of the above E) None of the above

6) Cravings: A) Always lead to a relapse B) Can arise without warning or. can come from a trigger C) Usually last several hours at a time D) Can lead us to put ourselves in high risk situations E) Band D Name: ------p. 2

7) Believing you can use drugs or alcohol one more time and still control your substance use is an example of: A) Logical thinking B) Angry thinking C) Magical thinking D) Automatic thinking

8) Which is true about the term "relapse": A) It begins the moment the person starts to use drugs or alcohol again B) It begins with slight, often unseen changes in our thinking, attitude, and behavior long before the person starts to use drugs or alcohol again C) It should lead to embarrassment and shame D) It can't occur if you have enough willpower

9) One major reason why many people don't recognize their addiction is: A) Weakness B) Withdrawal C) Denial D) Failure

10) "Most people can recover without support as long as they really want to." This statement is: A) True B) False

Score: ----- Summit Psychological Associates, Inc. ODADAS Outcomes Framework Adult Client Survey

Completing this survey will assist us in our ability to be most helpful to you. Please feel free to be honest in completing it. D 26-Week Group D 26-Week Individual D 12-Week Group D 12-Week Individual

Client Name:______Date: ______Clinician Name: ______

Point in Program at SP A: l.1Entry !Midway ~Graduation

I. Do you believe that you have a problem with alcohol or other drugs? □ Yes □ No □ Not Sure

2. Are you currently attending 12 step meetings (e.g. AA) each week? □ Yes □ No

3. Have you completed a written Relapse Prevention Plan? □ Yes □ No □ Not Sure

4. Are you currently abstinent from all alcohol and other drug use? □ Yes □ No

5. Is your goal to remain abstinent from all alcohol and other drug use, even after you complete treatment at SPA? □ Yes □ No □ Not Sure

6. Are you currently employed? □ Yes □ No

7. Is your housing situation stable? 0 Yes D No D Not Sure If no, do you have plans to establish stable housing? □ Yes □ No 8. Have you participated in case management services here at Summit Psychological Associates, Inc? D Yes □ No D Not Sure

9. May we contact you in the future to conduct a follow up survey? □ Yes D No

If yes, please provide us with your email address ______

or another method of communication

Rev 10/2017 SELF APPRAISAL REPORT Client: ______Person Completing: ______Date: ____

Listed below are a number of categories in which people commonly experience difficulties. Please indicate how the client is functioning in each area. Please circle one number for every item. 1 Not A Problem Somewhat a Problem A Moderate Problem A Serious Problem A Severe Problem 1 2 3 4 5 I Physical Functions IV Feelings & Moods 1. Sleep Pattern 1 2 3 4 5 33. Depression (sadness) 1 2 3 4 5 2. Eating Pattern 1 2 3 4 5 34. Frequent Mood Swings 1 2 3 4 5 3. Bladder Control 1 2 3 4 5 35. Anxiety 1 2 3 4 5 4. Bowel Control 1 2 3 4 5 36. Lacie of Energy 1 2 3 4 5 5. Seizures or Convulsions 1 2 3 4 5 37. Feeling Angry 1 2 3 4 5 6. Speech (e.g. stuttering) 1 2 3 4 5 38. Not Liking Self 1 2 3 4 5 7. Weight Problem 1 2 3 4 5 39. Not Liking Others 1 2 3 4 5 8. Sexual· Functioning 1 2 3 4 5 V Inner Thoughts and Ideas II Experience at Work/School 40. Thoughts About Hurting Yourself 1 2 3 4 5 9. General Performance 1 2 3 4 5 41 . Thoughts About Hurting Others 1 2 3 4 5 10. General Satisfaction 1 2 3 4 5 42. Having Unwanted Thoughts Again 11. Lateness 1 2 3 4 5 and Again 1 2 3 4 5 12. Absenteeism 1 2 3 4 5 43. Worrying About Your Health 1 2 3 4 5 13. Negative Feelings About 44. Believing You are Inferior to others 1 2 3 4 5 Work/School 1 2 3 4 5 45. Seeing Things That are Not There 1 2 3 4 5 14. Relationships with Supervisors 46. Hearing Things That are Not There 1 2 3 4 5 or Teachers 1 2 3 4 5 47. Experiencing Confusion 1 2 3 4 5 · c;_ Relationships with Co-Workers 48. Memory Problems 1 2 3 4 5 or Peers 1 2 3 4 5 VI Alcohol and Drug Use Ill Behavior 49. Have you ever felt you should cut 16. Difficulty with Daily Routine 1 2 3 4 5 down on your drinking or drug use?_Yes _No 17. Letting Others Take Advantage 50. Have people annoyed you by criti- ofYou 1 2 3 4 5 cizing your drinking or drug use? _Yes _No 18. Hyperactivity (cannot sit still) 1 2 3 4 5 51 . Have you felt bad or guilty about 19. Difficulty Paying Attention 1 2 3 4 5 your drinking or drug use? _Yes No 20. Doing Things Impulsively 1 2 3 4 5 52. Have you ever had a drink or used 21 . Physically Abusing Others 1 2 3 4 5 drugs first thing in the morning to 22. Gambling 1 2 3 4 5 steady your nerves or to get rid of 23. Using Alcohol to Cope with a hangover? (Eye-Opener) _Yes _No Problems 1 2 3 4 5 24. Using Drugs to Cope with VII Other Difficulties Problems 1 2 3 4 5 Add additional problems not listed above 25. Lying 1 2 3 4 5 53.______1 2 3 4 5 26. Hostile Behavior 1 2 3 4 5 54. 1 2 3 4 5 27. Withdrawal from Others 1 2 3 4 5 While receiving services with us have you also received mental 28. Dependency (relying on others to take care of you) 1 2 3 4 5 health services at another agency? Yes No 29. Poor Peer Relationships 1 2 3 4 5 If yes, name of agency/clinician______10. Problems with Conduct 1 2 3 4 5 . Not Trusting Others 1 2 3 4 5 How recentty have you been seen there? 32. Stealing 1 2 3 4 5 _Currently scheduled _seen within past month FOR OFFICE USE ONLY: Forensic: Yes No Date: ______Clinician: Office Location (Circle): A R C

SUMMIT PSYCHOLOGICAL ASSOCIATES, INC. CLIENT SATISFACTION SURVEY Summit Psychological Associates, Inc. values input from our consumers of service. Please rate your satisfaction for each question, and add comments. Thank you.

1. Ease of Access to our services ( e.g. office location, convenience of appointment times, time gap between calling us and being seen for your first appointment, time gap between your first and second appointments, ease of reaching us by phone, length oftime spent in our waiting room before your appointments)

1 2 3 4 Poor Below Average Above Average Excellent Comments: ------2. Clinician Effectiveness (e.g . how well your therapist listened, understood your problems, included you in treatment planning, and helped address your problems; the helpfulness of your clinician in obtaining other care) 1 2 3 4 Poor Below Average Above Average Excellent Comments: ______

3. Dignity and Respect shown to you by our agency ( e.g. how well you have been treated by the staffat Summit Psychological Associates, Inc. how comfortable you feel with your 1reatment, the level of sensitivity to your culturaVraciaVethnic background, pleasantness ofthe facility)

1 2 3 4 Poor Below Average Above Average Excellent Comments: ------4. Personal Improvement thus far (e.g. level of satisfaction with your personal progress toward achieving some or all ofyour treatment goals at Summit Psychological Associates, Inc. how productive your treatment has been)

1 2 3 4 Poor Below Average Above Average Excellent Comments: ______

5. What program or service would you like to see offered at Summit Psychological Associates, Inc.? Comments: ______

The following items are included to improve our sensitivity to multicultural issues.

Do you consider yourself to be a member ofa racial or ethnic minority? Yes No IfYes, please answer the following two questions: I. Client's Race: □ Asian □ Native American □ Alaskan Native □ Black/African American □ Native Hawaiian/Other Pacific Islander □ White □ Other

2. Client's Ethnicity: Is the client Hispanic/Latino? □ YES* □ NO *If Yes, Please Specify: □ Puerto Rican □ Cuban □ Mexican □ Other Hispanic 12.16.2014