Section XXXV: Substance Abuse/Dependence

What Does Addiction Mean to me?

Goals of the Exercise

1. Identify and accept the need for substance abuse treatment.

2. Accept the unmanageability of use of mood-altering substances, and participate in a recovery program.

3. Verbalize a commitment to abstain from the use of mood-altering drugs.

4. Establish a sustained recovery, free from use of all mood-altering substances other than prescribed medications used exactly as directed by a physician who is aware of the patient's substance use history.

Additional Problems for which this Exercise may be Useful

Suggestions for Processing this Exercise with Veterans/Service Members

The “What Does Addiction Mean to Me?” activity is for veterans/service members who resist accepting a diagnosis of substance dependence or abuse due to mistaken ideas about what the terms mean. It explains the DSM-IV-TR criteria and analyzes how they fit the veteran/service member's life situation, including non–substance-using addictive behavior. Follow-up can include bibliotherapy on alcoholism and addiction; keeping a journal about lessons learned, conclusions, and plans made; and discussion with the therapist/therapy group of all of the above. Follow-up can also include bibliotherapy using books listed in Appendix A of The Veterans and Active Duty Military Psychotherapy Treatment Planner and/or videotherapy using My Name Is Bill W. or other films listed for “Substance Abuse” in Rent Two Films and Let's Talk in the Morning, 2nd ed., by John W. Hesley and Jan G. Hesley, published by John Wiley & Sons.

EXERCISE XXXV.A What Does Addiction Mean to me?

You may be doubtful about whether you are an alcoholic or addict, no matter what anyone else says. To answer this question for yourself, you need to be able to identify patterns of addictive or abusive use of alcohol, other drugs, or compulsive behavior, and to see whether your life fits these patterns. This exercise explains what these terms mean in plain English to help you decide.

1. For each of the following patterns, please write about whether this has happened in your life, and if it has, please think of at least one example.

a. Tolerance. This is when you need to use more of a chemical or do more of a behavior (or doing it to a greater extreme) to get the same effect, or feeling less effect if you use or do the same amount.

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b. Withdrawal. This means either feeling ill or uncomfortable after stopping use of the chemical or the behavior, or using the chemical or practicing the behavior to relieve or avoid feeling ill or uncomfortable.

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c. Loss of control. This means you use, drink, or practice an addictive behavior for longer or in greater quantity than you intended.

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d. Attempts to control. This fits if you have had a persistent desire to cut down or stop, or have made efforts to control or cut down your using/drinking/addictive actions, including making rules or bargains with yourself to limit it.

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e. Time spent. This refers to spending a significant amount of time thinking about using, drinking, or practicing the addictive behavior; planning or preparing for it; using/drinking/practicing; and dealing with the consequences (such as being hung over or coming down, or being broke until payday).

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f. Sacrifices made. This includes giving up or reducing social, work, family, or recreational activities that were important to you because they conflicted with your addictive behaviors—for example, drifting away from friendships with people who won't drink or use with you.

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g. Continued use despite known suffering. This means continuing to use, drink, or practice another addiction in spite of knowing that you have had major physical, psychological, legal, financial, or relationship problems that were caused or made worse by that behavior.

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2. Looking back over these symptoms, what do they tell you about your use of substances or other addictive behaviors?

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3. For each of the following stages of addiction, please note whether you have experienced this, and if you have, please think of an example of how your life fits the description.

a. First stage. The first experience—when you begin using a chemical or engaging in a behavior and discover that you like the way it makes you feel.

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b. Second stage. Tolerance and withdrawal appear, and you find that you can use the chemical or behavior to cope with situations or feelings that are difficult or uncomfortable.

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c. Third stage. You begin deliberately and routinely using the chemical or behavior to cope with stress or other problems. You may feel uneasy about it, and may try to cut down or control use; your normal life is disrupted and others may start thinking that you have a problem.

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d. Fourth stage. You come to feel that you can't cope with your life's stresses without the chemical or behavior. You feel that you must pay whatever price comes with continued use; you feel trapped; your life seems to be falling apart; and/or relationships with others are damaged or lost.

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4. Looking over these four phases in the development of an addiction, what have you learned about your own pattern of use?

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Be sure to bring this handout back to your next therapy session, and be prepared to discuss your thoughts and feelings about the exercise.

Problem Identification

Goals of the Exercise

1. List and discuss negative consequences resulting from, or exacerbated by, substance dependence.

2. List and discuss reasons to work on a plan for recovery from addiction.

3. Identify and accept the need for substance abuse treatment.

4. Accept the unmanageability of use of mood-altering substances, and participate in a recovery program.

5. Verbalize a commitment to abstain from the use of mood-altering drugs except for using prescribed medications exactly as instructed by a physician who is aware of the patient's substance use history.

Additional Problems for which this Exercise may be Useful

Suggestions for Processing this Exercise with Veterans/Service Members

The “Problem Identification” activity is suited for individual or group use. This activity walks veterans/service members through systematically listing, at one time and in one place, negative things that have happened in their lives as the result of substance abuse—in a way, conducting a self-intervention. Follow-up might include writing about reflections afterward; sharing responses with the therapist, treatment group, and program sponsor; and the “Personal Recovery Planning” activity. Other follow-up activities could include bibliotherapy using books listed in Appendix A of The Veterans and Active Duty Military Psychotherapy Treatment Planner or videotherapy using “My Name is Bill W.” or other films listed for “Substance Abuse” in Rent Two Films and Let's Talk in the Morning, 2nd ed., by John W. Hesley and Jan G. Hesley, published by John Wiley & Sons.

EXERCISE XXXV.B Problem Identification

People don't usually get treatment or help until they find themselves in some kind of crisis. Crises are good motivators, but they don't usually last as long as the underlying problems. To stay motivated and stay in recovery, we need to look at our addictive behaviors over the long term, beyond the crises that get us to act. If you wonder whether you have a problem with alcohol, another drug, or another addictive behavior, or how serious your problem is, compare the events in your life with each of these categories.

1. Below is a brief, partial list of common experiences that cause people who are practicing addictive lifestyles to decide that they should change these patterns, that their addictions are causing them problems, and that they want help. Please check all those that apply to you.

Loss of Important Relationships Because of Addictions

_____ Divorce or equivalent _____ Children, parents, siblings alienated
_____ Loss of close friendships _____ Loss of respect from coworkers

Practical Difficulties Resulting from Addictions

_____ Unpayable debts _____ Loss of employment
_____ Loss of a vehicle _____ Loss of a home
_____ Loss of professional status _____ Bankruptcy
_____ Legal problems (e.g., arrest, jail, probation, loss of driver's license)

Dangerous/Harmful Situations Resulting from Addictions

_____ Health problems _____ Recreational accidents
_____ DUIs, DWIs, or car wrecks _____ Work injuries, falls, or other accidents
_____ Fights while under the influence or coming down _____ Harm to others as a result of one's own actions under the influence
_____ Suicidal ideation, attempts _____ Self-injury
_____ Violence

Things We Once Thought We Would Never Do

_____ Letting down friends _____ Repeatedly breaking promises
_____ Lying to partners/families _____ Stealing from partners/families/work
_____ Letting down employers _____ Abusing family members
_____ Selling drugs _____ Committing crimes to support addiction
_____ Exchanging sex for alcohol or other drugs _____ Endangering others, especially children

2. When you think about your life without alcohol, other drugs, or the other addictive behavior, what emotions do you feel?

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3. Do you see any other evidence that your use of alcohol, other drugs, or other addictive behavior is causing problems in your life? If you do, what is it?

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4. On a scale of 1 to 10 (1 = not at all and 10 = extremely important), how important is it for you to make changes to your use of alcohol, other drugs, or other addictive behavior at this time?

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5. On a scale of 1 to 10 (1 = not at all and 10 = extremely confident), how confident are you that you could begin to make changes to your alcohol, other drug, or other addictive behavior if you wanted to?

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Be sure to bring this handout back to your next therapy session, and be prepared to discuss your thoughts and feelings about the exercise.

Personal Recovery Planning

Goals of the Exercise

1. List and discuss negative consequences caused, or exacerbated by, addiction.

2. List and discuss reasons to work on a plan for recovery from addiction.

3. Identify and accept the need for substance abuse treatment.

4. Accept the unmanageability of use of mood-altering substances, and participate in a recovery program.

5. Verbalize a commitment to abstain from the use of mood-altering drugs, except for prescribed medications used exactly as instructed by a physician who is aware of the patient's substance use history.

Additional Problems for which this Exercise may be Useful

Suggestions for Processing this Exercise with Veterans/Service Members

The “Personal Recovery Planning” activity is for veterans/service members who are at least somewhat motivated for recovery and need structure and direction. It guides veterans/service members in identifying goals for recovery to frame planning and strengthen motivation, then walks them through several domains of life functioning and prompts them to identify supportive resources and relationships and commit to a plan to use them. Follow-up can include keeping a journal; reporting back to the therapist, therapy group, and sponsor on the outcomes of activities in the personal recovery plan; or bibliotherapy using the books listed in Appendix A of The Veterans and Active Duty Military Psychotherapy Treatment Planner.

EXERCISE XXXV.C Personal Recovery Planning

There are many ways to maintain a healthy lifestyle, free of self-defeating addictive behavior. Your recovery plan will be your own creation, not exactly like anyone else's. It won't be a finished product when you're done, but it will give you a guide to fall back on when things get difficult and confusing. You may have tried on one or more occasion to cut back or abstain from addictive behavior and discovered that some things work and some things do not. Please draw on that experience as you work through this exercise.

1. When you think about recovery, what do you want to accomplish? Beyond absti-nence, some goals may include self-respect and dignity, peace of mind, healthy rela-tionships, improved health, career progress, avoiding legal problems, and improved finances. Please list the three things most important to you.

a. _____

b. _____

c. _____

2. For each goal, how would a return to your addiction affect your chances of success?

a. _____

b. _____

c. _____

3. For each goal, what successful result will show that you've achieved that desired outcome?

a. _____

b. _____

c. _____

4. For each goal, what specific warning signs will tell you if you're getting off track?

a. _____

b. _____

c. _____

5. Success in recovery has positive and negative parts: finding things to do that help you remain abstinent and finding things not to do because they may lead to relapse. Drawing on all you have learned and the experiences of others, please fill out the following.

a. Recovery activities

1. What treatment sessions will I attend each week? When and where?

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2. What support group meeting(s) will I attend during the week? When and where?

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3. When, where, and for how long will I meet with my sponsor each week?

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b. Creating a daily structure and routine

1. What things will I do as part of my routine each day, and when will I do them?

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2. Each week?

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3. Each month?

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c. Basic self-care. Living compulsively, we often neglect the basics (e.g., proper nutrition, health care, adequate rest, and exercise). Building these into your life will help you cope with stress. What can you do in each of these areas to take care of yourself?

1. Proper nutrition:

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2. Medical care:

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3. Rest:

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4. Exercise/physical activity:

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d. Relationships and support systems. Relationships with loved ones and friends can have a tremendous effect on recovery, either by helping or hurting. You'll need to analyze past and current relationships and keep some, end some, and develop some new ones.

1. Old relationships. What relationships are likely to support your recovery, and what will you do to strengthen them?

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What relationships will probably undermine your efforts, and how will you end or distance them?

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2. New relationships. Where can you meet people to start some new, healthy, supportive relationships, and how will you go about finding them?

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3. How you can get support from relationships. Please list some people with whom you can talk when you feel troubled, confused, or discouraged, and write about how you will approach each of them to ask for this support.

Name How I Will Ask for Support
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e. Spirituality. Whether or not you're religious, recovery involves making changes in your values; people who include spiritual resources in recovery are usually more successful.

1. How will I address this component of my recovery?

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2. What questions do I have about this, and whom can I ask for assistance?

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f. Work. Your job can be a major source of satisfaction, self-esteem, security, and, sometimes, great stress. Recovering people are prone to workaholism and burnout, either because we want to make up for lost time or because we aren't used to moderation.

1. What will I do to keep my work within healthy, moderate limits?

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2. What will I do if something about my work is posing a risk to my recovery?

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3. How do I plan on dealing with stress related to work?

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g. Legal issues. Cleaning up any legal messes from our addictions is important—to be responsible, reduce stress, and gain self-respect. What am I doing in this area?

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h. Finances. This is a part of life with great impact on self-esteem and stress levels. Many newly recovering people are intimidated by financial problems when they get clean and sober, but with steady effort they can clear the difficulties up faster than expected.

1. What financial problems do I have and what am I doing to resolve them?

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2. What is my long-term plan for financial stability?

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i. Recreation. Early recovery is a time to start having healthy fun, with activities you have enjoyed in the past or with new activities, to help you cope with stress and enjoy life.

1. What old healthy recreational activities will I take up again?

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2. What new activities will I try, and/or am I interested in learning more about?

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3. What steps will I take to incorporate this into my weekly schedule?

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j. Other areas of life.

1. What other things do I see that I should focus on?

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2. What is one step I can take today to make progress on one of these issues?

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k. Crisis management. Your plan must include steps to handle crises. Please list things you'll do to handle an unexpected (or expected) crisis without relapsing into addiction.

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6. Finally, please list activities you know you need to avoid, as they may lead to relapse. This may mean not going to certain places, seeing some people, or engaging in particular work or recreational activities.

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Congratulations! You've laid a foundation on which to build, and created a reference that will come in handy when you're under stress and having trouble thinking clearly. By completing this exercise, you've done much of that thinking in advance.

Be sure to bring this handout back to your next therapy session, and be prepared to discuss your thoughts and feelings about the exercise and make modifications as needed.