T H E M A T R I X M O D E L

B
Early Recovery Skills
Group Handouts

I N T E N S I V E O U T PAT I E N T
A L C O H O L & D R U G T R E AT M E N T

A 16 -Week Individualized Program

Richard A. Rawson, Ph.D., Jeanne L. Obert, M.F.T., M.S.M.,

Michael J. McCann, M.A., and Walter Ling, M.D.

HAZELDEN
®
 Hazelden
Center City, Minnesota 55012-0176

1-800-328-9000
1-651-213-4590 (Fax)
www.hazelden.org

© 2005 by Matrix Institute

All rights reserved. Published 2005
Printed in the United States of America
Duplicating these handouts for personal or group use is permissible

The Matrix Model is a registered trademark of the Matrix Institute.

 B
Early Recovery Skills Group Handouts

DATE
COMPLETED
Scheduling
ALL SESSIONS Handout 1: Scheduling: Is It Important? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ALL SESSIONS Handout 2: Daily/Hourly Schedule (eight copies) . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Marking Time
ALL SESSIONS Handout 3: Calendars and Stickers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
ALL SESSIONS Handout 4: Calendar (five copies) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Session 1: Stop the Cycle

____________ Handout 5: Triggers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
____________ Handout 6: Trigger➞Thought➞Craving➞Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
____________ Handout 7: Thought-Stopping Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Session 2: Identifying External Triggers

____________ Handout 8: External Trigger Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
____________ Handout 9: Trigger Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Session 3: Identifying Internal Triggers

____________ Handout 9: Trigger Chart (from previous session)
____________ Handout 10: Internal Trigger Questionnaire ............................... 29

Session 4: Twelve Step or Other Spiritual Group Introduction

____________ Handout 11: Twelve Step Introduction ..................................... 31

Session 5: Your Body Chemistry in Recovery

____________ Handout 12: Road Map for Recovery ....................................... 35

Session 6: Early Recovery Problems

____________ Handout 13: Five Common Problems in Early Recovery: New Solutions ..... 39
____________ Handout 14: Alcohol Arguments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

continued

iii
 Early Recovery Skills Group Handouts

DATE
COMPLETED
Session 7: Thinking, Feeling, and Doing
____________ Handout 15: Thoughts, Emotions, and Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
____________ Handout 16: Addictive Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Session 8: Keep It Simple, Silly (KISS)

____________ Handout 17: Twelve Step Tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

◆ ◆ ◆

iv
Handout 1 • Early Recovery Skills Group

Scheduling: Is It Important?
Scheduling is a difficult and tedious thing to
begin doing if you’re not used to it. It is, however, an
important part of the recovery process. People addicted to drugs or alcohol
do not schedule their time. People who schedule their time are not actively
using, addicted individuals.

1. Why is it necessary?
If you begin your recovery in a hospital, you have the structure of the program
and the building to help you stop using. As an outpatient, you have to build that
structure around yourself as you continue functioning in the world. Your schedule
is your structure.

2. Do I need to write it down?

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

3. What if I am not an organized person?

Learn to be. Buy a schedule book and work with your therapist. It is vital to
solving your substance abuse problem. Remember, your rational brain plans the
schedule. If you follow the schedule, you won’t use. Your addicted brain generates
out-of-control behavior. If you go off the schedule, your addicted brain may be
taking you back to drinking or using drugs.

4. Who decides what I schedule?

You do! You may consider suggestions made by your therapist or family members,
but the final decision is yours. Just be sure you do what you wrote down. Changes
should be limited as much as possible.

5. Can I schedule in blocks of time instead of in hours?

Yes. Some people who have difficulty scheduling hour-by-hour find it easier to
begin by scheduling blocks of time. Instead of deciding what you are going to be
doing each hour, simply determine what you will do in the morning, in the midday,
in the afternoon, and in the evening. (There are Block Scheduling Cards provided
for you in the appendix.) Gradually you may be able to move to scheduling your
activities within those blocks of time more specifically.

1 continued on other side

Handout 1 • Early Recovery Skills Group Page 2 of 2

SCHEDULING: IS IT IMPORTANT? continued from other side

With practice, most people can schedule a twenty-four-hour period

and follow it. If you can, you are on your way to gaining control

of your life. If you cannot, talk with your counselor about how to

increase the structure of your treatment program.

•••

2
Handout 2 • Early Recovery Skills Group

Daily / Hourly Schedule

DATE DATE DATE DATE

7:00: ________________________ 7:00: _____________________ 7:00: _____________________

8:00: ________________________ 8:00: _____________________ 8:00: _____________________

9:00: ________________________ 9:00: _____________________ 9:00: _____________________

10:00: ________________________ 10:00: _____________________ 10:00: _____________________

11:00: ________________________ 11:00: _____________________ 11:00: _____________________

12:00: ________________________ 12:00: _____________________ 12:00: _____________________

1:00: ________________________ 1:00: _____________________ 1:00: _____________________

2:00: ________________________ 2:00: _____________________ 2:00: _____________________

3:00: ________________________ 3:00: _____________________ 3:00: _____________________

4:00: ________________________ 4:00: _____________________ 4:00: _____________________

5:00: ________________________ 5:00: _____________________ 5:00: _____________________

6:00: ________________________ 6:00: _____________________ 6:00: _____________________

7:00: ________________________ 7:00: _____________________ 7:00: _____________________

8:00: ________________________ 8:00: _____________________ 8:00: _____________________

9:00: ________________________ 9:00: _____________________ 9:00: _____________________

10:00: ________________________ 10:00: _____________________ 10:00: _____________________

11:00: ________________________ 11:00: _____________________ 11:00: _____________________

Notes:

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

Reminders:

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

3
Handout 2 • Early Recovery Skills Group

Daily / Hourly Schedule

DATE DATE DATE DATE

7:00: ________________________ 7:00: _____________________ 7:00: _____________________

8:00: ________________________ 8:00: _____________________ 8:00: _____________________

9:00: ________________________ 9:00: _____________________ 9:00: _____________________

10:00: ________________________ 10:00: _____________________ 10:00: _____________________

11:00: ________________________ 11:00: _____________________ 11:00: _____________________

12:00: ________________________ 12:00: _____________________ 12:00: _____________________

1:00: ________________________ 1:00: _____________________ 1:00: _____________________

2:00: ________________________ 2:00: _____________________ 2:00: _____________________

3:00: ________________________ 3:00: _____________________ 3:00: _____________________

4:00: ________________________ 4:00: _____________________ 4:00: _____________________

5:00: ________________________ 5:00: _____________________ 5:00: _____________________

6:00: ________________________ 6:00: _____________________ 6:00: _____________________

7:00: ________________________ 7:00: _____________________ 7:00: _____________________

8:00: ________________________ 8:00: _____________________ 8:00: _____________________

9:00: ________________________ 9:00: _____________________ 9:00: _____________________

10:00: ________________________ 10:00: _____________________ 10:00: _____________________

11:00: ________________________ 11:00: _____________________ 11:00: _____________________

Notes:

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

Reminders:

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

4
Handout 2 • Early Recovery Skills Group

Daily / Hourly Schedule

DATE DATE DATE DATE

7:00: ________________________ 7:00: _____________________ 7:00: _____________________

8:00: ________________________ 8:00: _____________________ 8:00: _____________________

9:00: ________________________ 9:00: _____________________ 9:00: _____________________

10:00: ________________________ 10:00: _____________________ 10:00: _____________________

11:00: ________________________ 11:00: _____________________ 11:00: _____________________

12:00: ________________________ 12:00: _____________________ 12:00: _____________________

1:00: ________________________ 1:00: _____________________ 1:00: _____________________

2:00: ________________________ 2:00: _____________________ 2:00: _____________________

3:00: ________________________ 3:00: _____________________ 3:00: _____________________

4:00: ________________________ 4:00: _____________________ 4:00: _____________________

5:00: ________________________ 5:00: _____________________ 5:00: _____________________

6:00: ________________________ 6:00: _____________________ 6:00: _____________________

7:00: ________________________ 7:00: _____________________ 7:00: _____________________

8:00: ________________________ 8:00: _____________________ 8:00: _____________________

9:00: ________________________ 9:00: _____________________ 9:00: _____________________

10:00: ________________________ 10:00: _____________________ 10:00: _____________________

11:00: ________________________ 11:00: _____________________ 11:00: _____________________

Notes:

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

Reminders:

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

5
Handout 2 • Early Recovery Skills Group

Daily / Hourly Schedule

DATE DATE DATE DATE

7:00: ________________________ 7:00: _____________________ 7:00: _____________________

8:00: ________________________ 8:00: _____________________ 8:00: _____________________

9:00: ________________________ 9:00: _____________________ 9:00: _____________________

10:00: ________________________ 10:00: _____________________ 10:00: _____________________

11:00: ________________________ 11:00: _____________________ 11:00: _____________________

12:00: ________________________ 12:00: _____________________ 12:00: _____________________

1:00: ________________________ 1:00: _____________________ 1:00: _____________________

2:00: ________________________ 2:00: _____________________ 2:00: _____________________

3:00: ________________________ 3:00: _____________________ 3:00: _____________________

4:00: ________________________ 4:00: _____________________ 4:00: _____________________

5:00: ________________________ 5:00: _____________________ 5:00: _____________________

6:00: ________________________ 6:00: _____________________ 6:00: _____________________

7:00: ________________________ 7:00: _____________________ 7:00: _____________________

8:00: ________________________ 8:00: _____________________ 8:00: _____________________

9:00: ________________________ 9:00: _____________________ 9:00: _____________________

10:00: ________________________ 10:00: _____________________ 10:00: _____________________

11:00: ________________________ 11:00: _____________________ 11:00: _____________________

Notes:

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

Reminders:

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

6
Handout 2 • Early Recovery Skills Group

Daily / Hourly Schedule

DATE DATE DATE DATE

7:00: ________________________ 7:00: _____________________ 7:00: _____________________

8:00: ________________________ 8:00: _____________________ 8:00: _____________________

9:00: ________________________ 9:00: _____________________ 9:00: _____________________

10:00: ________________________ 10:00: _____________________ 10:00: _____________________

11:00: ________________________ 11:00: _____________________ 11:00: _____________________

12:00: ________________________ 12:00: _____________________ 12:00: _____________________

1:00: ________________________ 1:00: _____________________ 1:00: _____________________

2:00: ________________________ 2:00: _____________________ 2:00: _____________________

3:00: ________________________ 3:00: _____________________ 3:00: _____________________

4:00: ________________________ 4:00: _____________________ 4:00: _____________________

5:00: ________________________ 5:00: _____________________ 5:00: _____________________

6:00: ________________________ 6:00: _____________________ 6:00: _____________________

7:00: ________________________ 7:00: _____________________ 7:00: _____________________

8:00: ________________________ 8:00: _____________________ 8:00: _____________________

9:00: ________________________ 9:00: _____________________ 9:00: _____________________

10:00: ________________________ 10:00: _____________________ 10:00: _____________________

11:00: ________________________ 11:00: _____________________ 11:00: _____________________

Notes:

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

Reminders:

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

7
Handout 2 • Early Recovery Skills Group

Daily / Hourly Schedule

DATE DATE DATE DATE

7:00: ________________________ 7:00: _____________________ 7:00: _____________________

8:00: ________________________ 8:00: _____________________ 8:00: _____________________

9:00: ________________________ 9:00: _____________________ 9:00: _____________________

10:00: ________________________ 10:00: _____________________ 10:00: _____________________

11:00: ________________________ 11:00: _____________________ 11:00: _____________________

12:00: ________________________ 12:00: _____________________ 12:00: _____________________

1:00: ________________________ 1:00: _____________________ 1:00: _____________________

2:00: ________________________ 2:00: _____________________ 2:00: _____________________

3:00: ________________________ 3:00: _____________________ 3:00: _____________________

4:00: ________________________ 4:00: _____________________ 4:00: _____________________

5:00: ________________________ 5:00: _____________________ 5:00: _____________________

6:00: ________________________ 6:00: _____________________ 6:00: _____________________

7:00: ________________________ 7:00: _____________________ 7:00: _____________________

8:00: ________________________ 8:00: _____________________ 8:00: _____________________

9:00: ________________________ 9:00: _____________________ 9:00: _____________________

10:00: ________________________ 10:00: _____________________ 10:00: _____________________

11:00: ________________________ 11:00: _____________________ 11:00: _____________________

Notes:

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

Reminders:

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

8
Handout 2 • Early Recovery Skills Group

Daily / Hourly Schedule

DATE DATE DATE DATE

7:00: ________________________ 7:00: _____________________ 7:00: _____________________

8:00: ________________________ 8:00: _____________________ 8:00: _____________________

9:00: ________________________ 9:00: _____________________ 9:00: _____________________

10:00: ________________________ 10:00: _____________________ 10:00: _____________________

11:00: ________________________ 11:00: _____________________ 11:00: _____________________

12:00: ________________________ 12:00: _____________________ 12:00: _____________________

1:00: ________________________ 1:00: _____________________ 1:00: _____________________

2:00: ________________________ 2:00: _____________________ 2:00: _____________________

3:00: ________________________ 3:00: _____________________ 3:00: _____________________

4:00: ________________________ 4:00: _____________________ 4:00: _____________________

5:00: ________________________ 5:00: _____________________ 5:00: _____________________

6:00: ________________________ 6:00: _____________________ 6:00: _____________________

7:00: ________________________ 7:00: _____________________ 7:00: _____________________

8:00: ________________________ 8:00: _____________________ 8:00: _____________________

9:00: ________________________ 9:00: _____________________ 9:00: _____________________

10:00: ________________________ 10:00: _____________________ 10:00: _____________________

11:00: ________________________ 11:00: _____________________ 11:00: _____________________

Notes:

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

Reminders:

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

9
Handout 2 • Early Recovery Skills Group

Daily / Hourly Schedule

DATE DATE DATE DATE

7:00: ________________________ 7:00: _____________________ 7:00: _____________________

8:00: ________________________ 8:00: _____________________ 8:00: _____________________

9:00: ________________________ 9:00: _____________________ 9:00: _____________________

10:00: ________________________ 10:00: _____________________ 10:00: _____________________

11:00: ________________________ 11:00: _____________________ 11:00: _____________________

12:00: ________________________ 12:00: _____________________ 12:00: _____________________

1:00: ________________________ 1:00: _____________________ 1:00: _____________________

2:00: ________________________ 2:00: _____________________ 2:00: _____________________

3:00: ________________________ 3:00: _____________________ 3:00: _____________________

4:00: ________________________ 4:00: _____________________ 4:00: _____________________

5:00: ________________________ 5:00: _____________________ 5:00: _____________________

6:00: ________________________ 6:00: _____________________ 6:00: _____________________

7:00: ________________________ 7:00: _____________________ 7:00: _____________________

8:00: ________________________ 8:00: _____________________ 8:00: _____________________

9:00: ________________________ 9:00: _____________________ 9:00: _____________________

10:00: ________________________ 10:00: _____________________ 10:00: _____________________

11:00: ________________________ 11:00: _____________________ 11:00: _____________________

Notes:

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

Reminders:

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

10
Handout 3 • Early Recovery Skills Group

Calendars and Stickers

It is useful to both you and your therapist to know where
you are in the recovery process at all times. Marking a
calendar as you go along helps in several ways:

1. It’s a reminder of where you are in the stages of recovery. (The way you are
feeling might be related to changes in body chemistry.)

2. There is often a feeling of pride that results from seeing the number
of days sober.

3. Recovery can seem very long unless you can measure your progress in short
units of time.

Use the Clean and Sober stickers your therapist gives

you to record every alcohol- and drug-free day you achieve. Clean
Handout 4 contains calendar pages for the time you are and
in treatment. You may decide to continue this exercise Sober
following the program.

If you regularly record your days sober with stickers, this simple procedure
will help you and your therapist see your progress more easily.

David
NAME ________________________________ March
MONTH ________________________________

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

1 2 3 4
Clean Clean Clean
and and and Us ed
Sober Sober Sober Alc oh ol
5 6 7 8 9 10 11
Clean Clean Clean Clean Clean Clean Clean
and and and and and and and
Sober Sober Sober Sober Sober Sober Sober

12 13 14 15 16 17 18
Clean Clean Clean Clean Clean Clean Clean
and and and and and and and
Sober Sober Sober Sober Sober Sober Sober

19 20 21 22 23 24 25
Clean Clean Clean Clean Clean Clean Clean
and and and and and and and
Sober Sober Sober Sober Sober Sober Sober

26 27 28 29 30 31
Clean Clean Clean Clean Clean Clean
and and and and and and
Sober Sober Sober Sober Sober Sober

11
 NAME ________________________________ MONTH ________________________________

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Handout 4 • Early Recovery Skills Group

13
Calendar
 MONTH ________________________________

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Handout 4 • Early Recovery Skills Group

14
Calendar
 MONTH ________________________________

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Handout 4 • Early Recovery Skills Group

15
Calendar
 MONTH ________________________________

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Handout 4 • Early Recovery Skills Group

16
Calendar
 MONTH ________________________________

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Handout 4 • Early Recovery Skills Group

17
Calendar
Handout 5 • Early Recovery Skills Group

Triggers
Triggers are people, places, objects, feelings, and times that
cause cravings. For example, if every Friday night you cash
a paycheck, go out with friends, and use drugs, the triggers
would be the following:

➞ Friday night
➞ After work
➞ Money
➞ Friends who use
➞ The bar or club
Your addicted brain associates the triggers with drug and alcohol use. As a result
of constant triggering and using, one trigger can cause you to move toward drug or
alcohol use. The trigger➞thought➞craving➞use cycle feels overwhelming.
An important part of treatment involves stopping the craving process. The first
and easiest way to do that is this:
1. Identify triggers.
2. Prevent exposure to triggers whenever possible (for example, do not
handle large amounts of cash).
3. Deal with triggers in a different way (for example, schedule exercise and
an outside meeting for Friday nights).

•••

Remember, triggers will affect your brain and cause cravings even though you have
decided to stop drug and alcohol use. Your intentions to stop must therefore translate
into behavior changes, which steer you clear of possible triggers.

1. What are some of the strongest triggers for you?

______________________________________________________________________________________________________

______________________________________________________________________________________________________

2. What particular triggers might be a problem in the near future?

______________________________________________________________________________________________________

______________________________________________________________________________________________________

19
Handout 6 • Early Recovery Skills Group

“If I…

Trigger ➞Thought ➞Craving ➞Use

The Losing Argument

If you decide to stop drinking or using and end up moving toward drugs or alcohol,
your brain gives you permission by using a process we call relapse justification. Using
thoughts start an argument inside your head: your rational self versus your addiction.
You feel as though you are in a fight, and you must come up with many reasons to
stay sober. Your addiction is really just looking for an excuse, a relapse justification.
The argument inside you is part of a series of events leading to drug and alcohol use.
How often in the past has your addiction lost this argument?

Thoughts Become Cravings

Craving does not always occur in a straightforward, easily recognized form. Often
the thought of using passes through your head with little or no effect. It takes effort
to identify and stop a thought. However, allowing yourself to continue thinking about
drug or alcohol use is choosing to start a relapse. The farther the thoughts are
allowed to go, the more likely you are to relapse.

The Automatic Process

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

Trigger ➞ Thought ➞ Craving ➞ Use

Thought Stopping
The key to success in dealing with this process is not to let it get started. Stopping
the thought when it first begins prevents it from building into an overpowering craving.
It is important to do it as soon as you recognize the thoughts occurring.

Your addiction is really just looking

for an excuse, a relapse justification.

21
Handout 7 • Early Recovery Skills Group

Thought-Stopping Techniques
A New Sequence
To get recovery started, it is necessary to change the trigger-use sequence. Thought
stopping provides a tool for breaking the process. The process looks like this:

Thought-stopping
techniques

Trigger Thought

Continued Cravings Use

thoughts

You make a choice. It is not automatic.

Thought-Stopping Techniques
Try the techniques described below and use those that work best for you.

Visualization: Picture a switch or a lever in your mind. Imagine yourself

actually moving it from on to off to stop the drug or alcohol thoughts.
Have another picture ready to think about in place of those thoughts.
You may have to change what you are doing to make this switch.

Snapping: Wear a rubber band loosely on your wrist. Each time you
become aware of drug or alcohol thoughts, snap the band and say “no!”
to the thoughts as you make yourself think about another subject. Have
a subject ready that is meaningful and interesting to you.

Relaxation: Feelings of hollowness, heaviness, and cramping in the

stomach are cravings. These can often be relieved by breathing in deeply
(filling your lungs with air) and breathing out slowly. Do this three times.
You should be able to feel the tightness leaving your body. Repeat this
whenever the feeling returns.

Call someone: Talking to another person provides an outlet for your

feelings and allows you to hear your own thinking process. Have phone
numbers of supportive, available people with you always so you can find
someone to listen at any time.
•••

Allowing the thoughts to develop into cravings is making a choice to remain addicted.

23
Handout 8 • Early Recovery Skills Group

External Trigger Questionnaire

1. Place a check mark next to activities or situations in
which you frequently used drugs or alcohol. Place a zero
next to activities or situations in which you never have
used drugs or alcohol.

______ When home alone ______ After work

______ When home with friends ______ When carrying money

______ At a friend’s home ______ After going past dealer’s

______ At parties residence

______ When with drug-using friends

______ At sporting events
______ After going past a liquor store
______ At movies
______ After payday
______ At bars/clubs
______ Before going out to dinner
______ At the beach
______ Before breakfast
______ At concerts
______ At lunch break
______ At the park
______ While at dinner
______ When I gain weight
______ After passing a particular
______ Before a date
freeway exit
______ During a date
______ At school
______ Before sexual activities
______ While driving
______ During sexual activities
______ In the neighborhood
______ After sexual activities

______ Before work

2. List any other settings or activities in which you frequently used drugs or alcohol.

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

25 continued on other side

Handout 8 • Early Recovery Skills Group Page 2 of 2

EXTERNAL TRIGGER QUESTIONNAIRE continued from other side

3. List activities or situations in which you would not use drugs or alcohol.

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

4. List people you could be with and not use drugs or alcohol.

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

•••

26
 Trigger Chart
Patient name: _____________________________________________________ Date: _____________________________________
Instructions: List people, places, objects, or situations below
according to their degree of association with drug or alcohol use.

0 PERCENT 100 PERCENT

CHANCE OF USING CHANCE OF USING

NEVER USE ALMOST NEVER USE ALMOST ALWAYS USE ALWAYS USE
Handout 9 • Early Recovery Skills Group

________________________ ________________________ ________________________ ________________________

27
________________________ ________________________ ________________________ ________________________

________________________ ________________________ ________________________ ________________________

________________________ ________________________ ________________________ ________________________

________________________ ________________________ ________________________ ________________________

________________________ ________________________ ________________________ ________________________

________________________ ________________________ ________________________ ________________________

________________________ ________________________ ________________________ ________________________

________________________ ________________________ ________________________ ________________________

________________________ ________________________ ________________________ ________________________

➧
➧
➧
➧

These are “safe” situations. These are low-risk situations, These situations are Involvement in these
but caution is needed. high risk. Staying in these situations is deciding to stay
is extremely dangerous. addicted. Avoid totally.
Handout 10 • Early Recovery Skills Group

Internal Trigger Questionnaire

1. During recovery, there are often certain feelings or
emotions that trigger the brain to think about using drugs
or alcohol. Read the following list of emotions and check which
of them might trigger (or used to trigger) thoughts of using for you.

______ Afraid ______ Passionate ______ Irritated

______ Frustrated ______ Criticized ______ Sad

______ Neglected ______ Inadequate ______ Excited

______ Angry ______ Pressured ______ Jealous

______ Guilty ______ Depressed ______ Bored

______ Nervous ______ Insecure ______ Exhausted

______ Confident ______ Relaxed ______ Lonely

______ Happy ______ Embarrassed

2. I thought about using when I felt

______________________________________________________________________________________________________

______________________________________________________________________________________________________

3. In the list above, circle the emotional states or feelings that have triggered your
use of drugs or alcohol recently.

4. Has your use in recent weeks/months been

______ Primarily tied to emotional conditions?

______ Routine and automatic without much emotional triggering?

5. Have there been times in the recent past in which you were attempting not to use
and a specific change in your mood clearly resulted in your using? (For example,
you got in a fight with someone and used in response to getting angry.)

_____ Yes _____ No

29 continued on other side

Handout 10 • Early Recovery Skills Group Page 2 of 2

INTERNAL TRIGGER QUESTIONNAIRE continued from other side

If yes, describe:

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

6. Go back to the Trigger Chart from your previous session (page 27) and enter your
emotional, internal triggers.

30
Handout 11 • Early Recovery Skills Group

Twelve Step Introduction

What Is the Twelve Step Program?
In the 1930s, Alcoholics Anonymous (AA) was
founded by two men who were unable to deal
with their own alcoholism through psychiatry or
medicine. They found there were a number of
specific principles that helped people overcome
their addictions, and they formed Alcoholics
Anonymous to introduce addicted people to
these principles of self-help. The AA concepts
have been adapted for stimulant and other drug
addictions, and even to compulsive behaviors such as
gambling, overeating, and compulsive sexual behaviors.
What people addicted to drugs and alcohol have found is that fellow addicted people
can provide enormous support and help to one another. For this reason, these groups
are called fellowships, where participants show concern and support for one another
through mutual sharing and understanding.

Do I need to attend Twelve Step meetings?

If outpatient treatment is going to work for you, it is essential to establish a network
of support for your recovery. Attending treatment sessions without going to Twelve Step
meetings may produce a temporary effect, but without involvement in self-help pro-
grams, it is unlikely that you will develop a truly successful recovery. Matrix patients
should attend at least three Twelve Step meetings per week during their treatment.
Many successfully sober people go to ninety meetings in ninety days. The more one
participates in treatment and Twelve Step meetings, the greater the chance for recovery.

Can I go to CA, AA, MA, CMA, or NA?

Yes. Although each type of meeting focuses somewhat on a different substance (CA
focuses on cocaine, AA on alcohol, MA on marijuana, CMA on methamphetamine, and
NA on narcotics), the basic principles are the same. Many people with cocaine problems
prefer AA for a variety of reasons. The important thing is to feel comfortable and get
as much out of the meeting as possible.

Are all meetings the same?

No. There are different types of Twelve Step meetings: (1) Speaker meetings feature a
recovering person telling his or her personal story of drug and alcohol use and recovery.
(2) Topic meetings have discussions on a specific topic such as fellowship, honesty,
acceptance, or patience. Everyone is given a chance to talk, but no one is forced to do
so. (3) Step/Tradition meetings are special meetings where the Twelve Steps and Twelve

31 continued on other side

Handout 11 • Early Recovery Skills Group Page 2 of 4

TWELVE STEP INTRODUCTION continued

Traditions (another component of Twelve Step programs) are discussed. (4) Big Book
meetings focus on reading a chapter from the Big Book, Alcoholics Anonymous, which
is often a story about someone’s personal experience or a recovery-related topic.

Who can join?

Nobody really “joins” CA, AA, or NA. They are not organizations that have dues, leaders,
and membership lists. People who have a desire to stop using drugs simply go to
meetings.

Are Twelve Step programs religious?

No. None of the Twelve Step programs are religious, but spiritual growth is considered a
part of recovery. However, the spiritual choices participants make are very personal
and individual. Each person decides what Higher Power means to him or her. There
are atheists as well as religious people in the programs.

How do I find a meeting?

You can call directory information, ask for AA, CA, or NA, and speak to someone who
can tell you when and where meetings are scheduled. Directories are also available
that list meetings by cities, addresses, and meeting times as well as give information
about each meeting (who the speaker will be, whether there is a Step study, and
whether it is a nonsmoking meeting, a men’s or women’s meeting, or a gay meeting,
for example). Another way to find a good meeting is to ask someone who goes to
Twelve Step meetings.

What Are Sponsors?

The first few weeks and months of recovery can be frustrating. Many things may
happen that are confusing and frightening. During this difficult period, there will be
many times when recovering people need to talk about problems and fears. A sponsor
can help guide the newcomer through this process.

32
Handout 11 • Early Recovery Skills Group Page 3 of 4

TWELVE STEP INTRODUCTION continued

What do sponsors do?

1. Sponsors help the newcomer by answering questions and explaining the
Twelve Step recovery process.
2. Sponsors agree to be available to talk and listen to their “sponsees’ ” difficulties
and frustrations, and to share their own insights and solutions.
3. Sponsors make recommendations and suggestions for problems that their
sponsees are having. These recommendations come from their personal experi-
ences with long-term sobriety.
4. Sponsors are people with whom addiction-related secrets and guilty feelings can
be easily shared. They agree to keep these secrets confidential and to protect the
newcomer’s anonymity.
5. Sponsors warn their sponsees when they get off the path of recovery. Sponsors
are often the first people to know when their sponsees experience a slip or
relapse. Thus, sponsors often push their sponsees to attend more meetings or
get help for problems.
6. Sponsors often give their sponsees guidance in working through the Twelve
Steps of AA, CA, NA, and other groups.

How do I choose a sponsor?

Selecting a sponsor is easy. The newcomer simply asks someone to be his or her sponsor.
Most people will select a sponsor who seems to be living a healthy and responsible
life and who seems to have something they want.
Some general guidelines for selecting a sponsor include the following:

1. A sponsor should have several years of sobriety from all mood-altering drugs.

2. A sponsor should have a healthy lifestyle and not be struggling with major
problems or addiction.

3. A sponsor should be an active and regular participant in Twelve Step meetings.

Also, a sponsor should be someone who actively “works” the Twelve Steps.

4. A sponsor should be someone to whom you can relate. You may not always agree
with your sponsor, but you need to be able to respect your sponsor.

5. You should choose a sponsor whom you are not likely to become sexually or
romantically interested in.

33
Handout 11 • Early Recovery Skills Group Page 4 of 4

TWELVE STEP INTRODUCTION

Alternatives to Twelve Step Programs

There are alternatives to Twelve Step groups that are not based on the concept of a
Higher Power. These various groups offer similar options for sobriety and rational
recovery. Although these alternatives have different philosophies, they generally
offer a self-help approach that focuses on personal responsibility, personal empower-
ment, and strength through a sober social network.

Questions for Discussion

1. Have you ever been to a Twelve Step meeting? If so, what was your experience?

2. Do you plan to attend any Twelve Step meetings? If so, where? When?

3. How might you make use of Twelve Step meetings to stop using?

•••

34
Handout 12 • Early Recovery Skills Group

Road Map for Recovery

Recovery from drug and alcohol use
is not a mysterious process. After the use of
drugs and alcohol is stopped, the brain goes through a biological readjustment. This
readjustment process is essentially a “healing” of the brain chemistry changes that were
produced by drug or alcohol use. It is important for people in recovery to understand why
they may experience some physical and emotional changes in their thinking process
during the beginning stages of recovery.

The Stages

Withdrawal Stage
During the first days after substance use is stopped, some people experience difficult
symptoms. The extent of the symptoms is often related to the amount, frequency, and
type of substance use.
For stimulant users, the first three to ten days can be accompanied by drug craving,
depression, low energy, difficulty sleeping, increased appetite, and difficulty concen-
trating. Although stimulant users do not experience the same degree of physical
symptomology as alcohol users, the psychological symptoms of craving and depression
can be quite severe.
People who drink alcohol in large amounts have the most severe symptoms. These
symptoms can include nausea, low energy, anxiety, shakiness, depression, emotionality,
insomnia, irritability, difficulty concentrating, and memory problems. These symptoms
typically last three to five days, but they can last up to several weeks. Some people
must be hospitalized to detoxify safely.
For opiate users and prescription drug users, the seven- to ten-day period of with-
drawal (longer for benzodiazepine users) can be physically uncomfortable and may
require hospitalization or medication. For people dependent upon these substances,
it is essential to have a physician closely monitor withdrawal. Along with physical
discomfort, many people experience nervousness, insomnia, depression, and difficulty
concentrating. Successfully completing withdrawal from these substances is a major
achievement in early recovery.
For marijuana users, withdrawal symptoms include insomnia, restlessness, loss
of appetite, depression, shakiness, and irritability. Recent research demonstrates
that long-term marijuana users exhibit increased aggressive behavior during the first
week of abstinence.

35 continued on other side

Handout 12 • Early Recovery Skills Group Page 2 of 3

ROAD MAP FOR RECOVERY continued

Early Abstinence: Honeymoon

For stimulant users, this four- to five-week period is called the honeymoon. Most people
feel quite good during this period and often feel “cured.” This period should be used as
an opportunity to establish a good foundation for recovery because the honeymoon
is not the end of the recovery process. If the energy, enthusiasm, and optimism felt
by substance users during this period are directed into recovery activities, it can be
tremendously positive for the future success of the recovery effort.
For alcohol users, the next four to five weeks is a period where the brain is
recovering. Although the physical withdrawal symptoms have ended, it is still necessary
to get used to the absence of alcohol. Thinking may be unclear, concentration may
be poor, nervousness and anxiety may be troubling, sleep is often irregular, and, in
many ways, life feels too intense.
For opiate and prescription drug users, there is essentially a gradual normaliza-
tion during this period. In many ways, the process is similar to the alcohol recovery
timetable. Slow, gradual improvement in symptoms is evidence that the recovery is
progressing.
For marijuana users, a strong psychological dependence on the drug is often
developed and may result in intense cravings at cessation of use. While symptoms
of withdrawal and early abstinence may not be as noticeable with marijuana as with
some other drugs or alcohol, it is believed that many people relapse to prevent the
occurrence of symptoms. Because marijuana is stored in the body, its effects may be
felt for days or weeks following use. Habitual use of this drug interferes with memory,
speech, comprehension, and decision-making ability, all of which continue to be notice-
ably affected during early recovery.

36
Handout 12 • Early Recovery Skills Group Page 3 of 3

ROAD MAP FOR RECOVERY

Protracted Abstinence: “The Wall”

From six weeks to four months after drugs and alcohol are
stopped, a variety of annoying and troublesome symptoms
may be experienced by many drug and alcohol users. These
symptoms are caused by the continuing healing process in the
brain. They are experienced mostly as emotional or thinking
difficulties. They are often subtle but can affect a patient’s
functioning. It is important to be aware that some of the feelings
during this period are the result of brain chemistry, and, if drugs and alcohol are
avoided, they will pass. Most common are symptoms of depression, irritability, difficulty
concentrating, low energy, and a general lack of enthusiasm. Relapse risk goes up
during this period, particularly for stimulant users. Patients must focus on staying
sober one day at a time. Exercise can help tremendously during this period. For most
substance abusers, completing this phase of recovery is a major achievement.

Readjustment
After 120 days, the brain has substantially recovered. Now the recovering person’s
major job is developing a life that includes activities and fulfillment that support
continued recovery. Although the difficult start-up of the recovery process is over, hard
work is needed to improve and maintain the quality of life.

•••

37
Handout 13 • Early Recovery Skills Group

Five Common Problems in

Early Recovery: New Solutions
Everyone who attempts to stop drug and alcohol use
runs into situations that make it very difficult to maintain sobriety. The following
chart lists five of the most common situations encountered during the first few weeks
of treatment. Next to these problems are some suggested alternatives for dealing with
these situations.

PROBLEM NEW ALTERNATIVE

Using friends and associates

• Try to make new friends at Twelve
Step meetings or other spiritual
• Continued association with old
recovery groups.
friends or friends who use can
• Try new activities that will increase
cause triggering.
your chances of meeting sober people.
• Plan activities with sober friends or
family members.

Anger or irritability Tell yourself the following:

• Recovery involves a healing of brain
• Small events can create feelings
chemistry.
of anger that seem to preoccupy
• Moods will be affected; it’s a natural
the thinking process.
part of recovery.
• Exercise helps.
• Talking to a therapist or a supportive
friend helps.

Alcohol in the home • Get rid of all drugs and alcohol, if possible.
• Ask others if they would refrain from
• Even if you decide to stop drinking,
drinking and using at home for a while.
it doesn’t mean everyone else in
your house will decide to stop. • If you continue to have a problem, consider
moving out for a while.

Boredom or loneliness
• Put new activities in your schedule.
• Stopping drug and alcohol use often • Go back to activities you enjoyed before
means that many usual activities your addiction took over.
and people must be avoided. • Develop new friends at outside meetings.
Consider exchanging telephone numbers.

39 continued on other side

Handout 13 • Early Recovery Skills Group Page 2 of 2

FIVE COMMON PROBLEMS IN EARLY RECOVERY: NEW SOLUTIONS continued from other side

PROBLEM NEW ALTERNATIVE

Special occasions
• Have a plan for answering questions
about not drinking.
• Parties, dinners, business
• Have your own transportation to and
meetings, weddings, holidays,
from events.
and other events can be difficult
without alcohol and drugs. • Leave if you get uncomfortable or start
feeling deprived.

1. Are any of these issues likely to be a problem for you in the next few weeks?
If so, which ones?

______________________________________________________________________________________________________

______________________________________________________________________________________________________

2. How will you deal with them?

______________________________________________________________________________________________________

______________________________________________________________________________________________________

•••

Try to make new friends at

Twelve Step meetings or other
spiritual recovery groups.

40
Handout 14 • Early Recovery Skills Group

Alcohol Arguments

Have you been able to stop using

alcohol completely? For people addicted to cocaine,
methamphetamine, opiates, and prescription drugs, alcohol use is often not seen as a
problem. At about six weeks into the recovery process, many people return to alcohol
use. Has your addicted brain played with the idea? These are some of the most common
arguments against stopping the use of alcohol:

“I came here to stop using drugs, not to stop drinking.”

Drug treatment includes stopping alcohol as well as other drug use. It is part
of recovery from addiction.

“I’ve drunk and not used, so it doesn’t make any difference.”

Drinking over time greatly increases the risk of relapse and readdiction. A single
drink does not necessarily cause relapse any more than a single cigarette causes
lung cancer. However, with continued drinking, the risks of relapse are greatly
increased.

“Drinking actually helps. When I have cravings,

a drink calms me down and the craving goes away.”
Alcohol interferes with the chemical healing in the brain. Continued alcohol use
eventually intensifies cravings, even if one drink seems to reduce cravings.

“I’m not an alcoholic, so why do I need to stop drinking?”

If you’re not addicted to alcohol, you should have no problem stopping alcohol use.
If you can’t stop, maybe alcohol is more of a problem than you realize.

“I’m never going to use drugs again, but I’m not sure I’ll never drink again.”
Make a commitment to total abstinence and choose a period of time that feels
comfortable to you. Give yourself the chance to make a decision about alcohol with
a drug-free brain. If you reject alcohol abstinence because “forever” scares you,
then you’re justifying drinking now and risking becoming readdicted to drugs.

41 continued on other side

Handout 14 • Early Recovery Skills Group Page 2 of 2

ALCOHOL ARGUMENTS continued from other side

Answer the following questions:

1. Has your addicted brain presented you with other justifications for drinking alcohol?
(If yes, what are they?)

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

2. How are you planning to deal with alcohol issues in the future?

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

•••

42
Handout 15 • Early Recovery Skills Group

Thoughts, Emotions, and Behavior

Addiction changes the way people think,
how they feel, and how they behave. How
do these changes affect the recovery process?

Thoughts
Thoughts happen in the rational part of the brain. They are like pictures on the
TV screen of the mind. Thoughts can be controlled. As you become aware of your
thoughts, you can learn to change channels in your brain. Learning to turn off thoughts
of drugs and alcohol is a very important part of the recovery process. It is not easy to
become aware of your thinking and to learn to control the process, but with practice
it gets easier.

Emotions
Emotions are feelings. Happiness, sadness, anger, and fear are some basic emotions.
Feelings cannot be controlled, and they are neither good nor bad. It is important to
be aware of your feelings. Talking to family members, friends, or a therapist can help
you recognize how you feel. Some feelings are more pleasant than others, but it is
normal to have all kinds of emotions. Drugs and alcohol can change your emotions by
changing the way your brain works. During recovery, emotions are often still mixed
up. Sometimes you feel irritated for no reason or great even though nothing wonderful
has happened. You cannot control or choose your feelings, but you can control what
you do about them.

Behavior
What you do is called behavior. Work is behavior. Play is behavior. Going to treatment is
behavior, and using drugs or alcohol is behavior. Behavior can result from an emotion,
from a thought, or from a combination of both. Addiction to substances floods your
thoughts and pushes your emotions toward drug or alcohol use. This very powerful,
automatic process has to be brought back under control for recovery to occur. Structuring
your time, attending spiritually oriented meetings, and engaging in new activities are
all ways of regaining control. The goal in recovery is to learn to combine your thinking
and feeling self and behave in ways that are best for you and your life.

•••

43
Handout 16 • Early Recovery Skills Group

Addictive Behavior
As drug and alcohol use increases,
the user tries to keep life under control.
That gets harder and harder to do. Finally, the user does desperate things to try to
continue to appear normal. These desperate behaviors are called addictive behaviors.
They are the things people do in relation to their drug and alcohol use. Sometimes
the behaviors only occur when people are using or moving toward using. Learning
to recognize when one or more of these behaviors is beginning to happen will help you
know when to start fighting extra hard to move away from relapse.

Which of these behaviors do you think are related to your drug or alcohol use?
Check all that apply.

______ Lying

______ Stealing

______ Being irresponsible (not meeting family/work commitments)

______ Being unreliable (being late for appointments, breaking promises, and so on)

______ Being careless about health and grooming (wearing “using” clothes, stopping
exercise, eating a poor diet, having a messy appearance)

______ Getting sloppy in housekeeping

______ Behaving impulsively (without thinking)

______ Behaving compulsively (too much eating, working, sex)

______ Changing work habits (working more, less, or not at all; changing jobs;
changing hours)

______ Losing interest in things (recreational activities, family life)

______ Isolating (staying by yourself much of the time)

______ Missing or being late for treatment

______ Using other drugs or alcohol

______ Stopping prescribed medication (Antabuse, naltrexone)

•••

45
Handout 17 • Early Recovery Skills Group

Twelve Step Tips

Alcoholics Anonymous has developed some short sayings
that help people in their day-to-day efforts to stay sober.
These concepts are often useful tools in learning how to
establish sobriety.

One Day at a Time

This is a key concept in staying sober. Don’t obsess about staying sober forever; just
focus on today.

Turn It Over
Sometimes addictive people jeopardize their recovery by tackling problems that cannot
be solved. Finding a way to let go of issues so that you can focus on staying sober is
a very important skill.

Keep It Simple
Learning to stay sober can get complicated and seem overwhelming if you let it. In
fact, there are some very simple concepts involved. Don’t make this process difficult.
Keep it simple.

Take What You Need and Leave the Rest

Not everyone benefits from every part of Twelve Step meetings. It is not a perfect
program. However, if you focus on the parts you find useful rather than on the ones
that bother you, you will probably find that the program has something for you.

Bring Your Body, the Mind Will Follow

The most important aspect of Twelve Step programs is attending the meetings. It
takes a while to feel completely comfortable. Try different meetings, try to meet
people, read the materials—just go and keep going.

HALT
This acronym is familiar to people in Twelve Step programs. It is a shorthand way
of reminding recovering people that they are especially vulnerable to relapse when
they are too hungry, angry, lonely, or tired.
Hungry
Angry
Lonely
Tired

47 continued on other side

Handout 17 • Early Recovery Skills Group Page 2 of 2

TWELVE STEP TIPS continued from other side

Hungry: When addicted people are using, they often neglect their own nutritional
needs. Recovering people need to relearn the importance of eating regularly. Being
hungry can cause changes in body chemistry that make people less able to control or
defend themselves. Often the person feels anxious and irritable but doesn’t associate
the feelings with hunger. Eating regularly increases emotional stability.

Angry: This emotional state is probably the most common cause of relapse to drug
and alcohol use. Learning to deal with anger in a healthy way is difficult for many
people. It is not healthy to act out anger with no regard for consequences. Nor is it
healthy to hold it in and try to pretend it doesn’t exist. Talking about anger-producing
situations and how to handle them is an important part of recovery.

Lonely: Recovery is often a lonely process. Relationships have sometimes been

lost because of the addictive process. Some are regained; many are not. People with
addictions may have to give up friends who drink and use when they enter recovery.
The feelings of loneliness are real and painful. They make people more vulnerable
to relapse.

Tired: Sleep disorders are often a part of early recovery. Frequently, recovering people
have to give up chemical sleep aids that they used in the past. Being tired is often a
trigger for relapse. Feeling exhausted and low on energy leaves people very vulnerable
and unable to function in a healthy way.

•••

1. How often do you find yourself in one or more of these emotional states?

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

2. What could you do differently to avoid being so vulnerable?

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

48