Treatment for Stimulant Use Disorders
Treatment Improvement Protocol (TIP) Series 33

Daily Schedule and Planner

• Do you have a clinic visit today? What time is the appointment?
• When will you have breakfast, lunch, and dinner?
• Are you going to work or school today? When are those commitments?
• When is your 12-Step or other self-help meeting?
• Have you scheduled time for exercise?
• Have you scheduled time for recreation and leisure activities?

Identifying External Cues and Triggers

Stimulant cues are those things in your life that remind you of stimulant use and can trigger drug hunger. Below are lists of people, places, events, objects, and activities. Check those items around which or whom you have frequently used stimulants. Within each list, circle the item that you think is most strongly associated with your stimulant use.

Identifying Internal Triggers

Stimulant cues can include certain feelings and emotions that can trigger drug hunger. Below are lists of emotions, feelings, and circumstances. Check those items that, in the past, have been associated with your stimulant use. Within each list, circle the item that you think may be the internal trigger with which you may struggle the most.

• How do you feel immediately before using stimulants?
• Typically, how do you want to feel immediately before using stimulants?
• In the past few days, what were you feeling when you either used or wanted to use stimulants?

Action Plan for Cues and Triggers

Stimulant use becomes associated with certain people, places, activities, behaviors, and feelings. These act as reminders about your previous stimulant use. When you experience these reminders or cues and do nothing about them, they can develop into thoughts about using, feelings of craving, and possibly stimulant use. But the process can be interrupted.

Many external triggers can be avoided. All triggers can be defused. However, when you try to ignore the triggers, they can become overwhelming and lead to cravings. You should develop action plans so that you can avoid being exposed to cues and reminders, and if you are exposed, so that you can stop them from becoming triggers and cravings.

• Do you have the feeling that an upcoming event or situation will become a trigger for stimulant cravings? If so, avoid the event or situation if possible!
• Are you in a situation or at an event that is making you think about stimulants? Can you leave the situation? If you can, leave now!
• Are you stuck in a situation that is making you think about stimulants? If so, visualize a switch or lever in your mind. Imagine that you can move the lever from the "On" to the "Off" position and thereby turn off the drug thoughts. Have another picture ready to think about in place of the drug thoughts.
• Were you just in a situation that made you think about stimulant use or that provoked stimulant cravings? If so, take action now! Call your 12-Step sponsor, call your counselor or a sober friend, take a quick walk, do physical exercise, or engage in a relaxation exercise. Also, make plans to attend the next available 12-Step meeting.
• Imagine a situation during which you cannot leave but which makes you think about using stimulants. What specific steps would you take to stop having thoughts about stimulants? What would you do once you left the situation?
• Imagine that you just left a situation that made you think about using stimulants. You are now having thoughts about stimulant use and are feeling stimulant cravings. What specific steps would you take?
• In the previous example, imagine that you are at work and you have stimulant thoughts and cravings. What specific steps would you take?
• In the same example, imagine that it is 6:00 p.m. and you have stimulant thoughts and cravings. What specific steps would you take? What steps would you take if it happened at 11:00 p.m.?

Action Plan for Avoidance Strategies

Stopping your stimulant use is more than simply having the desire and determination to stop. Rather, it requires action and behavior. More specifically, it requires specific plans of action that can decrease the likelihood of encountering reminders of your stimulant use.

Because there are numerous reminders of stimulant use in your environment, it is essential that you take specific steps to avoid them. Some of these steps may seem unnecessary to you at first glance. But experience shows that decreasing the reminders of your stimulant use will reduce the chances of experiencing drug thoughts, triggers, and cravings.

Feelings, Thoughts, and Behaviors

When you use stimulants, things tend to get out of control. You spend more money than you mean to, you use more drugs than you intend, and you experience negative consequences because of your stimulant use. Because of this, you probably experienced embarrassment, shame, and guilt. These feelings are a normal part of the addiction process. To deal with these problems, you probably developed certain patterns that helped you cope and make it through another day.

• Feelings: Because you had to deal with intense feelings, such as shame or guilt, you may have shut down your emotions. You probably stopped talking about how you felt and stopped being concerned about how others felt.
• Thoughts: Because it was hard to face the fact that you were engaging in behaviors that you didn't really like, you may have developed ways of thinking that allowed you to believe that there was no problem or that the problem was someone else's. You may have denied to yourself and to others that there was a problem, you may have minimized the extent of the problem, you may have developed some type of justification for the situation, or you may have blamed someone else.
• Behaviors: Because it was hard to listen to other people tell you that you had a problem, you may have learned to walk away and stop the discussion, blown up in anger, or intimidated others so that they wouldn't confront you. Or you may have spent a lot of time alone so that no one would bother you.

Relapsive Feelings, Thoughts, and Behaviors

These types of feelings, thoughts, and behaviors are tools that you learned that helped you to survive while you were using stimulants. They need to be replaced by healthy tools that will help you to survive and grow when not using stimulants.

• What are some of the ways in which you shut down your feelings? What are the benefits and risks associated with this? What can you do to change this?
• What are some of the ways in which your thinking becomes distorted so that you don't have to face reality? What are the benefits and risks associated with this? What are some ways to help you avoid this?
• What are some of the behaviors that you engage in so that you can avoid difficult feelings or facing reality? What are the benefits and risks associated with this? What types of behaviors would be more healthy?

Permission To Relapse

Relapse is not an event. It is not simply using stimulants after a period of abstinence. Rather, like addiction and recovery, relapse is a process. Similarly, relapse does not suddenly appear out of nowhere. Like recovery, it generally begins with small steps that ultimately lead to full-blown relapse and a return to stimulant use.

One of these small steps that lead to relapse is making up reasons why starting to use stimulants again may be okay. For example, you might start daydreaming about certain circumstances and situations in which using stimulants would be permissible.

The problem is, fantasizing about situations can lead you to situations that are very high risk for relapse. All of a sudden, you "find yourself" in a dangerous situation and experience powerful cravings and urges. The good news is that by identifying examples in which you justify relapse, you can stop the chain of events and avoid relapse.

Delayed Stimulant Withdrawal

Most people expect to experience several problems when they stop using stimulants. You may have been very sad or depressed, felt extremely tired and sleepy, had severe stimulant cravings, and found it very hard to concentrate. It is easy to recognize that these problems are directly related to abruptly stopping the use of stimulants. Most people call them withdrawal symptoms.

However, many people don't realize that some of these symptoms can reoccur a few months after last using stimulants. For example, after a few months, some people will feel sad or depressed, but generally not as depressed as during withdrawal. Some people will have a lack of energy and feel that they just don't care about things (apathy). Even though it may have been several months since you last used stimulants, you can experience a type of delayed stimulant withdrawal. These symptoms:

• Are a normal part of recovery
• Are part of the brain's healing process
• Are temporary
• Can be endured
• Can be lessened by participation in recovery efforts

What About Alcohol?

You came to treatment because you have a problem with stimulants. You made a commitment to stop using stimulants. But you may not have made a commitment to stop using alcohol, especially if you have never had any problems with it. At the same time, people in your recovery program and in your 12-Step group may be putting a lot of pressure on you for complete abstinence from all drugs, including alcohol. Why should you stop using alcohol?

Action Plan for the Holidays

Are you the kind of person who normally looks forward to and enjoys the holidays? Or do you typically hope that the holidays pass by quickly? Either way, the holidays and other special events can be high-risk situations.

Evaluating Your Self-Efficacy Regarding Relapse

An important lesson to be learned during recovery is to avoid high-risk situations whenever possible. Thus, one of your most important goals during recovery is learning how to avoid situations that are high risks for triggers, cravings, and relapse. However, not all high-risk situations can be avoided. You may run into your old dealer or drug-using friends, or someone at work may offer you drugs.

Because you will not be able to avoid all high-risk situations, another important goal during recovery is learning to respond to high-risk situations and preparing yourself for these. A part of this goal is evaluating your ability to handle these emergencies. The feeling that you can handle certain high-risk situations and prevent relapse is called "self-efficacy."

On one hand, it is foolish to believe that you can handle all high-risk situations or that you can handle any high-risk situations without first developing skills and tools to avoid relapse. On the other hand, it is equally foolish to believe that you cannot develop skills and techniques to handle high-risk situations. The task is to evaluate how you think you can handle certain situations that you are likely to encounter.

• Describe a high-risk situation that you encountered since starting treatment. How did you handle the situation? What happened?
• How would you rate your ability to handle the situation? Were you unsure and fearful? Were you certain and confident? Were you somewhere in the middle?
• What do you wish you had done? What would you do if the same situation happened today? Do you feel that you have made some progress in learning to deal with high-risk situations?
• What do you feel that you need to learn about to increase your ability to handle high-risk situations?

Increasing Your Self-Efficacy

Self-efficacy regarding relapse is the belief that you have developed the skills to handle certain high-risk situations. This usually involves having specific action plans to (1) refuse going to an even higher risk situation, (2) refuse offers of alcohol or other drugs, (3) leave the high-risk situation, (4) defuse the trigger by engaging in some activity, (5) speak with a sponsor or recovering friend, and (6) process the situation in a 12-Step or recovery meeting.

You can increase your self-efficacy in dealing with high-risk situations through experiences in real life as well as through role-playing exercises. You may discover that you are over-confident and need to develop more tools. Or you may discover that you have more tools than you thought.

Stress: Identifying Your Warning Signs

Stress, anxiety, and anger are strongly connected to the ways in which you think and feel. They are also strongly connected to your physical well-being. That is, your experience of stress is related to the ways in which you think and perceive; they cause strong emotional responses, and they affect your physical well-being.

Above all, stress, anxiety, and anger are warning signs. They are ways that your body alerts you to the fact that something is wrong. They may not tell you exactly what is wrong, but they are warning signs that something needs to be changed.

When you are involved in stimulant use, it becomes easy to ignore these warning signs. An important task of recovery is to learn ways to decrease the levels of stress, anxiety, and anger in your life. But in order to do so, you must first learn to identify your warning signs. To help you accomplish this task, check off the following that have applied to you since being in treatment. Discuss what was going on in your life shortly before and while experiencing these warning signs of stress.

• Feeling anxious, nervous, fearful, or afraid. When do you have these feelings?
• Worrying about what might happen; imagining the worst. About what?
• Feeling irritable, cranky, and moody. When? What days and times?
• Feeling overly stimulated and distressed by the things around you. When? Where?
• Feeling angry, annoyed, and combative. When? Where? With whom?
• Feeling restless, impatient, and fidgety. When? What days and times?
• Experiencing tension in your muscles. Where? When?
• Experiencing stomach aches, cramps, diarrhea. When?
• Feeling exhausted, weary, and fatigued. When?
• Having problems concentrating and following what you read or hear.
• Having problems falling or staying asleep or having restless sleep.

Anger: Identifying Your Warning Signs

Recovery-Related Stress Reducers

Life is full of stressors, or things in the world that put some type of pressure on us to do something, to act in a certain way, or to follow a rule. But stress is our internal response to stressors. For example, being caught in a traffic jam is a stressor. Getting angry, agitated, and anxious is a response to being caught in the traffic jam. That's stress. However, there are things that can stop the cycle of stressors becoming stressful experiences. These can be important aspects of your recovery.

Learning To Solve Problems

During periods of active stimulant use, people are often overwhelmed by drug-related problems. They often hope that problems will disappear. When ignored, problems tend to worsen and become more numerous. The good news is that problems can be solved. But the solution involves an action plan.

Managing Your Anger

People get angry. It's a part of life. You will become angry at various times in your life. However, it is unhealthy to remain angry. Anger can make you impulsive, prompting you to say and do things that you don't mean to do. Anger can be a trigger for stimulant cravings.

You will become angry during your recovery. You will think about situations associated with deep-seated emotions. You will be expected to talk about feelings that you have never discussed with anyone before. As you become increasingly aware of the negative consequences of your stimulant use, you may experience strong emotions that are uncomfortable.

You probably learned unhealthy ways to deal with anger. You may tend to repress your anger and pretend that everything is okay. You may impulsively explode and express your anger through physical or emotional abuse of others. Or you may let it build up and let it eat away at you. However, you can learn to manage and express your anger in healthy ways.

• Identify your anger signs. What are the physical, emotional, and behavioral warning signs of anger? Do your muscles get tense? Do you clench your fist or teeth? Do you become irritable, nervous, or short tempered?
• Evaluate the situation. Why are you angry? Are you overreacting to a real situation? Are you reacting to a situation that may never happen? Are you angry about one thing but expressing anger about another? Are you feeling impulsive, threatened, or scared?
• Talk it out. Rapidly identify someone with whom you can talk about the problem. Who do you know whom you can call immediately? Can you call your sponsor or a friend in recovery? Make plans now to attend the next 12-Step or recovery group meeting to talk about it. Identify someone who is not part of the problem.
• Cool off. It is better to talk out your anger rather than to act on it. Whether or not you can rapidly find someone with whom you can talk, take a break from the situation and cool off. Before you act on your anger, take a walk, do some exercise, do something physical, or take a shower.
• Wait before responding. If the problem is such that you have to respond, then don't respond until your physical and emotional signs of anger have gone away. Don't make a decision while feeling the signs of anger. Can you wait an hour? Can you wait a day? It will give you time to organize your thoughts and review your options. Talk with the person with whom you are angry only after you cool off.
• Review options for action. If you must respond, review your options. What has worked in the past? What option would be best for your recovery?

Selective Memory About Stimulant Use

There is no question that stimulants can provide a dramatically euphoric experience that is outside of normal human experiences. That is one of the reasons why people use stimulants. You probably had several stimulant-induced experiences during which you felt intensely euphoric, extremely powerful, and invulnerable. However, these experiences are accompanied by equally strong but negative experiences.

You also had many experiences during which you felt extremely depressed, agitated, and irritable. Similarly, you also experienced many adverse consequences related to your stimulant use, such as financial and employment problems, problems with family and friends, health-related concerns, and legal problems.

It is natural to focus on the positive side of things and to want to downplay the negative side. In certain areas of life, that is a good rule to live by. But one of the tasks of recovery is to always remember the negative consequences caused by your stimulant use. One of the signs of relapse is when people selectively remember only the good times associated with stimulant use, especially the euphoric experiences. People who tell "war stories" and focus on their wild stimulant-related experiences can make themselves and the people listening to them experience triggers, cravings, and urges for stimulants.

• Do you sometimes catch yourself either fantasizing or talking about "how good things were" back when you used stimulants? When you did this, what were you feeling? How did you feel afterward?
• Have you ever heard someone give a "drugalogue" or a "war story" about his wild experiences using stimulants and about all the positive but none of the negative aspects? How did it make you feel? Why do you think that people do this?
• Some people tend to have vivid memories of the euphoric effects of stimulants during certain times, such as when they feel overwhelmed, when they don't feel good, or when they are exhausted. Have you ever fantasized or talked about the euphoric effects of stimulants during times when you were not feeling good?

Fantasies About Controlled Use

After being in recovery for several weeks or months, you generally start feeling better. Although the healing process is just beginning, your thinking begins to be somewhat more clear, you are learning to experience and express your feelings more effectively, and you are learning problem-solving skills. A few or many of the negative consequences of your stimulant use are becoming less severe and numerous.

It is during these early recovery phases that you may have fantasies about being able to return to stimulant use. You may believe that if you made some changes, you could once again use stimulants. You may tell yourself that if you are "careful" you could use stimulants without losing control. You may believe that you are ready to try using stimulants "one last time" to test whether you can use stimulants without losing control over its use. These are called "fantasies of controlled use." They are classic warning signs of impending relapse.

If you experience fantasies of controlled use, you should immediately develop an action plan. This plan should include: (1) recognizing these as fantasies and rejecting them as options; (2) recognizing these as warning signs of impending danger; (3) immediately seeking a 12-Step sponsor, a counselor, or a recovering friend to speak with; (4) attending a 12-Step and recovery group meeting as quickly as possible; and (5) talking about these warning signs at the meetings.

• Have you ever thought about how nice it would be to use stimulants without all the adverse consequences?
• Have you ever thought about how good it would be to use stimulants but not lose control over them?
• Have you ever used stimulants without eventually losing control, such as losing control over the amount of the drugs, the amount of money or time spent on the drugs, or on your stimulant-induced behavior?
• When you used stimulants in the past, what were some of the most troubling problems that you experienced as a result of your stimulant use?
• What is your action plan for dealing with the warning sign of fantasies of controlled use? What are the specific steps of your action plan?

Those Ugly Reminders

If you find yourself thinking about those "great" times when you used stimulants or fantasizing about being able to control your stimulant use, you may benefit from what can be called "ugly reminders" about your stimulant use. These can help you to remember that your stimulant use included some fairly serious negative consequences and problems.

But don't go overboard. It is important to remember the kinds of problems that your stimulant use caused. You don't, however, want to beat up on yourself. Rather, when you experience the warning signs of selective memory and fantasies of control, remind yourself about the dark side of your stimulant use.

• Make a list of all the people who were hurt as the result of your stimulant use. List the friendships that were damaged as a result of your stimulant use. Put down friends' names and mention at least one specific way in which they were hurt because of your stimulant use. When you feel cravings, fantasize about controlled use, or begin to daydream about how nice things were when you used stimulants, review the names on this list and call one of them.
• Do you have some visible reminder of the negative consequences of your stimulant use? This can include an eviction notice, a job termination notice, divorce papers, a car repair bill, notices from bill collectors, or a hospital bill. Take one of these and put it inside a table-top picture frame. Whenever you feel cravings, have selective memories about the positive aspects of stimulant use, or fantasize about controlled use, put the ugly reminder where you will see it for the next couple of hours.
• Make a list of all of the things that you lost as a result of your stimulant use. These can include lost jobs, opportunities for advancement, relationships, cars, money, and memories. Keep this list handy and look at it when you begin having cravings or thinking about the stimulant highs.

Recreational and Leisure Activities

When you were using stimulants, there were times when your life focused on obtaining, using, and recovering from the effects of the drugs. There were times when your life was probably chaotic, out of control, and without structure. Recovery is an opportunity for you to develop a structure to your life and fill it with healthy activities.

Recreational activities are experiences in which you actively participate in an organized activity, generally with others, to have fun and enjoy life. They include participation in sports, arts and crafts endeavors, and table games, as well as sober dances, bowling, touch football, and card games. Some involve physical exercise. Leisure activities are things that you do primarily for relaxation and pleasure, and which don't involve much work. These include taking walks, having friendly conversations, reading books, watching movies, or watching sports activities.

• Before you began using stimulants, what type of recreational activities did you enjoy? What type of leisure activities did you enjoy? What were some of the benefits that you obtained from these activities?
• On Client Worksheet 22, Examples of Recreational and Leisure Activities, there are lists of recreational activities. Which of these do you find interesting? What are some of the benefits that you might obtain from these activities? In what ways could you incorporate these into your recovery program?
• On Client Worksheet 22 there are lists of leisure activities. Which of these do you find interesting? What are some of the benefits that you might obtain from these activities? In what ways could you incorporate these into your recovery program?
• Do you have any healthy hobbies? Do you see anything on Client Worksheet 22 that grabs your attention? Can you think of something else that would be personally satisfying?

Examples of Recreational and Leisure Activities

Recreational activities, leisure activities, and hobbies are all ways in which you can have fun, enjoy being with others, and add healthy activities to your life. They can also help you take your mind off drugs, add structure to your life, and maybe even learn something new. They can help you avoid being bored and restless. They can help you reduce stress and anxiety.

Exercise and Recovery

Some people find having a regular schedule of intense exercise workouts, such as aerobics and step-aerobics especially enjoyable. But exercise doesn't always have to be intense to be healthy and can be somewhat more gentle, such as vigorous walks, bike rides, and skating. Also, some people find it difficult to engage in exercise just for the sake of exercise. They may find greater satisfaction in exercise activities that are social and involve groups of people. This can include dancing, tennis, swimming, or having entire groups going for walks, taking bike rides, going for runs, and skating.

Some of the benefits of exercise include increasing your physical well-being, improving your emotional well-being, improving your mental alertness, improving your sleep, providing you with more energy, and reducing your stress and anxiety. Exercise also provides structure to your life and can help to prevent weight gain.

• When was the last time that you engaged in regular exercise? What kind of exercise have you been involved with in the past?
• What type of exercise appeals to you the most? Intense, vigorous workouts by yourself? Competing with others? Social and gentle aerobic activities?
• What would you like to gain from exercise? What is the primary thing that would motivate you to exercise?
• Look at Client Worksheet 24, Types of Exercise Activities. What specific types of exercise would you consider doing? What would be a reasonable exercise schedule that you could incorporate into your recovery program?
• What obstacles might get in the way of your engaging in regular exercise? What steps can you take to overcome these obstacles? Are there clubs or organizations that you could join?

Types of Exercise Activities

You may not have noticed, but there are numerous opportunities for participating in exercise activities nearby. Unless you live in a very rural area (and maybe even if you do), you probably live near a county or city recreation department, a local YMCA gym, a Jewish Community Center, and private exercise clubs and gyms. Many of these, especially gyms that are sponsored by non-profit organizations, offer services that are low-cost or even free. You can get local information through the yellow pages under "gyms," "exercise," "recreation," and by contacting the local city or county recreation department.

Nutritional Self-Assessment

If you are typical, your use of stimulants and other drugs, especially alcohol, has had a bad impact on your diet. Stimulants suppress your appetite by making you feel as if your hunger is satisfied, even though you have not eaten anything. When your appetite is artificially suppressed by stimulants, you eat less and therefore do not consume sufficient calories and nutrition. At the same time, stimulants speed up the metabolism of your body, creating an even greater need for calories. Also, if you typically use alcohol in combination with stimulants, you may have gotten most of your calories from alcohol, often called "empty calories."

In addition to not eating frequently enough, you may have learned poor ways of eating. For instance, you may have learned to eat impulsively. Also, you may have developed the habit of eating foods with little nutritional value when you did eat.

Nutritional self-assessment

• If you tended to use stimulants in binges, for how many days did you binge? During a typical stimulant binge, how many days would you go without eating? What was the longest period of time that you went without eating?
• During a typical stimulant binge, how many times did you actually stop and eat a meal? Did you frequently "forget" to stop and eat?
• During or following a stimulant binge, when you did eat, what did you eat? What would you eat for breakfast? What would you eat for lunch? What would you eat for dinner?
• When you did eat, did you make plans to prepare and eat meals or did you eat impulsively?
• Now, during your recovery, do you make plans to prepare and eat meals or do you eat "when you can?"
• What did you eat for breakfast today? What did you have for lunch today or yesterday? What did you have for dinner yesterday?
• Do you notice that there are times when you crave fats and sweets?

The Food Guide Pyramid

You probably remember reading something about the Food Guide Pyramid, a guide to daily food choices, although you may not have thought about how it applies to you. Reviewing these five food groups and incorporating this information into your life can be important aspects of your recovery. Eating regularly, and eating meals that are balanced among these food groups, can help to decrease stimulant cravings, increase sleep, increase concentration, decrease withdrawal-related anxiety and depression, and provide sufficient energy required for recovery. The following provides a basic description of the five food groups and the recommended number of servings per day for each food group. Keep in mind that a "serving" is actually a fairly small amount.

My Nutrition Improvement Action Plan

Stimulant-addicted people learn to act on impulse. It becomes commonplace to not eat regularly, to eat on the run, and to select foods based only on taste and not nutritional value. There is often no set schedule for meals, no meal planning, and an overreliance on high-calorie, high-fat fast foods, such as hamburgers and fries. However, with a little planning, eating can be transformed from an impulsive activity to an important and healthy component of recovery.

Sample Behavioral Contract for Stimulant Abstinence

This is an agreement between _____________________ (the client) and ____________________ (the clinician) to help _____________________ (the client) maintain abstinence from stimulants.

I request my counselor to establish a schedule for collecting urine specimens from me for 24 weeks. I will provide urine samples three times per week on a Monday, Wednesday, and Friday schedule during the first 12 weeks of treatment. During the second 12 weeks (weeks 13 through 24), urine samples will be collected two times per week on a Monday-and-Thursday schedule. A clinical staff member of my sex will observe the urination. Half of each urine sample will be submitted for immediate analysis, and half will be saved at the clinic. Samples will be assayed for a variety of drugs of abuse, among which are cocaine, amphetamines, opioid drugs, marijuana, and sedatives. Each specimen for the collection request will consist of 3 ounces of urine. If the quantity is insufficient for analysis, that shall be considered a failure to provide a scheduled sample.

If I travel out of town due to an emergency, I will inform my therapist in advance of leaving. My therapist is authorized to verify such absences with __________________________ [significant other, etc.]. If I require hospitalization, my therapist will arrange to collect urine samples in the hospital. If I am sick and do not require hospitalization, I will still arrange to produce scheduled urine specimens. If I have difficulties with transportation, or inclement weather makes it difficult to travel, I will arrange (with the help of clinical staff) a way to get to the clinic for urine collection. On certain major holidays, the clinic will be closed. My therapist and I will mutually agree to modifications of the urine testing schedule during holiday weeks.

If for appropriate medical reasons, I am prescribed medication that is also a drug of abuse, I will provide to my therapist the name and phone number of my physician or dentist. I hereby give my therapist permission to contact my physician or dentist by phone and mail if I am given such a prescription. I agree to provide to my therapist a photocopy of the prescription or permit my therapist to see the prescription container. If the medication is appropriately prescribed, the appearance of the drug in urine tests will not be counted as relapse to drug use.

Components of a Functional Analysis

A functional analysis is a technique that can help you to understand your stimulant use so that you can engage in problem-solving solutions that will reduce the probability of future stimulant use. It allows you to identify the immediate causes of your stimulant use. A functional analysis is a method that helps you examine three aspects of your stimulant use:>

• The types of circumstances, situations, thoughts, and feelings that increase the likelihood that you will use stimulants (triggers)
• The positive, immediate, and short-term consequences of your stimulant use
• The negative and often delayed consequences of your stimulant use.

Preparing To Conduct a Functional Analysis: Identifying Your Triggers

This worksheet should be completed before using Client Worksheet 32, Conducting a Functional Analysis of Your Stimulant Use, and Client Worksheet 31, The Functional Analysis Worksheet. This worksheet will help you to identify the circumstances, situations, people, locations, thoughts, and feelings that increase the likelihood that you will use stimulants.

• List the places where you frequently used stimulants:
• List the people with whom you frequently used or purchased stimulants:
• List the times or days when you most frequently used stimulants:
• List the kinds of activities in which you were typically engaged when you used stimulants:
• List the feelings and emotions that you experienced after you were exposed to triggers:
• List the kind of things that you were thinking about after you were exposed to triggers:

The Functional Analysis Worksheet

Conducting a Functional Analysis of Your Stimulant Use

This worksheet is used in combination with Client Worksheet 31, The Functional Analysis Worksheet. It should be used only after completing Client Worksheet 30, Preparing to Conduct a Functional Analysis: Identifying Your Triggers.

Functional Analysis: Important Points To Consider

Self-Management Planning

By now, you have identified several of your triggers. You can organize them into categories, such as high-risk places, people, times of the day, activities, and feelings. This helps you to see that certain triggers are external and exist primarily in your environment (such as places) and some are internal, such as feelings and thoughts. Different triggers require different responses.

Self-Management Planning Worksheet

Relationship Happiness Scale

This scale is intended to estimate your current happiness with your relationship in each of the ten areas listed below. Ask yourself the following question as you rate each area: How happy am I with my partner today in this area? Then circle the number that applies. Remember, you are indicating your current happiness. That is, it represents how you feel today. Also, do not let your feelings in one area influence the rating in another area.

Daily Reminder To Be Nice

It is easy for partners to take each other for granted, especially when stimulant use is part of the relationship. This worksheet is a way to help remind you that there are some simple and effective things that you can do to help reverse certain negative behaviors that may have become habitual in your relationship. This worksheet can help to remind you to do a few nice things for your partner and to record how often you actually engage in these behaviors.

with permission from Sisson and Azrin, 1989.

The Perfect Relationship

In each area listed below, write down the activities that would exist in what would be an ideal relationship for you. Be brief, specific, and positive about what you would like to occur.

Regarding "household responsibilities," I would like my partner to:

Regarding "child-rearing," I would like my partner to:

Regarding "social activities," I would like my partner to:

Regarding "independence," I would like my partner to:

Regarding "personal habits," I would like my partner to:

Regarding "managing money," I would like my partner to:

Adapted with permission from Sisson and Azrin, 1989.

Positive Requests

If you or your partner wants the other to make changes, the most effective way to accomplish this is by using positive communication. This is more effective and more pleasant than by negative communication, such as making demands, nagging the other person, or trying to order the other person to do something.

Engaging in positive communication is a skill, and it can be learned. It also takes practice. In the beginning, it may seem unnatural, but as you practice and incorporate it into your daily lives, it becomes natural.

The ways in which requests are made can be pleasant and will increase the likelihood that the requests will be fulfilled.

Reciprocal Contract for Behavior Change

This contract is designed to assist you in achieving and maintaining positive changes in your relationship. During treatment, you will be asked to develop several of these contracts which will document reciprocal changes requested by you and your partner. By making a public commitment and placing it in writing, you are actively taking steps toward achieving and maintaining positive changes in your relationship.

I, ___________________________, agree to make every effort possible to make the following changes at my partner's request. I understand that this change is very important to him/her and therefore is also very important to me.

Improving Communications

Disagreements and Fights

Good and Poor Listening Skills

Recovery Self-Evaluation

For each of the following topics, rate how satisfied you are at this time.

• Which areas have you improved the most since you began treatment?
• What are the areas that you feel need the most improvement?
• What specific action plans do you plan to engage in to accomplish these goals?
• What areas of your treatment plan do you think need enhancement?

Adapted with permission from Rawson et al., 1995.