Intensive Outpatient Treatment (IOP) thread

[adore79]

There are many people who would like to attend IOP but for one reason or another are unable to. I have just started the program and so for the benefit of those who cannot attend, I will use this thread to do my best to take someone through an IOP using the worksheets that I do in the program.

Feel free to add any info you want or to discuss the information.

WORKSHEET #1

Recovery Checklist
Check all the things that you do reguarly or have done since entering treatment:

Schedule activities daily
visit physician for checkup
Destroy all drug paraphenalia
Avoid people who use alcohol
Avoid people who use drugs
Avoid bars and clubs
Stop using alcohol and drugs
Pay financial obligations promptly
Identify addictive behaviours
Avoid triggers (when possible)
Use thought stopping for cravings
Attend Individual/Conjoint sessions
Attend Treatment Groups
Attend 12-Step or mutual-help meetings
Get a sponsor
Exercise daily
Discuss thoughts, feelings, and behaviors honestly with your counselor, in group, in journal, etc...

What else have you started to do?

Which behaviours are easy for you to do?

Which behaviours take the most effort?

Which behavior have you not begun?

What might need to change in order to begin?

[adore79]

WEEKLY RECOVERY PLAN

Sunday
Physical-
Mental-
Emotional-
Social-
Spiritual-

Monday
Physical-
Mental-
Emotional-
Social-
Spiritual-

Tuesday
Physical-
Mental-
Emotional-
Social-
Spiritual-

Wednesday
Physical-
Mental-
Emotional-
Social-
Spiritual-

Thursday
Physical -
Mental-
Emotional-
Social-
Spiritual-

Friday
Physical -
Mental-
Emotional-
Social-
Spiritual-

Saturday
Physical -
Mental-
Emotional-
Social-
Spiritual-


Include length of time for each activity
Physical- active: exercise, walking, hot bath, 3 square meals, measurable action (include length of time for each activity)
Mental- gathering information/knowledge about addiction and or recovery, reading or other info.
Emotional- Feelings- use a journal, identify, express, seek acknowledgement.
Social- Contact with another recovering person at AA, sponsor, coffee, phone call etc...
Spiritual- any action that access "your spirit"

Recovery is a planned, measurable set of actions
Relapse is the lack of a specific plan and/or a lack of action.

[adore79]

WORKSHEET #3

List The Positives and Negatives of alcohol and or drugs

Positives

Negatives

[keithj]

adore,

While I personally found treatment plans similar to the one you've posted to be wholly insufficient for me to recover, I do appreciate your posting it here. Might do somebody some good. People can try it and report back to us.

[Rowan]

Good idea, Felicia, and very generous of you to share it here. Thanks.

I'm coming up on 3 years clean and sober and I see plenty that I can use today.

[adore79]

Alcohol & Other Drug (AOD) Inventory

AOD History

1. Age of first use of alcohol:
Other drugs:
What were the results?

2. What drugs and types of alcohol did you use during Middle School?
How often and how much for each?

3. In high school?

4. Between 18-25?

5. Between 25-40?

6. After 40?


Concept 1: Powerlessness over amount of alcohol consumed

1.1 Have you ever tried to stop drinking/drugging completely? What were the results? Give examples:






1.2 Have you ever tried to limit or control the amount of alcohol or drugs you used by limiting dosage (for instance, promising yourslef or someone else you would have only 2 drinks at a party?) What were the results? Give examples:




1.3 Give examples of how you tried to limit or control the amount of alcohol or drugs you used by switching drinks (for instance, switched from straight liquor to a mixed drink or beer, or switched to a drink you do not like): What was the results?



1.4 Give examples of how you tried to limit or control the amount of alcohol or drugs you used by limiting the time for drinking/drugging (for instance, decided not to drink before a certain hour in the day.) What was the results?



1.5 Have you ever awakened in the morning after drinking/drugging and found that you could not remember some part of the evening? Give examples:




Concept 2: Powerlessness over bad results from drinking/drugging

2.1 What have you done to try to drink without bad results (for example, to drink only at home, or not to leave the house after starting to drink.) What was the result?




2.2 What have you done to try to limit or avoid the bad effects of drinking/drugging on your health (for example, take medication for alcohol-related high blood pressure or stomach problems) What was the result?




2.3 How else did you try to control the results of your drinking/drugging, and were you successful? What was the result?



Concept 3: Unmanageability: the unacceptable results of my drinking/drugging

3.1 What was it in your life that was unacceptable to you while still drinking/drugging?



3.2 What crisis might have eventually have occurred if you hadn't stopped using?


3.3 How has drinking/drugging affected your self-esteem, self-image or self-respect?



3.4 Have you ever gotten into physical fights as a result of your drinking/drugging?


3.5 Have you ever lost a job or promotion due to your drinking/drugging? Any other job-related problems due to AOD use?


3.6 Have you ever lost a lover or significant friend as a result of your drinking/drugging?



3.7 Have you been hospitalized (regular or psychiatric) as a result of your drinking/drugging?



3.8 Have you been very depressed and/or felt life was not worth living (alcohol and other drugs often cause severe depression)? Have you attempted suicide?


3.9 How has drinking/drugging affected your health (heart, liver, stomach, skin, nervous system?

3.10 Give some examples of your drinking/drugging putting your life or the life of others in danger?




3.11 What is it about your behavior when you drink that your lover/family/friends object to most?




3.12 Has any physical abuse happened to you or others as a result of your drinking/drugging?


3.13 How has your drinking/drugging adversely affected you even when you are sober?

CONCLUSIONS

4.1 What convinces you that you can no longer use alcohol or drugs safely?




4.2 Are you admitting or accepting? What is the difference between these two things? How are you accepting through your behavior?



4.3 Are you an alcoholic or chemically dependent person?


4.4 Give reasons why you should continue a program of recovery

[adore79]

The 'Cycle of Change' provides a helpful way of understanding how different ways of helping a substance user are appropriate at different times
This diagram adapted from Prochaska and DiClemente (1982) which shows the different stages a user typically goes through during their substance using.

1. Pre-Contemplation:
the substance user has no desire to change. They do not see their using as problematic even if others do.

How to help in the pre-contemplation stage: As the user doesn't see there is anything to change, the most appropriate support is limiting the impact and harm of their substance use to them and to everyone else. Also help the user to become aware of the consequences of their use and associated beahviour.

2. Contemplation:
at this stage the substance user starts considering their situation and whether they want to change. They are more aware of their situation and may want to get out of it. However, they are still using at this stage.

How to help in the contemplation stage: support at this stage continues to be about minimising the impact and harm of substance use. In addition support can be given by helping to motivate the user to change, such as exploring with them the choices they have and offering them information to better inform their choice.

3. Preparation:
the user makes a decision to change their substance using behaviour and starts to prepare themselves to do so.

How to help in the preparation stage: appropriate support involves helping and encouraging the user to make the changes they want to make, whilst acknowledging their anxiety about changing.

4. Action:
the user takes practical steps to bring about a change to their substance using behaviour.

How to help in the action stage: appropriate support is about encouraging the positive changes the user is making in their behaviour.

5. Maintenance:
When someone reaches maintenance they have achieved a change in their substance using behaviour. A substance user may have either stopped using drugs or alcohol, or moved to a more controlled, less harmful way of using and is maintaining that change.

How to help in the maintenance stage: supporting the changes that have been made by the user, such as removing triggers to use from the home. It is important also to adjust to changes in family life and in the relationship with the user, which are likely to have resulted from the user’s changed behaviour.

6. Lapse and Relapse:
a lapse is when the user briefly returns to their old substance using behaviour. It is possible for them to go from lapse back to any stage of the cycle. However, a relapse is when the user fully returns to their old substance using behaviour and then needs to go through the Cycle of Change again.

How to help in the lapse and relapse stages: appropriate support to the user is about reducing harm from substance use and helping the user re-engage with treatment, so a lapse doesn’t become relapse.



Understanding a substance user’s cycle and the support friends and families can provide is very important. The above is just a brief outline of how to help. There are many more ways that you might be able to help at each stage. Adfam suggests that you get help and support with exactly how you can do this.

What to do if you have tried all this and the family member continues to use substances.
It’s usual to feel helpless and frustrated in these situations. First of all, there are many people who have been through the same kind of problems as you, and come out of the other side. Finding help for yourself is the best thing that you can do for your family.

Remember:

A user can only stop if they want to. It may be that a user has become dependent; if this is true, then it will be very difficult for them to stop and they will probably need treatment.
However, with the right help and support a dependent drug/alcohol user can stop using. There is support and treatment available.
The family can be a vital avenue of support for users.
But often, the family cannot do it alone. There are support services dedicated to helping the families of substance users.
Families feel embarrassed, often ashamed, to reveal to others what is happening and their need for help. People who work families know this and won’t judge you; indeed they usually admire the courage that families show in asking for help.
Make sure that you are getting the help, support and advice you need – both to be able to help them and to live your life as best you can. You can try and help a substance using family member, but coming off drugs/alcohol is a very difficult process - ultimately someone will only seek treatment or help if they want it.

[adore79]

Change Plan Worksheet

The changes I want to make are:



The most important reasons I want to make these changes are:


I plan to do these things to reach my goal:



The first steps I plan to take in changing are:



Some things that could interfere with my plan are:



Othere people could help me in changing in these ways:



I hope my plan will have these positive results:



I will know that my plan is working if:



A counselor or professional I can call if I think I have a problem is:

[adore79]

Triggers

Triggers are people, places, objects, feelings, and times that cause cravings. For example, if every Friday night someone cashes a paycheck, goes out with friends, and uses stimulants, the triggers might be:

Friday night
After work
Money
Friends who use
A bar or club

Your brain associates the triggers with substance use. As a result of constant triggering and using, one trigger can cause you to move toward substance use. The trigger-thought-craving-use cycle feels overwhelming.

Stopping the craving process is an important part of treatment. The best way to do that is to do the following:

1. Identify trigger.
2. Prevent exposure to triggers whenever possible
3. Cope with triggers differenetly than in the past.

Remember, triggers affect your brain and cause cravings even though you have decided to stop substance use. Your intentions to stop must translate into behavior changes, which keep you away from possible triggers.

What are some fo the strongest triggers for you?


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

[4dogsandakid]

I'm in an outpatient program and this thread is very helpful! Thanks!

[Believe808]

Felic, What a great idea. Thank you. I will be using some of these sheets myself.

[adore79]

The Losing Argument

If you decide to stop drinking or using but at some point end up moving toward using substances, your brain has given you permission by using a process called relapse justification. Thoughts about using start an argument inside your head, your rational self versus you substance dependent self. You feel as though you are in a fight, and you must come up with many reasons to stay abstinent. Your mind is looking for an excuse to use again. You are looking for a relapse justification. The argument inside you is part of a series of events leading to substance. use. How often in the past has your stubstance dependence 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. But its important to identify these thoughts and try to eliminate them. It takes efforet to identify and stop a thought. However, allowing yourself to continue thinking about substance use is choosing to relapse. The further the thoughts are allowed to go, the more likely you are to relapse.

The automatic process

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

trigger-->thought-->craving-->use

Thought stopping

The only way to ensure that a thought wont lead to a relapse is to stop the thought before it leads to craving. Stopping the thought when it first begtins prevents it from building into an overpowering craving. It is important to do it as soon as you realize you are thinking about using.

A new sequence

To start recovery, it is necessary to interrupt the trigger-thought-craving-use sequence. Thought stopping provides a tool for disrupting the process.

This process is not automatic. You make a choice either to continue thinking about using (and start on the path toward relapse) or to stop these thoughts.

Thought stopping techniques

Try the techniques described below, and use those that work best for you:

Visualization. Imagine a scene in which you deny the power of thoughts of use. For example, picture a switch or a lever in your mind. Imagine yourself actually moving it from on to off to stop the using thoughts. Have another picture ready to think about in place of those thoughts.

Snapping. Wear a rubber-band loosely on your wrist. Each time you become aware of thoughts of using, snap the rubberband and say, no! to the thoughts as you make yourself think about another subject. Have a subject ready that is meaningul and interesting to you.

Relaxation. Feelings of hollowness, heaviness, and cramping in the stomach are cravings. These often can be relieved by breathing in deeply (filling lungs iwth 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 thinking process. Have phone numbers of supportive, available people with you always, so you can use them when you need them.

[adore79]

External Trigger Questionnaire

Place a checkmark next to activities, situations, or settings in which yo frequently used substances; place a zero next to activities in which you never have used substances:

home alone
home with friends
friends home
parties
sporting events
movies
bars/clubs
beach
concerts
with friends who use drugs
when gaining weight
vacations/holidays
when its raining
before a date
during a date
before sexual activities
during sexual activities
after sexual activities
before work
when carrying money
after going past dealers residences
driving
liquor store
during work
talking on the phone
recovery groups
after payday
before going out to dinner
before breakfast
at lunch break
while at dinner
after work
after passing a particular street or exit
school
the park
in the neighborhood
weekends
with family members
when in pain

List any other activities, situations, or settings where you frequently have used.


List activites, situations, or settings in which you would not use.



List people you could be with and not use.

[serenityqueen]

This is extremely thoughtful of you Felicia, taking the time to post all of this for everyone. I'm sure there are many who will benefit from these worksheets. God Bless you for doing this. You very well could save some lives here Hon. We just adore you!

Hugs,
Judy

[adore79]

Internal Trigger Questionnaire

During recovery certain feelings or emotions often trigger the brain to think about using substances. Read the following list of feelings and emotions, and place a check mark next to those that might trigger thoughts of using for you. Place a zero next to those that are not connected with using.

afraid
frustrated
neglected
angry
guilty
nervous
confident
happy
passionate
criticized
inadequate
pressured
depressed
insecure
relaxed
embarrassed
irritated
sad
exited
jealous
bored
exhausted
lonely
envious
deprived
humiliated
anxious
aroused
revengeful
worried
grieving
resentful
overwhelmed
misunderstood
paranoid
hungry

What emotional states that are not listed above have triggered you to use substances?


Was your use in the weeks before entering treatment
___. Tied primarily to emotional conditions?
____. Routine and automatic without much emotional triggering?

Were there times in the recent past when you were not using and a specific change in your mood clearly resulted in your wanting to use? (for example, you got in a fight with someone and wanted to use in response to getting angry)?

Yes____
No_____

If yes, describe

[Dean62]

Wow Fel they sure are keeping you busy. This looks like some good information, thanks for posting it.

[adore79]

Everyone who attempts to stop using substances runs into situations that make it difficult to maintain absitinence. Listed below are five of the most common situations that are encountered during the first few weeks of treatment. Also there are some suggested alternatives for handling these situations.

Friends and associates who use: You want to continue associations with old friends or friends who use.

1. Try to make new friends at 12 steop or mutual help meetings.
2. Participate in new activities or hobbies that will increase your chances of meeting abstinent people.
3. plan activities with abstinent friends or family members.

Anger, irritability: small events can create feelings of anger that seem to reoccupy your thoughts and can lead to relapse.

1. Remind yourself that recovery involves a healing of brain chemistry. strong, unpredictable emotions are a natural part of recovery.
2. engage in exercise
3. talk to a counselor or a supportive friend.

Substances in the home: you have decided to stop using but others in your house may still be using.

1. Get rid of all drugs and alcohol.
2. Ask others to refrain from using and drinking at home.
3. If you continue to have a problem, think about moving out for a while.

Boredom, loneliness: stopping substance use often means that activities you did for fun and the people with whom you did them must be avoided.

1. Put new activities in your schedule.
2. Go back to activities you enjoyed before addiction took over.
3. develop new friends at meetings.

Special occasions: parties, dinners, business meetings, and holidays whithout substance use can be difficult.

1. have a plan for answering questions about not using substances
2. start your own abstinent celebrations and traditions.
3. have your own transportation to and from events.
4. leave if you get uncomfortable or start to feel deprived.

Are some of these issues likely to be problems for you in the coming weeks? Which ones?



How will you handle them?

[adore79]

People who abuse substances often feel that their lives are out of control. Maintaining control becomes harder and harder the longer they have been abusing substances. People do desperate things to continue to appear normal. These desperate behaviors are called addictive behaviors- behaviors related to substance use. Sometimes these addictive behaviors occur only when people are using or moving toward using. Recognize when you begin to engage in these behaviors. Thats when you know 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?

lying

stealing

being irresponsible (for example, not meeting family or work commiments)

being unreliable ( for example, being late for appointements, breaking promises)

being careless about health and grooming

getting sloppy in housekeeping

behaving impulsively ( without thinking)

behaving compulsively (for example, too much eating, working, sex)

changing work habits (working more, less, not at all, new job, change in hours)

losing interest in things

isolating

missing or being late for treatment

using other drugs or alcohol

stopping prescribed medication

[adore79]

Often people who stop using drugs say life feels boring. Some reasons for this feeling include the following:

1. A structured, routine life feels different from a lifestyle built around substance use

2. brain chemical changes during recovery can make people feel listless (or bored)

3. People who use substances often have huge emotional swings (high to low and back to high). Normal emotions can feel flat by comparison.

People who have been abstinent a long time rarely complain of continual boredom. The problem of boredom in recovery does improve. Meanwhile you should try some different activities to help remedy the problem of boredom in recovery.

List five recreational activities you want to pursue:
1.
2.
3.
4.
5.

Have you started doing things that you enjoyed before using drugs? Have you begun new activities that interest you? what are they?



Can you plan something to look forward to? What will you plan?




How long has it been since youve taken a vacation? a vacation doesnt have to involve travel, just time away from your regular routine. what kind of break will you plan for yourself?




Here are some tips to reduce feelings of boredom:

1. Recognize that a structured, routine life feels different from a lifestyle built around substance use.

2. Make sure you are scheduling activities. Forcing yourself to write down daily activities helps you fit in more interesting experiences.

3. Try not to become complacent in recovery. Do something that will futher your growth. Sometimes boredom results from not challenging yourself enough in your daily living.


WHich of the suggestions listed above might work for you? It is important to try new ways of fighting boredom. Boredom can be a trigger that moves you twoard relapse.




next installment: avoiding relapse drift

[Chamabama]

These are very helpful. Thank you for posting them!

[adore79]

Avoiding Relapse Drift

How Relapse Happens

Relapse does not happen without warning, and it does not happen quickly. The gradual movement from abstinince to relapse can be subtle and easily explained away or denied. So a relapse often feels as if it happens suddenly. This slow movement away from abstinince can be compared to a ship gradually drifting away from where it was moored. The drifting movement can be so slow that you dont even notice it.

Interrupting Relapse Drift

During recovery people do specific things that keep them abstinent. These activities can be called "mooring lines." People need to understand what they are doing to keep themselves abstinent. They need to list these morring lines in a specific way so they are clear and measurable. These activities are the "ropes" that hold recovery in place and prevent relapse drift from happening without being noticed.

Maintaining Recovery

Use the Morring Lines Recovery Chart to list and track the things that are holding your recovery in place. Follow these guidlines when filling out the form:

Identify four or five specific things that now are helping you stay abstinent (for example, working out for 20 min, 3 times a week.)

Include items such as exercise, therapist and group appointments, scheduling activities, 12-step meetings, eating patterns.

Do not list attitudes. They are not as easy to measure as behaviors.

Note specific people or places that are known triggers and need to be avoided during recovery.

You should complete your morring lines recovery chart weekly. Place a checkmark next to each mooring line that you know is secure and record the date. When two or more items cannot be checked, it means that relapse drift is happening. Sometimes events interfere with your mooring lines. Emergincies and illnesses cannot be controlled. The mooring lines disappear. Many people relapse during these times. Use the chart to recognize when you are more likely to relapse, and decide what to do to keep this from happening.

[adore79]

Mooring Lines Recovery Chart

You have learned new behaviors that keep you in recovery. These behaviors are the mooring line that keep your recovery steady and in place. It is important to chart the new behaviors and check every week to make sure the lines are secure. Dropping one or more of the mooring lines allows you to drift toward relapse.

Use the chart below to list activities that are important to your continuing recovery. If there are specific people or things you need to avoid, list those. Check your list each week to make sure you are continuing to stay anchored in your recovery.

[Astro]

Fel, thanks for sharing this information with our members!

[adore79]

Guilt and Shame

Guilt is feeling bad about what you've done.

What are some things you have done in the past that you feel guilty about?




Feeling guilty can be a healthy reaction. It often means you have done something that doesn't agree with your values and morals. It is not unusual for people to do things that they feel guilty about. You can't change the past. It is important to make peace with yourself. Sometimes that means making amends for things you've said and done.

Remember the following:

It's all right to make mistakes.
It's all right to say, "I don't know," "I dont care," or "I don't understand."
You don't have to explain youself to anyone if you're acting responsibly.

Do you still feel guilty about the things you listed? What can you do to improve the situation?




Shame is feeling bad about who you are.

Do you feel ashamed of being dependent on substances?

Do you feel you are weak because you couldn't or can't stop using?

Do you feel you are stupid because of what you have done?

Do you feel that you are a bad person because you are involved with substance use?

Recovery is always a hard process. No one knows why some people can stop using substances once they enter treatment and decide to be abstinent and other people struggle to maintain abstinence. Research shows that family histories, genes, and individual physical differences in people play a role. Being dependent on drugs or alcohol does not mean you are bad, stupid, or weak.

What we do know is taht you cannot recover by:
Trying to use willpower
Trying to be strong
Trying to be good

Two things to make recovery work are
Being smart
Working hard

Everyone who is successful at recovery will tell you "it was the hardest thing I ever did." No one can do it for you, and it will not happen to you.

[adore79]

Motivation for Recovery

Ask any group of people who are new to recovery why they want to stop using right now and you will get many different answers:

I was arrested, and it's either this or jail.
My wife says if I don't stop, we are finished.
Last time I used I thought I was going to die; I know I'll die if I use again.
They are going to take the children from us unless we stop.
I've been using for 20 years now; it's time to change.

Which of the people quoted is most likely to be successful in recovery? It seems logical to think that people who want to stop using for themselves and not because someone else wants them to are more likely to do well in treatment. However, that may not be true. Research shows that the reasons people stop using don't predict whether they will be able to lead substance-free lives.

What does make a difference is whether they can stay substance free long enough to appreciate the benefits of a different lifestyle. When debts are not overwhelming, relationships are rewarding, work is going well, and health is good, the person in recovery wants to stay abstinent.

Fear will get people into treatment, but fear alone is not enough to keep them in recovery.

Motivation for Recovery:

List some of your reasons for entering treatment (for example, medical problems, family pressure, job problems, depresssion.)




List some of your reasons for continuing to work on your recovery today.




Do you feel that your reasons for initially stopping substance use are the same as your reasons for staying abstinent today? Why or why not?