exercise 1.

Section IIE

ADDICTION

231
 Therapists Overview

AM I HAVING DIFFICULTY LETTING GO?1

GOALS OF THE EXERCISE

1. Recognize and understand emotions regarding loss that still may be unresolved.
2. Increase insight into specific aspects of loss that are unresolved.
3. Identify any areas that will need additional assistance in being resolved.

SUGGESTIONS FOR PROCESSING THIS EXERCISE WITH THE CLIENT

This activity is designed for the client who may be uncertain of his/her own unresolved
grief issues. It also can be useful with the client who is very aware that he/she has grief
issues to resolve but does not know how to begin or how to get unstuck. The exercise can
be tailored to address a grief reaction for losses other than bereavement.

1
Most of the content of this assignment (with minor revisions) originates from J. Finley and B. Lenz, The Addiction
Treatment Homework Planner (New York: John Wiley & Sons, 2003). Copyright 2003 by J. Finley and B. Lenz.
Reprinted with permission.

233
 EXERCISE IIE.A

AM I HAVING DIFFICULTY LETTING GO?

Grief and sorrow can be related to the death of a loved one, a relationship ending, a
catastrophic illness, the loss of a job, a major financial loss, or any serious personal set-
back. The loss may have been either expected or unexpected. For people coping with
addictions, these losses might be related directly to their addictive behaviors and life-
styles, or unrelated. Sometimes these losses occur well into a persons recovery, and
inability to cope with loss can put him/her at risk of relapsing into addictive behavior to
deal with painful emotions. In addition, losses that occurred while we were actively
engaged in addictive behaviors may not be resolved for us and may act as relapse triggers
in early, late, or middle recovery if healing does not occur. Though very personal and
painful, healthy resolution of loss requires and begins with assessing whether we have
losses that are unresolved. This exercise will guide you through the process of reflecting
on whether unresolved grief is a recovery or treatment issue for you and what your un -
resolved losses might be.

1. Following is a list of signs that may indicate that you are dealing with an unresolved
loss (old or new). These are normal, not abnormal, reactions to loss. Please check all
those that apply to you:
Inability to stop talking about the loss
Avoiding certain discussions
Replaying what you feel you should have done differently
Feeling or believing that if you express any emotion about the loss, it will take over
(e.g., if you start crying you wont be able to stop, or if you express your anger
youll go out of control)
Disbelief that the loss occurred
Withdrawing from others or isolating
Changes in your behavior
Trouble sleeping or eating
Apathy
Difficulty concentrating
Guilt regarding the loss
Feeling as if youre falling apart
Hopelessness about the situation, or your feelings, ever changing
Feeling a lack of control in other areas of your life
Feeling betrayed
Suicidal thoughts

234
 EXERCISE IIE.A

Anger and resentment

Dissatisfaction with everything or everyone
Feeling a lack of purpose
Having a sense of failure or worthlessness
Overwhelming stress
Numbness
Other:

2. What loss or losses do you believe are related to the signs you checked in question 1?

3. What methods of coping with these losses have been successful? How did they help?
How did they not help?

4. What has been the most difficult aspect of thinking about letting go (i.e., do you feel
you would be abandoning or betraying someone you lost if you let yourself heal)?

5. List any fears you may have about letting go.

6. On which item that you selected in the preceding list would you like to work first?

Be sure to bring this exercise back to your next therapy session so you can discuss
your thoughts and feelings about it with your therapist or group.

235
 Therapists Overview

DEPRESSION INTERACTS WITH ADDICTION2

GOALS OF THE EXERCISE

1. Increase understanding of the interaction of addictive behaviors and emotional prob-

lems or disorders.
2. Reduce the risk of relapse by using therapeutic strategies to overcome both addictive
and emotional issues.

SUGGESTIONS FOR PROCESSING THIS EXERCISE WITH THE CLIENT

This assignment is meant for dual-diagnosis clients who are suffering from depression,
dysthymia, bipolar disorder, or cyclothymia, or for clients who are coping with both
addiction and serious loss in their lives. It guides clients to an awareness of the role of
self-medication for emotional distress in their addiction and to exploration of healthier
alternatives. Follow-up could include bibliotherapy that is related to the clients mood
disorder(s), homework assignments to engage in healthy alternative activities identified
through this exercise and then to report back on the results, and assignment to a
treatment/support group for a mood disorder.

2
Most of the content of this assignment (with minor revisions) originates from J. Finley and B. Lenz, The Addiction
Treatment Homework Planner (New York: John Wiley & Sons, 2003). Copyright 2003 by J. Finley and B. Lenz.
Reprinted with permission.

236
 EXERCISE IIE.B

DEPRESSION INTERACTS WITH ADDICTION

What is the connection between substance abuse or non-chemical addictions and emo-
tional issues? Many people suffer from both addictive problems and mood disorders such
as depression or bipolar disorders and are unable to overcome either problem alone. In
fact, having a mood disorder makes it more likely that a person will develop an addiction
and vice versa. Others find that when they are faced with a death of someone close to
them, a divorce, or some other painful loss, they feel they cant cope without blocking
their pain with alcohol, another drug, or some addictive behavior. This exercise will help
you identify and plan for these issues.

1. Please describe the ways that your addiction has lead to increased depression.

2. Sometimes when people do things to try to improve their mood, they end up getting
hooked, either on a chemical or on a behavior such as gambling or high-risk sex.
Please describe how your mood problems may have led you to behave addictively.

3. Many people feel that there are experiences they couldnt handle without drinking,
using, or acting out in some way. What situations might make you more susceptible to
relapse?

4. Some of the methods used to overcome chemical dependence and other addictions,
such as participating in recovery programs, learning new coping skills, and finding

237
 EXERCISE IIE.B

replacement activities, also help with mood problems. What recovery tools might help
you deal with depression, other mood problems, or a serious loss?

5. Some techniques used with mood disorders may seem not to fit into recovery from
substance abuse, such as the use of prescribed mood-altering medications. If you are
under a doctors instructions to take medications for a mood disorder, have you talked
about your substance abuse issues with the doctor who prescribed the medications?
What did the doctor tell you about this?

6. If you are taking prescribed mood-altering medications, what has your doctor told you
might happen if you stopped taking those medications?

7. Have you also talked about medication use with your sponsor or other people who are
working with you on your addictive issues? What did these people tell you?

The official position of Alcoholics Anonymous is that if your doctor knows you are an
alcoholic or an addict and has prescribed medication, and you are taking it exactly as
prescribed, you are doing what you need to do to stay sober. Other programs have similar
policies. If anyone in your 12-Step group challenges this, they dont know their program
well enough. If you have questions, call your programs local central office, or check
what the official literature says.

8. Do you know others in your 12-Step program who take prescribed mood-altering
medications? How do they avoid falling into the trap of substance abuse?

238
 EXERCISE IIE.B

9. Please use this space to describe the tools that you will use to cope with the combined
problems of substance abuse and mood disorders or grief and loss.

239
 Therapists Overview

EARLY RECOVERY EMOTIONS3

GOALS OF THE EXERCISE

1. Normalize common stresses and changes that newly recovering people experience.
2. Assess current experiences and learn more about feelings, thoughts, and events that
may come up during the recovery process.
3. Identify the benefits of continuing recovery.

SUGGESTIONS FOR PROCESSING THIS EXERCISE WITH THE CLIENT

This exercise presents a list of common feelings, thoughts, and experiences in early
recovery and asks the client to write about his/her experiences with each. This may be
given as an individual or group assignment, to be followed by a discussion with the
therapist or group, and to establish a baseline from which to track further change in the
future.

3
Most of the content of this assignment (with minor revisions) originates from J. Finley and B. Lenz, The Addiction
Treatment Homework Planner (New York: John Wiley & Sons, 2003). Copyright 2003 by J. Finley and B. Lenz.
Reprinted with permission.

240
 EXERCISE IIE.C

EARLY RECOVERY EMOTION

There are common patterns of events, thoughts, and feelings that newly sober people
often experience as they change to a lifestyle that does not involve using alcohol or other
drugs or engaging in other compulsive behaviors. This exercise will help you identify
where you are in this process and what is your current level of motivation.

1. Following is a list of common emotions that people experience. For each of the
following, please write about whether this is happening or has happened to you. If it
has, give an example.

a. Feeling physical changes in my body as it becomes free of alcohol/other drugs.

b. Feelings of hope and exhilaration.

c. Feelings of letdown and fear.

d. Frustration.

e. Feeling more connected to other people.

f. Loneliness.

g. Feeling strange or out of place.

241
 EXERCISE IIE.C

h. Ongoing cravings, urges, thoughts of using/drinking.

i. Feeling doubtful or questioning myself, my spirituality, values, or abilities.

j. Mood swings.

2. The reason I decided to get clean and sober now is:

3. I want to change these things about my life:

4. Now, we ask you to do an exercise in imagination: Picture yourself in the future,

living a life free of any drug or harmful behavior on which you have been depending.
What alternative ways are you using in this future life to react to difficult situations
and uncomfortable feelings? As you picture yourself living this way, how does that
image of yourself make you feel?

242
 Therapists Overview

WHY DO I MATTER AND WHO CARES?4

GOALS OF THE EXERCISE

1. Accurately assess my importance in other peoples lives.

2. Examine evidence in others behavior to identify caring and concern.
3. Create a plan to identify others to whom I matter and reach out for their emotional
support.

SUGGESTIONS FOR PROCESSING THIS EXERCISE WITH THE CLIENT

This assignment is aimed at the client who is at risk for suicidal gestures or attempts, or
others who are suffering from interpersonal isolation and feelings of worthlessness. Its
approach is to correct distorted perceptions of personal worthlessness to others by guid-
ing the client in surveying situations in which he/she is needed and valued. It includes an
assessment of actions by others indicating that they care about the client and the creation
of a plan to reach out for support and help.

4
Most of the content of this assignment (with minor revisions) originates from J. Finley and B. Lenz, The Addiction
Treatment Homework Planner (New York: John Wiley & Sons, 2003). Copyright 2003 by J. Finley and B. Lenz.
Reprinted with permission.

243
 EXERCISE IIE.D

WHY DO I MATTER AND WHO CARES?

When we are experiencing depression, we often feel worthless. We may become con-
vinced that our lives really dont matter and no one understands or cares about what we
feel, or even that others would be better off without us. These feelings and perceptions
are normal in depression, but often they arent accurate. This exercise will help you to
assess the evidence to get a true picture of whether your life matters and others truly care
about you, and to create a plan to form stronger connections with people to whom you are
important and get their emotional support.

1. First, think of things that others have done for you that have been helpful and
important in your life. They may have been family members, friends, teachers, faith
leaders, employers, team coaches, or anyone else who has really helped you along the
way. Please give three examples, describing who they were, what they did for you,
and why it mattered.

2. Now reflect on whether youve done similar things for others during the past year.
Name three people whose lives youve touched in a good way, and describe what you
did.

3. What do you think these people would say if someone asked them whether your life is
important to them?

4. Get three other people, friends, or family members, to answer this question, and
record their responses here: If I were going to do something to help other people
what are some things I could do that would be helpful, and who could I do them for?

244
 EXERCISE IIE.D

5. Use this pace to create a simple plan to start doing one thing for other people during
the next two weeks, either based on a suggestion in response to question 4 or to
another idea.

6. Please use this space to list five people with whom you feel you can talk if you are
feeling troubled, confused, or discouraged, and write about how you will approach
each of them to ask for this support. Please think of people you see in recovery
program meetings, or in your faith community, or in some other setting, who seems to
have a lot of life experiences like your own and to be a wise and gentle person. The
person or persons may be older, or not. Its best to choose people for whom you feel
respect, but no romantic attraction.
Name How I Will Ask for Support

245