It s helpful to watch the video Who is Slick on the slickrecovery.com website before completing this form.

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1 Recovery Worksheet The Voice of Addiction Worksheet How has my drug or alcohol use hurt key areas in my life? It s helpful to watch the video Who is on the slickrecovery.com website before completing this form. & Denial: Below list the various things has told you to encourage denial and keep using despite numerous harmful consequences. Example: Your not as bad as a bunch of your friends so you don t have a problem! 1) 2) 3) 4) & Relapse: If you have in the past tried to cut down or quit everything, has probably tried convincing you to return to chemical use. List below things has said designed to get you to return to using once you have decided to stop. Example: If you just do it once, nobody will know 1) 2) 3) 4) Resisting : will certainly try to get you to return to using; when he does so, what thoughts or behaviors can you do to resist him? Example: I will keep a picture of my kids in my pocket and if I m tempted to relapse I will look at it to remind me how returning to using will hurt my kids. 1) 2) 3) 4) worksheets and videos can be viewed at:

2 Recovery Worksheet Consequences of Using How has my drug or alcohol use hurt key areas in my life? For best results fill this form out with people who know you well and will be honest. Area of Importance Relationships - Conflicts with family - Avoiding family - Neglecting family - Resentments - Lost friends How has my drug or alcohol use negatively impacted this area in my life? What has said to help me ignore or minimize this problem? Work - Lost jobs - No motivation to work - Conflicts with boss - Conflict with workers - Missed time Finances - Debt - Unpaid bills - Stealing, Health - Car accidents - Medical problems Emotional - Depression, - Anxiety/fear - Anger/resentment - Sadness, Legal - DUI - Divorce - Assault - Possession - Distribution Spiritual - Violating values - Avoiding religion/god - Guilt/Shame - Anger at God worksheets and videos can be viewed at:

3 Relationship Consequences: How has my using negatively impacted my relationships? Examples might be, conflicts, avoiding, neglecting, resents, lost relationships etc, etc. Recovery Worksheet Consequences of Using Drugs & Alcohol Observed by my Family and Friends From To Dear I am trying to honestly examine if my drug or alcohol use has hurt me or others and considering if I would be better off giving up drugs and alcohol permanently. Would you please complete this form as honestly as possible and return it to me. Feel free to use additional paper if you think that would be helpful. Work/Employment Consequences: How has my using impacted my employment? Examples might be lost jobs, missed work, conflicts with employers or co-workers, lost advancement opportunities, unable to drive to work due to license suspension, etc. Financial Consequences: How has my using impacted my finances? Examples might be debt, financial dependence on others, unpaid bills, stealing, etc. etc. Health/Medical Consequences: How has my using impacted my finances health? Examples might be illness, accidents etc. Emotional/Mental Health Consequences: How has my emotions or mental health? Examples might be depression, anxiety, anger, resentment, poor impulse control, sadness, etc Legal Consequences: How has my using impacted my legal issues? Examples might be DUI, divorce, assault, possession, dealing, etc. Spiritual Consequences: How has my using impacted my spiritual life. Examples might be violating values, shame/guilt, anger at God, avoiding religion, etc. Other Consequences List any other problems you have observed due to my using drugs or alcohol worksheets and videos can be viewed at:

4 Recovery Worksheet Why I Like Getting High Learning new ways to cope without drugs and alcohol For each drug you use check in the appropriate boxes what reasons you use it, (alcohol is a drug) Reasons I like using Alcohol Pot Speed Meth Cocaine Opiates Pain Meds Sedatives Like xanax All Other Drugs To fit in with friends this is what my friends do so I want to fit in Reduce Boredom: It makes my life less boring. To Have Fun: It makes fun stuff more fun. For Social Comfort: I like it because it helps me relax and speak up in social situations To Relax & Reduce Stress after a long day it helps me relax To Sleep- I have difficulty sleeping without it. To Reduce Physical Pain I need to cope with pain To Reduce Emotional Pain to cope with fear, hurt, anger, depression etc Physical Addiction I use to avoid withdrawal symptoms Energy it gives me the energy to get things done. Weight Loss It helps me lose weight Focus It helps my attention stay focused Sexual Pleasure it helps me perform or enjoy sex Courage Assertiveness I say things I might not always have the courage to say Excuse Bad Behavior It lets me do things I typically would feel too guilty to do To reduce worry & anxiety: It helps me not worry about problems To function normally: I need it to work, and do life. List you own reasons: worksheets and videos can be viewed at:

5 Recovery Worksheet Why I Like Getting High - page 2 Learning new ways to cope without drugs and alcohol Circle the items below that you checked on page one To Fit In With Friends Reduce Boredom To Have Fun For Social Comfort To Relax & Reduce Stress To Sleep To Reduce Physical Pain To Reduce Emotional Pain Physical Addiction Energy Weight Loss Focus Sexual Pleasure Courage Assertiveness Excuse Bad Behavior To Reduce Worry & Anxiety To Function Normally List Your Own Reasons This section is designed to help you to consider how to develop healthy ways to address the positive things your drug or alcohol use provided. List alternate ways you can begin to address this area without drug and alcohol use. What is saying to you as you complete this worksheet? Video s, Counseling, Interventions, Worksheets by Saul Selby MA LADC webisite: / phone: / setfree@usfamily.net

6 Recovery Worksheet Relationships & Recovery Do I need to change my relationships with using friends of family? This worksheet is designed to help you consider what, if any, relationship changes you need to make to support your recovery. In column #1 list all the people you used drugs or alcohol with, n column #2 indicate the type of relationship you had with the person, in column # 3 indicate what if any changes you thing you need to make in this relationship, and in column # 4 indicate if you need to send them a letter describing your intention to avoid using people and using settings. 1-Names of People You Used Drugs or Alcohol With List the names of the people you used drugs or alcohol with 2-Type of Relationship Friend, Associate, Dealer, Family Member, Significant Other 3-Setting Boundaries changes I need to make. 1) Avoid Entirely 2) See only in sober setting 3) Make no changes at all 4) Other indicate what you mean 4 Communication of Boundary How will you inform this person that your relationship with them needs to end or change. Options are none, phone, letter, face to face. worksheets and videos can be viewed at:

7 Recovery Worksheet Stages of Change By Drug Moving Through The Stages Toward Recovery Directions: List dates you were in each stage for each drug used (see sample column on right) Then answer questions on the bottom on the back of the form or and uses separate paper if needed. Stages of Change Alcohol Pot Speed Meth Cocaine Opiates Pain Meds Sedatives Like xanax All Other Drugs Sample Column Pre-Contemplation I don t have a problem and I don t need to stop using this drug 3/1998 To 6/2002 Contemplation I m confused, a part of me wants to stop using and a part of me wants to keep using. 6/2002 To present Determination/Preparation I have become convinced that I need to stop using this drug. not yet Action My determination to quit is being demonstrated by a number of behaviors like going to recovery meetings, changing friends, avoiding triggers. Maintenance I have successfully been abstinent from this drug for a period of time and I m fine-tuning ways to insure on-going success. Questions: answer questions on the back and separate paper. Not yet How did keep us stuck in early stages what did he say? What happened that caused you to move from one stage to the next. Were there consequences or just new insights? What is telling you now to keep you from moving to action for all the drugs you use? What would have to happen to help you move toward the Action stage for drugs you have not yet reached action? worksheets and videos can be viewed at:

8 Recovery Worksheet Relapse Prevention Planning Identifying Triggers Circle Emotions That Might Use To Nurture Relapse Shame Guilt Anger Resentment Depression Self-Pity Boredom Rejection Fear Anxiety Loneliness Joy Stress Sadness Grief List Others Circle Activities or Places That Might Use To Nurture Relapse Payday Weekends Sex Conflicts Seasonal Changes Types of Music Smells Smoking Bars or Restaurants Anxiety Concerts Trips out of town Being on Vacation Being Alone With Using People List Others Names of People Might Use to Trigger You Type of Relationship How Will I Manage or Change This Relationship worksheets and videos can be viewed at:

9 Recovery Worksheet Relapse Prevention - Trigger Journal Coping with Triggers & Date of Craving What Triggered The Craving What Did Say To Encourage Relapse How I Coped With This Trigger/Craving worksheets and videos can be viewed at:

10 Recovery Worksheet Amends Seeing the damage my addiction has caused From To Dear I know that my drug/alcohol use has hurt you and damaged our relationship. If possible, I want to improve our relationship and make amends for the different ways I have hurt you. Would you be willing to complete this form and return it to me so that I can work toward making amends? If not, I understand. However if you do complete this form and return it to me I will use it to develop a plan to make amends and contact you within a week to describe my amends plan. Ways my using/drinking has negatively impacted you (that I am aware of) How has my using/drinking negatively impacted our relationship? (circle the areas to the left and describe details in box) Financial harm Emotional hurt Physical hurt Dishonesty Other What can I do to improve our relationship and make amends? worksheets and videos can be viewed at:

11 Recovery Worksheet Proposed Amends Plan From To Dear thank you for taking the time to complete my amends form. Based on the information you provided I have developed the amends plan listed below. Please let me know what you think of the plan. Thanks again Type of Harm Done Proposed Amends Plan worksheets and videos can be viewed at: