Core Behavioural and CBT Skills for Relapse Prevention and ... · handouts, or the format may be transferred to a flip chart page. Words may be used, or people may feel more comfortable

1

Core Behavioural and

CBT Skills for Relapse

Prevention and Recovery

Management

Portfolio Exercises

Laura Freeman

NHS Education Scotland

Psychological Interventions Team

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Introduction to the Portfolio

This set of portfolio exercises has been designed to complement the Core

Behavioural and CBT Skills for Relapse Prevention and Recovery

Management Course which has been designed by the NES Psychological

Interventions Team. These portfolio exercises cover a range of skills, which

are included in Motivational Enhancement, Coping and Social Skills to

Prevent Relapse, and Reinforcement Management.

With the exception of the first two handouts which were included as

introductory exercises for the course, all of these tools are designed to be

used collaboratively with service users. While they may be used in the

training as exercise worksheets, they are actually designed to be used with

service users therapeutically to explore issues and develop skills.

The use of these worksheets should be guided by the learning needs of the

service user. While some people will be happy with filling these forms out as

a paper and pencil exercise, others will not be comfortable with this format.

All of these forms can be presented in multiple ways, from a service user

reading and then filling in the worksheet, to the practitioner reading it through

with the individual and helping them complete it. People may use the copied

handouts, or the format may be transferred to a flip chart page. Words may

be used, or people may feel more comfortable using pictures, symbols, or

“texting” language. Even the checklist exercises can be adapted with

individual items on separate cards which could then be sorted into piles or put

into order of importance. The worksheet provides a structure for the process

of the exercise – the practitioner needs to be creative and respond to the

needs of the individual to help them with the process.

Many of these exercises will look familiar – they have been a part of the work

done in alcohol and other drug services often for decades. The goal of this

Portfolio is to encourage practitioners to explore creative ways to expand

beyond verbal exercises and harness the many other styles of learning

represented amongst service users. Services in Scotland face a number of

specific challenges which may impact the effectiveness of interventions which

rely on verbal processes. We have high rates of alcohol related brain damage

and potential cognitive impairment from non-fatal overdoses. The prevalence

of head injuries may also impact the effectiveness of verbal learning, as will

the diazepam-induced anterograde amnesia. The prevalence of trauma

histories amongst the people with problematic substance use also

complicates the provision of traditional alcohol and other drug treatment.

These issues highlight the importance of responding to the individual learning

style of the people with whom we are working, and to find ways to document

the process to enhance memory and long-term learning.

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Models, Motivation and Moving On

How would your clients complete the blanks in this sentence? Write down the different answers in the first column.

I have an alcohol/drug problem because…. and I expect my treatment to include….

1 2 3

In Column 2, note the model that is reflected based on the discussion,

and in Column 3, implications for change.

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Session 1: 3 Common Principles of Effective Behavioural Interventions and the Relationship to Person-Centred Needs

In their review of 20 years of research, Carroll and Rounsaville (2006) identified three common principles to effective substance abuse treatments which are outlined below. It is recommended that training strategies should reinforce the core skills that are included in motivational enhancement, relapse prevention, and reinforcement management. These principles have also been found to be effective in addressing a range of mental health and behavioural concerns. It is useful to consider an individual’s recovery journey in relationship to these three principles. In practice, the work done with individuals will always reflect a blending of these principles, but at different points in their journey, service users will have different needs. At times there will be more of an emphasis on enhancing motivation and at other times developing a rewarding, reinforcing lifestyle will be highlighted. The principles are inter-related and inter-woven, but an awareness of which interventions emphasise which of these principles can help staff match interventions to changing needs of the service user’s recovery journey in a person-centred manner.

Three Common Principles of Effective Behavioural Interventions

Carroll, K. & Rounsaville, B. (2006). Behavioral therapies: The glass would be half full if only we had a glass. In Miller, W. & Carroll, K. (Eds.), Rethinking Substance Abuse: What the Science Shows, and What We Should Do About It. New York: Guilford Press.

Enhancing

Motivation

Examples:

Brief Interventions

Motivational

Interviewing

Motivational

Enhancement

Behavioural Self

Control Training

Community

Reinforcement and

Family Training

Developing Control

Over Impulsive

Behaviour

Examples:

Coping and Social

Skills Training

Community

Reinforcement

Approach and

Contingency

Management

Behavioural Self

Control Training

Compassionate Mind

Training

Reinforcement

Management

(Developing a

rewarding,

alternative lifestyle)

Examples:

Community

Reinforcement

Approach and

Contingency

Management

Behavioural Couples

Therapy

Social Behaviour

Network Therapy

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Service Mapping Worksheet for the Recovery Journey

Consider these three categories of core skills. Depending on the recovery needs of an individual:

Which agencies in your local area would provide offer services in each category to that individual?

What specific, evidence-based interventions would be offered?

How can we make sure the person is linked up to the category they need at this time?

Three Common Principles of Effective Behavioural Interventions

Enhancing

Motivation

Developing Control

Over Impulsive

Behaviour

Reinforcement

Management

(Developing a

rewarding,

alternative lifestyle)

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Session 2: Identifying Problems

Below are some problems that can be made worse by drug and alcohol use. Put a check beside any that you have had.

Medical or Physical: ____Head Injury in past (#: ) ____Overdose experiences ____Stomach problems ____Dental/teeth problems ____Seizures or convulsions ____Large weight gain or loss ____Diarrhoea or constipation ____Nose or sinus problems ____HIV issues ____Hepatitis issues ____Waking up at night with a start ____Difficulty breathing ____Difficulty breathing at night ____Heart problems ____Chronic pain ____Specific pain problem ____Chronic fatigue ____Memory problems ____Other (Specify): Relationships: ____Fights with partner ____Fights with children ____Fights with other family or friends ____Feeling alone ____Difficult to talk to other people ____Difficulty solving problems ____Loss of friends ____Only knowing people who use ____Problems with children/parenting ____Loss of partner ____Children at risk/in care ____Problems in sex life ____Other (Specify): Legal: ____Arrested – possession/dealing ____Arrested - theft or robbery ____Arrested - assault/other violence ____DTTO, probation or parole ____Divorce or separation ____Child visitation issues ____Other (Specify):

Emotions and Feelings: ____Depression ____General anxiety or stress ____Panic attacks ____Anxiety around other people ____Anxiety when outside ____Other specific fears/phobias ____Sudden swings in mood ____Problems controlling anger ____Problems dealing with the past ____Remembering/flashbacks to past ____Hallucinations ____Feeling suspicious or paranoid ____Memory problems ____Can’t sit still – always moving ____Can’t relax ____Can’t concentrate ____Other (Specify): Housing, Finances, and Skills: _____Finding a place to live/sleep _____Furnishing/equipping your home _____Finances and budgeting _____Home skills (cooking, shopping) _____Taking care of your home _____Taking care of yourself _____Other (Specify): Daily Routines ____Problems getting to sleep ____Severe snoring ____Problems waking up ____Eating too much or too little ____Not eating a balanced diet ____Bored during the day ____Lack of fun things to do ____Loss of sports or hobbies ____Lack of physical exercise ____Problems finding or keeping work ____Problems with training or school ____Other (Specify):

Laura Freeman, Ph.D.

Addiction Interventions

7

Session 2: Identifying Things to Work On

Now, look at this list again. 1) Check what would you like to change in your life. 2) Number those checked in order of importance.

Medical or Physical: ____Head Injury in past (#: ) ____Overdose experiences ____Stomach problems ____Dental/teeth problems ____Seizures or convulsions ____Large weight gain or loss ____Diarrhoea or constipation ____Nose or sinus problems ____HIV issues ____Hepatitis issues ____Waking up at night with a start ____Difficulty breathing ____Difficulty breathing at night ____Heart problems ____Chronic pain ____Specific pain problem ____Chronic fatigue ____Memory problems ____Other (Specify): Relationships: ____Fights with partner ____Fights with children ____Fights with other family or friends ____Feeling alone ____Difficult to talk to other people ____Difficulty solving problems ____Loss of friends ____Only knowing people who use ____Problems with children/parenting ____Loss of partner ____Children at risk/in care ____Problems in sex life ____Other (Specify): Legal: ____Arrested – possession/dealing ____Arrested - theft or robbery ____Arrested - assault/other violence ____DTTO, probation or parole ____Divorce or separation ____Child visitation issues ____Other (Specify):

Emotions and Feelings: ____Depression ____General anxiety or stress ____Panic attacks ____Anxiety around other people ____Anxiety when outside ____Other specific fears/phobias ____Sudden swings in mood ____Problems controlling anger ____Problems dealing with the past ____Remembering/flashbacks to past ____Hallucinations ____Feeling suspicious or paranoid ____Memory problems ____Can’t sit still – always moving ____Can’t relax ____Can’t concentrate ____Other (Specify): Housing, Finances, and Skills: _____Finding a place to live/sleep _____Furnishing/equipping your home _____Finances and budgeting _____Home skills (cooking, shopping) _____Taking care of your home _____Taking care of yourself _____Other (Specify): Daily Routines ____Problems getting to sleep ____Severe snoring ____Problems waking up ____Eating too much or too little ____Not eating a balanced diet ____Bored during the day ____Lack of fun things to do ____Loss of sports or hobbies ____Lack of physical exercise ____Problems finding or keeping work ____Problems with training or school ____Other (Specify):



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Session 2: Daily Routine Worksheet

The purpose of this worksheet is to provide participants with the opportunity

to relate the content of the course with their work. The following questions

can be used as a personal review of the material, as a part of a consultation

with other professionals, or a structure for peer or individual supervision.

Consider an individual with whom you work, either currently or in the past….

1. How do they describe their mental health in general? How do they describe their sleep? What are their beliefs about their mental health, and what do they tell themselves?

2. What time do they wake up in the morning and what do they do? What are their morning rituals?

3. What types of physical exercise do they get during the day? Do they get outside in the sunshine? What about mental exercise?

4. What do they eat and when?

(Over)

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5. List all the substances they use, including legal, illicit and prescribed.

6. Which parts of their living space do they use? Do they spend most of their time in one place? Do they use their bedroom for “active” activities while awake?

7. What do they do in the 2 hours before bedtime? What are their “wind down” rituals?

8. What time do they go to sleep? What do they do when if they are unable to fall asleep?

9. How do they sleep during the night? Do they describe waking up with a start? Nightmares? What do they do to cope with any sleep problems?



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Session 2: Happiness Scale The Happiness Scale is used as a part of the Community Reinforcement Approach (CRA). For the most recent overview of CRA, see: Meyers, R. J., Roozen, H.G., and Smith, J. E. (2011). The Community Reinforcement Approach: An Update of the Evidence. Alcohol Research & Health, 33 (4), 380-387.

This scale is intended to estimate your current happiness with your life in each of the

ten areas listed below. Ask yourself the following question as you rate each area:

How happy am I with this area of my life?

You are to circle one of the numbers (1-10) beside each area.

Numbers toward the left indicate various degrees of unhappiness, while numbers

toward the right reflect various levels of happiness.

In other words, state according to the numerical scale (1-10) exactly how you feel

today.

Remember: Try to exclude all feelings of yesterday and concentrate only on the

feelings of today in each of the life areas. Also try not to allow one category to

influence the results of the other categories.

Completely Unhappy Completely Happy

Drug use

1

2

3

4

5

6

7

8

9

10

Job or Education Progress 1 2 3 4 5 6 7 8 9 10

Money Management 1 2 3 4 5 6 7 8 9 10

Social Life 1 2 3 4 5 6 7 8 9 10

Personal Habits 1 2 3 4 5 6 7 8 9 10

Marriage/Family Relationships 1 2 3 4 5 6 7 8 9 10

Legal Issues 1 2 3 4 5 6 7 8 9 10

Emotional Life 1 2 3 4 5 6 7 8 9 10

Communication 1 2 3 4 5 6 7 8 9 10

General Happiness 1 2 3 4 5 6 7 8 9 10

Name:______________________ Date:_______________________

(Meyers & Smith, 2000)

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Session 2: Exploring the Relationships Between Substance Use and Mental Health

This worksheet is designed to explore the relationship between substance use and mental health. First, list all of the legal, illicit, and prescribed substances currently being used, either regularly or periodically. Second, list the current mental health and social problems. Then, look for ways in which the two columns interact.

Substances Currently Being Used Mental Health and Social Problems

What is the perceived coping potential of the substances used (e.g.

substance related beliefs)?

What is the impact of the substance use on mental health?



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Session 2: What I Want From Treatment: William R. Miller and Janice M. Brown

Adapted from: Center for Substance Abuse Treatment. Enhancing Motivation for

Change in Substance Abuse Treatment. Treatment Improvement Protocol (TIP)

Series 35. DHHS Publication No. (SMA) 99-3354. Rockville, MD: Substance Abuse

and Mental Health Services Administration, 1999.

Instructions People have different ideas about what they want, need, and expect from treatment. This questionnaire is designed to help you explain what you would like to have happen in your treatment. Many possibilities are listed. For each one, please indicate how much you would like for this to be part of your treatment. You can do this by circling one number (0, 1, 2, or 3) for each item. This is what the numbers mean:

0 NO means that you definitely do NOT want or need this from treatment.

1 ? means that you are UNSURE. MAYBE you want this from treatment.

2 YES means that you DO want or need this from treatment.

3 YES! means that you DEFINITELY want or need this from treatment.

FOR EXAMPLE: Consider item #1, which says, "I want to receive detoxification." If you definitely do NOT want or need to receive detoxification, you would circle 0. If you are UNSURE whether you want or need detoxification, you would circle 1. If you DO want detoxification, you would circle 2. If you DEFINITELY know that detoxification is an important goal for your treatment, you would circle 3. If you have any questions about how to use this questionnaire, ask for assistance before you begin.

What I Want From Treatment

DO YOU WANT THIS FROM TREATMENT?

NO 0

Maybe 1

Yes 2

YES! 3

1. I want to receive detoxification, to ease my withdrawal from alcohol or other drugs.

0 1 2 3

2. I want to find out for sure whether I have a problem with alcohol or other drugs.

0 1 2 3

3. I want help to stop drinking alcohol completely. 0 1 2 3

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4. I want help to decrease my drinking. 0 1 2 3

5. I want help to stop using drugs (other than alcohol). 0 1 2 3

6. I want to stop using tobacco. 0 1 2 3

7. I want to decrease my use of tobacco. 0 1 2 3

8. I want help with an eating problem. 0 1 2 3

9. I want help with a gambling problem. 0 1 2 3

10. I want to take Antabuse (a medication to help me stop drinking).

0 1 2 3

11. I want to take a medication to help me stop using alcohol or heroin.

0 1 2 3

12. I want to take methadone. 0 1 2 3

13. I want to learn more about alcohol/drug problems. 0 1 2 3

14. I want to learn some skills to keep from returning to alcohol or other drugs.

0 1 2 3

15. I would like to learn more about self help groups: 12-Step programs like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) or Smart Recovery.

0 1 2 3

16. I would like to talk about some personal problems. 0 1 2 3

1. I need to fulfil a requirement of the courts. 0 1 2 3

17. I would like help with problems in my marriage or close relationship.

0 1 2 3

18. I want help with some health problems. 0 1 2 3

19. I want help to decrease my stress and tension. 0 1 2 3

20. I would like to improve my health by learning more about nutrition and exercise.

0 1 2 3

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21. I want help with depression or moodiness. 0 1 2 3

23. I want to work on my spiritual growth. 0 1 2 3

24. I want to learn how to solve problems in my life. 0 1 2 3

25. I want help with angry feelings and how I express them.

0 1 2 3

26. I want to have healthier relationships. 0 1 2 3

27. I would like to discuss sexual problems. 0 1 2 3

28. I want to learn how to express my feelings in a more healthy way.

0 1 2 3

29. I want to learn how to relax better. 0 1 2 3

30. I want help in overcoming boredom. 0 1 2 3

31. I want help with feelings of loneliness. 0 1 2 3

32. I want to discuss having been physically abused. 0 1 2 3

33. I want help to prevent violence at home. 0 1 2 3

34. I want to discuss having been sexually abused. 0 1 2 3

35. I want to work on having better self-esteem. 0 1 2 3

36. I want help with sleep problems. 0 1 2 3

37. I want help with legal problems. 0 1 2 3

38. I want advice about financial problems. 0 1 2 3

39. I would like help in finding a place to live. 0 1 2 3

40. I could use help in finding a job. 0 1 2 3

41. Someone close to me has died or left, and I would like to talk about it.

0 1 2 3

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42. I have thoughts about suicide, and I would like to discuss this.

0 1 2 3

43. I want help with personal fears and anxieties. 0 1 2 3

44. I want help to be a better parent. 0 1 2 3

45. I feel very confused and would like help with this. 0 1 2 3

46. I would like information about or testing for HIV/AIDS or Hepatitis C.

0 1 2 3

47. I want someone to listen to me. 0 1 2 3

48. I want to learn to have fun without drugs or alcohol. 0 1 2 3

49. I want someone to tell me what to do. 0 1 2 3

50. I want help in setting goals and priorities in my life. 0 1 2 3

51. I would like to learn how to manage my time better. 0 1 2 3

52. I want help to receive disability payments. 0 1 2 3

53. I want to find enjoyable ways to spend my free time. 0 1 2 3

54. I want help in getting my child(ren) back. 0 1 2 3

55. I would like to talk about my past. 0 1 2 3

56. I need help in getting motivated to change. 0 1 2 3

57. I would like to see a female counsellor. 0 1 2 3

58. I would like to see a male counsellor. 0 1 2 3

59. I would like to see the counsellor I had before. 0 1 2 3

60. I would like to see a doctor or nurse about medical problems.

0 1 2 3

61. I want to receive medication. 0 1 2 3

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62. I would like my spouse or partner to be in treatment with me.

0 1 2 3

63. I would like to have private, individual counselling. 0 1 2 3

64. I would like to be in a group with people who are dealing with problems similar to my own.

0 1 2 3

65. I need someone to care for my children while I am in treatment.

0 1 2 3

66. I want my treatment to be short. 0 1 2 3

67. I believe I will need to be in treatment for a long time.

0 1 2 3

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Session 2: Timeline Exercise Major life events:

Birth Current

Timeline of mental health events:

Birth Current

Timeline of substance use:

Birth Current

Development of Beliefs and Assumptions When (or at what periods) did problematic substance use

happen?



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The positive things about using … The negative things about using:

Exploring the Pros and Cons of Using this Substance: Beside each point, write down a number between 1 (Not Important) to 10 (Extremely) for how much it matters to you.

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Making A Change: Positives Making A Change: Negatives

Staying the Same: Positives Staying the Same: Negatives

Exploring the Pros and Cons of Making a Change

Beside each point, write down a number between 1 (Not Important) to 10 (Extremely) for how much it matters to you.

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The positive things about changing … The negative things about changing:

Exploring the Pros and Cons of Changing: Beside each point, write down a number between 1 (Not Important) to 10 (Extremely) for how much it matters to you.

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Session 3: Functional Analysis

This collaborative exercise helps to identify potential skills for managing relapse and developing an alternative lifestyle. Consider the identified problem behaviour. This may be substance use (e.g. alcohol binge) or mental health (eg. self harm). Then consider what happens before the behaviour happens. Finally, explore the short and long term consequences.

Environmental Triggers

Thoughts and Feelings

Behaviour Positive Consequences

Negative Consequences

Short term:

Long term:

Short term:

Long term:

This exercise can help a person explore the relationship between triggers, their behaviour and the consequences. It is also useful in identifying

skills needed to help the person manage triggers and control impulsive behaviour. This form can also be used to explore and reinforce

alternative behaviours

Laura Freeman, Ph.D. Addiction Interventions

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Session 3: Functional Analysis of Recovery-Orientated Behaviour

This collaborative exercise explores healthy, recovery-orientated behaviours in your life. Choose something healthy or fun that you do right now that does not involve alcohol and/or drugs. Then consider what happens before the behaviour happens. Finally, explore the short and long term consequences.

Environmental Triggers

(Who with? Where? When?)

Thoughts and Feelings

(What were you thinking? Feeling emotionally? Feeling physically)?

Behaviour (Be specific – What do you do, how long and

how often?)

Positive Consequences

(Relationship? Emotions? Physical Health? Legal? Job/education? Money?)

Negative Consequences

(What are the barriers? Who, where, when? Thoughts,

emotions, physical?)

Short and long term:

Short and long term:

Laura Freeman, Ph.D. Addiction Interventions

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Session 4: Discovering Triggers

Adapted from: Budney, A. and Higgins, S. (1998). A Community Reinforcement Plus Vouchers Approach: Treating Alcohol and other drugs Addiction. NIDA. Page 60.

Discovering Triggers of Your Alcohol and Other drugs Use

1. List the places where you are most likely to use alcohol and other drugs: 2. List the people with whom you are most likely to use alcohol and other drugs: 3. List and times or days when you are more likely to use alcohol and other drugs: 4. List any activities that make it more likely that you will use alcohol and other

drugs: 5. Do you think that you use alcohol and other drugs when you are feeling certain

ways? Read through the following list and mark the ones that are relevant to you. For those you have marked, list specific examples from your own experience.

6. List the places where you are unlikely to use alcohol and other drugs: 7. List the people with whom you are unlikely to use alcohol and other drugs: 8. List the times or days when you are unlikely to use alcohol and other drugs: 9. List the activities you engage in when you are unlikely to use alcohol and other drugs:

This form was originally adapted from Miller and Munoz 1982.

a. at the end of (or during) a tense day

b. when faced with something you fear or are anxious about

c. when you’ve failed to accomplish something you’d planned

d. when you feel you have been taken advantage of

e. when you are bored f. when you are in a social situation

g. when you feel bad about yourself

h. when you are depressed i. when you want to feel

energized or high j. when you are faced with a

tough problem k. when you want to be friendly l. when you wish your

personality was different m. others not listed here

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Session 4: Self-Management Plan

Adapted from: Budney, A. and Higgins, S. (1998). A Community Reinforcement Plus Vouchers Approach: Treating Cocaine Addiction. NIDA. Page 65.

Self-Management Planning Sheet

Trigger Plans +/- Consequences Difficulty (1 – 10)

1. a.

b. c. d. e.

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Session 4: Coping with Cravings and Urges

Adapted from: Carroll, K. (1998). A Cognitive-Behavioral Approach: Treating Cocaine Addiction. NIDA. Pages 53-54.

Coping With Cravings and Urges

Reminders: • Urges are common and normal. They are not a sign of failure. Instead, try to learn from them about what your craving triggers are. • Urges are like ocean waves. They get stronger only to a point, then they start to go away. • If you don’t use, your urges will weaken and eventually go away. Urges only get stronger if you give in to them. • You can try to avoid urges by avoiding or eliminating the cues that trigger them. • You can cope with urges by - - Distracting yourself for a few minutes. - Talking about the urge with someone supportive. - “Urge surfing” or riding out the urge. - Recalling the negative consequences of using. - Talking yourself through the urge.

Each day this week, fill out a daily record of craving and what you did to cope with craving.

Example :

Date/Time Situation, thoughts, and feelings

Intensity of Craving (1-100)

Length of Craving

How I Coped

Friday, 3 pm

Fight with boss, frustrated, angry

75

20 minutes

Called home, talked to Mary

Friday, 7 pm Watching TV, bored, trouble staying awake

60

25 minutes

Rode it out and went to bed early

Saturday, 9 pm

Wanted to go out and get a drink

80

45 minutes

Played basketball instead

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Session 4: Coping with Cravings and Urges, Page 2

Date/Time Situation, thoughts, and

feelings

Intensity of Craving

(1-100)

Length of

Craving

How I Coped

This form was originally adapted from Kadden et al. 1992.

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Session 4: Coping with Thoughts about Using

Adapted from: Carroll, K. (1998). A Cognitive-Behavioral Approach: Treating Cocaine Addiction. NIDA. Page 64.

Coping With Thoughts About Using

There are several ways of coping with thoughts about using alcohol and other drugs: • Thinking through and remembering the end of the last time you used • Challenging your thoughts • Recalling the negative consequences of using • Distracting yourself • Talking through the thought

Before the next session, keep track of your automatic thoughts about using when they occur, and then record a positive thought and coping skills.

Thought about using substances

The positive thought or the coping skills used

This form was originally adapted from Monti et al. 1989.

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Session 4: Problem-solving Worksheet

Adapted from: Budney, A. and Higgins, S. (1998). A Community Reinforcement Plus Vouchers Approach: Treating Cocaine Addiction. NIDA. Pages 79-80.

Problem-solving Worksheet

Procedure:

1. Gather information: Recognize that a problem exists. Is there a problem? You get clues from your body, thoughts, feelings, behaviour, reactions to other people, and the ways that other people react to you. Think about the problem situation. Who is involved? When does it happen? Exactly what takes place? What effect does this have on you?

2. Define the problem: Describe the problem as accurately as you can. What

goal would you like to achieve? Be as specific as possible. Break it down into manageable parts.

3. Brainstorm for alternatives: List all the things that a person in your situation

could possibly do. Consider various approaches to solving the problem. Even list alternatives that seem impractical. Try taking a different point of view, try to think of solutions that worked before, and ask other people what worked for them in similar situations.

4. Consider the consequences: Look at each of your alternatives in turn. What

things could you reasonably expect to result from taking each action? What positive consequences? What negative consequences are long-term? Which are short-term? Which do you think you could actually do?

5. Make a decision: Which alternative is the most likely to achieve your goal?

Select the one likely to solve the problem with the least hassle. Do it! The best plan in the world is useless if it isn’t put into action. Try it out.

6. Evaluate its effectiveness: Which parts worked best? Reward yourself for

them. Would you do anything differently next time? After you have given the approach a fair trial, does it seem to be working out? If not, consider what you can do to strengthen the plan or give it up and try one of the other possible approaches. Remember that when you’ve done your best, you have done all you can do.

Continued on next page

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Session 4: Problem-solving Worksheet, Page 2

Problem-solving Worksheet

Practice Exercise Choose a problem that may arise in the near future. Describe it as accurately as you can. Brainstorm possible solutions. Evaluate the potential outcomes. Prioritise solutions.

Identify the problem situation: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Brainstorm a list of possible solutions: Pros: Cons: 1._____________________________ _________________ _________________

_________________ _________________ _________________ _________________ _________________ _________________

2._____________________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________

3._____________________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________

4._____________________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________

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Session 4: Seemingly Irrelevant Decisions

Adapted from: Carroll, K. (1998). A Cognitive-Behavioral Approach: Treating Cocaine Addiction. NIDA. Pages 76.

Seemingly Irrelevant Decisions

When making any decision, whether large or small, do the following: • Consider all the options you have. • Think about all the consequences, both positive and negative, for each of the options. • Select one of the options. Pick a safe decision that minimizes your risk of relapse. • Watch for “red flag” thinking - thoughts like “I have to . . .”, or “I can handle . . .” or “It really doesn’t matter if . . .”

Practice monitoring decisions that you face in the course of a day, both large and small, and consider safe and risky alternatives for each.

Decision

Safe alternative Risky alternative

This form was originally adapted from Monti et al. 1989.

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Session 5: Recreational Survey

Name: Date: Please tick the column which best describes your thoughts/feelings about each row.

SPORTS AND GAMES

Activity Did at least 4x’s last year

Would like to try…

Have tried and liked it…

No Interest

Football

Tennis

Swimming

Golf

Jogging/Running

Aerobics

Gymnastics

Bowling

Ten-pin bowling

Darts

Karate

Pilates

Tai Chi

Yoga

Snooker

Billiards/Pool

Rugby

Badminton

Suduko

Crossword Puzzles

Internet Based Games

Computer Games

Chess

Dominoes

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Session 5: Recreational Survey, Page 2

Scrabble

Jigsaw Puzzles

Table Tennis

Shinty:

Other:

Outdoor Activities




No Interest

Walking

Hillwalking

Bike/Dirt bike riding

Fishing

Going to the beach or shore

Going to the park

Ice Skating

Sailing

Windsurfing

Skateboarding

Camping

Gardening

Picnics

Birdwatching

Other:

Art, Music, Dance and Drama Drawing/Painting

Photography

Sculpture

Woodworking

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Jewellery Making

Knitting

Sewing

Cooking/Baking

Listening to music

Singing/ Karoake

Playing instrument

Dancing

Scottish Country Dancing

Line Dancing

Acting

Other:

Other Activities




No Interest

Shopping

Museums

Art Galleries

Fairs

Historical Sites and Events

Sporting Events

Eating Out

Travelling

Library

Cinema

Music Concerts

Theatre

Talking with a Friend

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Attending a Party

Volunteer Activities

Watching TV

Reading

Meditation

Creative Writing

Support Groups

Other:

Other:

Other:

How would you rate your satisfaction with the recreational activities in your life?

Very Dissatisfied Dissatisfied Satisfied Very Satisfied

Are there problems that make it difficult for you to develop a healthy recreational lifestyle? If yes, describe:



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Session 5: Goal Setting Worksheet for Reinforcing Recovery (With Directions)

Consider the Summary Worksheet. Select one or two of the areas, and decide on a goal(s) for the next month or so. (1) Find a goal that is positive. Say what you want to do - not what you don’t want to happen. Make the goal brief, specific and decide on how you want to measure it. Make sure the goal is realistic and builds on things that you can do already. Next, what steps will you take to reach that goal (2) and how long will the step take (3)? Finally, what will you have as a reward after each step (4). This might be something good that comes out of the step, or you might plan a specific way to reward yourself positively and celebrate.

(1) Set a goal that is positive, brief,

specific, measurable and realistic.

(2) What are the steps you plan to

work towards your goal?

(3) How long will you plan for each

step to take?

(4) What will be the reward or “positive” with each step?

Circle the area you would like to make changes in:

Alcohol and Other Drug Use

Mental Health

Physical Health

Family + Significant Relationships

Employment/Training/Education

Recreational/Social

Legal

Goal for Change – I would like:

Step 1: Step 2: Step 3: Step 4:





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Session 5: Brief Goal Setting Worksheet for Reinforcing Recovery (1)

Set a goal that is positive, brief, specific, measurable and realistic.

(2) What are the steps you plan to

work towards your goal?

(3) How long will you plan for each

step to take?

(4) What will be the reward or “positive” with each step?

Circle the general area you would like to make changes in:

Alcohol and Other Drug Use

Mental Health

Physical Health

Family + Significant Relationships

Employment/Training/Education

Recreational/Social

Legal

Goal for Change – I would like:

Step 1: Step 2: Step 3: Step 4: Step 5:





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Session 5: Highlighting Progress

Highlighting the progress made as someone works towards a goal is essential. When someone is making changes in their lives, finding a visual way to see is often used to help people see the change happening. Highlighting progress can be as simple as a colour coded calendar, or as complex as graphs and charts. It is useful to create templates of charts, graphs or calendars which can be easily picked up and put to use. Here are two different examples.

Days of the Week

How often did you see the changes or the new behaviour?



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Session 5: Highlighting Progress

Name: Month: What do you want to see yourself doing? What’s your goal? Choose a colour and use it to mark the days when you reach your current goal.

Sunday Monday Tuesday Wednesday Thursday Friday Saturday



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Core Behavioural and CBT Skills for Relapse Prevention and ... · handouts, or the format may be transferred to a flip chart page. Words may be used, or people may feel more comfortable

Documents