Help yourself………. overcoming a drug problem SE F L H LP E MAN A UL Kaleidoscope Project Old School Building Powells Place Newport NP20 1EL 08454 506307 [email protected]Written and published by Kaleidoscope 2008 Special thanks to Rondine Molinaro for her ideas, dedication and hard work on this project. Thanks to Martin Browning and Sarah Mooney for their illustrations. Thanks also to Phil Harris, author of Empathy for the Devil, and James Varty. Copyright Kaleidoscope 2008 Are you thinking of trying to give up using drugs without seeking formal treatment? If so, this manual may give you some tools and ideas to help put this into practice. If you decide not to opt for formal treatment, but need a little support in implementing changes in your life, This book might be for you! www.kaleidoscopeproject.org.uk DYDD A NOS / DAY AND NIGHT ALL WALES DRUG & ALCOHOL HELPLINE 0800 6 33 55 88 2 7 / DAN Cover image by Aaron Jasinski. www.aaronjasinski.com
Transcript
Help yourself……….
overcoming a drug problem
SE FL H LP EMAN AU L
Kaleidoscope ProjectOld School BuildingPowells PlaceNewportNP20 1EL08454 [email protected]
Written and published by Kaleidoscope 2008
Special thanks to Rondine Molinaro for her ideas, dedication and hard work on this project. Thanks to Martin Browning and Sarah Mooney for their illustrations. Thanks also to Phil Harris, author of Empathy for the Devil, and James Varty.
Copyright Kaleidoscope 2008
Are you thinking of trying to give up using drugs
without seeking formal treatment?
If so, this manual may give you some tools
and ideas to help put this into practice. If you
decide not to opt for formal treatment, but
need a little support in implementing
changes in your life, This book might be
for you!
www.kaleidoscopeproject.org.uk
DY D D A N O S / DAY A N D N I G H T
A L L WA L E S D R U G & A L C O H O L H E L P L I N E
0800 6 33 55 88
2 7/D A N
Cover image by Aaron Jasinski. www.aaronjasinski.com
SELF HELP MANUAL
www.kaleidoscopeproject.org.uk
The type of drug you want to stop is important. Are
you using only one drug, or are you using 2 or more
different drugs at the same time?
With some drugs, it is inadvisable to attempt
stopping suddenly without seeking medical
help. Benzodiazepines and alcohol in particular
have risks, if you have been using high levels
of these substances for a long period. Coming
off high doses of a drug like Heroin can have
complicated side-effects, which may
require some medical help. If you are in
any doubt, contact your GP or ask to speak
to a drugs worker at Kaleidoscope.
Some people can give up using drugs quite easily. It can take
time, and might involve changing ways of thinking and
behaviour. For other people, structured treatment and the
support of a trained drugs worker is the right option. The
thing to remember is that everyone is different. What is right
for someone else might not be right for you.
SELF HE PL MANUAL
It is hard to let old beliefs go. They are familiar. We are comfortable
with them and have spent years building systems and developing
habits that depend on them. Like a man who has worn eyeglasses
so long that he forgets he has them on, we forget that the world
looks to us the way it does because we have become used to seeing
it that way through a particular set of lenses. Today, however, we
need new lenses. And we need to throw the old ones away.
— Kenich Ohmae
Inspirational quotes
If you keep on doing what
you've always done, you'll
keep on getting what you've
always got.
— W.L. Bateman
If we don't change, we don't
grow. If we don't grow, we
are not really living.
— Gail Sheehy
www.kaleidoscopeproject.org.uk
If you don't like something
change it; if you can't change
it — change the way you
think about it.
— Mary Engelbreit
Live as if you were to die
tomorrow. Learn as if you
were to live forever.
— Mahatma Gandhi
Change your thoughts and
you change your world.
Change starts when
someone sees the next step.
— William Drayton— Norman Vincent Peale
Is self-change for me? ...................................... 1
Lapse analysis .................................................. 58
Life balance ...................................................... 62
What if I relapse? .............................................. 65
www.kaleidoscopeproject.org.uk
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SELF EH PL MA ANU L
To help you recognise what sort of support
you may need, answer the following
questions truthfully. If your answers are
divided between ‘never’ and ‘sometimes’,
then it is possible that you may be able to
initiate self-change. If, however, your
answers are a mixture of ‘often’ and ‘nearly
always’, then you might be best suited to
more structured treatment.
Dependence Questionnaire
1. Do you find yourself thinking about when you will be able to take more drugs?
2. Is taking drugs more important than anything else you might do during the day?
3. Do you feel that your need for drugs is too strong to control?
4. Do you plan your days around getting and taking drugs?
5. Do you take drugs in a particular way in order to increase the effect it gives you?
6. Do you use drugs morning, afternoon and evening?
7. Do you feel you have to carry on taking drugs once you have started?
Never Sometimes Often Nearly Always
Is self-change for me?
8. Is getting the effect you want more important than the particular drug you use?
9. Do you want to take more drugs when the effects wear off?
10. Do you find it difficult to cope with life without drugs?
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SELF EH PL MA ANU L
Never Sometimes Often Nearly Always
Leeds Dependence Questionnaire (Raistrick et al, 1994)
It is possible to start making changes in your life that
may have a knock-on effect on your drug use, and
might help your motivation to change your drug use
completely. The process of thinking about and then
actively deciding to change, is known as the ‘cycle of
change’.
Making Changes
So, where are you in the cycle of change?
You may find that you
experience different kinds of
problems than those listed above. You may have
answered ‘never’ to all questions, but still feel that you
have a problem with drugs.
However, the questionnaire may help you to think more
generally about your relationship with drugs.
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1
2
6
6
Pre-Contemplation
ContemplationDecision
Active Change
Maintenance
Lapse
Relapse
Start
Change Secure
3
4
5
The cycle of change has several stages :
• In pre-contemplation, the person does not want to change – they
are more motivated to continue current behaviour.
• In contemplation the person is ambivalent - they are ‘in two minds’
about what they want to do.
• In decision, they have decided what they want to do about the
behaviour.
• In active change, they are going about making the change.
• In maintenance, the change has become part of the person's life,
and if it remains secure, the person can be thought of as leaving
the cycle.
• A lapse can be thought of as a ‘blip’ – the person may partake in the
old behaviour again. This may lead to a relapse, which is a
complete return to the old behaviour.
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SELF EH PL MA ANU L
People do not always move through the
cycle from start to finish.
Some people switch between stages. For
example, someone could go from being
in two minds about making a change,
decide to make a change, but then go
straight back to just thinking about it
again. Deciding to make a change is just
the start; putting these thoughts into
action is the difficult part.
One of the most effective ways to
maintain a focus on changing is to keep a
record of your progress. This is called
self-monitoring.
Self-monitoring will help you to make sure you are keeping track of
your commitment to change, and can assist you in recognising
problematic patterns in your drug using behaviour.
To monitor yourself well, firstly you should start thinking about why
you use. What are your triggers? Triggers are specific feelings or
events that lead you to use drugs. They can be internal (certain moods
or feelings) or external (seeing certain people or places, or seeing
things associated with using drugs like rizlas, tin foil, spoons, needles
or 10 pound notes).
Secondly, you need to start looking at the behaviour around and the
consequences of your use of drugs. You can then record these on a
table like this :
Self – Monitoring
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SELF EH PL MA ANU L
Thoughts FeelingsExternal
triggersBehaviour
Long term
consequences
Short term
consequences
I used coke at
the weekend
with Ben and
Sam. They
were buying
some so I
went along
with it too
We used at a
club after we
have been
drinking
We use Coke
most Friday
nights and
some Saturday
nights if we all
go out
I usually think
that I deserve
a treat after a
hard week at
work
I know my
girlfriend
would be
angry, but I
think ‘to hell
with her’, I can
do what I want
I’m still young.
Why shouldn’t
I have fun
I am usually
drunk, but felt
like I wanted
some fun
Felt like I’d be
more sociable
and fun if I
used it
Felt excited
beforehand,
and like I was
‘one of the
lads’
I felt a bit
guilty
afterwards, as
my girlfriend
hates me
using it and
she worries
about me
Alcohol, I
drank about 8
pints, costing
£20. Once I
start drinking
its hard to
keep up with
Ben and Sam.
More likely to
use coke when
I’m drunk as
well
Cocaine,
snorted 2
grams = £100.
First line at
about 9, last
about 2.30
POSITIVE
Fun
Good Laugh
Relief
Real buzz
Don’t care
aboutanything else
Confident
Powerful
NEGATIVE
Feel rough the
next day
Bad come
down – feel
anxious for a
few days
Don’t play
footy on a
Saturday any
more
Headaches
Emotionally
drained,
irritable &
depressed
Costing loads
and I cant
afford it.
Big arguments
with my
girlfriend. Its
hard to see her
upset
6
S LE F HE PL MAN AU L
Thoughts FeelingsExternal triggers
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SELF HE PL MAANU L
Behaviour Short term consequences Long term consequences
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SELF EH PL MA ANU L
In the external triggers column, think of
the words Who, Where & When. Who
gives you the urge to use drugs when
you see them and speak to them? Are
there certain places that make you think
of drugs when you are in them? Are
there certain times in the week that you
get cravings and urges to use drugs?
In the feelings column, try to record both physical and emotional
feelings. For example, you might feel physically excited before you use
drugs, and then emotionally guilty after using. In the behaviour
column, try to record exactly how much of the drug you used in units
(bags, grams, eighth’s), and also record the monetary value in pounds
(£). Also, record the frequency of use, i.e.: once a week? once a
month?. How long do you spend using each time? All day? Half a day?
From 7 p.m. till 3 a.m.?
In the short term positive consequences column, be sure to list every
aspect of using that appeals to you – or gives you something you think
of as positive, i.e. : confidence, fun. In the long term negative
consequences column, list all the negative aspects that come with
your drug use. Look at the effects on relationships, family, physical
well-being, emotional state, legal problems, effects on your job,
financial effects and any other effects on your life as a whole.
The good thing about monitoring in this way, is that sometimes when
using drugs, you fail to see the bigger picture of exactly how your use
affects the rest of your life. It is easy to see how it might be affecting
you physically, but how is it impacting on the rest of your life? Seeing
the bigger picture might help you to start thinking about change.
If you have lots of different situations in which you use drugs, you may
want to fill in some additional sheets to examine each occasion you
use. These sheets help people to see what the function of their drug
use is, and this is very important in trying to change behaviors.
The Pros and Cons of usingOnce you have filled in your self-monitoring table, you might become
aware of exactly how much you are using, and how that is impacting on
your life. If you do, it is time to start looking in more detail at the pros
and cons of your drug use. Here is an example:
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SELF EH PL MA ANU L
Good things Bad things
Improved Health, feel better about myself.Better relationships with family and partnerMore moneyNo more hangovers / comedowns
Can stick with my using friendsWill forget about my problems when I useWill get that ‘buzz’ when I use
Will miss my using friendsWill not get that ‘buzz’ anymoreWill feel stressed and anxiousWill not feel part of my ‘gang’ anymore
Relationships will sufferRejection from non-using friends and
familyFinancial difficultiesLegal problems if caughtWorsening health
Sto
p U
sin
gC
on
tin
ue U
sin
g
Obviously, there will be some things you like about using drugs,
otherwise you wouldn’t use them. But are the good parts of using
worth the bad things that happen as a result of your use?
Is that buzz you get on a Friday night worth the 3 days of arguments
with your partner that follow? Try to think about all of the ways in
which using drugs impacts on the different parts of your life, such as
your family, friends, employment, future prospects, etc.
SELF EH PL MA ANU L
Sto
p U
sin
gC
on
tin
ue U
sin
g10
Good things
11
SELF EH PL MA ANU L
Bad things
Sto
p U
sin
gC
on
tin
ue U
sin
g
12
SELF EH PL MA ANU L
When you have finished, look honestly at the benefits of using. Weigh
them up with the disadvantages of using. How do you feel when you
have done this? Does it encourage you to want to stop using drugs?
What do you think will happen if you continue to use drugs?
Looking InwardHow do you feel about yourself, now that you have started to look at how your drug use affects you and the environment around you? Do you feel that you have changed as a person as a result of your use? Do you think you act and behave differently when under the influence of drugs?
Its possible that you have been living with stress and pressure
without even realising it. Or maybe you have realised it, but are
pushing it to the back of your mind so you don’t have to deal with it.
Some people feel stressed because they feel as though they are
having an internal fight with themselves between the person they
have become due to drug use and the
person they want to be.
Ask yourself the following questions:• What is the real you like?• What is important to you?• Who are the most important people in
your life?• What is the using you like?• What is important when you are using?• Who is affected by your using?
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SELF EH PL MA ANU L
It is good to get a clear picture
in your head of exactly why you
want to change, and what your
long term goals are. Write your
reasons for change and goals
that you want to achieve in the
table below :
Why do I want to change ?
Reasons for Change Long-term Goals
Eg : I’m sick of being irritable with my family after I have used drugs. It’s not fair on them and I know they worry about me
Eg : I want to do a college course so I can build myself a good career
I want to feel fitter and healthier, and I want to be proud of who I am
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SELF EH PL MA ANU L
• Before you use, think about it. Practice
distracting yourself and delay using
• Plan ahead: think about what you will
do instead of using
• Remind yourself why you want to
change
• Remind yourself of the benefits of not
using
• Do pleasurable things that do not
involve using
So now that you have made a
conscious decision to stop
using, where do you start?
There are many things you can begin to do
that will help you to get started with an attempt
to change. Simple strategies that are known to
work for people who are trying to change an addictive
behaviour include some of the approaches outlined
below:
Planning Change
It is a good idea to keep this
chart handy. If you have any
moments in the future when
you feel tempted to use again,
you can look at it and
remember your reasons why
you wanted to stop using in
the first place.
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SELF EH PL MA ANU L
• Avoid high-risk situations, such as people who use and certain
places
• Practice urge management skills (we’ll talk about those later..)
• Spend more time with people who don’t use drugs
Once you have decided that you want to stop using, try and set
a realistic date for this to happen. Try and follow the following
tips:
• Make sure that your ‘quitting date’ falls at a time when most things
are running relatively smoothly in your life. If you have chaos all
around you, it probably isn't an ideal time to think about stopping.
Try and keep a diary, and mark the date off in it as your first goal.
Try to look at this date beforehand as a new chapter in your life that
will bring positive rewards.
• Go through your house, car etc,
and remove anything that might
remind you of using. Any drug
using equipment, smoking aids,
pictures, films and certain types of
music that might remind you of
using. Delete any numbers in your
phone of dealers or using friends if
you can.
• Have a look back at the table where
you listed your reasons for change.
Copy these onto a card that you
can carry around with you and look
at whenever you get an urge to
use.
SELF EH PL MA ANU L
What About Withdrawal?Withdrawal can be considered as signs and symptoms that appear
when a drug used regularly over a long period is suddenly stopped or
decreased. Different drugs have different effects on your body, and
this also influences whether withdrawal symptoms are likely to be
experienced. Here is a simple guide, but if you are in any doubt, please
speak to a member of Kaleidoscope staff or your GP who will be able to
advise you of the possible affects.
Stimulants like cocaine, crack and
amphetamine have very few physical effects
when you stop, but tend to have more
psychological and emotional effects.
Cannabis can also have emotional and
physical effects when you stop using it,
especially the stronger strains of skunk weed.
Withdrawal symptoms are actually signs that the body is readapting to
being drug-free, and are therefore positive signs of recovery.
With most drugs, the psychological and emotional withdrawal
symptoms that will occur once you stop include :
• Anxiety • Depression • Anger• Confusion • Irritability • Urges to use drugs
The severity of symptoms depends a lot on the individual and the
amount and frequency of drug used, but most people who stop using
find that it is never really as bad as they expected.
Strategies like distracting yourself, delaying and decatastrophising
(ie: remembering that it is not the end of the world…..unpleasant
feelings will pass) will help. Doing things that reduce stress are also
helpful, such as having a hot bath or listening to relaxing music.
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SELF EH PL MA ANU L
Coming off Opiates like heroinComing off Heroin is more complicated, as you will experience physical
withdrawal symptoms on top of those listed above. These include :
• Sweating • Fluctuations in temperature• Aching joints and restless legs • Nausea• Diarrhoea • Loss of appetite• Yawning & sneezing • Running eyes and nose• Insomnia
Regular heroin use changes the way that cells in your brain function.
The cells get used to heroin being around, so if heroin stops appearing
all of a sudden, the brain overcompensates. This leads to the brain and
central nervous system being over stimulated by a chemical in your
body called noradrenaline.
WHAT CAN I DO TO ALLEVIATE THE PHYSICAL SYMPTOMS?
Withdrawal symptoms will be at their
worst after about 36 to 72 hours, and
most of the physical symptoms should
begin to fade after about 5 - 7 days. The
lack of sleep (insomnia), sweating and
diarrhoea may take a little longer.
Coming off heroin can be very difficult,
particularly for people who have beenusing large amounts over a long period.
Many people need medical help to
support them through hero in
withdrawal. However, people who have
used for only a short period may find
that they can recover from a heroin
problem themselves.
*** It is inadvisable to
come off certain drugs like
benzodiazepines (valium /
diazepam, etc) and also
a l c o h o l w i t h o u t
professional help, if you
have been using these
substances regularly and
in large quantities. The
withdrawal symptoms
from these substances
can result in seizures andfits, and can be fatal.
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SELF EH PL MA ANU L
Making that change…..When setting a date to change your drug use, bear the following points
in mind. Once again, the severity of withdrawal symptoms that you
experience will depend on the nature of your drug use
• Keep a record of your daily plans
• Take it easy for at least a few days, if not more
• Expect to sleep badly
• Take time off work
• Stay somewhere warm with supportive people
• Keep things as stress-free as you can
• Get in stock a lot of food, drinks, dvd’s and books.
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SELF EH PL MA ANU L
To help yourself stay more comfortable :
• Wear loose comfortable clothing in layers, so you can take a layer
off if you feel too hot, and replace it if you get cold again
• Have lots of warm baths or showers
• Try to lie down as much as you can
• When you start eating, eat bland foods that don’t smell too much,
like a plain ham sandwich with no butter.
• Take frequent sips of water or juice
• Eat sweets to help with excess saliva in your mouth
• Try and force yourself up early in the morning if you are managing
to sleep
• Once you get over the worst, try to be active in the day to increase
your chances of sleep during the night
• If you are tossing and turning, turn on the tv and make a cup of
tea. Don’t just lie there and get more frustrated.
• When you feel like you can’t take anymore, remind yourself of how
many hours/days you’ve done already, and think to yourself ‘It will
all be over soon’
• Ask your GP for some medication to help with stomach cramps and
diarrhoea.
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SELF EH PL MA ANU L
Maintaining ChangesSome people believe that once they have stopped using drugs,
the battle is won, and life returns to normal. It doesn’t. You need
to work at staying abstinent, or free from drugs. In the past, the
chances are that you used drugs to cope with the stresses of
day-to-day living, or maybe you used them as a release after a
hard week at work. Now, all of a sudden, you will have to learn to
cope with life without the use of drugs, and you will have to find a
different way to cope or a new kind of ‘release’ from a hard week
at work. What we are talking about here is coping skills; that is,
learning skills to help you cope in different situations. There are
a variety of coping skills that you might want to employ to help
you maintain the changes that you have made.
The following two brief examples are typical coping problems
that people who are recovering from drug problems might
experience. Of course, this does not mean that they apply to
you; everyone is different, and similarly, everyone recovers
from drug problems differently.
• In the past, when problems arose, you might have
ignored them, and might have turned to using drugs as a
way of forgetting problems were there. Now you have to
face your problems head-on, and learn different ways of
dealing with them.
• In the past, you might have become withdrawn, and
reluctant to talk to your family for fear of arguments and
recriminations. Now, you have to learn to communicate
with them again in a positive way.
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SELF EH PL MA ANU L
Problem SolvingWhen you first stop using drugs,
problems can seem magnified
and might cause you to panic a
little. Slow down, and think about
the problem. Try to condense it
into something specific.
moment. After all, she is just-ified
in not trusting me after
everything I’ve put her
through lately.
2. I could stay at home more, so
she knows I’m not out using
drugs.
3. When I do go out I can make
a point of telling her exactly
where I’m going and how
long I’ll be to reassure her.
4. I could invite friends round to
my house instead of going
out
5. I could keep going out, and
she will eventually realise I
am not using again
6. I could go out, but call her a
few times while I’m out and
come back when I say I will
be back
Once you have listed all your
options, pick out the ones that
seem unrealistic. Look at the
options that remain, and chose a
solution that seems most
workable for you. Think of how
you will put this option into
practice.
Promise yourself that you will try
the chosen solution for a period of
time, and see if it helps reduce the
initial problem.
21
For example, don’t say : ‘My
problem is that my girlfriend
keeps worrying that I’m still
using, she follows me around and
stuff, and whenever I go out she
phones all the time and waits by
the door when I get in to check my
eyes ’
But rather : ‘ My girlfriend still
doesn’t trust me’
Condensing it already makes the
problem seem smaller.
Once you have defined the
problem, try to think of
alternative ways that could deal
with the problem. Remember, the
more options you have the better,
and stay focused on the problem
you are thinking about.
For example, with the example
above:
1. I could reassure my girl-
friend, and tell her I can
understand why she doesn’t
trust me very much at the
22
SELF HE PL MAANU L
Problem Alternatives
Try and fill in your ownproblem solving sheet below :
23
SELF HE PL MAANU L
Solution Outcome ?
SELF EH PL MA ANU L24
Communication SkillsWhen you were using drugs, you
may have had a few heated
debates and arguments with
your partner, friends or family.
Communicating probably wasn’t
top of your list. Getting out of the
situation and letting off steam by
using drugs might have been
your way of coping. Here are a
few suggestions on how to start
communicating with others in a
positive way :
• Try to keep statements
positive : Talk about what
you want, rather than what
you don’t want
• Make ‘I’ statements about
your feelings, rather than
‘You’ statements about the
other person’s behaviour.
• Try to understand the other
person’s situation
• Share the responsibility of
finding a solution
For example , instead of this:
You blame me for everything that
goes wrong in this house, instead
of talking to me you just shout –
no wonder I go out and use!’
You could try this instead:
‘I feel like I’m being blamed for
things that go wrong. I know I’ve
been hell to live with recently, but
perhaps if we sat and talked
about it together we might find a
way of sorting out these
problems’.
SELF EH PL MA ANU L25
Goal SettingIn order to keep focused, and to improve other areas of your life, you
could think about setting yourself a few small, short-term goals week
by week.
For example, to improve your self-esteem and fitness, you might want
to think about joining a gym. If you have been out of work for a while,
you might want to think about getting a job, or look at retraining or
further education. The important thing is to break these longer-term
goals up into more achievable goals.
Making your goals more achievable is more likely to bring about
success, instead of ending in failure, and resulting in negative feelings
about yourself. Goals should also follow these 3 guidelines :
• Brief : Keep them as brief as possible, to avoid confusion.
• Positive : Try to focus on goals that you are going to do, as
opposed to not going to do.
• Measurable : Only use measurable, specific goals. They should
be specific descriptions of behaviour, which can be clearly
achieved when looked back on.
For example:
Instead of saying: ‘I really need to join a gym and start getting back
in shape’
You could say: ‘Go to the leisure centre and join the gym on Friday
afternoon’
Instead of saying: ‘I need to get a job so that I have something to do,
I need to look for work soon’
You could say: ‘I will check Thursday’s paper for job ads and phone 3
of them that interest me’
Instead of saying: ‘I really should start going to NA meetings’
You could say: ‘Go to the Newport NA meeting this Tuesday’. Using
the examples above as a reference, fill in your goals in the table below.
Tick off the boxes marked Brief / Positive / Measurable to check your
goals are on the right track.
SELF EH PL MA ANU L26
Goal Brief? Positive? Measurable?
Recreational ActivitiesWhen you stop using drugs, you
might suddenly become aware of
how much extra time you have on
your hands. It is important to fill this
time up doing something positive
that you enjoy, that will give you an
exhilarating feeling to replace the
'highs' that you used to get from
drugs. Physical exercise is ideal for
this, or a hobby that you enjoyed
before you started using.
SELF EH PL MA ANU L27
SELF EH PL MA ANU L28
Fill in the following table, to explore what kind of activities you could
start doing to fill up that extra time :
Generating New Leisure Activities
What activities did you
enjoy but are no longer
doing?
1.
2.
3.
What activities have you
always wanted to try?
Can you think of any non-
drug using friends who
also might like to do this?
Could this activity be
scheduled in for a high-
risk time when I’m most
vulnerable to using?
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Have any non-drug using others suggested any leisure activities for you to do together?
1.
2.
3.
Think of 3 friends that you admire. What do they do in their leisure time?
Can you think of any non-drug using friends who also might like to do this?
Could this activity be scheduled in for a high-risk time when I’m most vulnerable to using?
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Managing Stress and AnxietyLiving life without using drugs to cope with stress and anxiety can
seem difficult at first. When you were using drugs, drugs may have
masked stress and anxiety, and it can be frightening to experience
such feelings again.
To start with, you may even panic when you feel stressed-out about
something. Take deep breaths, and focus on the fact that these
feelings will pass.
Here are some relaxation techniques you can use for the times you feel
stressed out and anxious:
1. CONTROLLED BREATHING • Concentrate and focus as
much as you can on your • Find somewhere you can sit breathingdown
2. VISUALISATION • Place your arms by your side TECHNIQUEand your palms of your hands
flat against your stomach • Find somewhere to sit down
and close your eyes• Close your eyes
• Think of, and visualise in your • Pay attent ion to your mind a place or time when you breathing. Inhale slowly were really happy - a very through the nose, taking strong, positive memoryseveral seconds.
• Concentrate on focusing on • Exhale through the mouth, the small details of your trying to make the exhalation memory. for example, if your phase last twice as long as the memory is of a favourite inhalation.seaside place, picture in your
• If you are doing this correctly, mind how the sunlight glints you should feel your hands on the water, the sound of the gently rising and falling. wind as you’re standing on the
SELF EH PL MA ANU L31
beach, the patterns and This technique may take some
texture of the sand, the smell practice but persevere – it really
of the seaweed, the sound of can help in a number of ways. It
the seagulls etc – whatever is can physically calm you down as
appropriate to your own your thoughts shift away from
experience. Visualise as many ones of panic and anxiety to more
details as possible – sights, positive, happy thoughts. It can
sounds & smells. also make you feel more in
control of your ability to cope • Remember how good you felt with your anxiety/panic as you at that time, how happy and find that you have a tool to enable relaxed you felt. Stay with you to manage your feelings that feeling.effectively.
• If you don’t have a happy 3. GENERAL EXERCISE memory that is appropriate
for this technique, then try to Taking regular and energetic
visualise a place that you exercise is one of the best ways of
would like to be in the future, keeping your system in balance
where you imagine you would and working off anxiety and
be safe and happy. stress. It uses up all of your
frustrated energy and makes you • Concentrate on the small feel happy and calm.details and how good you felt
in that place, until you are
nicely relaxed
S LE F HE PL MAN AU L
Monitoring your anxietyIt is a good idea to monitor your anxiety levels, so that you can be aware of when and why you feel most anxious or stressed out.
Keep a record of these on a monitoring table :
32
Day and timeAnxiety level
(1-10)What triggered the attack?
10-10-08: Monday afternoon, 3pm
6 Argued with my girlfriend
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33
How did you cope? Success rate (1-10)
Went for a walk around the park
8
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Who can help ?You may not realise it while you are using, but your use and addictive
behaviour place a huge strain on your family, partner and close
friends. However, you may find that your loved ones are very
supportive of any attempts you might make to stop using drugs. This
is beneficial for you, as it is a lot easier to stop using if you have
supportive people around you to help you through the tough
moments.
Try to be as truthful as you can with them about your use. If you
experience cravings, tell them, so that they might help to distract you.
Having a supportive member of the family or a friend around you when
you are trying to stop using will make what you are trying to do so
much easier. Don’t take their offers to help for granted – use them!
It might be a good idea to show them this manual so that they will have
a better idea of what you are going through as you try to make
changes in your life. Alternatively, Kaleidoscope also have a manual
specifically for significant others who are trying to support a loved one
through their drug problems.
34
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Your Social Network
35
Have a think about all the people that you have contact with in your life
right now. They can be family members, partners, friends, or even
professionals that you might have come into contact with.
Then, think about how they might influence your decision to stop using
drugs : would they be a positive influence, or a negative influence?
Would they be prepared to help, or not? There might be someone in
your network who would be a positive influence, but because of your
using, you have not had any recent contact. This is then an ideal
opportunity to regain contact and start rebuilding your relationship.
Also, think about how they can help? Would they be able to do an
activity with you? Would they be prepared to be there for you when
you experience a craving or an urge to use drugs? Would they be able
to give you a lift to and from support group meetings?
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The next step is to record all the people you have contact with in
something called a ‘Social Network Map’. Here is an example for a man
called David
Rachel - Girlfriend(Positive)
Mother(Positive)
James - friend(Positive)
Richard - friend(Negative - drug user)
Mike - friend(Positive)
Angela - friend(Negative - drug user)
In the space below, fill in your own social network map :
DAVID
In parallel to this you might need to try to re-evaluate your
relationships with your friends who still use drugs. Will continuing in
these relationships jeopardise your abstinence? If so you might want
to think about cutting ties with these people.
Your drug using friends may question your decision to do this, but the
best thing to do is to answer them honestly, giving your reasons for
wanting to quit drugs.
Narcotics Anonymousor other support groups
If you find that you don’t have enough people in your social network
map that could help you, another option is to find a support group.
Groups like NA are a great way of meeting people who are also trying
to deal with the pressures of life whilst maintaining abstinence from
drugs. You might just meet someone you click with, who you can meet
for a coffee on days that you are at a loose end and you could help to
support each other.
There is an NA meeting held at the Kaleidoscope Project in Newport
every Tuesday from 1pm-2:30 pm. Other support groups are also
available in the area.
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• One of the most common problems that people experience
when asking people for help, is that they feel like they might be
judged or laughed at, and end up looking silly. It is a big thing to
be able to put these fears aside and ask. However, you will find
that most people you ask for help will admire your courage and
determination, and will not judge you or laugh at you.
• If you are unsure – think about the consequences of not asking
for help
• Before asking, make sure you know what kind of help you are
going to ask for.
• Are you asking for their general support, and just to help to
keep you motivated?
• Are you asking them to spend time with you to help you fill your
time?
• Are you asking them to be available for a chat if you have a
craving or an urge to use drugs? Remember your
communication skills, and ask them in a gentle but assertive
way if they would be prepared to help you.
• For example : ‘Hi Mum. I know how you’re really disliked the
fact that I’ve been using cannabis. I’ve decided to give up using
it, and I’d really appreciate your help. Friday nights are a really
hard time for me, so I wondered how you would feel about us
spending some time together each Friday for the next few
Rewarding your successesOnce you have decided on some goals and stuck to them, it is important that you reward yourself when goals have been completed. These help to reinforce your new behaviour, making it more likely that you will stick with the change you have made.
Rewards can be anything you like, but there are a few things to bear in mind when choosing a reward:
• It should be something that you can give yourself fairly soon after your success. The sooner you get the reward, the more effective it will be in supporting your new behaviour
• It should be something that you can easily get or afford
• It should be something over and above the normal pleasures of life – something which you regard as a luxury
• It should be something which is a pleasure for you
Some examples of rewards are cd’s, books, magazines, games, clothes, luxury food items, going out to a restaurant, going to the cinema or theatre, going bowling, etc
Write down in the space below, 5 things that could serve as material rewards for you doing well and achieving your goals:
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Staying aware of high risk situationsHigh risk situations are situations that are more likely to lead to you
using. They could be people, places, times or even moods or feelings.
If you are trying to make changes, the risk of failing is higher if you are
not aware of these high risk situations, or not prepared to deal with
certain situations effectively.
There are several ways of dealing with high-risk situations. One of the
best is to try to avoid them, particularly for the first few weeks after
your decision to change. Sometimes this will take some forward
planning. For example, don’t visit friends who you know will be using
at the time, even if the visit has nothing to do with using drugs. The
temptation is likely to arise, and it can be difficult to deal with in the
early stages.
It is important at this stage to make a list of high risk people, places
and things in an ‘Avoidance Table’ like this:
List all the people you need to avoid at this time :
• Other users: Mike, Emma & Paul – they will tempt me to use
with them.
• Dealers : Craig and Phil – they will tempt me to buy, and even
offer to give me a ‘lay-on’ (pay later)
• Family : My step-Dad – he thinks I’ll never change and always
puts me down. He thinks I’ll never get off drugs
List High Risk places that you need to avoid at this time :
• The estate where I used to score
• The Pub on the High St, where I used to use
AVOIDANCE PLAN
AVOIDANCE PLAN
List High Risk things (such as drug paraphernalia) that you
need to avoid, and how you will do this:
• Too much cash in notes. Ask Mum to look after my wages or
giro
• Rizlas: Chuck out all of the rizlas that I have around the house
• Dealers numbers in my phone – delete them, or change mobile
number if they keep ringing me
What are some safe activities that you can get involved in
now?
• Going to the gym
• Try NA meetings
Where can I seek support and who can give me support?
• My Mum
• My Brother
• My step-brother Steve, who has been through it and is now
clean
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List all the High Risk people I need to avoid at this time :
List High Risk places that I need to avoid at this time :
List High Risk things that I need to avoid at this time :
What are some safe activities that I can get involved in now?
Where can I seek support, or who can give me support?
AVOIDANCE PLAN
Right, so now that you have identified your high risk people, places
and things – it’s time to work out a strategy for when you find yourself
in a high risk situation that is unavoidable. For example, you have
successfully avoided your old using buddies, but you find yourself
bumping into them at a party that you thought would be safe.
42
Now, in the table below, list your own personal Avoidance Plan :
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Learning refusal skills
Risk Situation : Bumping in to one of my using mates when I
least expect it
STRATEGY RESPONSE
What excuse could you use if you bumped into
someone on the street?
Eg : ‘Sorry I can’t stop – I’m going to meet a
friend’
How would you phrase this response that felt
natural and comfortable?
Eg : ‘Sorry mate, but I stopped using a month
ago’
How could you do this in a way that made you
look confident?
Eg : - Be calm yet assertive and look the
person in the eye, so that he knows you’re
serious
How can you steer the conversation away?
Eg : ‘Did you watch the Champions League
game last night?’
What questions might you ask to the person
who insists on you using?
Eg : ‘Why are you insisting I use with you, I
wouldn’t do this to you if you were trying to
stop’
Make an excuse to escape
quickly
Say NO
Watch body language
Change the subject
Confront those offering
If friends who still use then tempt you to go off and use with them, you
need to learn some Refusal Skills that will help you get out of the
situation.
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SELF EH PL MA ANU L
Risk Situation :
What would your RESPONSE be?
(What excuse would you give to escape quickly?
How would you Say NO ? What would you do with
your body language so you look like you mean
what you are saying?
How would you change the subject? How would
you confront those offering?)
What is your STRATEGY?
(excuse? say no? body
language? change the
subject? confront those
offering?)
Using the table above as a reference, fill in your own Refusal
Skills table below :
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Some situations are unavoidable. These include such things as:
• The time of day (coming home from work)
• Certain mood states (stress, anxiety, boredom)
Again, you should think ahead so that you have a ready-made plan for dealing with these situations when they arise. For example, boredom can be relieved temporarily by planning activities to do when the feeling strikes.
However, having an emergency plan when things get tough is also a great idea. If all else fails and you decide to go ahead and use, delaying the decision will help you to put this decision is perspective and consider the consequences of going through with it Your emergency plan might look something like this:
• I will quickly leave or change the situation or environment
• I will put off the decision to use for 15 minutes
• I will try to challenge my thoughts about using. Is this realy what I need right now? What will be the consequences of using? Is it worth it?
• I will think of something unrelated to using
• I will remind myself of my successes to this point, and why I wanted to stop using in the first place
• I will call someone off my list of emergency numbers and tell them I feel vulnerable before I use
Cravings and Urges to use are another natural part of the recovery
process. The chances are that you will get them at some point. They can
vary in intensity, from a fleeting urge to use, to pacing around for an
hour totally dominated by feelings and thoughts of using. However,
cravings do become less frequent and less intense as time goes on. The
best thing to do is to learn about your own cravings, and find out what
sets them off.
To do this, it is a good idea to keep a craving diary, so you can
pinpoint where and when they are happening, and what they
feel like:
CRAVINGS AND URGES
S LE F HE PL MAN AU L46
Brief description of the situation. What did the craving feel like?
Date/Time it began
3:30 pmWas walking in town and saw a guy scoring off a dealer.
Heart started racing, mouth watering, tingling sensation in my head.
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47
How long craving lastedStrength of craving (0-10)Mood at the time it started
Jealous / Anxious 6 About 10 mins
SELF EH PL MA ANU L What can I dowhen I experience a craving
or an urge to use?1) Recognise the craving: Immediately verbalise to yourself that
you are having a craving. Think about your behaviour and
feelings. Looking at a craving in this way reduces your fear of
them, and gives you a chance to analyse them
2) Practice your relaxation techniques: Take a little bit of space
and calm down. Close your eyes and focus on your breathing.
While you are breathing deeply, say to yourself ‘It is just a craving,
it will pass’. There is a useful technique called ‘urge surfing’.
Imagine you are a surfer riding the waves at the beach. As each
craving wells up, ride over it and feel it ‘crash’ beneath you on the
beach.
3) Positive self-statements: Tell yourself something that counters
the thoughts about using. Try to keep to simple statements, like
’Look how far I’ve come – I haven’t used for a month’ or ‘Look what
a good parent I’ve been recently’
4) Delay using: Tell yourself that you will wait 15 minutes before
you make that final choice to use
5) Distraction: Find something to do to distract yourself and use up
all of your frustrated energy. Try to do something that needs you
to focus and concentrate. Try doing some housework, play on the
computer, go for a brisk walk, basically anything that you enjoy
doing. Phone a friend or a family member and ask them to come
over if they are able to.
6) Reward yourself: If you beat the
craving, congratulate yourself and
be proud that you have overcome
it. Try and acknowledge what you
have achieved with a treat; you’ve
earned it!
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Remember: CRAVINGS WILL ALWAYS PASS !!
IF YOU BEAT THE CRAVINGS THE FIRSTFEW TIMES, THEY WILL BECOME
MUCH EASIER TO BEAT
TriggersMost cravings come about as
a result of being exposed to a
Trigger. Triggers can be
Internal (certain moods or
feelings), or External (friends
who use, dealers, places you
used to use in, rolled-up
notes, tin foil etc,).
Everyone has different
Triggers that bring about the
desire to use. It is important
to look in detail at your own
Triggers:
1. List the places where you are most likely to use :
2. List the people with whom you are most likely to use:
3. List the times or days when you are more likely to use:
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Feelings when you might be vulnerable
At the end of (or during) an intense day
When faced with something you fear or feel anxious about
When you’ve failed to accomplish something you’d planned
Examples from your
experience
4. List any activities that make it more likely that you will use:
5. Do you think that you use 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 :
Feelings when you might be vulnerable
When you feel you have been taken advantage of
When you are bored
When you are in a social situation
When you feel bad about yourself
When you are depressed
When you want to feel energised or high
When you are faced with a tough problem
Examples from your
experience
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6. List the places where you are unlikely to use
7. List the people with whom you are unlikely to use
8. List the times or days when you are unlikely to use
9. List the activities you engage in when you are unlikely to use
Feelings when you might be vulnerable
When you want to feel friendly
When you wish your personality was different
Others not listed here
Examples from your
experience
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Seemingly Irrelevant Decisions (SIDs)
SIDs stands for ‘seemingly irrelevant decisions’. This refers to
decisions that you might make without being aware that the situation
might set you up for a lapse or a craving.
For example:
‘I had to return a DVD to a mate I used to use with. I wanted to return
the dvd because although I was avoiding him, I didn’t want to
completely offend him and not give him his film back. On Monday
evening I called in, and planned to drop the DVD off and leave. When I
got there he invited me in, and I didn’t want to appear rude so agreed
to go in. Once we got inside, he started using while he was chatting to
me. He then offered me a line, and before I knew it I was using with
him. I kept telling myself that I could handle just one line, but I stayed
there and left at 4 a.m.’
So, without having the intention of going to his friend’s house and
using, this is exactly what ended up happening. Making the decision to
drop the dvd off in person is a good example of a seemingly irrelevant
decision. He didn’t see any danger in this at the time. he could have
posted the DVD through the letter box or better still, post it in the mail.
Do you remember any SIDs that you have made in the past that led to
Looking at these will help you avoid setting yourself up in the future.
SELF EH PL MA ANU L
Justifying thoughtsSometimes, you say things to yourself that justify the desire to
use again. One of the most common examples of this is saying to
yourself : ‘I can use once more and not get hooked again’. Some
people also find themselves thinking about ‘testing’ how well
they have recovered by allowing themselves to use. They might
justify this by thinking that one more time wont hurt. However,
we know that it’s not that simple.
Challenging these thoughts as soon as they enter your head is the best
way to deal with them. In the table below, try to think of how you can
challenge the examples of justifying thoughts:
Eg. I am kidding myself. I have said that before and always end up using again
Thoughts prior to lapse
Challenging Responses
It’s just the once – to show that I don’t need it
Everyone else is still using
55
No one would know if I used
No one has the time to help me.
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I am alone
Thoughts prior to lapse
Challenging Responses
Well, no-one really cares about me
I deserve it
I need it
These cravings are driving me insane
I’m not going to be able to stop, so what’s the point?
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How do I deal with a lapse?A lapse does not mean that you • What did you use? Was it your
have gone back to square one; this usual drug of choice, or did you
is the difference between a lapse binge and go on a blow out?
and a relapse. A lapse, although • What decisions could have been dangerous, can also be seen as an made along the way to prevent opportunity to learn from your it from happening?mistakes. If you feel totally
Perhaps the most important thing negative about the incident, you to look at is how you felt before the will miss the opportunity to learn lapse. Maybe something in your from your mistakes, and then you recovery programme had gone might make the same mistakes wrong. Maybe you had stopped again. It’s all about looking back at going to the gym. Maybe you had your lapse, and trying to stopped trying to communicate understand:properly with your partner, and you
• What happened had a row. Maybe you bumped into
• How it happened an old using buddy and forgot your
refusal techniques.• How you can stop it happen-
ing again Remember: lapses rarely just
happen out of the blue. They are Start by tracing the events that led usually a build-up of subtle to you using. You may need to go incidents that occur before the over things a few times, going right lapse takes place.back to see how the events
unfolded: Do not get into any self-defeating
thinking, such as ‘well, I’ve lapsed • Who were you with?now – I might as well use
• How did you feel, emotionally tomorrow’.and physically?
Try to keep it a one off lapse, and • Where did you get the money? start looking straight away at
where you went wrong.• How did you justify it to
yourself?
SELF EH PL MA ANU L
LAPSE ANALYSISTo practice, try to remember a lapse from your past, and describe it in the following table:
Day/Date of lapse
Time of lapse
Alone? Or with
someone else?
Descr ibe what
happened during
the day of the
lapse, from start to
end :
How did you justify
your decision to
use?
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SELF EH PL MA ANU L
How did you feel
before the lapse?
How did you feel
after the lapse?
Can you think of
any th ing tha t
happened in the
week before the
lapse that might
have influenced
the way you were
feeling?
Who could you
have called to ask
for help before
lapsing?
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Short Term Positive Consequences
What was desirable about the using experience?
Could this have been achieved any other way?
Behaviour: Has the time, money or amount ofconsumption increased or decreased compared to previous lapses?
Time
Money
Amount
Previously
Previously
Previously
Recent
Recent
Recent
60
Considering the costs of use, was lapsing worthwhile?
What were the worst consequences for you?
If you continued to use, what is the most likely outcome for you?
How could you remind yourself of this in future risk situations?
Long Term Negative Consequences
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62
For example, most people live life having to perform a mixture of
‘shoulds’ and ‘wants’.
Shoulds: Things we feel we should do, eg: visit a family member we
don’t get on with, going to work, doing the household chores, etc;
basically activities you think of as ‘chores’ that need to be done but
aren’t particularly enjoyable.
Wants: Things we want to do, (eg, going on holiday, buying new
clothes, going to the cinema); activities carried out for pleasure.
The problem arises when ‘shoulds’ out-weigh ‘wants’ in your life.
You might want to check yourself on this, to ensure that the two are as
balanced as possible, and consider putting more ‘wants’ in to your day
to give yourself more satisfaction from day to day. Try to monitor
yourself using a table like the one below, to list the activities you
perform throughout your day, and see how often you have ‘wants’.
Date / Time Activity Should Want
One of the best ways of ensuringsuccess in your desire to stop using is to try
to live as balanced a life as possible.
SELF HELP MANUAL
Date / Time Activity Should Want
LIFE BALANCESELF EH PL MA ANU L63
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It may also help you to get a good life balance if you list of all the things
that you think you need for a fulfilling life, and try to work towards
