My Addictions Recovery Self-Evaluation Checklist

Updated 9/17/18: Here’s a new version of this post as a pdf.: Self-Care Checklist for People with Substance Use Issues. (Link opens in a new tab.)

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To what extent do I agree that I have taken action this week on each recovery-supporting item suggested below?

I use the following scale to rate my agreement with each statement. If the statement does not apply to me – for example, I don’t use tobacco products – I write “N/A” (not applicable) on the line.

Illustration by Anne

5 – Strongly agree
4 – Agree
3 – Neutral
2 – Disagree
1 – Strongly Disagree

_____ I have taken prescribed medication(s) at the correct time(s) each day and in the correct dose(s).

_____ I have attended medical appointments, scheduled a medical appointment, or checked my calendar to remind myself of upcoming medical appointments.

_____ I have been aware of my basic needs and have done what I can to help get my needs met. I am working on self-care.

_____ I have practiced sleep hygiene and I am working on establishing a regular sleep pattern for myself.

_____ I am working on establishing a regular schedule for myself to support my stability. I am working on radically accepting the paradox that imposing structure on my days gives me the freedom to be more present for them.

_____ I have engaged in daily physical movement and/or physical activity.

_____ I have centered my diet around nutrient-rich, recovery-supporting foods and eaten on a regular schedule. I drink plenty of water and help myself stay neither too hungry nor too full.

_____ I have monitored my consumption of caffeine and have maintained, reduced or eliminated it.

_____ I have monitored my use of tobacco products and have cut back when I could.

_____ I have become aware of my physical sensations, feelings, thoughts, and actions without judging or criticizing myself or my experience. I observe and identify patterns of feeling, thinking and behaving. I am learning mindfulness.

_____ I am becoming aware of what has my attention. I can engage, disengage, and shift my attention based on what I think is beneficial for me. I am applying what I’m learning and practicing it.

_____ I have listened for negative self-talk. I can separate helpful thoughts from unhelpful thoughts. I attempt to replace my negative thoughts with supportive thoughts.

_____ I have become conscious of when I am experiencing strong sensory states, strong states of emotion, or many thoughts at once. I am aware of when I am in emotional or physical pain. I have used supportive self-talk and other tools to calm myself enough to be able to think before taking action. I am learning to tolerate distress and to regulate my emotions.

_____ I have attended individual and/or group counseling sessions.

_____ I have met with, talked on the phone with, or texted people who support my recovery. I am learning interpersonal effectiveness skills.

_____ I have worked on building social support, social connections, a social network, community membership, and a sense of belonging. I may have attended support groups such as SMART Recovery, Alcoholics Anonymous, Narcotics Anonymous, and others. I may have joined community groups and common interest groups, volunteer organizations, sports teams and/or engaged in other group activities. I seek enough social interaction to feel connected and stimulated, but not so much that I feel overwhelmed and over-stimulated.

_____ I am exploring and discovering my preferences and personal interests. I am trying different activities, pastimes and hobbies to see which ones engage me.

_____ I am working on believing in my worth and learning my strengths. I acknowledge myself when I believe I can do something, say I will do it, and do it. I am learning to support my sense of self-efficacy.

_____ I am discovering purpose and meaning through self-reflection, self-discovery, and interactions with others. I am taking action on my purpose through paid work, volunteer work, and/or education.

_____ A recovery-supporting practice personally effective for me that I have done this week is: ________________________________________________________________________________.

_____ MY TOTAL. I can choose to create a total or not based on what I deem helpful to me as I discover the recovery path that is uniquely effective for me. I can change the wording of the items on this list, as well as add and subtract items as my understanding evolves. I can weigh some items more heavily than others and rank them in the order that’s most beneficial to me. I can use this list or not. If it seems helpful to me, I can track my totals over time.

It’s my life. Don’t you forget.
It’s My Life, Talk Talk

. . . . .

How am I doing? How do I know?

What helps most people most of the time? Current data indicates that up to 98% of people with substance use disorders (SUDs) have co-occurring mental illnesses and significant numbers have experienced trauma in their lifetimes.

The list of recovery-supporting actions above is based on best efforts to distill current knowledge of evidenced-based practices, in priority order, that may assist many people much of the time with these challenges. At this time, no addictions treatment works for all people all the time.

I did not link the text above because every word could be highlighted and linked to multiple, readily-accessible sources. Where we couldn’t find research summaries, we created them. These links might be useful:

The content of this post is for informational purposes only and is not a substitute for medical, psychological or professional advice. Consult a qualified health care professional for personalized medical, psychological and professional advice.

Last updated 6/15/18

Radical Acceptance

Huge webs and chains of events in the past, over which I have no control, led up to this present moment.

I see this moment as it is, without judgment.

Mandala

This moment may make sense given what’s happened before it.

Today, I take full responsibility for what I say and for what I do.

I focus on what I can do in the present, not on what I can’t do about the past and can’t know about the future.

I accept who I am, I accept myself, and I accept my life.

I embrace who I am.

I can change what I used to do into what I want to do and value doing.

I will treat myself kindly and lovingly.

Regardless of the rationality or legitimacy or logic of the reasons, I may feel distressed by what I am witnessing or experiencing right this moment.

Blaming myself or others, criticizing myself or others, judging myself or others, having an opinion about myself or others, increases my distress and suffering.

I may not condone or agree with what’s happening. I simply see it as it is.

Fighting what’s happening or happened, trying not to let it happen, wishing it were different, trying to change it, thinking it shouldn’t be this way – all increase my distress and suffering.

Distress limits my ability to think, to observe, to recognize, to see what is, to see things as they are.

I can shift my focus. I can choose to what I give my attention.

I am calmer. I can choose what to think and do and say next. I have the power to do this and I take responsibility for this.

What happened and is happening might have meaning. But it might be random and have no meaning whatsoever about me or anyone or anything.

. . . . .

Written in response to the “Self-Affirming Statements” exercise, pages 55-56, in The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation & Distress Tolerance, recommended by my counselor, Dr. H.

To learn more about DBT for addictions recovery, see DBT Improves Emotion Regulation Skills for Addictions Recovery Success.

Mandala by Anne created in a workshop at the Franciscan Center, July, 2015.

What We Take for Granted

People suffering from addictions are not morally weak; they suffer a disease that has compromised something that the rest of us take for granted: the ability to exert will and follow through with it.
– Nora D. Volkow, M.D

Advances in Addiction and Recovery: NADAACNora D. Volkow, M.D., has written an eloquent, state-of-the-science essay on addictions treatment that is a must-read for all people struggling with addictions, for those who love them, for those who treat them, and for those who represent them. Given the statistics on the prevalence of addiction and its impact on everyone’s lives, that would be all of us.

Volkow is Director of the National Institute on Drug Abuse (NIDA) and her essay appears in the Fall 2105 issue of Advances in Addiction & Recovery, the quarterly journal from NADAAC, the association for addictions professionals of which I am a member.

Vokow powerfully expresses the interplay between the felt experience of the person struggling with addiction and the brain science that explains – as simply as I’ve ever read – the complex brain functions that create unbearable feeling states and the resultant behaviors that baffle both the person struggling and everyone else. Given the clarity and compassion with which Volkow expresses difficult concepts, I left a voice mail at NADAAC yesterday asking the organization to please make the full essay available online. It’s currently only available in a .pdf reader which can be reached from here.

I’ve excerpted sections below, about 800 words from the 2600-word essay. I am so deeply grateful to Laurel Sindewald who transcribed the entire essay within hours of my request so I could share excerpts.

To enhance readability, no quotation marks or block quotes are used. The remaining content of this post is comprised of verbatim quotes from “Can the Science of Addiction Help Reduce Stigma?” by Nora D. Volkow, M.D., Advances in Addiction & Recovery, Fall 2015 issue, pages 16-17, 19:

One of the terrible consequences of the slow acceptance of the brain disease model of addiction has been the low rate of adoption of methadone and buprenorphine. Since they are, themselves, opioids, they continue to be viewed as a “crutch,” and do not fit with erroneous but all-too-common perceptions that the addicted person must simply have the strength to endure sobriety, without aid, from day one. This comes from a failure to understand that the brain, which is comprised of the various self-control and reward circuits involved in addiction, is an organ like any other in the body (albeit much more complex), requiring time as well as support to heal. In fact, we do not ask a person who has suffered severe injury as a result of a car accident to walk without aid while their bones engage in self-repair; external support – often, crutches – are needed to take the burden off healing limbs. In some cases long periods of rehabilitation, lasting years, may be needed after accidents, to restore functioning that was lost. Brain diseases are no different.

This ensemble of brain changes [involving not only the reward regions but also several other brain circuits that are involved with executive function including self-control, the processing of negative emotions and memories, and the shaping of behavior through conditioning] could be likened to a broken video game. Because of the conditioning processes described above, the addicted person’s world is like a threatening virtual environment, a landscape calculated to pose maximal threats to their sobriety – in the form of drugs and drug cues – around every corner and lurking in every shadow. Yet the person playing the game must navigate this environment with a broken controller, such that no matter how hard they try to steer clear of hazards, their game-world avatar heads straight for the drug that will lead them to relapse.

I often compare drug addiction to another chronic, relapsing disease, diabetes. In diabetes, the pancreas is not able to make the insulin necessary for our cells to use glucose as fuel. No one thinks that, with sufficient willpower, a person with this condition could push through without medication. Their disease, even if it had behavioral antecedents and may have involved free choices in a person’s past – such as decisions about food or exercise – has a physical basis and requires medical management once it has developed. Fortunately, people often have a basic understanding that the diseased pancreas is the reason people with diabetes require constant medication, and thus no one questions when a person with diabetes excuses themselves before meals to take insulin or requires snacks at odd times. Drug addiction, despite decades of effort, still has not attained an equivalent level of social understanding: Just as the diseased pancreas cannot supply sufficient insulin, the brain affected by addiction cannot supply sufficient self-control, and the addicted person requires medical management – not judgment – to recover and lead a normal life.

People suffering from addictions are not morally weak; they suffer a disease that has compromised something that the rest of us take for granted: the ability to exert will and follow through with it. The desire to be rid of the drug and its destructive influence on their life and health and relationships is usually quite sincere, but the ability to follow through on the choice not to use the drug has been compromised by their disease. I have seen all too often how the cycle of relapse, and the shame and self-disappointment this disease produces can robe a person of hope and even, in extreme cases, the will to continue living.

Reducing the stigma that still surrounds drug addiction and its treatment requires getting across to the public, including policymakers, physicians, and addicted persons and their families, the complex nature of this condition. The complexity is not only biological but also philosophical, because it affects how we think about our own free will. It requires understanding that something as basic as our ability to make and follow through with choices in our own best interest is rooted in biological mechanisms that can become disrupted by drugs and, in some cases, compromised by a chronic disease.

[End of excerpts from “Can the Science of Addiction Help Reduce Stigma?” by Nora D. Volkow, M.D., Advances in Addiction & Recovery, Fall 2015 issue, pages 16-17, 19.]

What We Can Do

In July, 2015, I went to a women’s retreat in Tampa and I was asked by a fellow attendee with decades more experience than I have to develop a personal philosophy of recovery. At 2 years and 9 months without alcohol –  and continuing to be plagued by wishing to drink (with less frequency but too often to feel as if I can get on with my life) – my current philosophy of recovery is defined as “what can be done to keep me from drinking.”What we can do for ourselves and together

Since I work with others challenged by addiction, I’ve included “using” to mean using external sources rather than internal sources to handle our inner experiences: illegal substances or legal substances not as prescribed or intended; overeating or undereating food; people, relationships, sex, gambling, shopping, porn and/or other activities or processes.

I have used “we” rather than “I” because, while I am responsible for providing my own 24-7 addictions recovery care, alone, without the help of others? I drink.

Working Hypotheses

  • Pre-drinking or pre-using is a two-fold, heightened internal state: one of strong feelings perceived as unbearable – anxiety, fear, sorrow, pain, grief, loneliness, anger, rage, frustration, joy, agitation, boredom – and a sense of an inability to do anything about them – feeling helpless, hopeless, powerless, overwhelmed, useless, purposeless.
  • Some kind of dynamic exists between the self, addiction, consciousness/awareness/attention, and that heightened feeling state that can result in unconscious drinking or using. This is where will power, determination, commitment, working towards goals, or working to avoid consequences can fail. This is why that heightened internal state must be protected against at all times, at all costs.
  • The primary method we can use to help ease ourselves during heightened states of emotion is 1) become aware that we’re in the midst of that state, 2) calm ourselves just enough to be able to think and become aware of the judgmental statements we’re inwardly making to ourselves that are part of creating the state, 3) refute or transform those thoughts, then 4) further calm and reassure ourselves.
  • Accumulated, unresolved sessions with heightened feelings and negative thinking (“racing thoughts,” “spinning thoughts”) lead to relapse. To counter this power, we strive to find and equip ourselves with individual ways that help us prevent, resolve, work through, counter, or release strong feelings.
  • If we are experiencing strong feelings, most of the time it is not due to outside circumstances but due to inwardly brutalizing ourselves with judgmental self-talk, self-defeating beliefs, and/or pereceiving negative judgments from others, all of which are invoking shame. Brené Brown defines shame as “the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging – something we’ve experienced, done, or failed to do makes us unworthy of connection.” In contrast, guilt is “holding something we’ve done or failed to do up against our values and feeling psychological discomfort.” Brown offers this example from her TED talk: “Guilt: I’m sorry. I made a mistake. Shame: I’m sorry. I am a mistake.” (See Lifehacker on the difference between shame and guilt and why it matters.)

Tasks

  • Wrest and liberate our true selves from the past. Address our family of origin issues.
  • Monitor, tolerate, and manage our feelings and thoughts in the present.
  • Occupy, engage and anchor our true selves in the present.
  • Connect with others with common purposes to feel a sense of belonging.
  • Nourish and grow relationships with ourselves and others.
  • Practice radical self-care.*
  • Move from “What is wrong with us?” to “How do we build better lives?”
  • Take time to come to terms with the past, acknowledge personal strengths and limitations, develop our own systems of beliefs and values, and become self-accepting and self-appreciative.

Premises

  • Accept the all-day, every-day nature of this endeavor.
  • Accept the need for on-going physical and emotional self-care to maintain the endurance necessary for the continual effort required to abstain.
  • Accept that healing ourselves will require initiating and maintaining healing relationships with ourselves and with supportive others. While no relationship is perfectly safe, we seek relationships with others with whom we feel worthy and receive enough support and enough safety most of the time.
  • Accept that we are not all-knowing, accept that what we’re thinking may not take all knowledge and all views and all possibilities into account, and consult with others about what we’re thinking before we take action. If we don’t want to tell someone what we’re thinking of doing, that’s a sign that we need to talk with someone about it.
  • Accept that we need help with what we can’t do for ourselves.

Moment-to-Moment Consciousness

  • Pause.
  • Become aware of feeling flooded with emotion – sometimes all we can do is name one of the “big four” feelings: mad, sad, glad, afraid – then reassure and calm ourselves just enough to unsoak the brain so we can think again. (Celebrate this mastery and self-control!)
  • Catch every single self-critical thought. Transform self-critical self-talk into realistic, supportive self-talk. Examples: Negative self-talk: “I am a loser.” Transformed: “I am trying.”
  • Catch every single awfulizing, castrophizing, worst-case-scenario-envisioning, self-alarming, self-terrorizing thought and challenge it. Example: “I am going to die from this!” Challenged: “Right now, I am okay.”
  • From the dire state of believing we are helpless to keep ourselves from feeling overwhelmed, move ourselves to a safer, more objective, discerning place. Example: First thought: “I can’t bear this!” Second thought: “Wow, look how strongly I’m feeling about this. It’s okay. I’ve made it through this before. I’ll make it this time, too.”

On-Going Consciousness

  • Talk about what we’re feeling, thinking and doing with multiple, supportive, trusted others to 1) discharge distress, 2) learn about ourselves as we self-disclose, 3) connect with others through mutual self-disclosure, 4) experience universality by learning of commonality, 5) experience the shame-healing power of non-judgmental acceptance by others.
  • Be a supportive, trustworthy, non-advisory, non-judgmental listener and reciprocate the healing benefits of sharing.
  • Recognize, anticipate, and plan for situations that might trigger drinking or using.
  • Avoid or limit time with people who call us to our pasts, call us to question our value, or trigger shame.
  • Avoid situations and places that might provide environmental cues, triggering a complex decision-making phenomenon over which we have little to no control. (Desensitization might be possible over time but may be impossible in the moment in early recovery.)
  • Use imagination for creative thinking rather than anxious thinking, for fantasizing about recovery experiences rather than drinking or using experiences.
  • Reach out to others to continue to build connections, networks, communities, and relationships.
  • Continue to seek, create, and be open to invitations to new memberships in new or existing communities which are supportive and cohesive.

Consciousness of High Sensitivity

  • Accept the possibility that we might have the characteristic beauties and burdens of being a highly sensitive person.
  • Accept we may have strong, instant, persistent reactivity – rather than discerning responsiveness – to the words and actions of others and to stimuli in our environments.
  • Accept we may have greater difficulty than others regulating our feelings and thoughts.
  • Accept we experience things so strongly – body sensations, body functions, feelings, thoughts, situations, events, smoke alarm beep! perfume! – that we may think we don’t have the capacity to contain the experience within ourselves. What others may experience as physical and emotional discomfort we experience as physical and emotional pain. We have to find individual ways to handle this acuteness. Otherwise, it may become unbearable (see first bullet point) and lead to drinking or using.
  • Be aware enough to put up boundaries between ourselves and difficult others to keep from “catching” their feelings in what could be, for us, risk of emotional “contagion.”
  • Accept we may have the tendency to project or displace our feelings onto others to lighten the load. Example: Internal experience: “I’m feeling like such a loser. Is he/she thinking I’m a loser?” Outward expression to another: “Why are you such a loser?”
  • With those in our inner circles, pre-plan and co-negotiate terms of engagement during heightened feelings states. If we slip and blame or accuse others of our own feelings and thoughts, apologize immediately to preserve personal integrity and to attempt to preserve the relationship.

Limitations

  • In addition to substance use disorders, most people with addictions challenges struggle with the legacy of difficult early lives, trauma, and, frequently, acute levels of anxiety and/or depression. Many have co-occurring substance use disorders and mental illnesses. Luckily, what we can do for ourselves helps with all these conditions. But we have underlying reasons for why we drank or used. Addressing these reasons requires professional help.
  • We need to acknowledge and accept what we cannot do for ourselves by ourselves. Individually, we cannot be our own counselors, psychiatrists, physicians, pharmacists, nutritionists, sponsors, support groups, therapy groups, or communities.

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*Radical self-care includes extreme care and training for emotional and physical health, including nutrition, exercise, and sleep. We need to eat recovery-supporting foods in recovery-supporting amounts on a recovery-supporting schedule. We need to exercise and keep moving, i.e. avoid the couch unless meditating. We can ease our ways by accepting that sleep problems are normal for people in recovery and practice radical sleep hygiene to counteract the known challenges.

The opinions expressed here are mine and do not necessarily reflect the positions of my associates, clients, employers, friends or relatives.

The content of this post is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

New to Addictions Recovery? You Will Feel Better

Today, I have been abstinent from alcohol for 26 months and 3 weeks, a total of 812 days.

I wish I had been told on day one that I would feel better.

. . . . .

You will feel better.

Here’s why.

The Problem

You have 1) tough thoughts and 2) tough feelings. They wear you out, hold you down, beat you down, tear you up. It makes perfect sense that you take action not to have them. Whatever actions you have taken that have become problematic for you – drinking, using drugs, gambling, eating, cutting, serial relationships, etc. – their primary purpose is to help you handle tough thoughts and tough feelings.

What you don’t have are skills to handle tough thoughts and feelings without taking those problematic actions. You’re not bad or wrong. There are reasons. For now, all you need to know, though, is that you don’t have those skills. Yet. They can be learned. Therein lies hope.

But add the intensity of the distressed thoughts and feelings that come with abstinence, and this moment, right here, right now, feels unbearable. And so does the next one. And the next one.

You can see why learning to handle thoughts and feelings is now your top priority. You’ll drink or use or do again if you don’t.

Thoughts and feelings are tough to handle when abstinent

The Solution

Set up each day to help you handle tough thoughts and tough feelings. Put aside everything else and focus all your attention on how to help yourself tolerate, live with, accept, fight against, breathe in, stumble through and survive tough thoughts and tough feelings.

So let’s see if you’ve got this. You’re going to be pummeled by massive, excruciating thoughts and feelings at the same time as you’ll only just be learning a tiny bit about how to ease their impact. It’s crazy. Yet, this is exactly what needs to be done.

You can see why few are able to do it alone. If it were easier to do alone, you would already being it doing it. You’re going to need help from others, not because you’re a weak, shameful loser, but because you’re simply new to this. You need coaching and time to learn.

And get this: you can’t do it alone, but you’re the one who has to do it. It’s crazy. But it’s got to be done.

Get Started

Prior to every action you think of taking or every word you’re about to speak, ask yourself, “Is this helping me handle thoughts and feelings in a healthy way?” If it’s not, don’t do it. If you’re not sure, run it by someone who’s been abstinent or in addictions recovery longer than you have. Much of what you think to do and say in early recovery will not be helpful because it’s intertwined with former, problematic ways of handling thoughts and feelings. Again, you’re not bad and wrong. You just haven’t learned better or other ways yet. That’s to be expected.

As you help yourself handle thoughts and feelings, the intense distress you feel during early abstinence will decrease over time.

Although it seems impossible now, you will feel better.

. . . . .

I am working on a book manuscript. Other posts in the book manuscript series:

The most popular post on this blog so far: Abstinence Is Not a Choice

I am writing a first-person narrative of my own recovery story in this category.