The CAGE Questionnaire
C Have you ever felt the need to Cut down on your drinking?
A Do you get Annoyed at criticism by others about your drinking?
G Have you ever felt Guilty about your drinking or something you have done while drinking?
E Eye opener: Have you ever felt the need for a drink early in the morning?
The Family CAGE
C Have you ever felt that anyone in your family should Cut down on their drinking?
A Has anyone in your family ever felt Annoyed by complaints about their drinking?
G Has anyone in your family ever felt bad or Guilty about their drinking?
E Eye opener: Has anyone in your family ever had a drink first thing in the morning to steady nerves or get rid of a hangover?
New Rules/Old Rules Exercise
1. List the old rules you live by.
2. Firmly cross out the rules you would like to break.
3. Come up with some new rules you would like to have. Write these next to the old rules you have crossed out.
4. Try to recognize when one of the old rules you have crossed out is controlling your behavior. When this happens, write about how that situation makes you feel.
5. Work through some visualization exercises at home, or with your therapist. Imagine a situation in which you use one of your new rules. How would it look? How would it sound and feel? What would you do differently?
"Build Up Your Courage Muscles"
1. Choose a person to be your support. Would the best choice be a sibling? A close friend? A priest or rabbi? Choose someone who will remind you how strong you are, and who can role-play stressful conversations with you.
2. Make a list of three challenges you have successfully handled in the past.
3. Once you have made this list, ask yourself; "What qualities of character allowed me to handle these challenges?" "In what ways was I resourceful?" "What did I learn from these experiences that might be useful now?" Take some time to journal your responses.
4. Turn these responses into a written reminder of your strengths and abilities. Keep it posted somewhere where you can see your successes several times every day.
5. Find a talisman you can carry around with you to remind you of your strength. Is there a small figurine you could carry in your pocket and squeeze when you need a courage boost? A song that you can hum to yourself? A mantra or phrase that makes you feel confident? A painting you can hang in your bedroom or work space?
Anger Assessment Exercise
1. What would happen if you allowed yourself to feel your angry emotions, instead of letting them change into guilt?
2. What do you believe, deep down, about anger. Is it ok to be angry? If someone is angry at you, does it mean you have done something wrong?
3. How do other people in your current family situation deal with anger?
4. How did your parents deal with anger?
5. What are your patterns for dealing with anger? Are they similar to those of other members of your family?
6. Keep a journal or notebook with you at all times. Use it to write down all of your angry feelings throughout the day. Start writing as soon as you get angry. Try not to worry about what you’re writing, just get your initial feelings down on paper. Does it feel better to let it out right away?
Setting a Boundary Exercise
1. Identify the person you need to set a boundary with.
2. Write down your intentions- what boundary is it that you want to set?
3. Who will be your support person? A spouse? A close friend?
4. How will you vent your emotions when you enforce this boundary? Work out at the gym? Take a few minutes in a private place to cry? Paint or draw?
5. Identify the raw truth. Why do you need to enforce this boundary? Be completely honest. Plan out how you can explain the raw truth to the person you need to set a boundary with in a loving, positive, but firm manner. Would it be useful to role play this conversation with your support person?
6. Set a concrete time goal with yourself. When will you have this conversation with the person you need to set a boundary with. Choose a goal you can stick to, whether it’s a week, a month, or a few months. Enlist your support person to help you keep to this deadline.
"Trust Yourself First" Exercise
• Ask yourself the following four questions. Rate yourself on a scale of 1-10, with 1 being "not at all", and 10 being "all the time."
1. How well do you honor your needs? Do you sleep when you’re tired, eat when you’re hungry, or take a break when you’re feeling stressed?
2. When you make promises to yourself, do you keep them? If you promise yourself that you’ll spend a quiet evening alone reading a book, do you cancel when an unexpected invitation comes along?
3. Can you trust yourself to make tough choices? For example, would you walk away from a relationship that weakens your self-esteem, or from a job that pays the bills but leaves you feeling unfulfilled?
4. Do you stand up for yourself when someone steps over your boundaries or acts in inappropriate ways? Can you tell a friend that it’s not okay to criticize or tease you about a sensitive issue?
• Look at your answers. Did you score mostly 7s, 8s, and 9s? Or did you have more answers in the low range, maybe even some 1s and 2s? Rate your level of trustworthiness. Are there some changes you need to make?
• Journal about the changes you need to make to be more trustworthy to yourself. Is there a favorite activity you need to make room for every week? How could you make sure you keep this commitment to yourself?
Questions for Formulating a Relapse Agreement
1. Is detox necessary? As you know, this depends on the drug, how much is being used, and how long the relapse has lasted. For example, a relapsed heroin addict will need detox, but pot smokers or cocaine addicts will not.
2. Is the addict currently involved in a 12-step program? Does he or she have a sponsor? If yes to both, it may only be necessary for the addict to attend more meetings, and meet with her sponsor more often. If she is involved in AA but has no sponsor, finding a sponsor may be the solution. If the addict has neither of these, it may be necessary to consider going back to inpatient treatment or a halfway house.
3. How much support does the addict have at home? Do others in the addict’s house drink or use drugs? Is he or she living alone? Does he or she have structure in their life? It may be that the addict returned home too soon, or that the home environment is bad for recovery. A halfway house, or moving to a sober house, may be the best solution.
4. Is something blocking recovery? Do transportation issues make it difficult to get to meetings? Do long hours at work get in the way? When I counsel addicts, I ask them what they would do if this block prevented them from getting to their addiction. Usually, they would be able to find a way around it. Matt told me that his wife was resentful of the time he spent at AA meetings. I suggested that he invite his wife to go to meetings with him, and then go out for coffee with other recovering couples.
5. Are there signs that a mental health issue is blocking recovery? If so, the addict should probably see a psychologist experienced with addiction.
6. Is the addict following all the directions, working a strong program of recovery, and still relapsing? In this case, something is missing in the program. In all likelihood, the addict needs more support. If my client’s loved one keeps relapsing despite following all of his recovery guidelines, I suggest they meet with an addiction specialist to determine what needs are not being met, and what kind of support is required.