substance use

Substance Abuse 101


I decided to begin the year with the topic that holds the greatest degree of passion for me–alcoholism and alcoholics; actually addiction from all types of substances. There are millions of addicts in North America and depending on the study you read, the ranges begin with a low of 5% and can go up to as high as 12%. I think part of this discrepancy is definitional in nature; researchers and those working within the field of addiction use differing terms to define alcoholism or drug addiction.

There are three differing classes of substance user; those that are non-dependent users—people who use substances but are not yet dependent upon them…substance abusers—people who use substances in a manner that they were either not intended for or the use of said substances is causing problems in at least one major life area (MLA)…and those that are substance dependent which is defined by those individuals that are using substances in a manner that causes problems in MLA’s and where they often experience tolerance, withdrawal, and significant loss of control.

Given these definitions, we have approximately 8% of the population that is substance dependent. John Bradshaw (Bradshaw on the Family) believes that for every one addict there are three to four other individuals impacted by their disorder; so when we do the math on these types of numbers it is easy to see how addiction and addiction issues are so prevalent in our society. North America consists of approximately 350,000,000 people—if 8% are addicted, we have 28,000,000 people suffering from addiction. In addition, if we add in those directly affected from the addiction we are now at approximately 84,000,000 either addicted or impacted by an addiction. This is a HUGE societal issue both in terms of financial cost and in terms of the cost in human suffering. We spend billions of dollars every year in health care, occupational productivity losses and accidents, and corrections/policing to deal with the consequences of addiction. It has always surprised me why we do not spend more on both prevention initiatives and relapse prevention skills development.


There are a number of questionnaires that exist that provide an answer to this question; the Michigan Alcohol Screening Test, the Drug Abuse Screening Test, the Addiction Severity Index, the Alcohol Use Disorders Identification Test, and many others.

The easiest test is the Cage Questionnaire– Have you ever felt or tried to cut down on usage? Have people annoyed you by being critical of your use? Do you feel bad or guilty about your usage? Do you use first thing in the morning (eye-opener)? If you answer yes to any one of these questions you would benefit from seeking a qualified assessment from someone who specializes in addictive disorders.


If you know you are suffering from an addictive disorder, the first thing to do is seek help from someone who is trained and certified in this area. Many people (professionals included) are well intentioned but not effectively trained to treat addiction and may end up further enabling this problem or recommending unsuccessful strategies at resolution. Given the sheer prevalence of addiction, it continues to amaze me that you can receive a PhD education in psychology without ever taking a course in addictive disorders! Successful treatment for addiction involves many and sometimes all of the following recommendations–abstinence from all mood-altering substances, detoxification, medical examination, inpatient or outpatient intensive therapy, regular and ongoing attendance at the appropriate 12-step meetings, and relapse prevention post treatment for up to two years.

It is important to highlight that addiction is a relapsing disease; more people will relapse in their first year of recovery than remain abstinent. The largest contributors to relapse include– not attending 12-step meetings, isolation, undiagnosed and untreated concurrent disorders (other psychological disorders like depression, bi-polar disorder, etc), and no access to relapse prevention counseling.



Case Example – Substance Disorders

Having been privileged to work with thousands of addicts over the course of my career, I have seen my share of successes and devastation. In presenting these cases, all identifying information has been removed and all names of people and places altered to assure anonymity. I present these cases not as a means to sensationalize this disorder but to show the extremes of impact that addiction can have and the joys that are experienced through recovery.

John came to see me post inpatient treatment for a problem with Percocet. When we first met, he was very angry with the medical profession and he was holding them, more specifically his family physician, solely accountable for his disorder. Upon meeting John he presented very positively from a physical aspect, was well spoken, and cooperative. John entered treatment after he was discharged from a local hospital for severe withdrawal treatment. Apparently, John had experienced a back trauma in his work and sought medical attention from his family MD. His MD placed him on a short-term disability immediately and prescribed a dose of Percocet (oxycodone and acetaminophen) to address his pain issues. Through diagnostic testing, it was determined that the back trauma was muscular and not structural. It was suggested that he seek a course of physiotherapy to remediate the problem. John attended the physiotherapy but continued to complain of back pain to his MD. He later admitted that he continued these complaints as a means to obtaining more Percocet as John discovered that taking Percocet also allowed him to ignore other issues within his life. Over time, John’s MD had increased his intake levels to 70 Percocet per day or 350mg of oxycodone—this is a significant amount of narcotic but clearly shows the bodies ability for the development of tolerance levels. Of additional concern was the amount of acetaminophen being ingested and thus processed by the liver. Percocet is a highly addictive narcotic with an elevated tolerance cycle. It is a medication to be used with caution and constant monitoring…in John’s case neither of these conditions existed. John might have continued this addictive cycle had it not been for a business trip. Somehow, John did not fully think through the amount of prescription he would require while away and as a consequence ended up running out of his Percocet! Percocet is not a medication you want to run out of especially at the levels that John was taking. This drug has a short life within the body, which means withdrawal effects will begin soon after the last dose. Within six hours of not having his Percocet John began to experience higher levels of pain, was sweating profusely, and was very agitated. Within the first 24 hours after his last dose, John experienced a cardiac event as a result of his withdrawal–it was this event that placed him in the hospital and later into inpatient treatment.

As I stated, by the time John came to me he was very angry with his doctor and blamed him for the addiction. Not that the doctor wasn’t at fault for part of this occurrence, however it needed to become clear to John that it was his lying and deceit that led to the elevated prescribing. His doctor was simply responding to someone with pain management issues…however, upon further exploration the doctor might not have taken this route with John. As therapy evolved John was able to see his part in developing and maintaining this disorder, had accepted the need to remain abstinent, and was active in Narcotics Anonymous. Nevertheless, I jump ahead…how did he get here in the first place?

John came from a dysfunctional family system (like all of us) that was scattered with alcoholics. Because of this, he had sworn to himself that this would never happen to him; albeit that he would drink now and then, his use was not in a dependent class when we met. He was abusing alcohol now and then and also found that it became a precursor to his elevated Percocet usage. Upon taking Percocet for the first time, he felt an overwhelming sense of relaxation and release from his stresses, which he enjoyed. Over time and due to tolerance rationales he had to continue to increase the dosage to chase that same effect. On a few occasions, he feared of overdose but was afraid to seek medical attention because he knew he would lose his prescription. He began to lie to his physician about his pain levels and make claims that the physiotherapy was causing more pain to justify the increased prescription amounts. As his Percocet intake increased, he also began to isolate from others for fear they would discover what he was doing. John began to discover what every addict finds out—you can chase that original high forever but you‘d never find it again. It was only by “mistake” that John ended up stopping, had he not had a cardiac event he might still be using today or worse…he may have eventually overdosed. In a strange way, he remains forever grateful for that trip that sent him into withdrawals.


Relapse Prevention

We received a request to talk about Relapse Prevention, so that is what we will focus upon this week. This is such a large area to cover off; as such, I will do my best to provide information, meaning, and some exercises that will provide a good beginning in the area. Relapsing back into substance use means differing things to different researchers and treatment providers; some see short-term use or initiation of substance use (a couple of days) as a “lapse” and would suggest that a “relapse” does not occur until the use pattern “gets out of control”…I am of the mindset that once a person begins the re-initiation of substance use, they have relapsed. AA often uses the term “slip”; I however am not a supporter of this term as it carries a connotation of being a mistake of sorts versus a stance of accountability. When it comes to substance use for an individual that has a dependency disorder, accountability is a key feature for recovery to take place.

Relapse Prevention (RP) is an active approach towards the retention of abstinence and recovery development. It should begin at the conclusion of either an Inpatient or Outpatient treatment program and run concurrent to 12-Step recovery involvement. Many RP programs will run a minimum of six-month post-treatment upwards to two years. The highest risk for relapse is contained within the first year of recovery; it is escalated dramatically if an individual does not access RP activities. RP work carries more significance in the ability to maintain a recovery focus then initial treatment.

When it comes to dependency disorders much of the research suggests the following truths; abstinence is a requirement (controlled use is not an option), 12-Step programs significantly influence the ability to maintain abstinence, intensive initial treatment services can assist in setting a healthy foundational component to recovery (these can either be of an inpatient or outpatient setting), RP is essential to ongoing recovery, and spiritually based programming reduces relapse rates.

The beginning basic to RP focus upon concepts related to coping with cravings and urges to use. The areas involved in dealing with cravings & urges include Avoid, Confront, Distract, and Remind.

With respect to Avoidance, the following suggestions can be implemented.
• Avoid getting in the situation where you are tempted in the first place.
• Avoid making substances easy to attain. Get rid of it.
• Avoid your using friends, at least until you have some stability.
• Avoid passive activities that have naturally accompanied using, like watching television or lounging at home. Stay busy, make plans, and get out of the house and into a non-using situation.
• Avoid your triggers. You know what will trigger your using. Avoid these situations. Be proactive and plan for when they might occur so that you can handle them in a healthy way, without turning to substances.
• Avoid letting yourself be run down. If you are Hungry, Anger, Lonely or Tied (HALT), your inner strength, and awareness will be compromised. You need to nourish yourself and your spirit with healthy living and healthy choices.

With respect to Confronting, the following suggestions can be implemented.
• You cannot always control whether or not you will have an urge to use. However, you can control how you respond to that urge. Rather than worry about the urge, take a step back and let it happen. See it for what it is…a temporary feeling of desire or need. It will not last long and it cannot control you unless you allow it to.
• Confront your self-talk. Urges often come in the form of self-talk that gives you permission to use. For example, “I’ll just have a short one, that’s not really drinking”.
• When you encounter your urges as self-talk, you have to confront this self-talk immediately and forcefully. Say to yourself “I will not stray from my plan” or “I know better so I can do better.”
• Confront your urge with your long-term goals. Think about how you will feel tomorrow if you give in and how you will feel you if you do not. Consider the list of reasons you have created for why you want to stop using.

The next blog will continue with the other items that can be implemented to control cravings & urges. Controlling these areas is a very small, but important, part to RP. By week’s end, we will look at the more difficult work in this critical area to ongoing Recovery.


Relapse Prevention Part 2

The last two skill sets in addressing cravings and urges in the Relapse Prevention area include Distract and Remind. Similar to Avoidance and Confronting, implementing these two skill sets will go a long way in keeping you sober and on the path of recovery.

The third skill for coping with urges is Distraction. Distractions are things that you do to take your mind off the urge and point it in a healthier direction.

Here are a few examples of some Distractions:

take a walk, take a drive, do exercises at home or go to the gym, go jogging, listen to favorite music, telephone a friend, clean out the garage, cook something interesting, go to the library or bookstore, work in the yard, clean and polish the car, take a shower or bath, read the newspaper, a magazine, or book, drink something nonalcoholic, rent a video or DVD, write a letter or email, plan your next vacation, make a shopping list, clean out the refrigerator, plan future finances, surf the internet…The list of potential distractions is endless.

The fourth and final skill presented here for coping with cravings and urges is to Remind.

• Remind yourself of the reasons why you want to stop using and what you specifically hope to gain from this new pattern
• Remind yourself that you want better relations with friends
• Remind yourself that you want better health
• Remind yourself that you want to treat your family with the love and respect that they deserve
• Remind yourself that you want to work to your full potential at your job
• Remind yourself that you want to sleep better
• Remind yourself that you want to look better and age beautifully or handsomely

Your attentiveness to all four of these critical components as options to fend off a relapse will provide you with renewed strength and courage in moving forward. RP is an ongoing exercise of knowing where your weaknesses exist and having a pre-planned set of behavioural activities to counter these events if or when they occur. For those of you in early recovery that do not experience cravings or urges be thankful for that blessing and then do the exercises anyway, complacency, over-confidence, and attitudes of superiority have knocked down many an addict.

Approach your recovery with humility and a thankful heart–For this is a GIFT not a GIVEN!


Relapse Preventions – Final Thoughts

Our exploration related to Relapse Prevention simply touched the surface of a very complex area. I may come back to it as we move along or if there continues to be requests to learn more about this area–I always look forward to your emails (thanks Inny for requesting RP). All we had time for in a week was to cover the basics in addressing any cravings or urges. These tools of Avoid, Confront, Distract and Remind may become your life preservers if you have been attentive to the tasks.

It is imperative to remember that substance disorders are a relapsing reality; it is only the blessed few that will walk this path and never know the hideousness called Relapse. More people will relapse then remain abstinent. The vast majority of those relapses will occur within the first two-years of recovery. The primary reasons for relapse include…
• Complacency
• Attitudes of superiority
• Lack of humility
• Lack of commitment
• Keeping secrets
• Limited or no attendance at appropriate 12-step programs
• Difficulties with the spiritual aspects to recovery
• No access to relapse prevention treatment

If you do relapse, know that this is not the end of the world and it is critical that you stop again ASAP. Some people that relapse begin to think that they might as well “do it right” now that “everything” is ruined. Let me begin by telling you “Everything is not Ruined”!However, it could become that way if you keep going versus stopping soon into the relapse. Another strange message that AA and other 12-step programs send around relapse is that a person has to start over if they relapse. Don’t get me wrong here though, I think the world of the 12-step programs and believe they have contributed to the recovery of more addicts than any other treatment modality; so even if I question a few of the messages I still believe these programs are an addicts best chance at recovery. For some people this discounting of their previous experience or work can be counter-productive as they are more likely to be the ones’ that believe they “might as well do it up right given that it’s all gone”. Let me be the first to tell you, it is not all gone…if you stop soon into a relapse you can do some immediate damage control and you can simply pick up where you left off and learn from the experience.

As I stated before…Recovery is a Gift not a Given! Be grateful for everyday you have substance free and do the work needed to keep your gift…try and remember that people die because they did not get access to the help you have already received. Good luck and Good Recovery.


Spirituality in Recovery

This week it has been requested that I write on a topic that I have researched but by no means feel like an expert on; this area is so large that commentary upon a piece does not make one an expert. That topic is spirituality; my research in the area covered Judeo Christian perspectives in recovering alcoholics. I have read plenty in the area and spoken too many about their experiences; and from this I have come to understand that I know only a little. From the concepts and experiences that I have taken away I will share some here over the following week, including spiritual development.

Firstly, let us define the difference between religious and spiritual and explore how these fit into recovery processes.

Religious: A religion is a set of tenets and practices, often centered upon specific supernatural and moral claims about reality, the cosmos, and human nature, and often codified as prayer, ritual, or religious law. Religion also encompasses ancestral or cultural traditions, writings, history, and mythology, as well as personal faith and religious experience. The term “religion” refers to both the personal practices related to communal faith and to group rituals and communication stemming from shared conviction. Religions include Christian, Muslim, Buddhist, Islamic, Jewish, etc.

Spiritual: Spirituality, in a narrow sense, concerns itself with matters of the spirit, a concept often closely tied to religious belief and faith, a transcendent reality, or one or more deities. Spiritual matters are thus those matters regarding humankind’s ultimate nature and purpose, not only as material biological organisms, but also as beings with a unique relationship to that which is perceived to be beyond both time and the material world. Spirituality also implies the mind-body dichotomy, which indicates a separation between the body and soul.

Research in both of these areas is showing that individuals that are religious and/or spiritual are showing better recovery outcomes from a wide variety of physiological and psychological aliments. This is something that the founders of AA either knew or stumbled upon back in 1935. Many 12-Step programs are built around spiritual principles—not religious doctrine.

From a perspective of recovery from substance disorders, the 12-Step programs were all founded upon Judeo Christian concepts and principles couched softly to be inclusive of every possible religion or spiritual focus. Original AA documents included language like “Jesus”, “Lord”, and “Saviour” only to be altered into one term—God. The founders of AA altered what could have been determined to be a “religious” program into one that became “spiritually” focused. Then in the late 90’s there was research showing meaningful splits between “spiritually focused” groups versus “secularly focused” groups and the potentiality of outcome to this pattern. In other words, AA and other 12-Step groups were beginning to split upon meaningful dimensions of a spiritual program versus a non-spiritually focused program. Some meetings were still inclusive of discussing the concepts of God, Spirituality, and the Principles while others began to focus upon more life focused structures like Relationships, Communication, and Balance. It was also the first time ever AA was not in a growth position compared to every decade that preceded it since its inception in 1935. I personally do not see this as a coincidence; many AA groups were now beginning to mirror pop psychology and new age principles that would have drawn many away from the more traditional aspects of recovery to something you could now get without attending AA—just look in the self-help section of any bookstore. The problem becomes that bookstores cannot convey experience, strength, and hope that only comes from two alcoholics talking to each other. In those discussions, couched in those concepts, AA was the most successful recovery modality of any approach at treating addictions. It still is; with one caveat—groups that are spiritually focused produce better, longer-lasting and more meaningful recovery experiences than secularly focused recovery.

I have been privileged to meet thousands of alcoholics over the course of my career and the one thing I can clearly state is that those with a “spiritually” focused recovery have a better chance at long-term success in their recovery. I will provide examples as we go through the week. For today, those in recovery may want to explore those groups that are spiritual versus secular. For those suffering from other ailments, you may want to seek additional spiritual cures in addition to all of your other treatments…you may find additions to your recovery there.



This week’s blog will explore Interventions; the structures, the steps, the limitations, and the goals. There are times when a family member, a friend, or an employer has exhausted all efforts to refer someone they are concerned about to enter treatment for a substance disorder. In these circumstances, an Intervention Program may be the route to pursue.

Interventions are intense measures intended to place the full scope of someone’s addiction in front of them with an accompanying request that they choose treatment or be prepared to live with the consequences of continued addiction patterns. Not everyone is suited for an Intervention Program; all qualified Interventionist’s, will conduct a preliminary interview to determine a family/individual’s suitability for the process.

There a number of goals to an Intervention that are equally important; however, one key to a good Intervention is having the addicts’ supports well educated and supported regardless of the choices made by the addict at the Intervention. Primary goals include…

  • Education
  • Support Development
  • Psychological/ Emotional Healing
  • Treatment Acceptance
  • Consequence Enforcement

All Interventions begin with a preliminary consultation with the family and/or concerned persons’ requesting the Intervention. At this stage what is explored is the suitability for the Intervention to occur. An Intervention will only occur if…

  • All members are invested and willing to accept direction
  • All other means to offer assistance have been exhausted or the severity of the addicts condition warrants this type of action
  • There can still be an impact in circumstances where an Intervention has already been conducted without treatment success
  • All members are prepared to enforce meaningful consequences should the addict choose not to alter their behaviors
  • All members are prepared to address their own addictions should these exist
  • All members are prepared to stop any enabling behaviors with the addict

An Intervention is not a democratic process; the Interventionist will take complete control over the process and directions. This is a psychotherapeutic exercise whereby input on what to do or how to do things will not be acceptable. Interventionists will often excuse people from being part of the process if they do not see them as helpful to the addict.

Next time we will go through the steps to an actual Intervention and explore why these are used and what outcome is being sought.


Intervention Phases

Once it has been decided that an intervention is the appropriate activity the Interventionist will decide and request that the participants attend the initial educational session. There are six steps to any Intervention…

  • Phase One: Preliminary Interview
  • Phase Two: Psycho-education: Substance Disorders
  • Phase Three: Supports for Family/Friends and Impact Statements
  • Phase Four: Preliminary Intervention
  • Phase Five: Intervention
  • Phase Six: Post Intervention follow-up

It is important to note, that if at any time while working through the 6 phases of an intervention it is determined by the Interventionist that this is no longer a viable course of action the intervention will be halted and a recommendation will be made for any further actions that may need to take place. An intervention will only occur if there is a reasonable opportunity for impact and change for the addict.

The Psycho-Educational Phase is essential as most everyone has a perception of what an addictive disorder is and what needs to occur for this to resolve. Often times the information that people have is based upon their unique experience with “their addict” and this may not be an accurate depiction of the disease. During the Educational Phase, intervention participants are given up to date information on all features to an addiction—

  • Overview of all substances
  • Definitions of Use, Abuse, Dependency
  • Behavioral, Psychological, Physiological impacts—Bio-Psycho-Social-Spiritual Models
  • Common problems for Employment, Familial, and Support Systems
  • Enabling Patterns
  • Treatment Approaches
  • Treatment Recommendations/Options

Having all participants accurately informed about an addiction is essential in an intervention insomuch as ensuring people know what the likely course of direction will be should the addict choose to continue their addictive cycle post-intervention.

Next time we will explore the additional Phases to the intervention.


12-Steps Programs: Steps 1 – 3

The 12-Step Programs have saved and altered millions of lives across the globe. Today we will begin looking at these steps and the meanings/ interpretations behind them.

Before AA began, the Oxford Groups existed as a program of recovery from alcoholism. The Oxford groups were based upon the principles of absolute honesty, absolute purity, absolute unselfishness, and absolute love. What they discovered were that these four principles were difficult for anyone to maintain, let alone a recovering addict—thus AA was born as a program that was built upon the principle of “progress not perfection”; people were suggested that they made progress in their recovery not attain a perfect recovery. Absolutes were left behind and a “suggested program” was introduced.

Part of this program was the 12 suggested steps towards a life of recovery. The key to that statement is the “suggested” part, individuals could decide to do the steps or not do the steps, —and the only requirement to attending a 12-Step Program is the desire to change.

Today we will look at the first few steps of the AA program—other programs basically mirror the AA program by altering the word alcohol to suit the issue.

1–We admitted we were powerless over alcohol— that our lives had become unmanageable.

This step gets at the heart of accountability. Many have interpreted this as defeat. This is not intended as a statement of defeat, but rather a statement of becoming accountable for one’s actions and bringing a link between alcohol use and unmanageability. It is quite simple—over-use of alcohol causes problems in people’s lives and excessive over-use of alcohol destroys people’s lives. Alcoholics are infamous for seeking every other rationale besides alcohol for why their lives are in chaos; this step puts the accountability where it belongs.

2–Came to believe that a Power greater then ourselves could restore us to sanity.

As stated earlier, AA was built upon Judeo Christian principles and AA incorporated the need for spiritual recovery from alcoholism. Years of research had defined alcoholism as a bio-psycho-social disorder…today that has been extended to include spiritual. There have been vast amounts of research done in the area of spirituality over the past 15 years as it relates to alcoholism with many researchers drawing clear linkages between these two areas. AA was well ahead of its time in the development of this piece. The founders of AA understood the need for individuals to have a program of recovery that extended outside of the individual to something or someone more powerful and thus helpful. The simplistic definition of “insanity” is performing the same activity over and over and expecting different results; restoration of sanity here is the understandings that change were needed for change to occur.

3–Made a decision to turn our will and our lives over to the care of God, as we understood Him.

Having performed research in the area of spiritual belief systems and alcoholism, I am keenly aware of the differences between those that accept and rely upon God as part of their recovery versus those that choose a different path. What this step requests is that a person is willing to rely upon God for good direction in their life (some members of AA even define God as Good Orderly Direction)—most addicts have not done an outstanding job in directing their own lives and thus a spiritual outside support can be essential. It additionally moves one away from ego based direction to understanding and appreciating external direction. How God is defined is reliant upon each individual member of AA—there is no stated religion or spiritual belief system in this step.

These steps build the initial foundations for recovery. When we come back to this, we will begin to explore the action steps within the 12-Steps.

12-Step Programs: Steps 4 – 9

Once a foundation is set within a 12-Step Program, it is time to begin the work. Steps 4-9 are Action Steps within AA and the other 12-Step Programs. These steps are not to be taken lightly, require a significant amount of work, and will be life changing if approached and worked at properly. It is often within these steps that a person will discover if recovery is going to work for someone; those committed to the process will struggle, will experience a range of emotions likely never seen before, and will want to quit over and over but they will not allow themselves to be defeated by a process of internal change and resolution.

Step 4: Made a searching and fearless moral inventory of ourselves.

It is difficult to change what we do not know; this step is designed to explore the inner workings and character of the alcoholic. One is asked to identify resentments, fears, sex problems, and begin the process of knowing where amends will have to be conducted. The founders of AA knew that a life lived with resentments could not be lived by an addict thus it became the critical focus of step-4. Resentments are often driven by anger, ego, hurt, loss, pride, jealousies, etc….all of which are egocentric patterns; a sober alcoholic had to be more than egocentric to realize a world of recovery. Resentments would need to be driven out and replaced with “other-centeredness”, selflessness, and acts of altruism, humility, and honesty. Step-4 begins this process.

Step-5: Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

Knowing what we have done wrong in our lives is one thing—seeking absolution and resolution from God, ourselves, and another is an entirely different activity. Most addicts have difficulty living within their own skin as a result of their behaviors while under the influence of substances. They need to know that what they have done is forgivable. This step provides a clean slate and also a sense of accountability. This step is a working step at reparations between oneself and God; a healing of that relationship and a deeper understanding that actions are accountable for “Recovery without Divinity holds the potential for reduced individual and societal accountability”.

Step-6: Were entirely ready to have God remove all these defects of character.

Step-4 explores a listing of one’s positive and negative traits; in step 6, an addict needs to be prepared to let those things of the past slip away for a new life to begin. Some addicts get comfortable in their patterns and thus experience anxiety in relation to letting these go. This step begins to open one up to new patterns, which lead to new character traits.

Step-7: Humbly asked Him to remove our shortcomings.

This step acknowledges two things; one is that change is needed and the second is that this is not likely to occur simply within one’s own volition. An additional key to this step is the need to become humbled—not humiliated—but humbled, a trait often void in dysfunction.

Step-8: Made a list of all persons we had harmed, and became willing to make amends to them all.

The list of those needing amends is made back in step-4. However, it is at this point in one’s recovery they are asked to become prepared to make those amends. Like the other steps, this step is well placed from a timing perspective as early recovery phases of development would not have a person exist in a position of restitution. However, once a person has been able to fully explore their own clear contributions to their dysfunction they are now better placed to seek forgiveness versus blame for their respective conduct.

Step-9: Made direct amends to such people wherever possible, except when to do so would injure them or others.

This step is simply a follow through to the preparedness sought in step-8. The focus here is not to simply feel better by clearing away the wreckage of one’s past, but truly trying to make what was once wrong… right in another’s life. This step is well placed as so many addicts try to do this in their first week of recovery, which mirrors the many promises they have made in the past. This step is not about promise but about correction. For amends to carry greater meaning there needs to be some recovery time in place so that others are seeing an earnest effort at change. Another key here is not making amends if that amend would harm another human being; this is not about conscience clearing on the part of the addict.

Next time we will cover the steps that provide ongoing maintenance in the recovery process.