Out From Under: Treating Your Own Addictions Chapter 4

QUESTIONNAIRE #1
FAMILY RELATIONSHIPS

1. My relationship with my father when I was young was
a) very bad
b) bad
c) neutral
d) good
e) very good

2. My relationship with my mother when I was young was
a) very bad
b) bad
c) neutral
d) good
e) very good

3. My relationship with my [1,2,3] brother(s) when I was young was
(Oldest = 1; 2nd oldest = 2; etc. )
a) very bad
b) bad
c) neutral
d) good
e) very good

4. My relationship with my [1,2,3] sister when I was young was
a) very bad
b) bad
c) neutral
d) good
e) very good

5. How often was I in contact with my male cousins?
a) never
b) almost never
c) once or twice a year
d) often

6. How often was I in contact with my female cousins?
a) never
b) almost never
c) once or twice a year
d) often

7. How do I rate my relationship with my father now?
a) very bad
b) bad
c) neutral
d) good
e) very good

8. How do I rate my relationship with my mother now?
a) very bad
b) bad
c) neutral
d) good
e) very good

9. How do I rate my relationship with my brother(s) [1,2,3] now?
a) very bad
b) bad
c) neutral
d) good
e) very good

10. How do I rate my relationship with sister(s) [1,2,3] now?
a) very bad
b) bad
c) neutral
d) good
e) very good

11. How often am I in contact with my male cousins now?
a) never
b) almost never
c) once or twice a year
d) often

12. How often am I in contact with my female cousins now?
a) never
b) almost never
c) once or twice a year
d) often

13. Presently married?

14. Divorced?

15. Remarried?

16a. Do you have children?
16b. Do you see them regularly?
16c. If not, why not?

17. How often do you see your grandparents? If not, why not?

19) Has addiction played a part in the dissolution of any of your relationships? If yes, how?

QUESTIONNAIRE #2
YOU AS PARENT

Answer True or False with the face of each child in mind. Go through the entire questionnaire for each child.

My good feelings about who I am depend on receiving approval from you.

Your struggles affect my serenity.

My attention focuses on solving your problems or relieving your pain.

My attention is focused on pleasing you.

My attention is focused on protecting you.

My attention is focused on getting you to "do it my way."

My self-esteem is bolstered by solving your problems.

My self-esteem is bolstered by relieving your pain.

My own hobbies or interests are put aside. My time is spent sharing your interests and hobbies.

Your clothing and personal appearance is dictated by my desires as I feel that you are a reflection of me.

Your behavior is dictated by my desires as I feel that you are a reflection of me.

I am aware of how you feel.

I ask what you want.

The dreams that I have for my future are linked to you.

My fear of your anger determines what I say and do.

I use giving as a way of feeling safe in our relationship.

My social circle diminishes as I involve myself with you.

I put my values aside in order to connect with you.

The quality of my life is in direct relation to the quality of yours.

QUESTIONNAIRE #3
TRUSTBLOCK

Self-trust is necessary in order to trust others. The reserve energy which is constantly used up by self deception can be made available and aid in healing. These are difficult questions. But to heal and recover, hard work is necessary on a daily basis. (Answer these on a scale of 1 to 5. 1 = definitely no, 2 = maybe no, 3 = uncertain, 4 = maybe yes, 5 = definitely yes.)

I admit unconditionally the fact of my need to heal and recover as revealed by my actions.

I believe that this is the first and foremost aspect of rebuilding trust in myself.

I am perceived by others as dependable or consistent in some deep sense.

I can be expressive enough as a person so that I am usually understood clearly.

I have positive attitudes towards myself such as warmth, caring, liking, interest, respect.

I am secure enough within myself to permit separateness, and yet allow others to share in my healing.

I can enter fully into the world of feelings.

I perceive myself as I really am.

I know myself as I really am.

I can act with sensitivity in relationships.

I can be free from fearing external evaluation.

I am evolving as a person and am not bound by the past.

QUESTIONNAIRE #4
FUNBLOCK

1. How many times today will I laugh with friends or family?

2. How many times last week did I laugh because of a TV show or
a book?

3. How many times last week did I laugh with people in a group?

4a. How many different ways do I have fun? (Click Appendix 1)
4b. Am I mind-fun oriented, or body-fun oriented? What is my mix?

5. Do I have a hobby? If not, why not?

6. How well do my parents have fun?

7. Do my parents have fun?

8. What fun-filled plans do I have for the future?

9. Do I have any fun at work?

10. Do I really have fun having fun?

11. What creative things am I good at?
Spend some time on this question.

12. Has question 11 helped you to discover any creative abilities?

13. Did you have a good time in gym class when you went to school?

QUESTIONNAIRE #5
ANGER
There is no "total score." Each yes or no answer is educational.

1. Has anyone told me I have a "temper?"

2. Do unimportant matters bother me?

3. Do I have a hard time dealing with children?

4. Do I respond with verbal remarks when confronted?

5. Do I feel angry when others suggest improvements in my life?

6. Do I feel angry when people ask me do do something for them?

7. Do I feel angry when people want me to take care of them?

QUESTIONNAIRE #6
DRUG USE
Answer each question truthfully with one or more of the following:

A) Food
B) Alcohol or Prescription Drugs
C) Illegal Drugs
D) Cigarettes
E) Coffee
F) Sex
G) Gambling
H) Other

1) I use ____ to calm my nerves.
2) I use ____ to calm my anger.
3) I use ____ block felings.
4) I use ____ out of boredom.
5) I use ____ to dampen my guilt.
6) I use ____ to relieve depression.
7) I use ____ to go to sleep.
8) I use ____ to have fun. I also use ____ to have fun.
9) I use ____ to enjoy myself.
10. I use ____ to forget my troubles.

TRUE OR FALSE:

11. My answer to question 10 doesn't actually work.
12. My answer to question 9 doesn't actually work.
13. My answer to question 8 doesn't actually work.
14. My answer to question 7 doesn't actually work.
15. My answer to question 6 doesn't actually work.
16. My answer to question 5 doesn't actually work.
17. My answer to question 4 doesn't actually work.
18. My answer to question 3 doesn't actually work.
19. My answer to question 2 doesn't actually work.
20. My answer to question 1 doesn't actually work.

QUESTIONNAIRE #7A
CONTROL PATTERNS

Which apply to me?

I must be "needed" in order to have a relationship with others.

I agree with others so they will like me.

I focus my attention on protecting others.

I believe most other people are incapable of taking care of themselves.

I keep a "mental score of good deeds and favors," becoming very hurt when they are not repaid.

I am very skilled at guessing how other people are feeling.

I can anticipate others' needs and desires, meeting them before they are asked to be met.

I become resentful when others will not let me help them.

I am calm and efficient in other people's crisis situations.

I feel good about myself only when I am helping others.

I freely offer others advice and directions without being asked.

I put aside my own interests and concerns in order to do what others want.

I ask for help and nurturing only when I am ill, and then reluctantly.

I cannot tolerate seeing others in pain.

I lavish gifts and favors on those I care about.

I use sex to gain approval and acceptance.

I attempt to convince others of how they "truly" think and "should" feel.

I perceive myself as completely unselfish and dedicated to the well-being of others.

QUESTIONNAIRE #7B
COMPLIANCE PATTERNS

I assume responsibility for others' feelings and behaviors.

I feel guilty about others' feelings and behaviors.

I have difficulty identifying what I am feeling.

I have difficulty expressing feelings.

I am afraid of my anger, yet sometimes erupt in rage.

I worry to much about how others may respond to my feelings, opinions, and behavior.
I am afraid of being hurt rejected by others.

To others, I minimize, alter, or deny how I truly feel.

I am very sensitive to how others are feeling and feel the same.

I am afraid to express differing opinions or feelings.

I value others' opinions and feelings more than my own.

I put other people's needs and desires before mine.

I am too embarrassed to receive recognition and praise, or gifts.

I judge everything I think, say, or do harshly, as never "good enough."

I am extremely loyal, remaining in harmful situations too long.

I do not ask others to meet my needs or desires.

I do not perceive myself as a lovable and worthwhile person.

I compromise my own values and integrity to avoid rejection or others' anger.

QUESTIONNAIRE 8
EXPLORE YOUR STRENGTHS
Check them off and study them.

I am:

---academic ---active ---accurate ---adaptable ---adventurous ---affectionate ---aggressive ---alert ---ambitious ---artistic ---attractive ---bold ---business-like ---calm ---capable ---careful ---cautious ---charming ---cheerful ---clear-thinking ---clever ---competent ---confident ---competitive ---conscientious ---conservative ---considerate ---cool ---cooperative ---courageous ---curious ---daring ---deliberate ---determined ---dignified ---discreet ---dominant ---eager ---easygoing ---efficient ---emotional ---energetic ---fair-minded ---farsighted ---firm ---flexible ---forceful

---formal ---frank ---friendly ---generous ---gentle ---good-natured ---healthy ---helpful ---honest ---humorous ---idealistic ---imaginative ---independent ---individualistic industrious ---informal ---intellectual ---intelligent ---inventive ---kind ---leisurely ---light-hearted ---likeable ---logical ---loyal
---mature ---methodical ---meticulous ---moderate ---modest ---natural ---open-minded ---opportunistic ---optimistic ---organized ---original ---out-going ---painstaking ---patient ---peaceable ---persevering ---pleasant

QUESTIONNAIRE #9
HOW DOES MY RELATIONSHIP RATE?

With your closest relationship in mind, read carefully, first the characteristics of addictive love, then those of healthy love. Fill in the blank for each characteristic based on the following:
0 = never
1 = rarely
2 = sometimes
3 = often
4 = almost always
5 = always a few days, refer to your answers and about them

Addictive Love

---Feels all-consuming
---Cannot define ego boundaries
---Has elements of sadomasochism
---Fears letting go
---Fears risk, change, endings
---Allows little individual growth
---Lacks true intimacy .
---Plays psychological games
---Gives to get something back
---Attempts to change the partner
---Needs the other to feel complete
---Seeks solutions outside the self
---Demands and expects unconditional love
---Refuses commitment (antidependency)
---Looks only to partner for affirmation and worth
---Fears abandonment upon routine separation
---Recreates old negative feelings
---Attempts to "take care" of partner's
---Power games ("one-upmanship")

Healthy Love

---Allows for individuality
---Experiences and enjoys oneness with and separateness from a partner
---Brings out best qualities in both partners
---Accepts endings
---Experiences openness to change and exploration
---Invites growth in other partner
---Experiences true intimacy
---Feel freedom to ask honestly for what is wanted
---Experiences giving and receiving the same way
---Does not attempt to change or control the partner
---Encourages self-sufficiency of partner
---Accepts limitations of self and partner
---Does not insist on unconditional love
---Has the ability to make commitment
---Has high self-esteem and sense of well-being
---Trusts memory of beloved; enjoys solitude
---Desires, yet fears closeness
---Welcomes closeness; risks vulnerability
---Cares, but can remain detached
---Affirms equality and personal power of self and partner

Reprinted and adapted from Is It Love or Is It Addiction? by Brenda Schaeffer

QUESTIONNAIRE #10
PROBLEMS WITH DEBT?

Most compulsive debtors will answer yes to at least eight of the following 15 questions.

1. Are your debts making your home life unhappy?

2. Does the pressure of your debts distract you from your daily work?

3. Are your debts affecting your reputation?

4. Do your debts cause you to think less of yourself?

5. Have you ever given false information in order to obtain credit?

6. Have you ever made unrealistic promises to your creditors?

7. Does the pressure of your debts make you careless of the welfare of your family?

8. Do you ever fear that your employer, family or friends will learn the extent of your total indebtedness?

9. When faced with a difficult financial situation, does the prospect of borrowing give you an inordinate feeling of relief?

10. Does the pressure of your debts cause you to have difficulty in sleeping?

11. Has the pressure of your debts ever caused you to consider getting drunk?

12. Have you ever borrowed money without giving adequate consideration to the rate of interest you are required to pay?

13. Do you usually expect a negative response when you are subject to a credit
investigation?

14. Have you ever developed a strict regimen for paying off your debts, only to break it under pressure?

15. Do you justify your debts by telling yourself that you are superior to the "other" people, and when you get your "break" you'II be out of debt overnight?

If you answered yes to eight or more of these questions, the chances are that you have a problem with compulsive debt, or are well on your way to having one. If this is the case, today can be a turning point in your life. We have all arrived at this crossroad. One road, a soft road, lures you on to further despair, illness, ruin, and in some cases, mental institutions, prison, or suicide. The other road, a more challenging road, leads to self-respect, solvency, healing, and personal fulfillment. We urge you to take the first difficult step onto the more solid road now.

Reprinted with permission of Debtors Anonymous

QUESTIONNAIRE 11
WHERE'S MY FUN-TIME GOING?

Sleeping _____ hrs

Getting ready for work _____ hrs

Going to and from work _____ hrs

Total time on the job _____ hrs

Housework _____ hrs

Eating _____ hrs

Shopping _____ hrs

Misc. _____ hrs

TOTAL _____ hrs

_____________________ hrs
TOTAL available fun time
(Subtract above total from 24 hrs)

QUESTIONNAIRE #12
AM I AN ADDICT?

The following questions were written by persons recovering in Narcotics Anonymous. If you have doubts about whether or not you have a drug addiction (including alcohol), answer these questions as honestly as you can.

1. Do you ever use alone?

2. Have you ever substituted one drug for another thinking that one particular drug was the problem?

3. Have you ever manipulated or lied to a doctor to obtain prescription drugs?

4. Have you ever stolen drugs or stolen to obtain drugs?

5. Do you regularly use a drug when you wake up or when you go to bed?

6. Have you ever taken one drug to overcome the effects of another?

7. Do you avoid people or places that do not approve of you using drugs?

8. Have you ever used a drug without knowing what it was or what it would do to you?

9. Has your job or school performance ever suffered from thee effects of your drug use?

10. Have you ever been arrested as a result of drug use?

11. Have you ever lied about what or how much you use?

12. Do you put the purchase of drugs ahead of your financial responsibilities?

13. Have you ever tried to stop or control your using?

14. Have you ever been in a jail, hospital, or drug rehabilitation center
because of your using?

15. Does using interfere with your sleeping or eating?

16. Does the thought of running out of drugs terrify you?

17. Do you feel it is impossible for you to live without drugs?

18. Do you ever question your own sanity?

19. Is your drug use making life at home unhappy?

20. Have you ever thought you couldn't fit in or have a good time without using drugs?

21. Have you ever felt defensive, guilty, or ashamed about your using?

22. Do you think a lot about drugs?

23. Have you had irrational or indefinable fears?

24. Has using affected your sexual relationship?

25. Have you ever taken drugs you didn't prefer?

26. Have you ever used drugs because of emotional pain or stress?

27. Have you ever overdosed on any drugs?

28. Do you continue to use despite negative consequences?

29) Do you think you might have a drug problem?

"Am I an Addict?" This is a question only you can answer. We found that we all answered different numbers of these questions "yes." The actual number of "yes" responses wasn't as important as how we felt inside and how addiction had affected our lives.

If you are an addict you must first admit that you have a problem with drugs before any progress can be made toward recovery. These questions, when honestly approached, may help to show you how using drugs has made your life unmanageable.

QUESTIONNAIRE 13
THE GRAY AREA GAME

        In personal relationships there are many areas where there is no simple "black and white" answer. Relationships involve many gray areas where more than one answer is correct.

        But often people play the following game with each other. If the partner says "a" the other says "no, it's 'b.'" If the first partner had said "b" then the second would have insisted it was "a." There is an old song that deals with this called "Let's Call The Whole Thing Off."

        Look at your relationship and try to find gray areas where you have insisted you were "correct."

QUESTIONNAIRE #14
HOW CAREFUL WERE YOU?

1. How careful were you in following the instructions for each list and questionnaire in this chapter?

2. Did you answer every question?

3. List the answers that you consider the most important.

4. Have you changed the way you act toward others because of any of the answers? Which ones?

5. List the questions you have not yet answered.

6. Do you want to change any answers? Which ones?

7. Do you normally scan or just read parts of books?

8. How carefully did you think about your answers? Rate on a scale of 1 to 5 (0 = careless, 5 = best).

9. How much time have you spent reading the Appendixes? How carefully did you work on the lists? Rate on a scale of 1 to 5.

10. Which lists are still incomplete?

11. Were you surprised by any of the items on the lists? Which ones?

12. Did you change any list items? Which ones?

13. What changes in your self do you still have to make?

LISTS

#1 MY FEELINGS DURING SUBSTANCE USE

Write down any and all feelings and sensations you experience prior to, and during, your harmful activity, including food. See if anger, fear, tension, depression, etc. are present when you take drugs (including cigarettes and alcohol). If you are overweight, list the feelings you have while you eat and just before. This applies also to compulsive shopping, debts and relationships.

#2 MY DAILY SUCCESSES

Each day wrlte down successes, no matter how small. These can range from feeling good for a moment without help from a substance to having done one small thing this handbook suggests. Learn to recognize successes and continually "program" yourself to acknowledge them. YOU CAN JUST AS EASILY GET USED TO SUCCEEDING AS FAILING.

#3 PERSONS I KNOW WHO ARE NOT ADDICTED

1. List all of the persons you know who don't use drugs (including cigarettes and alcohol). Leave no one out of this group no matter how close or distant they might be.

2. Now eliminate those who have "activity addictions" such as shopping, workaholism, relationships.

3) Now eliminate those who are overweight.

4) Interesting, isn't it?

#4 HOW I OVERCOME URGES

List all the methods you have used to overcome urges in the past. Never mind whether or not you eventually relapsed. Just complete the list. It could include avoiding a dessert, a cigarette, driving over the speed limit, whatever. What is important is that you recognize your already known techniques. Give this list serious thought throughout the day today and come back to it often. Ask others around you what they do to overcome urges. (If you get any interesting or unusual strategies, please send them to us using the contact box on the Table of Contents page.)

#5 PAST FUN

List as many of the things as you can that you have done in the past to have fun. Think back to your childhood and try to remember what you enjoyed. Think of your teen years and your adult years. Use Appendix 1 for further help.

#6 100 BIG & LITTLE THINGS I KNOW HOW TO DO

Make a list of things you know how to do. You will definitely get to a hundred if ou keep at it.

#7 THE WAY I WANT TO BE

Go back through this chapter and list all of the attributes you would like to be part of your total self. Include all of them, no matter how long the list.

#8 DAILY FEELINGS

This is an ongoing list of your feelings and emotions. Start it with how you feel right now. Now add any you felt earlier today. ADD TO THIS LIST EVERY DAY. Read it every day to see what feelings tend to reappear.

#9 MY PERSONAL BILL OF RIGHTS

1. I have a right to numerous choices in my life beyond mere survival.

2. I have a right to discover and know my Child Within.

3. I have a right to grieve over that I didn't get that I needed or what I got that I didn't need or want.

4. I have a right to follow my own values and standards.

5. I have a right to recognize and accept my own value system as appropriate.

6. I have a right to say no to anything when I feel I am not ready, or if it violates my values.

7. I have a right to dignity and respect.

8. I have a right to make decisions.

9. I have a right to determine and honor my own priorities.

10. I have a right to have my needs and wants respected by others.

11. I have a right to terminate conversations with people who make me feel put down and humiliated.

12. I have a right not to be responsible for others' behavior, actions, feelings or problems.

13. I have a right to make mistakes and not have to be perfect.

14. I have a right to expect honesty from unsafe or others.

15. I have a right to tell all of my feelings.

16. I have a right to be angry at someone I love.

17. I have a right to be uniquely me, without feeling I'm not good enough.

18. I have a right to feel scared and to say "I'm afraid.

19. I have a right to experience and then let go of fear, guilt and shame.

20. I have a right to make decisions based on my feelings, my judgement or any reason that I chose.

21. I have a right to change my mind at any time.

22. I have a right to be happy.

23. I have a right to stable healthy relationships of my choice.

24. I have the right to my own personal space and time needs.

25. I have a right to cry.

26. I have a right to be relaxed, playful and frivolous.

27. I have a right to be flexible and be comfortable with doing so.

28. I have a right to change and grow.

29. I have a right be open and understood by others.

30. I have a right to make friends comfortable around people.

31. I have a right to be in a non-abusive environment.

32. I chave a right to be healthier than those around me.

33. I have a right to care of myself, no matter what.

34. I have a right to grieve over actual or threatened losses.

35. I have a right to trust others who earn my trust.

36. I have a right to forgive others and to forgive myself.

37. I have a right to give and receive unconditional love.

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