H.A.L.T.

Hungry, Angry, Lonely, Tired

In recovery it is important to stay in touch with your feelings and needs. H.A.L.T., this
tried and true slogan can help. Sometimes the onset of anxiety or a sudden change in
mood can be traced to you having forgotten to eat, forcing blood sugar levels to drop.
Other times you may be carrying resentment, or feeling lonely, or are just too tired.
Taking a little time out from a busy schedule to ask yourself if you are feeling too
Hungry, Angry, Lonely, or Tired, gets you in touch with your needs and feelings. When
you know what you are feeling, you can make choices and take the appropriate action to
get your need for food, companionship, or rest, met. Being too hungry, angry, lonely, or
tired, are conditions that leave you vulnerable to the temptations that lead you away from
your substance use goals. Part of recovery is learning to pay attention to these inner
signals and practice appropriate ways to meet your needs and resolve issues in a manner
that will enhance your substance use goals. You need to learn to communicate with your
body.

Hungry, Angry, Lonely, Tired.

These are things you are warned against when entering into recovery. When you become
too hungry, too angry, too lonely or too tired, you may seek relief in alcohol and/or drugs.
Learning to take care of yourself may be a new skill if you have been abusing drugs and
alcohol over a long period of time.
Thoughts
When you're hungry can you take the time to slow down and eat? When you're tired, can
you remember to maybe go to bed a little earlier? When you're angry can we remember to
express it in the right time and place, or recognize you're at fault? Are you actively
addressing social and personal support needs or sitting at home alone feeling lonely? Or
would you rather use?

Following are four articles addressing the needs H.A.L.T presents

HUNGRY-Substance abuse and Nutrition, Eating for Recovery

ANGRY- Anger … Manage It Or It Will Manage You

LONELINESS-Coping with Loneliness

TIRED-Tips for Healthy Sleep Hygiene

Edition Revised June 3, 2005

1
 SUBSTANCE ABUSE AND NUTRITION
Alcohol and drug abuse results in nutritional deficiencies due to:

Decreased dietary intake – Eating becomes less of a priority and results in a significant
drop in the amount of food consumed. The type and quality of food moves toward more
convenience and processed foods that are less nutritious.

Decreased absorption – As the body becomes weakened over time, its ability to absorb
the already lacking dietary vitamins and minerals becomes impaired. For individuals
abusing alcohol, the stomach and intestinal tract becomes damaged and can begin to leak
toxins and allergens into the body causing other health problems. A diet high in refined
sugars and processed foods can reduce the body’s ability to absorb fats, carbohydrates,
vitamins and minerals.

Increased use of nutrients - Stress increases the body’s need for all nutrients
particularly vitamin C, vitamin E, zinc, selenium and vitamin A. The body’s stress
regulators, the endocrine glands, require larger amounts of these nutrients to help
maintain a balanced healthy state. Once the body becomes unbalanced, it is difficult for
the mind to stay balanced and focused on the task of recovery.

Relapse can be the result of poor nutrition and unbalanced body chemistry due to
prolonged nutritional abuse. Low blood sugar, called hypoglycemia, can be a factor in
relapse. Blood sugar, or glucose, is the fuel that the brain uses to function. The body
regulates these blood sugar levels within narrow and defined ranges in order to keep the
brain working at its best. When blood sugar levels begin to drop, the individual can feel
sluggish, moody and possibly depressed and anxious. This feeling of being unbalanced
creates cravings that results in the individual re-using alcohol/drugs or reaching for
“quick” foods that are usually refined or processed and high in sugar and fat. Caffeine
and nicotine are other “quick” fixes.

Since fluctuations in blood sugar levels affect stress levels and mood, the goal is to stay
balanced by eating a healthy diet at regular times. Upon awakening in the morning,
blood sugar levels are at their lowest. A healthy breakfast is needed for balance.

© 2001. This Information has been used with the expressed permission of Michael
Desrochers R.N.C.P, director of Coal Harbour Natural Health Clinic.
www.coalharbournhc.com

2
 EATING FOR RECOVERY
Break the Fast
Your body needs energy to help you cope with the daily demands of Life. Eating food
within an hour or so of waking up can be difficult. Try tiny portions to start, such as one-
half cup milk or a piece of toast. If this is too much or if chewing food is a problem, try a
small amount of blender drink, wait an hour or so to build up an appetite and try to eat a
light, protein-based snack. Remember that it will take time to get an appetite for
breakfast but eating small portions daily, while gradually increasing the quantity, can
usually re-establish appetite within four to seven days.

Eat frequently
Start your day by eating breakfast and then have a light meal or snack about every three
to four hours after that. This provides a constant supply of energy and helps combat
fatigue, tension, mood swings, hunger and cravings. You can start to develop an appetite
by eating small frequent meals and snacks. Choose foods that you usually eat and enjoy
to re-establish a balances meal pattern

Eat a Variety of Foods

Your body needs more than 50 different nutrients each day. Eating a variety of healthy
foods from each group listed in Canada’s Food Guide to Healthy Eating will ensure that
you get enough of each essential nutrient.

A protein Snack in the morning and Afternoon

Include a protein food such as low-fat milk, cheese, yogurt and lean meats for your
morning and afternoon snacks. Protein helps to keep energy levels stable and enhances
your concentration and ability to remain alert. Eat before you feel hungry. Avoid eating
protein foods in the late evening. Instead, try light-carbohydrate foods to promote
calmness, relaxation and sleepiness.

Limit Your Intake of Caffeine

The caffeine in coffee, tea, chocolate and colas can make you nervous and irritable,
decrease your appetite, cause stomach upsets and interfere with sleep. The Average
caffeine content of Beverages varies:

Filter-drip coffee (1 cup=8oz=250ml) - 145-180mg

Instant coffee (1tsp = 5ml) - 80-90mg
Decaffeinated coffee (1 cup=8oz=250ml) - 5mg
Cola Drinks (1can=10oz=300mg) - 35-50mg
Cocoa (1 cup=8oz=250ml) - 18mg
Tea (1 cup=8oz=250ml) - 50mg

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Remember: caffeine is also found in headache remedies, allergy medications and
weight-loss products. Try to limit your caffeine intake to a maximum of 450 milligrams
per day (about three 250-millilter cups of coffee). Avoid caffeinated beverages at least
five hours before bedtime.

Tea has other positive benefits that may offset some of the negative effects of caffeine.
Black and green teas are antioxidants-the disease fighters.

Limit Your Sugar and Sweets

Sugar-rich foods are high in calories and low in nutrients. They may decrease your
appetite for regular meals and can cause rapid rises and falls in your energy levels and
leave you tired. Limiting sweets to small servings after meals can help control cravings
and avoid unnecessary weight gain.

Cut Back on Fat

Eating large high-fat meals can leave you feeling tired and can lead to weight gain and
other health problems. To energize yourself, reduce your fat intake and increase your
intake of grains, vegetables and fruits.

Hydrate Your Body with Water

Drink six to eight cups of water daily to help your body flush out toxins. This will help
enhance healing and recovery.

*Used with permission from the Centre for Addiction and Mental Health, Toronto
Canada © 2003 Centre for Addiction and Mental Health.

4
 Anger … Manage It Or It Will Manage You
By Richard Boyum
UW-Eau Claire Counseling Services

Anger is a very interesting emotion. It is much like dynamite. A little bit of it can go a
long way, but used inappropriately it can backfire and blow up in your face. Anger that is
not resolved or dissolved, or inappropriate levels of anger can lead to depression, a higher
incident of various types of accidents, broken relationships, and can also be a major
contributing factor to heart attacks and strokes in mid and later life. Keeping these
thoughts in mind, consider the following thoughts and ideas to both better understand
anger and to use I more appropriately.

1. Anger is often a function of frustration. Spend some time thinking about what you're
really frustrated about and what actions you might be able to take to handle those
frustrations.

2. Remember that, ultimately, you are responsible for your own anger. While situations
may contribute to your anger, someone else doesn't make you angry; at some point you
must accept responsibility for choosing anger over other emotions.

3. Speaking of emotions, anger is a basic emotion. There are things that are legitimate
and appropriate to be angry about, but responses to anger do not have to be hostile or
hurtful. In reality, anger is a way of protecting yourself. Spend some time thinking about
what you really want to achieve in situations where you feel anger.

4. Consider to what extent your anger response is learned. Who did you learn it from? In
what situations did it work for you in the past, but may not work for you in the present?
Realize that for some individuals there may be a genetic predisposition to anger. In
knowing this, you can make choices to keep yourself calm.

5. If you are prone to anger, rehearse appropriate and healthy responses that may be more
beneficial to your situation.

6. Realize that basic, normal, human behaviors can help you effectively manage your
anger. Getting appropriate exercise and making sure you get enough sleep can increase
the number of choices and responses you have to situations where you may find yourself
feeling upset.

7. Don not abuse alcohol and/or use other drugs. Drugs and alcohol tend to have a major
effect on the rational part of your brain. When this part of your brain is anesthetized, raw
emotion is more likely to take over.

8. Remember that you are not the content of your emotion; you are the invisible
awareness. In other words, don't think of yourself in terms of, "I am angry …", rather
think of yourself, as, "Right now I am very aware of the anger I am feeling". When you
do this, you can acknowledge your anger and somehow be a bit bigger than the feeling

5
itself. Through your acknowledgement, you can find a way to say, "That's just the way it
is, so what choices do I have now?"

9. Remember that anger can be overt, but it also can be covert, or passive-aggressive.
Passive-aggressive anger in the form of backstabbing, gossiping about individuals, or
baiting others can be as serious as more direct expressions, such as yelling at someone, or
confronting someone with overt threats. Either way, these behaviors can damage your
long-term goals. Think carefully about how you both directly and indirectly may use
anger, not to only hurt others, but also possibly hurt yourself.

10. Know that if you have a serious problem with anger, antidepressant medication and
mood stabilizers/ anti seizure medications seems to help individuals gain more
appropriate levels of control. You may want to talk with a physician or counselor, if you
think medication may be of help to you. Usually, a single consultation should give
professional enough information to help you decide whether medication is something you
would like to try.

11. Finally, remember at some level, anger is a choice. At times you may want to pick
other words, such as being bothered, upset, irritated. These words may help you get not
only at the nature of the difficulty you have, but at possible solutions that may be of help
to you.

Remember that anger is an appropriate emotion, but in our culture sometimes it is

overused. Use it carefully, and it may help you achieve your goals. Misuse it, and it will
create difficulties that will keep you from becoming the kind of person that you might
like to be. It may be of help for you to talk with a professional counselor about ways to
deal effectively with your expression of anger as an emotion. Some individuals find that
anger is a mask for fear, and once they understand that important distinction, they can
move forward in making more healthy choices. When you are angry, ask yourself, "Am I
really afraid of something happening, or not happening?" It is normal for people to feel
angry or mad, but it is also important for people to feel sad, to feel glad, and to feel
afraid. Don't let anger become an emotion that blocks the healthy expression of all of the
emotions you might feel. Hopefully, these thoughts and suggestions will help you further
explore when anger is helping you, and/or when anger hurts you.

*Article used with the expressed permission of the Author: Dr. Dick Boyum
http://www.uwec.edu/counsel/pubs/boyum.htm

6
 Coping With Loneliness
Author Cathleen Henning

Accepting it and moving on when the time is right

Loneliness may be painful and even frightening, and it may indicate a need for
introspection. Have you been feeling lonely for a long time? Perhaps it's time to make
some changes; it is possible to feel less alone. Loneliness is not a sign that you have
failed or that you will never have people in your life. It may take effort to change the way
you feel, but you can do it.

Accept it. There are many steps you can take to help yourself feel less alone, but before
you take those steps, stop and think about how you are feeling. Loneliness is an emotion,
and, as with other uncomfortable emotions, we often want to get rid of it as soon as
possible. Sometimes, though, these kinds of emotions may be learning tools. Before
rushing to eliminate loneliness, think about how you came to feel this way.
Changes are most likely in order, but think about the changes that will suit your
individual needs.

Sometimes, too, no change will eliminate loneliness. People may feel lonely even when
surrounded by loving friends and family. Time may be the only solution. You are not
flawed for feeling lonely, and, if you accept the feeling, you will find that it is not as
uncomfortable as you first thought.

Remember, too, that being alone and feeling lonely are not the same. If you are alone
these days but enjoying it, then don't feel as if you must change because other people
don't understand. Do, however, be sure that you have a support system and that you are
available to friends and family.

Reach out. If you had people to contact, you may be thinking, then you wouldn't be
lonely. Sometimes, though, when we are immersed in loneliness, we may forget about all
of our options. First, think about everyone you know and have ever known. Maybe you
think a certain friend or relative wouldn't want to hear from you. Think again -- you may
be surprised. Try contacting them and see what happens next. Be sure, however, to have a
list of possible contacts, just in case the first doesn't go as planned. Think of old friends,
too. You don't even have to tell them you're contacting them because you're lonely. Just
reach out and communicate, and you'll start to feel better. Second, if you truly believe
friends and family aren't an option, then reach out to people you don't know. You're
already on the Internet, and your options here are endless -- from chat rooms to forums to
games to pen pals.

Help someone else. A great way to spend time with people and feel good about your
contribution to the world is by volunteering. If your anxiety disorder is keeping you from
volunteering in a traditional way, use your imagination. Even going into an online chat
room and talking to someone else who is lonely is a significant way to help. If you are

7
ready to volunteer outside your home, look to places that will be anxiety-friendly: church,
hospitals, daycare or pre-schools, and nursing homes, are some examples.

Pursue your interests. Meet people who like to do what you like to do by becoming
involved in your hobbies and interests. If you already have a hobby, such as knitting, that
tends to be solitary, look for local classes or groups where you can meet other people as
well as learn more about your craft. If you've thought about an interest for a long time but
have never followed through, consider starting now. Look at your local newspaper for
classes, groups and meetings, if you need ideas. Take a nature walk. Attend a lecture at a
local museum. Take a cooking class. If you're not sure what your interests are, just start
participating until you find what you love.

Join -- or start -- a support group. Look around for a support group. Ask your therapist,
check the local newspaper, and contact local hospitals. If there aren't any for anxiety, try
a depression group. Consider starting your own support group if you can't find one; you'll
be helping yourself and other people. If you need a place to have meetings, contact local
churches, which often have space.

If you're not sure how to cope with your loneliness and you feel that it's making you
depressed, talk to your therapist about it (or get a therapist if you don't have one). Talking
about it may help you explore other issues or come up with unique ways to cope with
your individual feelings.

(c) 2004 by Cathleen Henning (http://panicdisorder.about.com). Used with permission of

About, Inc., which can be found on the Web at www.about.com. All rights reserved

8
 10 TIPS FOR HEALTHY SLEEP
1. Keep a regular sleep schedule. Our sleep-wake cycle is regulated by a rhythm in our
brain and the body's needs to balance both sleep time and wake time. That is also why it
is important to keep a regular bedtime and wake-time, even on the weekends when there
is the temptation to sleep-in. Individuals should not alter their sleep routine s by more
than 1 hr.

2. Avoid caffeine. Caffeine is a stimulant, which means it can produce an alerting effect.
Depending on the dose, caffeine products, such as coffee, tea, colas and chocolate,
remain in the body on average from 3 to 5 hours, but they can affect some people up to
12 hours later. Even if you do not think caffeine affects you, it may be disrupting and
changing the quality of your sleep. Avoiding caffeine within 6-8 hours of going to bed
can help improve sleep. Reduced caffeine can result in more restful sleep.

3. Avoid nicotine. Nicotine is also a stimulant. Smoking before bed makes it more
difficult to fall asleep. When smokers go to sleep, they experience withdrawal symptoms
from nicotine, which can cause fitful sleep. Nicotine can cause difficulty falling asleep,
problems waking in the morning, and may also cause nightmares. Difficulty sleeping is
just one more reason to quit smoking.

4. Avoid alcohol. Although many people think of alcohol as a sleep aid because of its
sedating effect, it actually disrupts sleep, causing nighttime awakenings. Consuming
alcohol leads to a night of less restful sleep. Nix the nightcap.

5. Don't eat or drink too much close to bedtime. Eating or drinking too much may make
you less comfortable when settling down for bed. It is best to avoid a heavy meal too
close to bedtime. Also, spicy foods may cause heartburn, which leads to difficulty falling
asleep and discomfort during the night. Try to restrict fluids close to bedtime to prevent
nighttime awakenings to go to the bathroom, though some people find milk or herbal,
non-caffienated teas to be soothing and a helpful part of a bedtime routine. If you are
going to eat, carbohydrates like breads and cereal may help to relax the body.

6. Exercise at the right time promotes sleep. Exercising regularly makes it easier to fall
asleep and contributes to sounder sleep. However, exercising sporadically or right before
going to bed will make falling asleep more difficult. In addition to making us more alert,
our body temperature rises during exercise, and takes up to 6 hours to begin to drop. A
cooler body temperature provides the signal that it is time to sleep. Finish your exercise at
least 3 hours before bedtime. Late afternoon exercise is the perfect way to help you fall
asleep at night.

7. Use relaxing bedtime rituals/routines. A relaxing, routine activity right before bedtime
conducted away from bright lights sends a signal to your body that it is almost time to go
to sleep and will make it easier to fall asleep. Avoid arousing activities before bedtime
like working, paying bills, engaging in competitive games or family problem-solving

9
activities. Try an activity that is relaxing, such as soaking in a hot tub, reading or
listening to music, or having a massage. Some studies suggest that soaking in hot water
(such as a hot tub or bath) before retiring to bed can ease the transition into deeper sleep,
but it should be done early enough that you are no longer sweating or over-heated. If you
are unable to avoid tension and stress, it may be helpful to learn relaxation therapy from a
trained professional.

8. Create a sleep-promoting environment. Design your sleep environment to establish the

conditions you need for sleep – cool, quiet, dark, comfortable and free of interruptions.
Also make your bedroom reflective of the value you place on sleep. Check your room for
noise or other distractions, including a bed partner's sleep disruptions such as snoring,
light, and a dry or hot environment. Consider using blackout curtains, eyeshades,
earplugs, "white noise" (fan), humidifiers and other devices. Make sure your mattress is
comfortable and supportive. Have comfortable pillows and make the room attractive and
inviting for sleep, but also free of allergens that might affect you and objects that might
cause you to slip or fall if you have to get up during the night.

9. Associate your bed with sleep only. Use your bed only for sleep to strengthen the
association between bed and sleep. If you associate a particular activity or item with
anxiety about sleeping, omit it from your bedtime routine. For example, if looking at a
bedroom clock makes you anxious about how much time you have before you must get
up, move the clock out of sight. Do not engage in activities that cause you anxiety and
prevent you from sleeping, i.e.: homework, bill payment, and workouts.

10. Limit sleep time in bed. If you do not fall asleep within 15-20 minutes of going to bed
and turning out the lights, it is best to get out of bed and do another relaxing activity until
you are feeling sleepy again. If anxiety about something you need to do prevents you
from sleeping, it is sometimes helpful to jot down notes in a "worry" or "to do" book.
Nap during the day only when needed to maintain alertness and plan on napping 20-30
minutes.

* Material Adapted from numerous freeware sources

10
 Structured Relapse Prevention—Coping Skills Exercises

Coping with Cravings

Quitting drinking or other drug use is likely to lead to cravings, especially in high-risk
situations. Learning to deal with urges and temptations is a very important part of pre-
venting relapse. We experience urges to use at different levels of intensity, which can
be viewed as being on a continuum, as illustrated below.

fleeting thoughts very strong urges

mild moderate severe

We can decrease cravings for alcohol and other drugs by using specific coping
strategies. Remember that cravings do not last forever and will decrease in number
and strength over time.
Try some of the following suggestions to help you cope:

Behaviour (What I Do) Cognition (What I Think)

• Self-monitor: Write out your thoughts and • Normalize the craving: “I am experiencing an
feelings. urge to drink/use drugs. It is OK to feel like
• Seek support: Tell someone what you are using.”
experiencing. • Use imagery (e.g., visualize the craving as a
• Distract yourself: Do something unrelated to wave that rises and falls, with you riding it out).
substance use. • Use positive self-statements (e.g., “I can cope
• Substitute another behaviour (e.g., eat some- with it,” or “I have been clean for two weeks
thing or drink a non-alcoholic beverage). and I don’t want to spoil it now.”

• Leave the situation, or do something to • Use thought stopping (e.g., picture a STOP
change it. sign).

• Take deep breaths (in through your nose, out • Think of the negative consequences of using
through your mouth) to relax yourself. alcohol or other drugs.

• Delay the response: Put off the decision to drink • Think of the benefits of not using alcohol or
or use other drugs for 15 minutes. other drugs.

Copyright © 2006 Centre for Addiction and Mental Health 81

Structured Relapse Prevention—Coping Skills Exercises

practice exercise
Now, come up with your own plan to deal with urges and temptations to use.
Be specific.
Describe a recent high-risk situation you experienced that resulted in a craving.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Using your example above, plan ways to deal with urges and temptations to use in
a similar future situation.
Whom are you going to seek support from?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
What will you do to distract yourself?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
What messages (positive self-talk) will you give yourself?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
What else can you do in this situation?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

82 Copyright © 2006 Centre for Addiction and Mental Health

Progressive Muscle Relaxation
Our bodies respond automatically to stressful situations and thoughts by becoming tense.
The opposite relationship also works: a good way of relaxing the mind is to deliberately
relax the body.

In a progressive muscle relaxation each muscle group is tensed in turn, and the tension is
then released. This relaxes the muscles and allows you to notice the contrast between
tension and relaxation.

Relaxation should be enjoyable so if any part of the exercise is too difficult skip it for the
moment. If you have any injuries you may wish to leave out that part of the exercise.

Preparation
Lie down flat on your back, on a firm bed, a couch, or on the floor. Support your head and
neck with a pillow or cushion. Alternativelty sit in a comfortable chair with your head
well-supported. Close your eyes if you are comfortable doing so.

Instructions
Focus your attention on different parts of your body in sequence. Go through the
sequence three times:

1) Tense & release: Tense that body part, hold it for a few moments, then relax

2) Lightly tense & release: Tense that body part with just enough tension to notice, then relax

3) Release only: Just pay attention to each muscle group and decide to relax it

Recommended sequence 8
1 Right hand & arm 7
(clench the fist & tighten the muscles in the arm)
2 Left hand & arm
3 Right leg 6
(tense the leg, lifting the knee slightly)
4 Left leg 1 5 2
5 Stomach & chest
6 Back muscles
(pull the shoulders back slightly)
7 Neck & throat
(push the head back slightly into the pillow/surface)
8 Face
(scrunch up the muscles in your face)

3 4

PSYCHOLOGYT LS http://psychology.tools