As I tell my patients all the time: you didn’t use drugs because you were ignorant, you used drugs because they were helping you with something. Until they weren’t.

As Russell Brand, the British comedian, author, and activist says, “A counselor at the treatment centre where I got clean, herself a woman in recovery, surprised me when she said, ‘How clever of you to find drugs. Well done, you found a way to keep yourself alive.’” (Recovery: Freedom From Our Addictions)

Of course, by the time people with Substance Use Disorders come to the Coleman Institute for Addiction Medicine to detox off various opiates (heroin, fentanyl, variations on oxycodone and hydrocodone such as Percocet®, Roxicet®, Vicodin®, etc., and the long-acting players such as methadone and buprenorphine products) the help the drugs may have offered earlier, is no longer helping. Now the drugs have become a problem. A prison. A death sentence.


When people recognize they must stop their drug of choice, but are still ensnared by the opposing, compelling reasons to use, I suggest they fill out a Cost Benefit Analysis (CBA). This is a tool from SMART Recovery®. SMART Recovery® is an international non-profit organization that provides assistance to individuals seeking abstinence from addictions. SMART is an acronym for Self-Management and Recovery Training.

Here’s how it works, and this is taken directly from the SMART Recovery website:

Divide a piece of paper into four squares, and label the squares for each of the questions below, and list your answers. Then consider if you are getting the results you’re looking for, or if change might be something to consider.

1. What do I enjoy about my addiction, what does it do for me (be specific)?

List as many things as you can that you like about whatever you are addicted to.

a. Where possible, find alternative ways of achieving the same goals.
b. Recognize positive thinking about the addiction as a potential relapse warning sign.
c. Realize that there are some things you like about the addiction you will have to learn to live without.
d. List what you enjoy about your addiction so you can ask yourself if it is really worth the price.

Realize that you aren’t stupid; you did get something from your addiction. It just may not be working on your behalf anymore.

2. What do I hate about my addiction, what does it do to me (give specific examples)?

List as many of the bad, undesirable results of your addiction as you can. Here it is extremely important that you use specific examples. Specific examples have much greater emotional impact and motivational force!

a. Ask yourself honestly “If my addiction was a used car, would I pay this much for it?”
b. Review this list often, especially if you are having a lot of positive, happy thoughts about all the great things your addiction does for you.

3. What do I think I will like about giving up my addiction?

List what good things you think/fantasize will happen when you stop your addiction.

a. This provides you with a list of goals to achieve and things to look forward to as a result of your new addiction-free lifestyle.
b. This list also helps you to reality test your expectations. If they are unrealistic, they can lead to a disappointment based relapse.

4. What do I think I won’t like about giving up my addiction?

List what you think you are going to hate, dread or merely dislike about living without your addiction.

a. This list tells you what kinds of new coping skills, behaviors and lifestyle changes you need to develop in order to stay addiction free.
b. It also serves as another relapse warning list. If all you think about is how much life sucks now that you are not doing your addiction, you are in a relapse thought pattern that is just as dangerous as only focusing on what you liked about your addiction.

The creators of the tool suggest that this be an organic document. It becomes more powerful as one continues to review and add to it, the farther one moves into recovery or considers recovery. It is also a very helpful document for a person to bring to a recovery meeting or to their therapist to jumpstart conversations about urges, coping skills, or other observations.

If your analysis reveals you are ready to stop using your drug of choice, please give us a call. The Coleman Institute for Addiction Medicine provides accelerated opioid and alcohol outpatient detox programs around the country. We have helped thousands of people to extend their list in favor of recovery.

Joan R. Shepherd, FNP