Name: _________________

Date: __________________
Step 1 Worksheet
Step One: “We admitted we were powerless over
alcohol/drugs, that our lives had become
unmanageable.”
Powerlessness:
7. Preoccupation – Describe how you worry or think about
drinking or using.
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8. List all attempts you have made to quit or control your
drinking and using.
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9. Give specific examples of the destructive behavior you have
caused. Include the behavior toward yourself and others in
your life related to your drinking or using.
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10.List specific examples of odd or insane behavior, loss of
 memory, or anger induced by your use of alcohol or drugs.
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11.How has your drinking or using affected your character?
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12.How has your drinking or using affected your reputation?
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13.How has your drinking or using affected your financial
situation?
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14.List any legal problems that you have had due to your use of
 alcohol or drugs. Include any accidents, arrests, and
dangerous situations you have placed yourself in.
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15.List any personal life goals that you have had and the effect
your alcohol and or drug use has had on these goals.
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10. What uncomfortable feelings are you experiencing right
now?
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11. What does being powerless over alcohol and drugs mean to
you?
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Unmanageability:
16.List any classes, treatment centers, detox centers, or
counseling that you have had due to your alcohol or drug
use?
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17.Describe your current physical and emotional condition.
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18.List any examples of family, employment, and social
problems caused by your use of alcohol or drugs.
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19.What does being unmanageable over alcohol and drugs mean
to you?
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20.Does the spiritual nature of self-help programs (A.A., N.A.)
present a problem for you? Describe what spirituality means
to you.
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21.Answer the following:
a. What is your current living situation?
 b. Are you satisfied with it?
c. Who is in your support system?
d. Describe the purpose of your life at this point.
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22.Are you powerless over your alcohol and drug use and is
your life unmanageable? Please explain.
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Reviewed by: ____________________________________________________________

Staff Signature

Completed by: ___________________________________________________________

Client signature