RecoveryRoadMap.com Supporting Recovery from all Addictions

Applying to be a Client

Virtual Treatment Program

Hi, thanks for caring enough about your self to apply to take the Virtual Treatment Program.

Once you are accepted as a client, we will then direct you to a series of online forms such as this one that will have various questions for you to answer and areas to provide your feedback and opinions. These will be sent to our counselors via email, who will then respond back to your via email within a reasonable time frame. As you progress through each recovery step, you will be directed to the next online form and treatment information page on your journey across the Recovery Road Map.

Acceptance of Client Responsibility:

By applying to take this program and submitting this form as acceptance of the following terms: You hereby agree that you will remain 100% responsible for your participation, your progress and the choices and decisions you make throughout the duration of this program. This website is in no way liable or responsible in any way for your current state, your recovery process, or your thinking, feelings, actions, or any guarantee of a change in your current situation in life. You acknowledge that no matter what outside help you receive you will always remain utterly and completely responsible for your life state.

The role of Virtual Counselors:

The online counselors shall act as virtual guides providing support and assistance as you walk along on your journey towards recovery and discovery. This program will require hard work at times, but will hopefully also be a source of joy and inspiration, and accomplishment as you progress along recovery road at your own pace and as you are willing to take the steps necessary to free yourself from the addictions that are preventing you from "being the best that you can be!"

Is there an additional cost?

If our counselors are able to help you improve the quality of your life and you wish to make an additional donation to the site great, however there is no obligation beyond your basic membership fee.

Please enter the NAME you wish to use:

Please enter a valid Email Address:

Before you begin...

1. What kind of help do you want from this Virtual Treatment Program?

Please describe the addiction or addictions that you are struggling with, and what you hope this program will help you accomplish.

2. What do you think is the most significant road block to your being able to live drug free?

3. Which of the following areas would you like to be a part of your program?

 Pro’s and Con’s of substance use or other addictive behaviors.
The process of drug addiction, and how someone ends up addicted.
Learning how to make healthy decisions about substance use now.
Learning how to make better future choices and learn from your past mistakes.
How substance use affects your major life areas.
How  substance use affects your thinking, feelings, urges, actions and reactions.
How  substance use affects your self-esteem.
How  substance use affects your family, friends and other relationships.
How to deal with past hurts (mentally, emotionally, physically, sexually).
Learning how to cope with social pressures. Learning assertiveness skills.
Understanding society’s messages about substance use, and how these messages effect what you personally believe.
Building a support system (professionals, family and friends) to make changes in your life.
Setting Goals - have a plan, short term, long term, re-evaluating your strategy.
Learn how to deal with your cravings and triggers.
Learning how to stay clean and sober. Finding a new way to live.
Telling your story, about why you drink or use drugs, and reading other clients’s stories.
Creating a relapse prevention plan - before you get into trouble.
If you do relapse and use alcohol or drugs, how you can stop and begin recovering again.

4. What else would you like to see in your "custom-designed addiction program"?