Living in Balance

Adults with substance use disorder

Living in Balance is a recovery skills program designed to teach adults about substance use disorder and to develop lifelong skills to manage their recovery. Sessions focus on concepts such as recurrence prevention, peer support, and the intersection of mental health challenges and addition, as well as practical matters like personal finance, health and wellness, family relationships, and problem solving. Each session includes accessible informational text, comprehension questions, and personal reflection questions; sessions may be covered with patients individually or in groups. The program is available in print and digital formats, both of which include guided meditation and visualization activities. Core program sessions available digitally also include slideshows that enable counselors to deliver presentations to patients. The complete Living in Balance collection consists of three parts: 12 Core Sessions; 25 Recovery Management Sessions; and 8 Co-occurring Disorders Sessions.

Abigail Karels, MA

• Agency/Affiliation: Hazelden Publishing
• Website: https://www.hazelden.org/store/item/628345?Complete-Living-in-Balance-Collection%2C-Revised-and-Updated-2025-Version
• Email: akarels@hazeldenbettyford.org
• Phone: (651) 213-4814

The goals of Living in Balance are:

• Describe ways in which alcohol and other substances affect feelings, behaviors, thinking, and physical health
• Relate the stages of change to one’s own recovery journey
• Explain triggers and cravings and develop recovery skills to help prevent a recurrence of symptoms and understand that return to use, also called a relapse, is not a failure but rather a sign that a treatment plan needs adjustment
• Recognize the value of peer support groups, explore available options (including Twelve Step and secular offerings), and understand the importance of finding a suitable peer support group and participating in it consistently
• Identify healthy activities and ways to spend leisure time in recovery
• Explain how substance use disorders and mental health symptoms and/or mental health disorders often intersect
• Relate spirituality to addiction
• Develop coping skills to manage stress, anger, and other negative emotions
• Understand how to maintain a healthy recovery from substance use disorder while also managing pain from chronic disease
• Explain the role of medication for mental health conditions and recognize that it can be beneficial to the recovery process

The essential components of Living in Balance include:

• 45 patient-centered sessions
• Each session is a 25-40-page PDF that includes:
  • Informational text (written for the patient, in accessible language)
  • Comprehension questions
  • Reflective and/or discussion-based questions
• The sessions are divided among three programs:
  • Core (12)
  • Recovery Management (25)
  • Co-occurring Disorders (8)
• Facilitator guides for each program, as well as an audio file (USB) that contains a meditation and visualization exercise:
  • Available in print or digital formats
  • Printable patient sessions in the print collection from the USB that comes with the facilitator guide
  • Digital patient sessions available through an annual subscription to Hazelden Betty Ford’s Behavioral Health Digital Experience:
    • The 12 Core sessions on the digital platform include slideshows that clinicians can present to patients live or virtually
• A specific session topic list follows:
  • Core Program Sessions:
    • Session 1: Definitions, Terms, and Self-Assessment
    • Session 2: Alcohol and Other Drug Education
    • Session 3: Triggers, Cravings, and Avoiding a Return to Use
    • Session 4: Planning for Sobriety
    • Session 5: Alcohol and Tobacco
    • Session 6: Spirituality
    • Session 7: Sex, Alcohol, and Other Drugs
    • Session 8: Stress and Emotional Wellbeing
    • Session 9: Skills for Reducing Stress
    • Session 10: Negative Emotions
    • Session 11: Anger and Communication
    • Session 12: Recurrence-Prevention Basics
  • Recovery Management Sessions:
    • Session 13: Intro to Self-Help Groups
    • Session 14: The Twelve Steps
    • Session 15: Sexually-Transmitted Infections
    • Session 16: Focus on AIDS
    • Session 17: Nutrition and Exercise
    • Session 18: Physical Wellness
    • Session 19: Problem Solving
    • Session 20: Thoughts and Beliefs
    • Session 21: Human Needs and Social Relationships
    • Session 22: Family Matters
    • Session 23: You and Your Parents
    • Session 24: Child Development and Parenting Skills
    • Session 25: Educational and Vocational Goals
    • Session 26: Money Management
    • Session 27: Insurance and Consumer Credit
    • Session 28: Sexual Abuse
    • Session 29: Compulsive Sexual Behavior
    • Session 30: Addiction and Loss
    • Session 31: Grief: Responding to Loss
    • Session 32: Spirituality and Recovery
    • Session 33: Advanced Recurrence Prevention
    • Session 34: Medication and Twelve Step Recovery
    • Session 35: Chronic Pain and Opioids
    • Session 36: Chronic Diseases
    • Session 37: Older Adults
  • Co-occurring Disorders Sessions:
    • Session 38: Effects of Substance Use on Mental Health
    • Session 39: What Are Co-occurring Disorders?
    • Session 40: Comprehensive Treatment and Medications for Substance Use Disorders
    • Session 41: Phases of Recovery
    • Session 42: Mutual Self-Help Groups and Co-occurring Disorders
    • Session 43: Twelve Steps for Co-occurring Disorders
    • Session 44: Important Information about Mental Health and Medications
    • Session 45: Recurrence Prevention

Child/Adolescent Services

Living in Balance directly provides services to children and addresses the following:

• Substance abuse, lack of substance education, mental health symptoms (e.g., anxiety, depression, anger, negative emotions), mental health disorders, stress, triggers and cravings, sex and addiction, relapse (i.e., recurrence/return to use), poor physical health and nutrition, chronic health problems, grief and loss, lack of spirituality, compulsive sexual behavior, poor social relationships, poor family relationships, HIV/AIDS, lack of problem-solving skills, chronic health challenges, lack of peer support, lack of education regarding prescription medications

Recommended Intensity

1-4 weekly 75-minute sessions

Recommended Duration

3-8 months

Delivery Settings

This program is typically conducted in a(n):

• Community Daily Living Setting
• Community-based Agency / Organization / Provider
• Group or Residential Care
• Hospital
• Justice Setting (Juvenile Detention, Jail, Prison, Courtroom, etc.)
• Outpatient Clinic
• Shelter (Domestic Violence, Homeless, etc.)
• Virtual (Online, Smartphone, Zoom, Telephone, Video, etc.)

Homework

This program does include a homework component.

Clinicians may assign portions of sessions to be done independently, as homework. Sessions may be completed during group or at home.

Languages

Living in Balance has materials available in the following languages other than English:

• Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed in this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

• Printers, comfortable space for a group (tables and chairs, or couches)
• Projector and/or computer with a projection screen
• Writing utensils, notebooks/writing paper
• Personnel: At least one counselor who is familiar with Living in Balance and comfortable facilitating sessions

Prerequisite/Minimum Provider Qualifications

Addiction counselors, psychologists, psychiatrists, addiction nurse specialists, and other behavioral health professionals who provide addiction treatment services (LADC, CADC, LCSW, LMFT, LMHC, etc.); some sessions can be led by peer support specialists, but generally a facilitator should have some licensure in addiction or mental health treatment.

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Manual details:

• Danya International, Inc. (2025). Living in Balance: Moving from a life of addition to a life of recovery. Core program. Hazelden.
• Danya International, Inc. (2025). Living in Balance: Moving from a life of addition to a life of recovery. Recovery sessions. Hazelden.
• Danya International, Inc. (2025). Living in Balance: Moving from a life of addition to a life of recovery. Co-Occurring disorders sessions. Hazelden.

All 3 manuals are sold as a package to create the Living in Balance Collection: https://www.hazelden.org/store/item/628345?Complete-Living-in-Balance-Collection%2C-Revised-and-Updated-2025-Version 

Facilitation resources are embedded in the digital version of the program available via subscription.

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

A two-day virtual open-enrollment training on Living in Balance is offered twice a year.

There are fidelity measures, and implementation support is offered.

Number of days/hours:

Two days; 7 hours each day

What is included in the Relevant Published, Peer-Reviewed Research section? 

• Hoffman, J. A., Caudill, B. D., Koman III, J. J., Luckey, J. W., Flynn, P. M., & Hubbard, R. L. (1995). Comparative cocaine abuse treatment strategies: Enhancing client retention and treatment exposure. Journal of Addictive Diseases, 13(4), 115–128. https://doi.org/10.1300/J069v13n04_01 

  Type of Study: Randomized controlled trial

  Sample:

  Age — Not specified

  Participants: 303

  Race/Ethnicity — 95% African American

  Gender — 68% Male

  Status — Participants were cocaine-abusing clients.

  Location/Institution: Outpatient cocaine abuse treatment program in Washington, D.C.

  Summary:

  The purpose of the study was to explore the clinical utility of providing a series of enhanced clinical services to a sample of cocaine-abusing clients (primarily crack smokers) relative to a standard group therapy treatment program. Participants were randomly assigned to one of six 4-month treatment conditions: (1) Standard Group Therapy only (SGT); (2) Standard Group Therapy with Individual Psychotherapy (S-I); (3) Standard Group Therapy with Individual Psychotherapy and Family Therapy (S-I-F); (4) Living in Balance Program (LIB) [Intensive Group Therapy only (IGT)]; (5) Intensive Group Therapy with Individual Psychotherapy (I-I); and (6) Intensive Group Therapy with Individual Psychotherapy and Family Therapy (I-I-F). Measures utilized include a questionnaire that focused on participants’ functional status at the time of discharge; treatment and other services they received since discharge; substance use; relapse; and other posttreatment outcome measures, such as employment, illegal activity, psychiatric symptomatology, health status, and social functioning. Results indicate that clients who were randomly assigned to the SGT condition, relative to all other treatment conditions, were much more likely to drop out of treatment in the first week, to remain in treatment for much less time overall, and to attend far fewer sessions than clients assigned to other forms of treatment. Findings also specifically suggest that providing more frequent and intensive group therapy services, relative to standard group therapy, enhances client retention and leads to a substantial increase in treatment exposure rates. Results also demonstrate that adding enhancements to standard treatment services, such as the individual psychotherapy and individual psychotherapy plus family therapy conditions examined here, will lead to significant improvements in clients’ retention and treatment exposure and will likely enhance the clinical efficacy of the treatment services provided. In addition, findings suggest that adding enhancements to cocaine abuse treatment, such as increasing the frequencies of group therapy services provided or adding individual treatment services to standard group therapy, will contribute significantly towards enhancing client retention and treatment exposure in cocaine abuse treatment. It was also shown that an intensified group therapy treatment program, namely the LIB program, was also superior in this regard to the most significantly enhanced standard group treatment program examined. Limitations include the limited generalizability due to participant gender and ethnicity.

  Length of controlled postintervention follow-up: None.

• Clearinghouse for Military Family Readiness. (2024). Living in Balance. https://www.continuum.militaryfamilies.psu.edu/program/fact_sheet_848 

• SAMHSA. (2015). Living in Balance. National Registry of Evidence-based Programs and Practices. https://www.georeentry.com/wp-content/uploads/what-works-living-in-balance.pdf

• Skypoint Recovery. (2024). Living in Balance Curriculum.  https://skypointrecovery.com/aftercare/living-in-balance-curriculum/