Counseling, Intervention & Assessment Services

Treatment & Support For Individuals & Families Affected By Substance Abuse

​​Sample Boundaries Agreement

Following are simple and reasonable boundaries that give us all structure and allow you to heal and grow. I/we love you and want you to succeed in everything you do. I/we will support your efforts so long as you respect the following:

  1. You remain clean and sober.
  2. No alcohol or other drugs in your possession, at home, on property or in car.
  3. So long as you test dirty for drugs, you cannot use the car/phone/etc.
  4. You submit to weekly testing on a random basis to stay accountable and rebuild trust.
  5. In order to support your efforts, you will receive weekly chemical dependency counseling starting today. You agree to follow the treatment plan developed by the therapist.
  6. To ensure you are in good health, you must be accessed by a psychiatrist and a medical doctor. The assessments must take place within two weeks, and you must follow the recommendations.
  7. (Note: Other boundaries might involve homework, grades, employment, curfew, chores, allowance, relationship with friends etc.)

These boundaries are all or nothing. Choosing to ignore any one of these boundaries - even once - is to choose drugs over sanity. There are consequences for choosing insanity. Consequences for violating any of the boundaries are as follows:

  • Inpatient rehab for a minimum of 30-days, or moving out of the house immediately and assuming all your own expenses. If you choose to move, all the locks on the doors will be changed and all your personal possessions will be placed in bags on the driveway for you to retrieve. If they remain unclaimed in one week, they will be donated.
  • Absolutely no monetary or other help from any family member. That includes no bail or attorney, should you be arrested.
  • No phone, car, auto insurance, Xbox etc.
  • If you come to the house, I/we will call the police immediately. I/we will no longer accept your phone calls or respond to your texts or emails. The only exception will be if you call to say you choose inpatient rehab. Then I/we will get you to treatment.
  • If you give the impression you might harm yourself, I/we will call 9-1-1 immediately.

Should you choose insanity, I/we suggest you call the local Health and Human Services Crisis Line at _______________________________________ for information on free County resources, including motel vouchers, shelters, detox, counseling, food banks, clothing, medical care and suicide prevention.

I/we realize I/we have an issue with "enabling" unhealthy behavior. As a result I/we commit to working a program of Al-Anon by going to meetings, reading, getting a sponsor and affording you the dignity of resolving your own messes in the future.

It is my/our hope that you use this opportunity to get sober, grow, find your passion in life and get back on your feet financially.

_______________________________________               _______________________________________
Name                                                                                 Name

_______________________________________               _______________________________________
Signature/Date                                                             Signature/Date

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