Relapse Prevention Tips

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Can I stay Sober On My Own?

Obtaining a Network of Recovery Support

One of the hallmark behaviors of people who relapse is failure to obtain a network of support. The addicts tendency is to isolate, withdraw and to be convinced that he/she "has this taken care of on my own." That is an automatic prescription for relapse, because the addict thought processes are constantly searching for a way to make you drink, drug, and ultimately die. For this reason, it is crucial that you connect with both program members and non-program members (for example, a sister or friend who does not have a drinking problem, but whom is very supportive of your seeking help) so that you have healthy people (and healthy thoughts) surrounding you.

Be honest with the people you trust about your efforts and verbalize your need for their support. This practice will feel awkward at first, but you will be surprised how many people really care about you and want you to be well.

   
How Do I Deal with Cravings?

Relapse Prevention: Have a Plan

One of the inevitable aspects of lifelong recovery from alcohol/drug abuse is that you will have cravings from time-to-time. The average craving only lasts about 60 seconds. It is the indulgence in the thought or the possibility of use that makes a negative thought or craving last for days on end. It is important that you have a plan in place for such moments. Here are some plan-in-place ideas:

  • Have several support people on speed dial. This way, if one isn't available when you call, you can call someone else, and you don't have to take the time to find any numbers.
  • Stand Still. If you are standing in the middle of the street, you can't do anything silly (like drink or use).
  • Just start running. Even in place. Again, this may sound silly, but you can run this thought off by focusing on something else.
  • Have a round the clock list of meetings on hand. Go to one immediately if you can.
  • Do the dishes.
  • BREATHE through the feeling

   
What Should I Consider in My First Year of Drug/Alcohol Recovery?

Early Relapse Prevention: Avoiding Major Life Changes When Possible

One of the common features of alcoholic/addict behavior is the tendency to seek impulsive and often self-defeating highs. This tendency can manifest itself in more than just drug/alcohol use. The first year of sobriety can often be more painful than the fun (or even painful) days of using, because the alcoholic/addict is so used to numbing and avoiding painful feelings. If a person is really focusing on his/her recovery, those painful feelings will soon come to the surface.

The tendency is for the person in early recovery to medicate these feelings by causing chaos or excitement in other areas of his/her life. Major geographic, job, relationship, financial, or lifestyle changes are highly discouraged in the first months and year of recovery. This suggestion is very hard for a person in early sobriety to grasp, as he/she is accustomed and even programmed to do something to escape feelings.

Note: For unavoidable changes, like getting fired, a partner leaving you, losing your home, death of a loved one, it is essential that you seek the support of other sober friends, a sponsor and possibly a mental health professional to cope with your situation and to avoid relapse.

   
How Do I Cope With Triggers in Relapse?

Know Your Triggers for Drug/Alcohol Use

A "trigger" is something that prompts one to think about, crave, and ultimately relapse on drugs/alcohol. Triggers vary depending on the alcoholic/addict and his/her history and patterns of use. For example, some alcoholics cannot go to bars after they get sober (at least for a long time), because it makes them think about the "romantic" aspects of their use. Others are fine in bars, because they always drank alone in their apartments.

Other common triggers for use are sex (or unhealthy emotional entanglements), other addictions to things like shopping, food, and work, or being in touch with former using friends. While each addict has much in common, each addict has differing patterns of use. It is suggested that you make a list of your past use "triggers" and be sure to avoid them at all costs. If you need to be in a particular situation (and as the Big Book of AA says, "if you have a legitimate reason for being there") then check with sober friends and/or a sponsor to get suggestions for coping.

It is also recommended that those of you in your first year of sobriety read the book Living Sober: Some Methods AA Members Have Used for Not Drinking, as it has a lot of details and suggestions regarding common trigger situations and alternative coping skills (other than alcohol/drug abuse)

   
How will 12-Step Meetings Contribute to my Drug Relapse Prevention?

Twelve-Step Meetings as a Part of Relapse Prevention

A major factor in obtaining long-term sobriety (from any drug or alcohol) is membership in a 12-Step Program. If your drug of choice is crack/cocaine, it is suggested that you attend Cocaine Anonymous (when available to you), coupled with Alcoholics Anonymous (for a larger and stronger network of support). These programs work because you are surrounded with an instant network of people who understand the exact feelings, thoughts and behaviors you have, are and will experience.

It is suggested that you attend a variety of meetings in your area so that you can find a group or several groups that work for you. A home group (which means a group that you attend every week at the same time) is suggested, so that accountability and consistent support can be accomplished. To find a list of meetings in your area to to alcoholics-anonymous.org

   

Maintenance

So, you've been sober for awhile. It seems like things are easier every day..and then, there it happens, you fall into a spiral of depression and the "poor me's." As the saying goes, "Poor me, poor me, pour me another drink..."

Addicts in recovery don't get the luxuries that others get...self-indulgence, self-pity, delusional thinking, you know...all the fun stuff! That being said, what is a "passerby" of emotions for the average Joe is a death wish for the recovering alcoholic or addict.

So, at first site of these negative thoughts, make sure to take some positive actions BEFORE the relapse occurs. Increase meetings, call your sponsor, do something nice for someone else and by golly DO THE DISHES.

   
What are Common Trends in Drug Relapse?

Drug Relapse Statistics/Trends

According to the educational text Substance Abuse Counseling: Theory and Practice (2005), "Some believe that the 'most common treatment outcome for alcoholics and addicts is relapse.'" (291; Dimeff & Marlatt, 1995, p. 176). This fact remains true, even 12 years after this quote was initially published.

According to AA, relapse involves the resuming of pre-recovery use/behaviors and the need to start again from the beginning of the recovery process. Even if you have 29 years sober, if you relapse, you are back at square one and step one. And sometimes, people who relapse never get another chance to recover.

A "dry" addict/alcoholic is someone who simply ceases use, but does not embark on any of the mental, physical and even spiritual changes that are suggested for an optimal life experience. A "recovering" addict is someone who not only ceases use, but who works hard to change his/her history of distorted thinking, negative repetitive (and self-destructive) behaviors, and seeks a network of support through which he/she can give and receive assistance.

It is strongly suggested that you be aware of the following sure signs of potential relapse during your recovery:

  • Getting involved in other compulsive/impulsive behaviors or addictions (i.e. eating too much, sleeping around, shopping constantly, or even becoming obsessed with AA)
  • Being unaware of your feelings/needs and/or not meeting your basic needs. It is important to eat, sleep, rest and have play time in-between work and recovery time.
  • Closed mindedness or a refusal to try a new way of viewing the world.
  • Continuing to hang around the same people and embark on the same people and expect things to turn out differently

   
Are there any recovery alternatives to Twelve-Step Treatment?

Recovery Choices Outside of Twelve-Step Programming

It is my repeated clinical experience that the most effective way for anyone to recover from addiction/alcoholism is through 12-step programs. That being said, I also believe in presenting my clients with a variety of options. Excellent resources to couple with 12-step programs are Residential Treatment (especially for those with a history of relapse), sober Halfway House Living, Intensive Outpatient Therapy, and even Inpatient Treatment for those in the very first stages of recovery.

Other treatment modalities, such as Harm-Reduction (most often used in treatment of the chronically mentally ill), Rational Recovery, Social Skills Training, or Cognitive Behavioral Therapy (to name a few) are also options to consider. More information on these can be obtained both online and at any larger library. It is important for you to do the research yourself, talk to people with similar experiences, and decide what form of treatment can help you lead a happy, healthy and drug/alcohol free life!

   
How does the idea of spirituality fit into relapse prevention?

Finding a Spiritual Connection to Avoid Relapse

Some people have a difficult time grasping the concept of a "Higher Power" suggested in 12-Step programs. The good news is that there is no spiritual or religious requirement for membership in such a group. The only requirement is your desire to stop using drugs and/or alcohol. Anything else is something that each person tailors to meet his/her needs. It is suggested that one find some sort of spiritual connection in maintaining sobriety. It can be a tree, a shoe, a crab-cake, or a good orderly direction (note the usage G.O.D. as an acronym).

   
How Do I Select a Sponsor?

How to Pick a Sponsor

One of the major components of any drug rehab program is the presence of a "sponsor." The sponsor is the person who essentially looks after the person in rehab and helps through their 12 steps. Before choosing a sponsor, it is suggested that you go to various meetings (especially early on) and listen and watch the members there. If you like what someone has to say (or think you'd like the recovery they seem to have), then get to know him/her a bit better. Ask that person to coffee and find out what you have in common, and find out his/her focus in the 12-step program. Additionally, it is suggested that you work with someone who has worked through the 12 steps already.

   
Can I seek Professional Help as Part of My Relapse Prevention Plan?

Professional Help in Relapse Prevention

Many people attempting to get sober have long struggled with other forms of mental illness. Such manifestations can range from mild, ongoing depression to Generalized Anxiety Disorder, to extreme cases of Paranoid Schizophrenia. These are serious forms of mental illness and cannot be treated individually or even with a 12-step treatment alone.

It is suggested that you seek the support of a psychiatrist and/or a therapist (note: most psychiatrists are excellent at medication management, but not therapy, so a separate counselor is suggested if it is within your budget). Most cities have local mental health centers that offer discounted rates for such services. If you do opt to seek professional help, however, it is essential that you tell your provider(s) that you are a recovering alcoholic. This way, you will not be prescribed any other drugs to which you can become addicted.

Note: If you find a sponsor or group of 12-step members who tell you that you cannot have a therapist or take medication, think again. This sect of the recovery program is not supported by the World Service Office of Alcoholics Anonymous. Twelve-step programs are self-help groups, not a group of medical professionals. If seeing a doctor makes you nervous, there are plenty of recovering psychiatrists/therapists that you can find through networking in your program.

   
What are some of the warning signs of a relapse?

Relapse Danger Signs

The behaviors that precede an addict's relapse follow a fairly standard pattern. Addicts and those close to them can learn to recognize and challenge this pattern. It includes:

-- Isolating oneself from others

-- Refusing to talk about one's own thoughts and feelings

-- Doubting one's ability to stay abstinent

-- Rejecting counseling, support groups, and other offers of help in the belief that one is "recovered"

-- Disturbed eating and sleeping patterns

-- Becoming overwhelmed by ordinary problems

-- Avoiding people who will give honest feedback

-- Denial of the seriousness of the addiction

-- Not complying with medication regimens

-- Outbursts of anger

   
What are diversions, and how do they help prevent relapses?

The Power of Diversions

A "diversion" is a learned behavior that can postpone or prevent a relapse when a craving strikes. Some people come up with their own diversions, but others learn them through therapy or support groups. Diversions include both emotional and physical management skills.

Because 12-step groups teach that recovery is "one day at a time," often the goal of a diversion is simply to postpone satisfying the craving. Diversions include:

-- Going somewhere else, if you are in an environment where others are using.

-- Calling a sponsor or other abstinent friend for support.

-- Writing a list of people who will be harmed if you use.

-- Writing a list of reasons you have to be grateful (for anything) right now.

-- Doing a kind deed for someone else.

-- Praying.

-- Exercising (try 10 push-ups or a brisk walk).

-- Deep breathing or meditation.

-- Eating or drinking something healthy.

-- Taking a nap.

   
Why do drug addicts have relapses?

Why Drug Addicts Have Relapses

Even after detox, many addicts continue to experience intense cravings for several months or more after use has stopped. These have a physical component, but may also be triggered by experiences such as being in a situation where you used to use drugs, or experiencing stress, anxiety, negative or even positive life events. In the early stages of recovery, almost anything can be a trigger -- a song on the radio, the smell of cigarette smoke.

Managing these cravings without using drugs is one of the primary goals of treatment. The addict may not be able to help having the craving or being in the specific life situation, but the choice to use is a voluntary one. Effective treatment focuses on teaching the addict that she has other choices, and training her to make them when a craving strikes.

Common reasons for relapse include:

-- Inadequate treatment that clears the body of drugs but does not address the person's skills for managing cravings.

-- Treatment that does not provide ongoing support to the addict in building a social and economic life away from drug-using environments.

-- Failure to treat underlying conditions such as depression, anxiety, attention-deficit disorders, or chronic pain.

   
What role does therapy play in relapse prevention?

The Role of Therapy

Therapy for recovering addicts can provide direction and coaching geared toward the individual. In many cases, even a motivated addict may slide back into using without therapy to replace old patterns of behavior with new ones.

Effective therapy will help the user identify high-risk situations, then teach skills for avoiding or coping with such situations. If a relapse does occur, the therapist can work with the user to analyze the triggers and patterns that preceded it, resulting in an ongoing learning process.

The work of relapse prevention also helps the recovering addict deal with the reactions of others to the changes in his or her life. Old friends who used drugs may be scornful, or may try to tempt the addict back to familiar patterns. Family members may be doubtful that this attempt will work, or resentful of the price they have had to pay for the addiction. In some cases, therapy with supportive family members can help by educating everyone in the household about the signs of relapse and codependent behaviors that supported the addiction.

   
How can a recovering addict avoid situations associated with drug use?

Don't Feed the Tiger

Recovery experts emphasize that it is important for users to establish lives away from the people and situations they associate with their drug use.

If you used amphetamines to help you stay awake for long hours at work, then you need to limit your work hours. If you spent a lot of time getting drunk in bars, you need to find chemical-free ways to enjoy your Saturday nights. If your favorite sister smokes a joint after dinner every night, try seeing her at breakfast or lunch. If your route home from work takes you past a place you used to use, try going home a different way.

Plan ahead for happy occasions as well as stressful ones. Holidays, birthdays, and weddings may trigger relapses. Addicts and supportive family members can plan to spend these days away from toxic people and old patterns.

   
What are triggers?

Triggers

A "trigger" is anything -- a sight, a sound, a smell, a feeling -- that can inspire cravings, usually by reminding the user of past drug or alcohol experiences.

In the early days after detox, almost anything can be a trigger. Reading the news, hearing a song on the radio, seeing a TV commercial showing people in a bar having a good time, catching a whiff of marijuana as you walk past a group of people. It may be necessary to limit media consumption and come up with a list of avoidance behaviors at first to continue in recovery.

Over time, external triggers are likely to lose some of their power. The alcoholic may be able to drive past a billboard with a picture of a cold glass of beer without experiencing a craving. More insidious are emotional triggers that may have contributed to the addiction in the first place -- feelings of not belonging, or anxiety about dating, for example. These will be different for everyone, and a personal relapse prevention plan should include a list of known triggers and strategies for managing them without putting the harmful chemical in their bodies.

   
What is the role of support groups in relapse prevention?

Support Groups

By far the most common form of aftercare for recovering alcohol and drug addicts is the support group. These can be treatment groups facilitated by a professional, but many recovering addicts are encouraged to turn to Alcoholics Anonymous or other 12-step groups. One major benefit of such groups is simply providing a drug-free social outlet to people whose previous friendships are likely to have been organized around their addictions.

In some areas, there may be few or no groups such as Narcotics Anonymous that deal specifically with drug addicts, who may end up attending AA meetings. This is not ideal, as alcoholism often follows a different psychological path than drug addiction, but many people find significant benefit nonetheless.

Many treatment facilities, particularly those connected with religious organizations, have 12-step groups in place and can introduce recovering addicts to the principles of the program. For those with a genuine motivation to recover, a 12-step group can provide guidance, social support, and a spiritual route toward that goal. Many participants choose a "sponsor," a more experienced person who can act as a point of first contact in managing cravings and difficult situations. A good sponsor can help the recovering addict fight "stinking thinking," the rationalizations that make using drugs sound logical and even beneficial.

   
Are there medications to prevent drug relapses?

A Pill to Prevent Relapse?

Drug and alcohol abusers may start their addictions as self-medication for problems like anxiety and depression, or may develop such problems as a result of the addiction. Treating these conditions may help prevent relapse, but must be done with care, as some antidepressant and anti-anxiety drugs are themselves addicting.

Antabuse is meant to be a relapse-prevention drug for alcoholics, and acts by producing unpleasant symptoms such as nausea and vomiting when alcohol is consumed. Its effectiveness is limited because the relapsing alcoholic can either stop taking Antabuse or ignore the symptoms.

Naltrexone and suboxone are two drugs that act not to punish the relapsing addict, but to prevent drugs from taking effect if consumed. The addict who uses alcohol or opiates while on these drugs simply doesn't experience the same high because the relevant receptors in the brain are blocked. Some addicts report these drugs have helped them achieve successful abstinence.

In the case of some other drugs, notably methamphetamine, there is no medical way to prevent relapse, and the best known treatments involve behavioral therapy and support groups. In any case, such non-medical treatments should accompany any drug used to prevent relapse.

   
What stress management skills can be useful to people in recovery?

Stress Management

Many people use drugs to mask underlying problems in their lives -- problems that are still there once they have become drug-free. One common trigger for relapse is having inadequate skills for managing stress and anxiety.

In therapy and in working with supportive others, addicts can learn these skills. They include:

-- Dealing with uncomfortable feelings and situations when they occur, instead of letting stress build up. Often, this can be as simple as acknowledging them: "I'm unhappy that I have to work late, and I feel tired."

-- Taking pleasure in everyday life. This can include planning good meals, time for exercise, and time for hobbies or activities the person finds relaxing and renewing.

-- Attitude of Gratitude

-- Identifying support people with whom you can talk out stressful situations.

-- Planning your responses to high-stress situations (such as being offered a drink or a hit of a drug).

-- Recognizing and planning responses to stressful feelings (loneliness, anger, boredom).

   
What is a relapse?

What is a Relapse?

A relapse is a recovering addict's return to the substance of choice -- or, more broadly, to any other substance that comes between a person and their reality. A craving is not a relapse unless the addict gives in and consumes the substance.

Some people who enter recovery for alcohol or another drug may be able to maintain abstinence from the first attempt. Others will suffer multiple relapses.

Addicts and those close to them may be tempted to see relapse as a sign of weakness or failure. Experts say relapse is a part of the disease of addiction, and point to it as a learning process that can eventually lead to recovery. At the same time, it is important to take steps to prevent relapse as far as possible. With each relapse, the addict runs the risk of physical damage, legal entanglements, and dangerous behavior.

   
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