The creation of this Relapse Prevention Plan is meant to be an aid in your recovery.

This Featured Post is the 5th in a series of 26. It is available as a download: Click on the PDF image. Save a copy to your computer. If you missed a previous post check the sidebar to the right under ‘Free Downloadable Modules’.

Please listen up, This Is Important:

“The best plan in the world does not mean a thing unless you put into action”

Sorry about that, I didn’t mean to shout. There is a reality to be addressed here, though, and that is that a number of people relapse with a beautifully constructed plan that they never used or put into action.

Having a great plan that is not utilized, or acted on is the same thing as having no relapse prevention plan and all. No positive action occurs. You cannot help hearing at 12 step meetings the often repeated phrase, “This is a program of action”. In fact, almost every single person who returns to 12 step meetings after relapse has this commonality, they almost universally say “I stopped going to meetings and working my program”.

If you are not a big fan of 12 step groups, let me just reinterpret that last statement as saying “I stopped acting on a plan of action”.

OK, I guess that’s enough chest thumping, and browbeating, let’s get on with the show…

Onward,

Creating Your Relapse Prevention Plan

To get started we should look at the various parts of our life that Addiction has affected.

Sometimes addiction is referred to as a “bio-psycho-socio-spiritual disease”.

I know, I know, is there anything else they could have added on there to make it less understandable?
Let’s break it down:

1. Bio=Biological

Addiction definitely affects us on a biological level. It affects just about every major system within our body, and can also alter our physical activity level.

2. Psycho=Psychological

We’re definitely affected on a psychological level. It is becoming generally accepted that the majority of people with addiction have another co- occurring mental health diagnosis. In fact, there are whole groups of Mental Health diagnosis that began with “Substance induced”. Take away the substance and sometimes you lessen mental health issues.

3. Social

Addiction affects us socially in many ways. I believe that addiction is a disease of isolation, and that in order to continue using, we break more and more family, friendship, and social ties. It wreaks havoc with our relationships.

4. Spiritual

Unfortunately, addiction affects us on a spiritual level as well. Many people who believe in a Higher Power admit that they feel they have become ‘disconnected’. Another way of looking at how Addiction affects us spiritually, it is that we have started act against our moral principles and values. We are doing things we never would have imagined.

If we can agree that addiction affects us in these different life areas, then perhaps it makes sense to develop a plan that addresses each of them. We want to expand and explore concepts at a greater depth rather than simply relying only on “Just Say No” approach.

Relapse Prevention Plan Work Sheet

Grab a sheet of paper and start writing. Our starting point will to answer a couple of questions on recovery and sobriety:

1. Do you really want to get and stay sober? Are you ready to go to any lengths, to do what ever it takes, to get and stay sober?

Pay particular attention to the second part of this question. A lot of people have a desire to stay sober if it is convenient and not too hard, or does not require “giving up too much.” Are you willing to make it the number one priority in your life with no “buts”

2. If you do not remain abstinence what will be the consequences of your return to using?

Think this all the way through, examine the short-term consequences and the long-term consequences. Thinking in terms of emotional consequences to yourself, the effects your actions will have on family and friends, and the toll it will take on you physically. How difficult will it be for you to read engage in recovery should you lapse or relapse?

3. Identify your top 5 relapse warning signs, put them in order of importance.

a. (For example)…I started withdrawing from people and getting lonely

b. (For example)… I began asking myself “Is this all there is?”

c.

d.

e.

4. For each of the items identified in the previous section, write out the problems they generated:

a. Withdrawing from people – I stopped going to fun things and started to believe nobody understood me…

b. “Is this all there is?” I began to question if the amount of happiness that I had was worth all the effort.

c.

d.

e.

5. Now for each of those problems identified in #3 previously, list some action you can take to prevent the problem from expanding and getting worse. It is important to make sure that your solutions are specific, achievable, time related, and measurable if possible.

a. Withdrawing from people – I can go visit my family this weekend. I can go to a 12 Step meeting at 8:00 p.m. tonight.

b. “Is this all there is?” I can write a list of 10 things that I am grateful for right now that I did not have when I was using. I can make a list of goals and see if there realistic…

c.

d.

e.

6. List any resources you may need to employ to deal with each of the problems, and set up any groundwork needed.

a. “I can go visit my family this weekend. I can go to a 12 Step meeting at 8:00 p.m. tonight” – I’ll have to make sure that I have an open invitation to visit. I’ll have to call the local AA office and find out where the local meetings are.

b. “Is this all there is?” one of my goals is to take some courses the local community college so I call up and find out what the entrance requirements are and what courses are available

c.

d.

e.

How did you do? I’ll bet that was a little bit more difficult than you anticipated. Don’t worry, or get discouraged, the idea is that your thinking, the emotions your feeling, and action you are taking, are all working together to develop a strong foundation for recovery.

OK, let’s move on and look at the Prevention Plan or action plan that encompasses all the elements of addiction as a bio-psycho-socio- spiritual disease:

Physical Or Biological Area

One of the most basic needs that we have is to be well physically. There are certain areas that we can take a look at and things we can do to help our physical well-being. De you need to address any of the following areas? If so, write down the action you will take to address it and the time frame you will have it done by.

A) Have you had a thorough physical checkup, including blood work with a hepatitis screen?

In my view, it is critical the get tested for hepatitis. It is not commonly included in a routine blood screening. I discovered I had hepatitis after being sober for 15 years. All my doctors missed it.

B) Are you eating in a healthy manner? Do you need to change your eating habits?

Drinking alcohol, or using drugs, for an extended period of time can severely interfere with the intake of vitamins, especially vitamin B. It is a great idea to take a multivitamin every day. Eat smarter, ‘nuf said.

C) Are you getting proper exercise?

We discussed the concept of ”move a muscle change thought” when we discussed cravings, but physical exercise also releases natural ‘feel good’ chemicals in the brain.

D) Are your sleep habits regular?

If you are not sleeping regularly, you will obviously be tired (Duhhh) but, this can cause an inability to think clearly, and be more susceptible to depression and anxiety which are clearly relapse triggers. If you need help or suggestions for sleep; search on the Internet for the phrase “ sleep hygiene” and look for a website that ends in .edu ( those are generally universities are colleges) or.gov( those will be government sites).

E) Are you complying with any medications prescribed by your physician or psychiatrist?

There are two sides to kick around on this question. One thing that is not uncommon to hear from people who have relapsed when questioned about their medication compliance is “I started feeling really good so I stop taking my medication”. So, keep taking it, it’s working. Now the flip side is if the medication is not working, ask your doctor or psychiatrist to try new one. This is especially true with the anti depressants, as the reality of the situation is there are many of them and not all of them work for everyone Sometimes it is a hit or miss situation to find one that will work for you.

Psychological Area

1. Is there a possibility you may benefit from a consultation with a psychologist psychiatrist?

It is more common than not for people with addiction to have, Co -occurring mental health issues such as anxiety, depression, or eating disorders. If this is the case, you may benefit from getting help with the mental health issues along with the Addiction issues.

2. Sometimes this situation may arise which will cause us to be temporarily depressed or anxious. List five things you can do to help with depression and anxiety.

Depression:
1.

2.

3.

4.

5.

Anxiety:
1.

2.

3.

4.

5.

Social Area:

1. Boredom and isolation have been identified consistently as being contributing factors to relapse. List 5 activities, or things you can do, to help with these problem areas, and when you will start them.

1.

2.

3.

4.

5.

2. There’s a high probability that our relationships with our family have suffered. List for concrete actions you can initiate that may help repair family some relationships.

1.

2.

3.

4.

List three things you can do to protect yourself when you find yourself in social situation where alcohol is being served, or drugs are being used.

1. Make sure I have away and out, drive my own car, or go with a friend so I can leave if I need to.

2. Practice a standard answer for refusing drugs or alcohol such as” no thanks” or “the doctor said I can’t drink any more”, whatever, be concise and direct in saying no.

3. Give them all a real good eye roll and say “That is soooo last year”

Spiritual Area:

1. List any behaviors you have developed that need to be corrected that go against your sense of values or ethics when you were using are still with you. How will you correct them?

1. I became sneaky and dishonest. I will stop doing things that I need to lie about. I’ll take responsibility for my actions

2. My in action sometimes hurt people, Earl lot of things I did not do – stepped up to the role of being a man, husband, and father. Be less selfish with my time.

3.

4.

5.

2. If you feel spiritually distanced from your Higher Power, ask yourself who moved? What concrete action steps can you take to move spiritually closer to your spirituality and/or Higher Power

1. I can start mediating and trying to connect by praying daily

2. I can try to go to church, or find one I like

3. I could try helping someone out

4.

5.

3. How can I improve relationships with the following:

A) Myself

B) My family

C) My higher power

D) The community of people around me

Yeah! You Are Done!

Don’t forget there is a clean copy that you can print off in a separate PDF titled relapse Prevention Plan

In Closing:

OK, we’re done with our relapse prevention discussions and exercises. We have looked at the meaning of the process of relapse, relapse warning signs, and relapse triggers and cues. We have constructed an individualized Relapse Prevention Plan. I hope this was of value to you.

I’ll say it again… Having a great plan that is not utilized, or acted on is the same thing as having no plan and all. No positive action occurs.

“The best plan in the world does not mean a thing unless you put into action”

This Featured Post 4th in a series of 26. It is available as a download: Click on the PDF image. Save a copy to your computer. If you missed a post check the sidebar to the right under ‘Free Downloadable Modules’.

This post is a comprehensive post on relapse prevention ending with an exercise that will help you to start the development of a relapse prevention plan.

For our purposes we’re going to look at 3 stages of relapse prevention:

1. Recognizing early relapse warning signs.

2. Identifying and avoiding relapse triggers and cues.

3. Preparing our own customized Relapse Prevention Plan

In the last post, Relapse Prevention Part 1, we thoroughly defined early relapse warning signs as changes in thoughts, attitudes, and behavior patterns. These signs for an indicator of stagnation or lack of growth, and a gradual return to our using patterns. To borrow a phrase from 12 step groups, we became “restless irritable and discontent”.
The seed of susceptibility had been sown.

Now we are moving on to identifying the relapse triggers and cues. If we are showing early relapse warning signs we’re very susceptible to a relapse. Triggers and cues are simply the stimulus that can have us reaching for drink or drug. Our susceptibility is like sticks of dynamite, the triggers and cues are simply the match that lights the fuse.

Metaphorically, we are like a gun powder keg ready to go off.

Let’s take all look at some of those flames that can light the fuse:

Clinical observation and research tell us that 3 types of stimulus can trigger intense drug craving, leading to renewed abuse:

1. Priming: “Just one” exposure to the formerly abused substance  be it a cigarette, a drink, or an illegal drug can precipitate rapid resumption of abuse at previously established levels or greater. Examples of combating this are to remove alcohol from your house, not going near drug dealers or hanging out with people who use. Even though you may be able to handle exposure 99 out of a 100 times it just takes “that once” when you are not quite ready for it.
Here is a personal example of how this happened to me. I was in a large store notorious for long lines at checkout, and those really annoy me. There was a cashier who was either new or struggling that day. I was becoming angry. The woman in front of me turned around to me and said “I can’t believe it, I hate this place.” She had been drinking and blasted me with alcohol breath. She caught me by surprise and I was not ready for it. The result of exposure to this, was that I was actively thinking about drinking all the way home, and well into the night.

2. Environmental cues: This is the classic “people, places, or things” that the 12 step programs warn so vehemently against. Any association that reminds you of past use can be a cue to use. One vivid illustration of the power of such cues is a negative one: A small percentage of American service personnel became addicted to heroin while overseas during the Vietnam War. When they were removed from that environment, the great majority, after detoxification, reported no further problems with opiates.

Here is an example of an environmental cue. I was walking in the mall one day just people watching and strolling leisurely. All of a sudden I was stopped dead in my tracks and was spinning around searching for a girlfriend of 30 years ago. What happened is that somebody had walked by me wearing a particular perfume that happened to be the same as my ex used to wear. That stirred memories and images of 30 years prior. I really expected to see my ex-girlfriend. This happened so fast my head was turning before realized who and what I was looking for.

3. Stress: Both acute and chronic stress can contribute to the establishment, maintenance, and resumption of drug or alcohol abuse. Some patients and treatment providers point to stress as the most common cause of relapse. The impact of stress recently was highlighted when researchers documented increased rates of smoking and alcohol consumption by New Yorkers after the September 11, 2001, attacks.

Stress and anxiety are such critical components that their relapse prevention plans that focus almost exclusively on methods to reduce stress and anxiety. I like to think of stress and anxiety as a focus on the future, of what may or may not happen. That seems like a bit of a waste to me, because three-quarters of the things that we worry about don’t happen, and the other quarter we couldn’t do anything about anyway. Not surprisingly, the 12 Steps have a slogan to deal with a tendency to fixate on the future.  That is “ a day at a time”, or ”stay in the present moment.”

A More Science Based Discussion of Relapse Prevention

Our knowledge of relapse is incorporated in science-based drug treatments.In cognitive-behavioral therapy, for example, patients learn to confront the consequences of their drug use, recognize the environmental cues and potentially stressful situations that trigger strong drug cravings, and develop strategies to steer clear or respond without relapsing.
This is essentially what we are trying to accomplish in these three sections we are spending on relapse prevention. We are looking at:

1. Early relapse warning signs.
2. Triggers and environmental cues
3. Strategies to deal with them

In having a discussion on relapse triggers and cues, what we are really talking about are those inputs or actions that can trigger cravings. Much of the scientific study on triggers and cues has come as a result of the study of cravings.

The general relapse prevention strategy of “recognize, avoid, and cope” is particularly applicable to craving. After identifying your most problematic cues, we should explore the degree to which some of these can be avoided.

There is, an exercise at the end of this document to help you identify those problematic cues. I have also separated this PDF into an individual file so you can print it out and work on it on its own.

New research findings appear to shed light on one of the deepest mysteries involving drug relapse:We know that former abusers of addictive drugs remain vulnerable to powerful drug cravings for months or years after establishing abstinence.

Scientists have known for some time that addictive drugs hyper-activate key brain circuits that provide pleasure and are closely linked to motivation and memory. Research also has shown that drugs change brain cells in these circuits in numerous ways, some of which might be linked to craving.

However, these changes generally last only as long as a drug is actually present, or a little longer. To explain how craving can recur after long abstinence, researchers need to show that the drugs change the cells in ways that change back slowly or not at all.During the past 3 years, research teams at Yale and Texas Southwestern Universities demonstrated that repeated exposure to cocaine produces alterations in gene activity in the nucleus accumbens that can persist for weeks.Last year, researchers at the University of Michigan showed that cocaine self-administration changes the actual shape of these neurons — a change that is long-lasting or even permanent.

Further research will tell whether these changes are critically important to long-term vulnerability to drug craving, or whether they play a relatively minor role. The studies were conducted with laboratory animals and cocaine, and we need to find out whether they also apply in humans and with other drugs.

What accounts for the extraordinary persistence of drug cravings?

It is important to recognize that experiencing some craving is normal and quite common. Craving does not mean something is wrong or that the patient really wants to resume drug use.Science-based medical treatments buffer patients against the craving that leads to relapse. There are some drugs that have been proven in some instances, to help with craving. It should be pointed out that these aids, in and of themselves, are not a sufficient basis to build an entire recovery or relapse prevention strategy on.

1. Methadone and other opioid agonist agents block the euphoric effects of opioids and stabilize brain processes whose disruption is linked to craving.
2. Naltrexone, an opioid antagonist, blocks opioid-induced euphoria and counters opioid craving with an aversive effect.
3. Disulfiram (Antabuse) is used to treat alcohol abuse, and it is currently being tested to determine whether it also can offset cocaine craving. Anti-anxiety agents are prescribed to moderate stress.

Explaining Drug and Alcohol Craving:

To explain the ideas of craving and conditioned cues, we can look at a couple of examples.  In scientific studies they have found that’s when cocaine addict start to chop the cocaine and lay it out in lines, that action itself releases naturally occurring euphoric stimulants into the brain.

A more traditional and generalized example might be of the conditioning experiments of Pavlov and his dogs. He conditioned the dogs in his experiments to salivate with the ringing of a bell. The bell became a trigger to the expectation that the dog would be rewarded by food, therefore, in anticipation of the food he started salivating. I have heard a lot of people describe “the hunt” as just as important for enjoyment as acquiring or imbibing in the substance.

A very important point is that cravings are traditionally time limited. In other words, if you can buy some time, and take some appropriate action, the craving will dissipate. I have also heard anecdotally that the farther along you are in treatment and recovery the less intense and less frequent cravings are. We are trying to extinguish those cravings.

How bothered are you by craving?

There is tremendous a variety in the frequency, level and intensity of craving that people experience. For some, achieving and maintaining some control over the effects of craving will be an important relapse prevention strategy. This may take some time to achieve. Other people deny they experience any craving at all.

Strategies To Cope With Drug Cravings:

Let’s take all look 5 strategies to help cope with craving:

1. Distraction

2. Talking about craving

3. Rolling with the craving

4. Recalling negative consequences

5. Changing Self talk

1. Distraction:

In a lot of instances a strategy that really works for handling cravings, and those triggers and cues is distraction.  A very effective form of distraction is doing something physical, take a walk or jog, go swimming, or mow the lawn. How about taking a bath, or hot shower? another illustration of the concept of distraction is to change your environment, it just get out of there, and go somewhere safe . Again, there’s a 12 Step slogan that illustrates this point and that is “move a muscle changes thought.”

2. Talking About Craving.

If you have created a support network, then use it.  Using supportive, abstinent friends and family members, talking to them about craving when it occurs, is a very effective strategy. Talk therapy is the basis of much of psychology. This can help reduce the feelings of anxiety and vulnerability that often accompany cravings. The trick here is that you have paid attention and found willing and appropriate listeners. If you are isolated and cannot get hold of anybody, get creative. There are 800 number hotlines to call, emergency crisis centers, you can go online to chat rooms and online forums.

3. Rolling With The Craving.

The concept of this technique is to let cravings come on, peak, and pass; in other words, to experience them without either fighting, fearing or giving into them. You can use imagery of a wave rolling up on the beach, or what other scenario grabs you. In the science-fiction book Dune, I remember reading the tool used for overcoming fear. I have to paraphrase it, but it went something like this “Fear is the mind killer, I will allow it to pass over me and through me and when it is gone, I will remain, but stronger”. This is a similar idea to rolling with the craving

4. Recalling Negative Consequences.

When experiencing craving, many people have a tendency to remember only the good effects, their euphoria of using. This called euphoric recall. As part of this, they often forget or under play the negative consequences the negative consequences. A strategy to combat this I what I call “playing the movie foreword”. What has really happened in the past when you picked up one drink or one drug? Chances are it never stopped there, it got worse and worse. Play that scene out to the logical conclusion.
This strategy can be a double-edged sword. I have had people base their entire relapse prevention strategy on remembering the negative consequences, recalling the pain. While this is a useful tool, the knowledge that bad things may occur doesn’t stop that many people from actually using.

5. Changing Negative Self-Talk Into Positive Self-Talk.

Let’s face it, we all talk to ourselves. There is an internal dialogue that accompanies us throughout the day. This strategy essentially means taking the “automatic thoughts” that accompany a craving, and consciously reframing them.
An example might be an automatic thought of “I really want to use that would make me feel great”, running around in your head over and over. Well, you can counter that by saying “Wait a minute, what would really happen if I used? Eventually my money or the drugs would run out,  I might go into withdrawal. I would get the shakes and have a massive hang over. That doesn’t sound like much fun.” Hey, they are your thoughts you can change them, if you want to.

Identifying Relapse Triggers

Let’s work to develop a comprehensive list of our own triggers. It may be helpful to concentrate on identifying the craving and cues that have been problematic in the past.

Are You Ready?

I have provided a large list of potential relapse triggers. the object of this exercise is to narrow the list down to the five potentially most troublesome for you. Start with quickly scanning the list, and marking any triggers that you think may apply to you. Now go back over the triggers you have marked and select the top five that you believe could be most troublesome. Take those five and arrange them in order from the most worrisome on down. Here we go:

1. Complacency
2. Isolation
3. Dishonesty
4. Depression
5. Argumentativeness
6. Self pity
7. Cockiness
8. Expecting too much from others
9. Letting up on daily disciplines
10. Forgetting gratitude
11. Omnipotence
12. Selfishness
13. Not attending 12 meetings
14. Obsessive and compulsive thinking
15. Boredom
16. Maintaining resentments
17. Old “people, places and things”
18. Keeping drugs and/or alcohol in the house
19. Grandiosity
20. Major or sudden “life” changes
21. Exhaustion
22. Anger
23. Anxiety
24. Boredom
25. Stopping medications against your doctor’s advice
26. Shame
27. Self pity, dwelling on unresolved conflicts or past hurts
28. Loneliness and isolation
29. Fear
30. Frustration

My Top 5 Relapse Triggers, and some solutions for them:

1.

2.

3

4.

5.

In this part of the course we’re going to take a look at a working definition of the relapse process. Hopefully, we will be able to increase our awareness of the early signs of relapse.

This Featured Post 3rd in a series of 26. It is available as a download: Click on the PDF image. Save a copy to your computer. If you missed a post check the sidebar to the right under ‘Free Downloadable Modules’.

When these early warning signs are recognized, it becomes possible to stop the process in its infancy and minimize the chances of having a using episode. The work done now, looking for early warning signs, recognizing your own triggers and cues, and constructing prevention plans to deal with them, can pay major dividends when crisis occurs.

It is our hope that over the next few weeks, you will come to have a thorough understanding of the relapse process and have developed a personalized plan to help you deal with any of the warning signs or dangerous signals that may arise.

Relapse Part 1

Addiction is known as a chronic relapsing disorder. Since relapse is such an integral part of addiction and addiction recovery, it makes sense that the serious business of preventing relapse is an absolutely critical element in alcohol and drug treatment.

According to the Department of Health and Human Services, Technical Assistance Publication No. 11:

“Addiction is a chronic relapsing disorder, thereby making the prevention of relapse one of the critical elements of effective treatment for alcohol and other drug (AOD) abuse. Studies have shown that 54 percent of all alcohol and other drug abuse patients can be expected to relapse, and that 61 percent of that number, will have multiple periods of relapse. It is not unusual for addicts to relapse within one month following treatment, nor is it unusual for addicts to relapse 12 months after treatment; 47 percent will relapse within the first year after treatment (Simpson, Joe & Lehman 1986). Although relapse is a symptom of addiction, it is preventable.”

Now, I put that emphasis on the last sentence of the quote above. One of my pet peeves is misinformation about the subject of relapse. It never fails that some well-intentioned soul will say something like “Only 5 percent of the people who give up drugs and alcohol are successful”, or, something like an “Addiction professional” saying to a packed lecture hall in rehab, “look to the left of you and look to the right to view those people won’t make it.” That happened to me. In my opinion, not only is that a disheartening thing to say, but it is simply not true.

Simply because one has a relapse certainly does not mean that they will never “get it”. You are not necessarily doomed to everlasting drug and alcohol use because of the occurrence of a relapse. Another study shows:

“Studies of lifelong patterns of recovery and relapse indicate that approximately one-third of patients achieve permanent abstinence through their first serious attempt at recovery. Another third have brief relapse episodes which eventually result in long-term abstinence. An additional one-third have chronic relapses which result in eventual recovery from chemical addiction (Gorski, Kelley & Havens, 1993).

Now I see those statistics as being quite a bit different from only 5% make it.I’m sorry if I got off on a bit of rant there, but since I’m writing this I guess it’s allowed.

The Addiction Relapse Process:

It is very important to understand that relapse, just like recovery, is a process not an event. In fact when we discuss the relapse process, it actually ends when a person picks up a drink or drug. At that point you are entering a using episode. Everything that happens before picking up is actually the relapse process.

When, exactly, somebody enters in to the relapse mode is very difficult to define with precision. What happens is that very subtle changes occur in a person’s attitudes, beliefs, and emotions, all leading to the point where return to chemical use makes sense. It is these subtle changes in attitudes and thought processes that move a person from “I know I can’t use I can use once more and control it.”

Let’s take all look a four stage model of relapse:

4 Stages of Drug And Alcohol Relapse

First stage - I am unaware. I don’t see it, and have no idea that I am in trouble. (People around us may notice subtle changes in attitude and behavior).

Second Stage - We become restless, irritable and discontent. Our focus shifts from internal to external; we stop focusing on ourselves and start focusing on other people around us. We start blaming and acting the victim. Fear and anger start to become evident.

Third stage - Unresolved feelings occur and they are not dealt with in a healthy manner. We go into emotional and physical withdrawal. We start to isolate. Negative attitudes such as compulsive behavior start to predominate. We start discounting recovery, we engage magical thinking.

Fourth stage - A crisis in our life causes or provides the excuse for us to start using again, or, we create a crisis that rationalizes our return to use. In other words, we have made the decision to use, and are ready to light the fuse.

As we move through the stages of relapse, a few different things are occurring. Firstly, the need to regain our ‘right’ to re-engage in our addiction seems to make sense. We talk ourselves into the false belief that this time we can control it.

Secondly, there is a gradual and progressive destabilization of our lifestyle. Lastly, Stress and Stressors will accelerate this process. The stress factors we’re talking about here can best be pointed out by observing the warning signs of relapse.

Contributing Factors to Relapse:

It is really important to understand some of the personal factors that could possibly contribute to the relapse process and end up in a return to drug or alcohol use. Here are 5 factors:

1. Exposure to any person, place, feeling, or situation where we have used drugs, alcohol, or experienced emotional trauma.

2. Frequent exposure to high-risk situations that have led to drug or alcohol use in past.

3. Recurrent thoughts or physical desires (cravings), to use drugs or alcohol.

4. Inadequate living skills to deal with personal conflict or negative emotions.

5. Inadequate skills to deal with social pressure to use substances.

Entering into addiction recovery requires changes in the aforementioned attitudes, behaviors and values. Relapse occurs when these attitudes and behaviors go back to ones similar to those exhibited when we were actively using alcohol or drugs.

Let’s get very specific and identify some relapse warning signs.

20 Relapse Warning Signs:

I’m going to provide you with a pretty extensive list of warning signs, this is a case of if the shoe fits wear it, or take what you need and leave the rest.

OK, here we go:

1. Getting impatient at that pace of which your recovery is happening.

2. Experimenting with controlled drinking or drug use.

3. Becoming overtired and fatigued.

4. Having the thought that it is OK to drink or drug if _______ (blank) occurs.

5. Making excuses for taking drugs or drinking; blaming it on people places and things

6. Starting to become jealous of people around you who can drink and drug in a controlled manner.

7. Not being ready for cravings.

8. Not expecting a bad days nor having a plan for them.

9. Expecting to get rewarded for staying sober. You should be doing this for your own sake.

10. Expecting people to believe your desire for sobriety too soon and at face value.

11. Blaming other people for your problems.

12. Not asking for help.

13. Stop going to aftercare or meetings.

14. Procrastinate on daily tasks.

15. Start to become defensive and let resentments build.

16. Start to associate with people who are drinking and using.

17. Start to become dishonest.

18. Start acting in a self important manner.

19. Begin having an “I don’t care attitude”.

20. Aspects of denial start to reemerge.

Knowing your own personal relapse warning signs can interrupt the relapse process and prevent your returning to drink or using drugs. Sometimes it’s helpful to look back at the last time we started drinking or using after period of abstinence. If we look at this, it will provide us with our own personal relapse warning signs.

Identifying Personal Relapse Warning Signs

1. We had mentioned before that entering into relapse mode involves some changes in thinking. Perhaps the most dangerous change in thinking involves the belief that you can once again pick up and start using, but control it. We also start remembering only the good times and not the bad times. The idea that we deserve it, or that drinking or using is a reward for our hard life becomes very attractive. We can also seduce ourselves into thinking that we just plain don’t have the ability to stay sober.

List some specific examples about how your thinking changed before your last relapse, or your observation of another person’s relapse:

1.

2.

3.

2. Not only does our thinking change but our attitude changes as we move closer and closer to relapse. Negative attitudes such as becoming self-centered, selfish, negative, and becoming lazy start to infiltrate our daily lives. And attitudes begin to develop that we’re being asked to do too much, I mean we’re only human and are being pushed to our limits as it is.

Try listing some very specific examples about how your attitudes have changed just before your last relapse or a relapse you might have observed and someone else:

1.

2.

3.

3. You might notice that in general, people engaged in good solid recovery behave a whole lot differently than people for using and abusing drugs and. These behavioral patterns are often easy to identify. Some typical signs that you may be sliding back into addictive behavior patterns are things like: neglecting personal hygiene, procrastinating, starting to take up high risk behavior is again, poor eating and sleeping habits, impulsivity, and showing a lack of self control.

List some specific examples about how your behavior patterns changed before your last relapse, or your observation of another person’s relapse:

1.

2.

3.

4. Let’ try to put it all together now. We have looked at the changes that occurred in your thinking, your attitudes, and your behavior patterns, in that time before your last relapse, or one that you had observed in somebody else. Let’s write them out. If you have never tried to stop using before and have never had an experience a relapse, just go ahead and was the patterns of behavior that were normal for you when you were using drugs or drinking either way list these warning signs of relapse, or patterns of using behavior.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Who said it was easy?

In Closing:

I hope you agree we did a pretty fair job at looking at the definition of the relapse process. It turned that it is a lot more to it than simply picking up a drink or a drug, in fact, as was previously illustrated; the return to use it is actually the end of the relapse process.

Chemical addiction is a disease, and, like many diseases, there is always the possibility of relapse. The process of alcohol and other drug abuse is complex, and is impacted by social, clinical, and medical factors. The solutions to the problem of chemical addiction are multi-faceted. Treatment strategies benefit from a relapse prevention component in virtually every case.

We hope you look forward to further investigations of relapse and relapse prevention over the course of the next two weeks.

In the meantime we wish you the best and happiest of recoveries.

Regards,

Bill Urell

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Some rules of addiction recovery are Golden, they should be taken into account forever instead of forgotten. These are useful and important trail markers to guide us and help us stay always on the right track.

As you define your goals, begin looking for the Golden Rules that connect with it. Chart your course by these Golden Rules and permit them to steer you to achievement and success.

Golden Rules, the 5 best ones for building a social support network.

Golden Rule # 1, you cannot do it on your own. The key reason why you might like to do that is gathering a large and varied support network is crucial. Remember, every time you tried to quit and stay sober alone, it failed. Addiction is a disease of isolation; recovery is about connection with others.

Golden Rule # 2, find and utilize people who are successfully in long term recovery. Follow those are actually doing it not just talking the talk. This might affect you down the road because without friends, isolation can take over. Isolation and boredom are breeding grounds for addiction.  Be sure and remember that there are millions in recovery and you could be one of them if you do what they do.

Golden Rule # 3, try out a few different support groups. 12 step meetings have been found to be very effective. Just about every treatment center recommends them as a foundation of social support. Why? They work. There are various reasons you should do this carefully. It is important because if the first meeting you go to doesn’t suit, you may give up on the entire idea of support groups instead of simply finding one more to your liking

Golden Rule # 4, Make sure that the professional support people on your life such as counselors and doctors know the whole story. Addiction causes changes in our body and mind; do not keep addiction history from them.

Golden Rule # 5, Enlist the support of your family but realize they cannot be your only support. Addiction is a family disease and they may have their own issues to work on such as anger, enabling or codependency. You may accomplish this by opening communication with them and setting some limits and boundaries. You need to work on your issues. They need to work on theirs. They may help but cannot take them on and solve them. This may make a difference to you as it empowers your own recovery and is a method to keep you accountable.

Follow these golden rules to develop a large and varied social support network and you will probably find your life easier, your progress rapid as well as your successes more frequent. Addiction recovery can certainly be done with the aid and support of people around you. Alone, it is next to impossible.

Early alcohol and drug addiction recovery is a wonderful time.

Our thinking clears up, our emotions come on line, the colors are brighter, the food tastes better and life starts to get good.

That is all wonderful. We seem to have regained our old abilities and so much more. To me, the danger in early addiction recovery involves not being aware of the limitations of early sobriety. Generally, people still have a mindset of instant gratification and “I want what I want when I want it”. Things are going great and we think we can take on the world right now. Bring it on.

While this attitude can be exhilarating not knowing one’s limitations in the early phase of addiction recovery can be a setup for disaster. Often in the early recovery stage people take on far more than they are capable of handling. An addictive mindset is to impose an unrealistic time frame on events happening. We want things done quickly. Early recovery is the time to develop stability and recovery skills. Once the foundation as set, we can start to build.

Traditional wisdom says that early recovery is not the time to engage in an intense new relationship, or make huge major life changes.

Continuing care plan of action:

1. Become familiar with H.A.L.T. hungry, angry, lonely, tired. A person in any of these conditions can be very susceptible to addiction relapse. Taking on too much, too quickly is an open invitation to become vulnerable. Constantly monitor your physical, mental, and spiritual condition. Remember very little in life has to be done ‘right now’.

2. Realize that the direction in which you are heading is much more important than the speed with which you are traveling. Slow but steady wins the race. Avoid unrealistic timeframes, self-imposed pressure, and stress.

3. Remember that you are each human being, and as such will make mistakes. That is how we learn and measure progress. On the one hand don’t beat up getting yourself, on the other hand, make sure you are learning the lessons of life.

We hope this was helpful in understanding yet another common drug and alcohol addiction relapse trigger.

Related articles

• You: Stress Can Derail Recovery (psychcentral.com)
• Ignoring stress leads recovering addicts to more cravings (esciencenews.com)

Maintaining sobriety from drug and alcohol use is a proactive process; certain skills and attitudes need to be developed and utilized.

by Bill Urell

There is an old adage that states quitting drug and alcohol use is easy, staying quit is the hard part. I’m not sure if I agree with the easy part, but it is a fact that many people have difficulty maintaining abstinence from drug and alcohol use and suffer a relapse. There are certain attitudes and behaviors that can be developed that will decrease the likelihood of returning to drug and alcohol use.

Here is a list of the top five sobriety tools:

1. Motivation level - maintaining abstinence from mood altering drugs is definitely doable, but in most cases difficult. In order to achieve difficult goals it makes sense that the motivation has to be very high. People who rank their sobriety as a number one priority often have better results than those who put maintaining recovery on their ‘to do’ list. There should be an absolute commitment not to drinker drug ‘no matter what’.

2. Handling cravings - as sure as the sun will rise tomorrow, thoughts and cravings of using drugs or alcohol will occur to anyone in recovery. The skill that needs to be developed is to stop these thoughts and cravings from becoming an actual using incident. The good news here is that cravings generally decrease in frequency and intensity over time. It helps to have a concrete plan of action in place prior to the occurrence of the craving for using thought.

3. Coping skills - often people in early recovery rely on coping skills that were developed to protect their drug and alcohol abuse. This might include becoming isolated and pushing people away, becoming dishonest in cheating, or becoming self-centered in the extreme. In other cases coping skills are either undeveloped, or underutilized. Some examples of life skills that may need some work are the ability to communicate, basic social skills, knowing how to develop and maintain interpersonal or intimate relationships.

4. Identifying, owning, and processing emotions - there is often stated rule in relapse prevention that advises people in recovery to avoid “people, places, and things” that could be dangerous to the recovery. In reality, is may not be the situations or triggers that are more dangerous, but our rather our inability to handle the emotions that these things generate. Our actions are often generated by our feelings.

5. Self-esteem and self-confidence - if a person does not have the self-confidence in their ability to remain abstinent, certainly undercuts the motivation to keep working at it. If a person does not start feeling better about themselves in recovery and gain self-esteem, then the idea of returning to drug and alcohol use can become very attractive. There needs to be some internal reward for going through all the effort of maintaining sobriety.

Relapse back into drug and alcohol use happens with alarming frequency for great number of people. It is therefore only prudent to develop plans that decrease the possibility of relapse. However, relapse not a part of the recovery process, many people stopped using drugs in our overall never to return to it. In my experience, however, these people have put a great deal of proactive planning into use. They have made recovery their number one priority and have been ferocious in their commitment.

Concerning drug and alcohol relapse and its prevention there is a good news, bad news, scenario. Here are three important points that everyone should be aware of:

1. Relapse is not uncommon following drug and alcohol addiction treatment.

The frequency with which relapse can occur following treatment is the bad news, the good news is relapse need not be a part of anyone’s addiction recovery. It is not mandatory that you have one or two slips or a full-blown relapse in order to achieve lasting abstinence and sobriety. However, relapse happens with her frequency that cannot and should not be ignored. Provisions should always be made for an action plan if relapse does occur.

2. [Tag-tec}Relapse[/tag-tec] is most certainly preventable.

It can be arguably stated that the most common cause of relapse is complacency. It is very important for someone in recovery to be monitoring their thoughts, feelings, urges, and actions at all times. It has been shown that being active in a 12 step program, and/or extended professional treatment at some level increases positive outcomes, and helps against relapse. Both sobriety and addiction treatment should be seen as an ongoing process and not an event with a definitive beginning and end. You never quite graduate.

3. Relapse is fairly predictable.

That statement may come as a surprise to some people. However, there are distinct signs and symptoms of one who is engaged in the relapse process. Unfortunately, the early stages of relapse are not noticeable to the person in recovery themselves, but they are apparent to those surrounding them. In easily remembered danger gauge is the acronym H.A.L.T. this stands for being hungry, angry, lonely, or tired. On a professional level, work should be done in identifying patients’ individual external relapse triggers and cues, as well as emotional triggers. It can be a little more complex than simply avoiding “people, places, and things”.

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HALT video covers those frequently discussed relapse triggers of hunger, anger, loneliness and being tired.

We hope this relapse prevention video helped.

“There is no mental defense against the first drinker drug”. I don’t buy it and here is why:

The idea that there is no mental defense against the first drink or drug, can lead one to believe that relapse is inevitable and addiction recovery is impossible. We might as well stand around doing nothing waiting for relapse to happen. That’s silly. Millions of people enjoy continued addiction recovery without a relapse. In fact, a well designed relapse prevention plan can increase your chances of continued sobriety dramatically.

In discussing relapse prevention and drug and alcohol relapse itself, it is very important to make two distinctions:

Firstly, relapse process is not an event. It involves the thinking processes, feelings, urge is in cravings, as well as the drug and alcohol seeking, that precede the actual use.

Secondly,

relapse prevention deals with all that happens, (the process) before the drink or drug is actually taken. Once you are actually drinking and drugging, you are in a using episode. The tools and study of relapse prevention are designed to deal with all that proceeds the action prior to the using the event

Relapse Prevention involves identifying your early warning signs of relapse and having a plan in place to interrupt the process. In other words, relapse is simply not going to strike one down without reason or warning like a mugger attacking in the night.

It is your job to self monitor your own relapse justifications, whether they are thoughts, feelings, or post acute withdrawal symptoms. You must have an early warning detection system in place, effective strategies to cope with them, and a willingness and ability to act on them.

I believe it is imperative for everyone, regardless of how well their addiction recovery is going, to have in place and effect if relapse prevention plan.

This simple but powerful relapse prevention tool requires just a bit of preparation.

Write yourself a letter that details the positive experiences you’ve had in recovery. Take a look at how your relationships have improved, whether you’re self-esteem is improved, and your physical and mental health. Detail your goals visions and dreams. Be positive and upbeat. Now, take that letter put it in an envelope and write the following on the envelope, “open in case of emergency”.

The next time you have an urge or craving to return to use open that letter and read it carefully. Think about what returning to drug and alcohol use really means, play that tape forward. Realize that you’re not really thinking about using drugs or alcohol once, but returning to a life full of pain and misery. Weigh your decision, because the power of choice is yours.

Don’t be afraid to break the seal on that letter in case of need, because after all, when you are done reading it you can always put it into another envelope and readdress to yourself.

I apologize for the infrequent updates over the last few days.

I have been attending a week long seminar to get certified in Advanced Relapse Prevention Therapy. At the same time my landlord decided to switch internet providers and we are without internet connection for a few days awaiting a modem. I am commandeering a terminal for 15 minutes at a Marriot Courtyard, so I can only give a quick update.

One of the most important parts about being in addiction recovery is learning how to prevent relapse. My certification will allow be to share some cutting edge information with you on relapse prevenrtion as soon as I get back up and running. My best regards,

Bill

There has been mention of recovery coaches or sobriety coaches in the press recently, particularly for people of means and affluence.

I think the idea of having a recovery coach has a certain appeal, a nice ring to it. What exactly do they do? What don’t they do? Oddly enough, I found it easier to locate information on what they don’t do. This information (disclaimer?) was taken from one of the more credible sites I found:

1.    We cannot diagnose any addiction.

2.    We don’t treat addiction per se.

3.    We can help someone become ready and willing to seek treatment.

4.    We can help someone explore their options for recovery or treatment.

5.    We know we aren’t chemical dependency counselors. We know we aren’t nurses, doctors, counselors, therapists, or psychiatrists.

6.    We are coaches and what we do is coach. We help people explore their wants, needs, and choices. We help them get clarity and move into action.

7.    We don’t dictate what recovery will look like for our clients.

8.    We don’t tell them what to do or how to do it.

To be honest, the idea of recovery coaches scares me. Let’s see, if I needed help would I really want a person who is not qualified to diagnose and treat me? There are some real questions and considerations when considering sobriety coaches:

1. Coaches are not regulated, certified and do not have to meet any educational requirements.

2. Anyone, qualified or not can call themselves a recovery coach.

3. There is no standardized code of ethics and standards.
If that sounds harsh, (I am expressing a point of view), but hear me out…

I am a state certified addictions therapist with a master’s level education. To reach that level of qualification requires years of specialized addiction education and many 100’s of hours of practical experience in dealing with patients. I am bound by a professional code of behavior and ethics.

With the very real threat of relapse looming large for anyone in recovery, I strongly suggest getting qualified help. I emphasize qualified help. To be fair, I have come across some recovery coaches who are educationally qualified and are state certified counselors also.

There are also many unqualified people in the field, and working with them could not only be a mistake, it could be dangerous.

Relapse is not an individual occurrence or event. Relapse is a process, a fluid progression of ideas and events that enable the concept of being unable to deal with life in sobriety. The relapse process may lead to a return to drug and alcohol use, emotional or physical collapse, death or suicide. The process is identified by tangible, predictable and identifiable relapse warning signs that begin quite some time before a return to use or collapse occurs. Relapse prevention planning teaches people to identify and  create plans to manage these symptoms and signs. The goal is to interrupt the progression early in the process and return to the path of recovery.

Relapse, most certainly does not have to be a part of recovery, there are those who do not return to drinking or drugging. Studies of life-long patterns of recovery and relapse indicate that not all patients relapse. Approximately one third achieve permanent abstinence from their first serious attempt at recovery. Another third have a period of brief relapse episodes but eventually achieve long-term abstinence. An additional one third have chronic relapses that result in eventual death from chemical addiction.

These statistics are consistent with the life-long recovery rates of any chronic lifestyle-related illness. About half of all relapse-prone people eventually achieve permanent abstinence. Many others lead healthier, more stable lives despite periodic relapse episodes. Click here for: tips for recovery.

No one in recovery wants to have a drug and alcohol relapse. But if it occurs, would you know what to do? These tips on how to survive a relapse may help avoid a lot of unnecessary pain.

Due to the frequency with which they occur, knowing what to do in the event of a relapse is an essential part of a relapse prevention plan.

First things first; don’t let guilt and shame paralyze you into inaction because you have had a slip or relapse. Unfortunately, in recovery, as in life, pain can be a valuable learning experience. The trick is to use the experience to get back into recovery and emerge from the experience even stronger.

Here are 5 tips to help you turn it around:

1. Don’t give in to despair. It is an attractive rationalization to believe that you have just proved you can’t do this. If you believe you can’t do something, what’s the point in trying? Go down that road and you’re off to the races.

2. Stop using. You are not a failure and hopeless; that is shame speaking. You are human, and as such we make mistakes. Don’t give into the idea that because you had a slip, you may as well go whole hog.

3. Get help immediately. Yes, that means telling someone you had a relapse and need help to stop now. Trying to keep it a secret will only increase the negative feelings generated.

4. Figure out what went wrong. Relapse just did not sneak up on you. It happened because of your action in wanting to use or your inaction of sticking to your recovery plan. Outside help of a counselor, sponsor or someone in long term recovery is needed to give an outside perspective.

5. Restart your recovery with overwhelming force. Become proactive in your recovery; apply even greater effort and priority to it. Apply overwhelming force, take what you think you need and double it. One key shared by people in long term recovery the idea that ‘I cannot drink or drug no matter what’. Adopt a ‘no matter what’ mentality.

And that is the tip of the iceberg on the subject of relapse prevention in drug and alcohol recovery. There is even more information available on what to do in case of a relapse on alcohol or drugs.