One of the most fear-inducing aspects of quitting opiate use (heroin, oxycontin, etc.) is the physical withdrawal that takes place as the patient stops use. Many of those addicted to opiates will have experienced some form of withdrawal at one point or another and the pain and suffering associated with the experience is often one of the key reasons why use continues. Opiate withdrawal is not fun.

There are a number of treatment options out there for opiate addiction and some of these utilize pharmacological aids to help patients get through the withdrawal period. One of the most common treatments includes the use of Suboxone, which is a prescription medicine used to replace opiates in such a way that the patient does not suffer the physical aspects of withdrawal.

The way Soboxone works is by blocking the specific receptors in the brain that opiates use to cause the euphoria associated with the drugs. By blocking these receptors, the patient no longer gets the “high” and eventually the craving disappears. In addition, however, the receptors believe something is happening and so the typical physical withdrawal associated with halting opiate use does not occur.

Obviously if you can quit opiates without suffering withdrawals you are on your way to stopping the addiction. However, it is extremely important to understand that in order to remain withdrawal free, you also need to continue use of Suboxone. If you stop taking Suboxone, your receptors once again start to crave the opiate and withdrawal symptoms start to appear.

Many people out there believe switching from opiates to Suboxone is extremely helpful.

Others, however, soon recognize that they may have simply substituted one addiction for another. Though using Suboxone is nowhere near as debilitating as consistent opiate use, as someone who suffers from addictions, often the goal is to rid all forms of addiction from your system, including those medications that may have helped you in the past.

Take the time to learn from others. The SoberRecovery community has a number of discussions about quitting Suboxone. It is something that should be done with the aid of your doctor and just like opiates, should not be done ‘cold turkey’ but rather gradually.

It is very important to understand that relapse, just like recovery, is a process not an event. In fact what we discussed 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 and can point. What happens is that very subtle changes occur in a person’s attitudes, beliefs, and emotions, all leading to the point were returned to chemical use makes sense. It is a subtle change 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 Relapse

First stage – I am on aware. I don’t see it, and have no idea I am in trouble. (people around us may notice subtle changes in attitude and behavior).

Second Stage – We become restless, incurable and discontent. Our focus chefs from internal to external, we stop focusing on ourselves and start focusing on other people around us. We start blaming, 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 the emotional and physical withdrawal, the start to isolate. Negative attitudes start to predominate such as compulsive behavior is, we start discounting recovery, we engage in May it magical thinking.

Fourth stage - A crisis in our life causes provides the excuse for us to start using it again, or we create a crisis that rationalizes are returned 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.

There’s 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.

Sober Recovery Forums | Addiction Recovery Forums

I was revisiting my favorite sober recovery forums and addiction recovery forums recently to see what people are talking about and where.

A few years ago I did a quick post on sobriety forums (See Sober Recovery Forums) and thought an update might be nice. Perhaps the most traveled SoberRecovery.com has undergone some big changes. The forums have continued to grow and are extremely well read and traveled.

Theses sober recovery forums have morphed more into a resource site for locating addiction treatment centers and halfway houses. This is a great resource if you are looking for treatment for yourself or a loved one. I have one question:

Sober Recovery Forums | Addiction Recovery Forums – On SoberRecovery.com – Where Did They Go?

Well, the good news is they are still there but you really have to hunt around on the home page to find them. Once you do…holy cow did they grow in the last 3 years. There are about 40 different categories with up to 30,000 threads.

There is an old saying in the 12 step rooms there is nothing in recovery someone else hasn’t felt the pain of and successfully worked through – you are not alone. Well that is certainly true in these sober recovery forums, as in most addiction recovery forums.

Sober recovery message boards and online sober recovery communities can have a place in a well rounded drug addiction recovery program. The double edge sword here is that alcoholism forums and recovery forums are there to express opinions. And, as we all know EVERYONE has an opinion on recovery. Some may be helpful, some may be harmful, you must use care.

There are many sober recovery forums and addiction recovery forums on the net, choose one that is well traveled and suits your interests.

Anabolic Steroids:

http://www.drugabuse.gov/drugpages/steroids.html
NIDA’s Web site devoted to steroids
http://www.steroidabuse.org
NIDA Research Report: Anabolic Steroid Abuse
http://www.drugabuse.gov/ResearchReports/Steroids/AnabolicSteroids.html
NIDA Infofacts: Steroids
http://www.drugabuse.gov/Infofacts

Emotional Addiction Recovery Video

I was just surfing the net when I came across this video posted on my colleague, Lisa Frederiksen’s  Breaking The Cycles blog ( which is among the best on the net for addictions). There was something about this that I think every addict, recovering addict or family member can identify with. It stirred a lot of emotion in me.

It is one of those movies that anyone who’s life has been touched by drugs will ‘get’. And others…. maybe they can learn.

Dry Drunk | An In Depth Explanation Of The Dry Drunk In Recovery

Dry drunk is a slang expression which describes a person who no longer drinks or drugs but is still behaving in a dysfunctional way.

What is a dry drunk, and the ‘dry drunk syndrome’ as it is sometimes called? It can best be described as someone who fits one of two conditions:

1. The first is someone who has given up drinking and drugging and not made any internal or emotional changes, they stay the same but the substance is gone.
2. Or in the second case, someone who once was abstinent and on a progressive path of recovery, but has slowly returned to chaotic and unrealistic thinking, which may be leading back toward relapse.

Being active in your addiction, sets up many trains of thought, attitudes, feelings, and actions that are destructive. Simply removing the alcohol or drugs without changing these underlying factors will produce a ‘dry drunk syndrome’. The dry drunk really refers to a condition and not the person.

It is important to recognize a reversion back to our old ways of thinking and acting, or lack of progress in moving forward in recovery.The dry drunk can be a precursor to the beginnings of relapse. The AA Big Book describes this condition as being “restless, irritable, and discontented”. This set of attitudes can apply to anyone who is chemically dependent, or even those were not.

A way of looking at the dry drunk syndrome is that it generates two distinct dangers to our recovery:

1. Dangerous attitudes and mental postures that exist or can develop in a person who has not worked on “underlying issues”, or move forward growing in recovery.

If left unchecked or unresolved…

2. These can result in certain sobriety threatening actions or behaviors.

Here are some of the attitudes and mental postures common with the dry drunk syndrome.

Superiority –

Superiority or grandiosity basically means a return to a self-centered, ‘the world revolves around’ me attitude. Chemically dependent people are self centered in the extreme. The key component here is that with grandiosity you are setting yourself up to be the center of attention, either superior to everyone around you, or by playing the victim. Either way, you’re separating yourself and putting distance between yourself and from the people and world around you.  You’re really saying I am not like you; the implication is that I am unique and rules don’t apply to me.  In the 12 step programs they call this believing that I am ‘terminally unique’. The belief that I am so unique, it will eventually kill me. It does not have to necessarily mean that I believe I am the best; it can also be seeking attention through playing the victim or sitting on the pity pot (being inferior).

Impulsivity –

Possibly one of the most common attitudes or observable behaviors of people with addiction problems is poor impulse control and impatience. We tend to do what we want, when we want, with little regard for self harm or hurting others around us. Impulsivity can be linked with grandiosity to engage in behaviors designed to make us the center of attention. Another common feature of impulsivity and lack patience has to do with time frames. We want and expect things to happen within our own time frame. Unfortunately, the time frame we impose on ourselves and others is often quite unrealistic. We expect instant gratification in all areas of our lives. Let’s face it drugs and alcohol work almost instantly, we have conditioned ourselves like Pavlov’s dog, to expect immediate rewards. Unfortunately things don’t happen that way. I heard the phrase “time takes time” so often in early recovery that I wanted to punch somebody in the nose. (No resentments there!).

Being judgmental –

This is a very destructive attitude for people in recovery. When we judge a person as being better than or less than, we are setting up a situation where we inflate our egos feeling better than other people. On the other hand, if we judge ourselves to be on the short end of the comparison, we can feel bitter and generate low self-esteem. Being judgmental is a low self-esteem generator. There is another aspect of being judgmental they can be very defeatist in nature. That is the fact that if we are busy judging other people, and taking their inventories, we are not paying attention to ourselves. Not only that, but we could be judging ourself as the success standard. Who are we to say we are always right? First thought wrong.

Whenever I caught myself being judgmental, I used when I called my centering thought: I am always in the middle. There are people richer than me and poorer than me. There are people smarter than me, and not so smart as me. There are people with junkier cars than mine, and there are people with nicer cars than mine. so, knowing that, I’m always in the middle. What’s the point comparing? Anyway, it works for me.

Complacency –

This is not only an attitude of somebody in dry drunk syndrome, but is a red flag, warning whistle, fireworks shooting, warning sign of someone who is well into the relapse process. An important facet of being in active recovery is just that, being active, and moving forward. It is not how fast you are going but rather the direction in which you are headed. If you become lazy or disinterested and stop being proactive about your recovery, the natural tendency is to fall back into addictive behaviors. Your re-engagement in them is just a short step away.

Once you are lured into any of these attitudes, they start to affect how you think. Once your thinking is affected and you start to buy into self-centered thoughts, chances are you’ll engage in the actions stemming from these self-centered thoughts.

I look at my sobriety and recovery as being always on the move. I am either moving toward a drink and drug, or away from a drug and drink. The key is that left alone, and not moving forward in recovery we are actually sliding toward using. It’s like parking a car on a hill, sooner or later the brakes will give out before that hill flattens out.
I wonder sometimes if complacency is not rooted in laziness, but rather than fear. Are we afraid of success? Are we afraid of failure? Are we just sitting around waiting for things to work out the way we want them to without putting the effort into it?

Becoming Very Negative

I was guilty of this for quite some time in my recovery. I kept asking “when do the good things start happening? Is this all here is?” If negativity sets in, it is real important to look what going on beneath the surface. Is it anger and resentments; is some person place or thing not working out the way you expect it? Could be excessive anxiety and worry setting in?

Possibly one of the most futile of all emotions is worry and anxiety because you’re focusing on what may or may not happen in the future. I do not know any people that are true fortune tellers or can see into the future. Being in a state of high stress or anxiety can consume all of your mental energy. I really don’t think it’s possible to be happy, serene and peaceful what being in a state of high stress and anxiety.

Here are some destructive behaviors and actions that can result from dry drunk thinking:

1. We become restless and irritable and discontent.

Little things start to annoy us. We start to look for differences in those around us, which causes separation. If you remember, this is actually the first stage in the relapse process. It is also is the trickiest because we cannot see it coming. If we do not have a support system of people around us who we freely gave permission to offer us feedback, we could be a world of trouble. Sometimes we are to even aware that we’re acting cranky until somebody pointed out to us.

2. We become bored, dissatisfied

We are easily distracted from productive tasks. I visualize this as having the vivid color go out of recovery. Nothing excites us anymore. This can be likened to returning to Earth from ‘the Pink Cloud’. The initial euphoria when the colors were brighter, the sounds were clearer, and the smells were more fragrant, has dulled into listlessness and a ‘so what’ attitude and perception. We can start to wonder about the whole point of becoming sober and staying that way. This is the time start a gratitude list. If we become unable to see the progress we’re making in recovery, or we start taking it for granted, is very easy for sobriety too lose its priority.
It is my firm is belief that for those in long-term recovery, complacency is the biggest demon we must fight. On the flip side, I believe the most viable asset one can have in recovery is persistence.  When things get rolling along and life seems to be working well, the temptation is to lose focus on maintaining our recovery. A parallel is that many people stop taking their medicine because they’re feeling better, and then wonder why they get sick again.

3. Our emotions and feelings either get listless and dull or we start overreacting.

Either we become emotionally dull or dead or we go hyper or ballistic. The key point here it is that our reactions are out of proportion to the event that caused them. Perhaps, an occurrence that happens every day suddenly sends us into a rage. This can enter the realm of misplaced or misdirected anger or other emotional venting. At this point it is a very good idea to seek some emotional support and get realistic feedback as to your progress. Let’s face it, in recovery and in life there are highs and lows, ups and downs. Maybe these are starting to feel a little more dramatic because we are not using drugs and alcohol to anesthetize ourselves any longer. This may sound corny but we do learn more from our mistakes that are successes. Pain can be a great motivator.

4. We start to the engage in ‘euphoric recall’

Euphoric recall is a real fancy way of saying we only remember the good times. We remember how much fun we had when we’re using, how much more social we were, how clever, witty, and handsome or beautiful.  It really is a journey into the fantasy land of the past.  At the same time we’re engaging in this selective recall of only the good times, another mind game is actually being played. We’re consciously or unconsciously choosing not remember all the pain and misery. We tend to ‘forget’ things like making a fool of ourselves at a party, throwing up all over the place, waking up in strange beds,(or other places), and not having memory of the night before. The best antidote for euphoric recall that I know of is simply to sit down with a piece of paper and make two columns: one for the good things that happened to me when I was using and the second to list the bad things that happened to me when I was using. Make a list. Look at it. Endgame.

5. We start to engage in magical thinking

We get unrealistic and magical expectations and fanciful dreams. This is kind of similar to euphoric recall but is not necessarily confined to the past. Magical thinking can involve unrealistic expectations, and unreasonable goals, and simply believing that things will occur if we wish for them aren’t enough. And example might be if I stay sober my girlfriend will come back to me or I’ve been good so long just one drink won’t hurt. My favorite example of the slide into magical thinking is the following sentence, just fill in the blanks.
It wasn’t____________( drugs, alcohol) that was my problem, it was____________ ( my job, my husband, my anxiety).
If you’re going down that road run, don’t walk, to someone who can remove that magical thinking and give your realistic perspective on how it really was.
Another great example that happened to me was this: I was driving down the road with my best friend in sponsor and started talking about the past by stated, in all sincerity:
“I wasn’t really all that bad.” my friend pulled off the road looked me right in the face, straight in the eyes and said “Yes Bill you were”. Then he started driving again.
That took the wind right out of my sails, brought me back to reality, and I never brought up the subject again.

6. We lose interest in self-improvement.

There’s a fine line between becoming peaceful and serene and, and becoming complacent and lazy. What happened to all those plans for a ‘new you’? Instead of doing more walking the walk we’re doing a lot more talking the talk. The ‘action’ part of the program seems to have deserted us. We have lost the momentum driving us forward in our recovery. We’re content to sit back on our laurels letting other people do the work and simply sit back and receive praise for how well we’re doing.  This is where it is very important to have a sense of reality, and a purpose and some goals and life.

7. We start to become unfulfilled

As a result of any combination of the points already discussed, a feeling of not having our dreams fulfilled can come into play. Many people have an idea that just becoming abstinent will solve all problems. Don’t get me wrong, stopping the use of drugs and alcohol can only improve things. However, there is a good chance that there is a lot of wreckage in the past that will take time to get cleaned up and resolved. This starts to move into the realm of having unrealistic expectations and time frames. We want things to happen quickly. But, without action and continual self-improvement, not much will change.
8. We start acting on our old defense mechanisms

We are not only thinking in terms of old attitudes and thought processes, now we’re starting to act on them. The walls, supports, and the barriers that we erected to support our drinking and drugging are starting to be acted on it again. Things like minimizing, rationalizing, and denial start to become real again. We start acting like we’re bulletproof, and infallible and our recovery. All that’ recovery stuff’ is for other people, on doing quite well without it think you very much.

Looking back at the list of attitudes, thought distortions and actions or behaviors they can generate, it is easy to see how the dry drunk syndrome is simply nothing more then reverting back to the way it was when we were active in our use.

If you are starting to notice some of the attitudes discussed creeping back into your life, it is time to start paying attention to the possibility of relapse and start turning your life in sobriety and recovery around. The ‘dry drunk syndrome’ is a bright red flashing warning sign for relapse.

This week will be looking at self sabotage and self-defeating behaviors common in early addiction recovery. A number of these behaviors may be the contributors, if not the cause of past relapses.

This Featured Post is the 8th 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’.

In this module we’re going to take a look at self-defeating behaviors and self sabotage. We will take a look at the definition of self sabotage, find out why we do it, and give a list of examples of self sabotaging behaviors.

When these self-defeating behavior’s are recognized, it becomes possible to stop the process in its infancy and minimize the chances of having it escalate into a disaster. The ultimate disaster would be a lapse or relapse.

When we examine self-defeating and self sabotaging behaviors, it should become pretty evident that we really are really talking about the behavior that is observed and acted on by those who are chemically dependent.

As I researched information for this section of the program, I found the parallels and similarities astounding.

It’s not too far of a stretch of imagination to say that instead of being addicted to drugs and/or alcohol, we could just as easily say we’re addicted to self- sabotage and self-defeating behaviors.  OK enough with a warm-up let’s get to work.

Self Sabotage And Self-Defeating Behaviors In Addiction Recovery

For people in recovery, thinking about using alcohol or drugs, or actually returning to their use is the ultimate in self-sabotage and self-defeating behavior. I mean, talk about shooting yourself in the foot, what good could possibly come out of a return to the use of drugs and alcohol?As we go through this module I cannot imagine anybody in recovery not having several ‘Aha moments’ or ‘light bulbs going off over your head’. OK, let’s get to it.

A pretty good working definition of self sabotaging behavior is this:

“Self sabotaging thoughts, behaviors, and feelings create a block in the road to success even when there is no rational or logical explanation as to why you cannot achieve your goals.”

An interesting thing about self sabotage is that it is not a lack of knowledge, effort or even desire that keeps you from achieving your goals and out comes.But rather, it is the committee in our head, or our own inner self-dialogue that confuses the issue.

Let’s take a look at some of the characteristics in attitudes of self sabotaging behavior. Daniel G. Amen, in his book, Don’t Shoot Yourself In The Foot came up with the following characteristics and contrasts.

Sabotaging Behavior  vs.  Successful Behavior

Lack of personal responsibility   vs  Taking personal responsibility
Lack of Awareness   vs  Taking initiative to be informed
Poor communication skills  vs  Positive communications with others
Negativity  vs  Setting and working towards goals
Poor choice making   vs  Making good living choices

If I took those contrasts above, and labeled the left side ‘engaging in addictive use’, and the right side in ‘engaging in recovery’, it would fit like a glove. The deeper I get into this, the more realize that engaging in your addiction is the ultimate in self-destructive behavior.

So, self-sabotage can lead you to, and position you in the middle of, “relapse mode”. For us, that is the ultimate danger. Self-defeating behavior can make you frustrated, bring up that feeling of being trapped again, and be very discouraging. Don’t get me wrong, everybody makes a poor decision or does not get the results they want all the time. But this idea of self sabotaging and self-defeating behavior is really problematic when it becomes insidious and a pattern rather than an exception.

What Do Researchers Say?

Great question, I’m glad we asked. In writing material for The Recovery Club I promised jargon free and easy to understand information. I think it is important for you to know that material presented did not just come off the top of my head, there is foundation for it.

Rather than quote sentence by sentence from research papers, I will give you a composite of what was likely to have caused self-defeating behaviors and where they come from. We talked before very briefly about modeling being a very effective means of learning, and that unfortunately, many of us were raised in less than fully functional families.

People with self-defeating and sell sabotaging behaviors often have some of these five characteristics in common:

1. – They may come from family systems where behavior was inconsistent.2. – Often there is a history of abandonment or detachment disorder.

3. – Many have a history of not getting their developmental needs met, or knowing how ask.

4. – Come from families with a ‘no talk’, or ‘don’t let and see you sweat rule.’

5. – They may have incidents of abuse in the past, or present.

One concept that was put forth that we’ll provide for your consideration is this: because our needs were not met as children by our care givers, we have a great deal of low self worth and shame. Shame is a belief that we are defective inside, at the core.

It is only normal to have our needs recognized and met. Unfortunately, that is not happening. What we learn are various ways to get attention.

1. Some to try to be as pleasing, hard working, and worthy as possible… they turn into the overachievers.
OR
2. For others, acting and out in a negative sense is a way to get attention. Unfortunately, this is not the best way to get your internal needs met.

OK, let’s try to string this all together and hopefully, it will make some sense. The dialogue in your head might run like this. Here we go…

“I’ve never been able to get my emotional needs met; as a kid I raising my hand saying Mommy, Daddy, look at me, look at me. I was ignored, or worse belittled, or told I could do better. I tried harder and harder but it was never good enough. This creates the emotion of shame which becomes deeply internalized into the core of my being. I am not worthy, I am never good enough, but ironically I keep trying harder and harder. Now here is where the self sabotage and self-defeating behavior comes in. I am right on the brink of success, finally proving to the people around me, and maybe even myself that I am worthy, capable and good. But because of all that shame that I grew up with, I ‘know inside’ I am not good, so I mess things up just when successes in sight.”

As I said before, if the shoe fits wear it. Maybe not all people in addiction recovery have been through a little life scenario as I’ve described it. But man, as I was writing that it had a definite ring of familiarity within me and from stories of people in recovery that I’ve heard.

You Might Have Self Defeating Behaviors If:

1. Honesty it difficult for you and you exaggerate the truth
2. You continue to engage in unhealthy habits such as smoking, drug or alcohol use, or over indulgence in destructive behavior.
3. Right on the brink of success ‘something happens’ that screws it all up
4. You set goals, but never achieve them
5. You feel superior or inferior to everybody else
6. You’re always making excuses
7. You have a lot of self doubt
8. You have unrealistic expectations
9. You worry too much and have a great deal of anxiety
10. Feelings of rage, anger, shame, or resentment can be overwhelming and paralyze you into inaction
11. I heard this one all the time, ‘You’re not living up to your potential.’
12. You’re a big procrastinator
13. Your view of the world is something like ‘we are all born to suffer and die.’
14. You do things that jeopardize your emotional, physical and financial stability
15. You stay ‘stuck’ in situations and feel there is no way out
16. You have a lot of “poor me’ attitudes, nobody understands me
17. You often belittle yourself and those around you
18. You stay stuck in abusive relationships

OK, that’s enough of that, kind of reminded be of that comedian…’You might be a Redneck if…’ I wanted to give you a flavor of the attitudes and mindsets that can generate a posture of self-sabotage and self defeat. I wasn’t my intention to drive your self-esteem into the ground.Let’s move into the solution…

8 Tips To Help Stop Self-Sabotage

1. What is your payoff?

I am a big believer in the idea that every action we take is done for reason. What is it that you really get from self-defeating behaviors and attitudes? Is it negative attention? A ‘reason’ to go back to using? Ask yourself “What is REALLY going on here?

2. Avoid situations that trigger extreme emotional reactions.

This is one of the items we spoke about in the section on triggers and cues. Extreme emotional reactions can provoke a relapse. If you can’t avoid this situation, at least try to get a realistic perspective on it. Ask yourself “How important is it really?’”

3. Take a look at your past.

Just don’t get stuck there. Try to identify where your belief system came from. Once you have identified where those defeating attitudes came from, let go of them. It is OK to acknowledge the past, but not to use it as an excuse to continue your behavior into the present.

4. Challenge staying in the victim role.

Again, in recognizing the past we’re not denying that bad things may happen to you. Try reclaiming your personal power by reframing your experiences as a source of strength. Not everyone has gone through what you have and survived. The process of growth in recovery is about regaining self empowerment.

5. Stop blaming people.

Being the victim and blaming others, results in one particular sneaky, self destructive attitude. That is the attitude of not needing to change. Recovery is all about change, but, if everything is always somebody else’s fault, why do I need to change? In the victim role, it is ‘poor me, look what they have done to me’ I couldn’t stop it from happening, so I will be a perpetual victim and take no action.

6. First thought wrong.

Man, do I hate this one. My sponsor used to tell me this all the time. People who have a habit of self sabotaging have got to come to accept that they are never upset for the reasons that first come to mind. First thought wrong. We need to look at the underlying issues, again, ask the question ‘What’s really going on here?’ Sometimes we will take those negative thoughts and try to make them come true by doing something really destructive. We create a self-fulfilling prophesy.

7. We need to change the thoughts we have about ourselves.

Stop the negative self talk. Start thoroughly and rigorously questioning where your beliefs and perceptions are coming from. Don’t judge yourself as you’re doing this, become willing to let go of those negative thoughts. Stop defending your ‘right’ to be wrong.

8. Are you done suffering yet?

Just as this question is a key motivator to move from using drugs and alcohol into recovery, it is a prime motivator to start changing our self-defeating attitudes and actions. Nothing changes if nothing changes. How much longer are you willing to keep stepping on your own feet, tripping and falling down? Maybe, just maybe, it’s time to stop the pain.

When we were discussing working with emotions and feelings in the previous module, we introduced the concept of Rational Emotive Behavior Therapy. We learned that the key to affecting emotional change is to challenge our beliefs about a particular action or situation. The same principle applies when we start to try to change self-defeating and self sabotaging behaviors.

Looking at the other way around, it might be possible to see that our belief system can be the motivator of our actions. What we mean by this is we act more on our beliefs, then on logical solutions and practical approaches. In fact, you may have tried logic and being reasonable, yet still things somehow get messed up. You continue to make poor and sometimes dangerous decisions and unhealthy choices time after time again.

Your belief system may be thought of as being responsible for what you look for in intimate relationships, the type of lifestyle you lead, and the work you do. If you have internalized messages of shame, being defective, and having low self-esteem, these can influence your actions and out comes.

We keep trying to fill “The hole in the soul” but it never quite works.

Here is a quick video on prescription pill dangers. Prescription pills, particularly opiates are rapidly becoming the fastest growing ‘drug of choice’.

Prescription pill addiction isn’t the most often thought of type of dependency, people instantly think about addictions to alcoholic beverages or illegal drugs. Many people don’t even think about the potential for an addiction to a prescription drug; nevertheless, prescription pill addiction has become more and more common in the United States. As strange as it may seem, illegal drug use among teenagers is in fact on the decline, but on the down side, prescription pill addiction is rising among teenagers these days. Because this is becoming a growing problem it is crucial that people be more aware of this type of addiction so as to spot it in family or friends .

This week will be looking at four key relationships in addiction recovery. A number of these relationships may have suffered through our actions and behaviors while under the influence of drugs or alcohol.

This Featured Post is the 7th 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’.

I have yet to meet someone who is able to honestly say that all their relationships are in the best shape they’ve ever been when they first enter recovery.

I believe that addiction is a disease of isolation.  The deeper and deeper we slide into our addictive actions and behaviors, the more and more distant we become from relationships that are important to us. I have identified four key relationships that undoubtedly suffer when we’re active in our addiction, and those are:

1. Our relationship to ourselves.
2. Our relationships to our family.
3. Our relationships to our higher power.
4. Our relationships in society.

1. The First Key Relationship: How We Relate To Ourself…

When honestly looking at our past behavior while under the influence of drugs or alcohol, I think it is real difficult to feel good about yourself. And perhaps that is the easiest and most simple definition of self-esteem. Common feelings turned inward, experienced by people in active use, are anger, loneliness, shame, guilt, and inadequacy, among many others.
It is common to have very low self worth, and not feel very important or very likable. It is extremely difficult to attract and give love when you don’t feel lovable. How do we change this? How do we start moving forward in a positive direction? I hate to state the obvious. but the first really positive action we can take is to become abstinent. Stop using drugs or alcohol and stay stopped.

As we enter into addiction recovery and move down the path toward sobriety, it is natural to feel a bit better about oneself. After all, you’re finally taking pro-active and positive steps to improve your life.We will have to come up with a richer definition of self-esteem, then simply how we feel about ourselves. Perhaps a broader concept would be to look at the value we place on ourselves emotionally, spiritually, and physically.

Where does self-esteem come from?

For some reason, I picture a little newborn baby in the hospital being held up behind the glass by the nurse. New parents are gazing fondly at their new child. Then I ask myself, does that child have low self-esteem? Where did this concept of not putting a value on ourselves come from? What’s that all about?

Somewhere along the line, I believe we learned how to feel about ourselves. One thing I know, is that one of the strongest forms of teaching and learning is modeling.
We tend to emulate what we are shown. If we are raised in a healthy family, a Leave It to Beaver situation, where our needs are met, love and reassurance freely given, I don’t think there will be low self-esteem issues.

Unfortunately, many people who  suffered through addiction come from less than ideal and emotionally functional families. Now I’m not all about blaming our parents, I really believe they did the best job that they could, but the fact is some of us were raised in less than ideal family situations. Think about that. We learn from what is modeled around us.
Leaving the past behind us, just think how our value and perception of ourselves plummeted as we became active in our addiction. I really think that at some deep level we know that drinking and drugging is not a positive influence in our life. Yet we continue to do it. That push and pull of wanting to stop, then having to use, can play havoc with how we feel about ourselves.

Enough. How About If  We Move Into Some Solutions?

One of the great things about being in addiction recovery is that our self-esteem can take a major boost. Sometimes though, the old feelings and thinking can re-occur. That is when self esteem tips can be a useful recovery tool.

When people talk about improving self-esteem, they usually mean self-confidence.  While the two are related, they are not exactly the same.  Self-esteem is all about self-worth and self-value.  It’s how we see ourselves in relation to other people and our environment.  It has nothing to do with vanity or conceit.
The lack of self-esteem is a major problem and has a leveling quality. Rich and poor, all strata of society alike, are afflicted by it, and people decide between happiness and unhappiness because of it.  If self-esteem is an area in your life where you need improvement, here are some tips you can use to build your self-value and improve the way you see yourself:

Self-esteem Tips

1.  Know what you want.  You can’t assess where you are in your journey if you have no idea what you want to have in life.  You also will not be able to judge whether you’ve been doing a good job or just so-so.

Set goals that are clear and doable.  Make sure that these are things you want to do and attain, and not things your parents, family, friends and colleagues insist you ‘should’ have. Is it just the latest trends that dictate your aspirations? If so, you will never catch up and be satisfied.  You can only claim your goals as your own if you recognize them as things you truly, genuinely want in your life.

2.  Assess your good points.  List the things that you do well and the things that make you a good person.  It could be anything: intelligence, a good sense of humor, good analytical ability, compassion, creativity, ability to spot trends, or people skills These are things that you have and can recognize as an integral part of your personality and talents.  No matter how low you feel in your life, these are qualities that you never lose.

3.  Recognize your liabilities.  Improving your self-esteem does not mean ignoring the things that make you human.  To be human is to make mistakes, just do not let them keep you stuck.  List your negative traits and label them as areas in your life you need to work on, areas for improvement.  Treating them as downright liabilities will make them seem an unalterable feature of your life, and create a feeling that you are helpless against them.

4.  Build slowly but surely.  Take little steps to improve your self-esteem.  Big successes build upon small successes.  You can’t decide to change your outlook drastically today and expect extreme results in the morning.  By taking it slowly and performing well during each turn, you gradually build a solid base of achievements that will boost your self-esteem more effectively.

5.  Make it a point to improve yourself daily.  Whatever you do, say or think should be geared towards improving your self-esteem.  Improve the way you dress, walk or talk.  Take further studies to hone your knowledge and skills, learn a new language, take up cooking classes, start a new hobby.  Being able to immerse yourself in worthwhile activity creates a feeling of capability and opens new opportunities for growth.

6.  Keep away from people who shoot you down with snide remarks and unfair criticisms.  Associate with positive people.  There will always be grouches and negativists who will think nothing about giving careless opinions that make other people think unworthy of praise or recognition.  If you find people who make it their life mission to belittle other people’s achievements, keep your distance.  They will not contribute anything good to your life.

7.  Be yourself.  You’ll never improve your self-esteem if you try to live life and find acceptance as a projected mask of yourself.  Pretending to be someone you’re not will fail to affirm your uniqueness and potential and will only make you sadder about your circumstance.  You can’t make everyone love you, so don’t try.

8.  Make other people feel good about themselves.  People tend to like you more if you’re honest and pleasant.  Polish your listening skills and body language to make people feel comfortable.  Respond to them visibly and with interest.You might think that this is the opposite of what you want to do to improve your self-esteem but by actually focusing your attention on other people, you create an aura of likeability that they gravitate towards, making them choose you over others.  And when you are singled out as a good person who’s terrific to be with, your self-esteem grows.

9.  You have the right to make mistakes.  Nobody’s perfect, regardless of what you’ve heard or what popular media wants you to believe.  By accepting that you will make mistakes and that it’s all right, you learn to recognize that it is a necessary process you need to go through in order for you to improve yourself.

10.  Recognize that you are a unique individual with a different set of talents and that you have something to contribute.  You may not be a big celebrity like Justin Timberlake, as rich as Bill Gates or as powerful as Oprah Winfrey, but your individuality makes you as important as they are, with as much right to exist and make something of yourself.

2. The Second Key relationship:How We Relate To Our Families…

I was asked to give a lecture on addiction and relationships to about 50 patients in an inpatient treatment facility. I asked the group to shout out emotional states or consequences of their active addiction while I wrote their responses on the board.  We developed a list; take a look at it very carefully because I am going to ask you a question after:

 
1. isolation
2. financial consequences
3. guilt
4. legal issues
5. shame
6. abandonment
7. anger and rage
8. loss of morality
9. cheating
10. poor health
11. job loss
12. dishonesty
13. Losing interest in life
14. divorce

Here Is the question:

With all that going on, why would you NOT think you relationships are in trouble?

Look at what you were bringing to the relationship. Look at your emotional contribution. The silence is deafening.

A person who is active in their addiction has one the self-centered goal in mind, and that is to continue using drugs and alcohol.  If someone close to them points out the fact that they are hurting themselves and others around them, the natural thing to do is to put up walls insulating themselves from the message.  The addict will continue to use and twist the relationship as long as it promotes his ability to continue alcohol or drug use.

I can’t tell you the number of times I have heard:

I just want my old _____________ (husband, wife, mate, friend) back. The obvious implication here is that things have changed, and if you go back to the list we mentioned before, it is not for the better. I have NEVER heard anyone say “the more I drank or drugged the better my relationships got.” Oops! Sorry for stating the obvious.

The Million Dollar Family Dilemma:

I could make a million dollars if I could solve this early recovery dilemma. There are two points of view on healing relationships as we move into sobriety, the recovering persons, and families. Unfortunately, they are almost always diametrically opposed. Here the two positions that are talking about:

The recovering person…

With good reason, wants to let go of past, live in the present, and move on to the future. They are very sincere in their conviction that they have finally got it right and that drugs and alcohol will no longer be a problem. And for everyone’s sake we hope it is true. They want to reestablish family relationships as if nothing has happened, and not dwell on the wreckage of the past or least tone it way down.

The family member(s),…

Sincerely hope that there is no return to drug or alcohol use. However, the past cannot just be ignored, the pain was very real to them each and every day while the user just ‘checked out’, leaving the family members holding the bag for a whole host of problems. They truly want to believe that is all over, but have very real concerns about it. The track record has not been good.

Conclusion:

The recovering person sincerely believes and wants this to be the last time, and wants everybody around him to believe in support him. That’s great, however here is the flaw. This may hurt, but I’ll let you have it right between the eyes, Your track record stinks. Why should anybody believe you this time?

Don’t get me wrong, your family wants to believe you, but what they are really looking for is a guarantee. I had one family member describe it to me as like being on a roller coaster, they would see progress get their hopes up high only to see them slide downhill into oblivion.

How about this for a different explanation: the family finally has your attention your head is out of the drug and alcohol induced cloud, you just might be capable of hearing them. They want you to listen to them. They are not being mean and vindictive they are simply trying to get the point across did they have been through hell too. You certainly were not able to listen what you are under the influence. Maybe they are thinking that if you know how bad it was, you would not possibly go back.

3. The Third Key Relationship: How We Relate To Our Higher Power (spirituality)…

One way or another our spirituality is definitely affected if by actively using drugs or alcohol. I am going to stick to that point within this Module. You might guess we will be dealing with spirituality in depth in a future session, and you would be right.

Perhaps one of the most simple, yet elegant exchanges I ever heard of when discussing how people become disconnected from their spirituality when using is this:

Recovering person “I felt I was more and more distant and disconnected from God, and my spiritual well-being.”
Person listening: Who moved?”

I used to be envious of people who had a strong connection to God or religion. I always wanted that, but something always held me back, I just couldn’t get there. The one thing I could not appreciate is that while under the influence of drugs or alcohol, it was very difficult to have faith in much of anything.

For those who do believe in something greater than themselves, I can’t recall ever having heard that their faith became greater and they became closer to their higher power while under the influence of drugs or alcohol.

I will just state that in order to grow in recovery, move closer to that peace and serenity that I think most of us want to achieve, I believe it is necessary to address spiritual issues and personal values. I’ll leave the definitions of them up to you for now.

4. The Fourth Key Relationship:Our Relationships In Society Or Community…

OK, we have covered relationships with ourselves, our family, and spirituality. Now it is time to tackle pretty much all else that is left, and by that I mean our relationships in society and with our community.

Almost by definition, our relationships in the society and community around us suffer and deteriorate. Two of the criteria from the DSM, the Diagnostic and Statistical Manual of Mental Disorders which mental health professionals use to diagnose substance dependence are:

1. A great deal of time is spent in activities necessary to obtain substance, use the substance, or recover from its defects.

2. Important social, occupational, or recreational activities are given up or reduced because of substance use.

I return once again to our idea about alcohol and drug addiction as being a disease of isolation. What may have started out in the beginning as casual use escalated over time. Our drug or alcohol or use became so prominent that it became the thing around which we organized everything in our lives. Not only does that include destroying relationships, but actually giving up fun things that we used to do.

One of the real benefits of 12 step programs, is they provide a way back into community, and learning how to reestablish those people skills we may of lost along the way. Aside from that, all the people in those programs are trying to head in the same general direction, that is, lead a life that is drug or alcohol free. What better place to become socially reconnected, or to use the program terminology, to partake of fellowship?

When asking people who have relapsed what they believe the causes are, there are two answers that come up over and over again. Boredom and isolation. Sometimes we become so lonely and withdrawn from society we actually forget or do not know how to reconnect again.

There are some standard answers, such as get a job, do volunteer work, etc. Now, when people complain that their bored or lonely I look them right in the eyes and say what are you going to do about that? Who said it was easy?

Sometimes life in recovery involves pushing the envelope and making a little bit of effort. If you need to work on shyness, or being uncomfortable with people, then so be it, let’s start working on it. I know you can do it because you are here reading these words, trying to improve yourself.

As they say in the 12 step programs, recovery is all about action. You can think, and study all you want, but nothing happens until you take action.

And in a larger philosophical sense, I believe that’s what makes us human. Making decisions, sometimes being right, sometimes being wrong, but doing something darn it.

In Closing:

Well there you have it, a look at the four key relationships in recovery. I want to touch bases on all for those areas, to put a more global view on the concept of relationships.

Some of these relationships such as self-esteem, dysfunctional relationships, and spirituality we will be visiting in more depth in the future.

A final thought or word of caution I might relate when it comes to relationships is this if: be very careful about superimposing your desired time frame on reality. In a lot of cases it took a long time for relationships deteriorate and crumble. It would be a very unrealistic to believe that they can be repaired in short order for instantly.

In some cases people associated with us have had enough of the talk, they want to see more of the walk. A sure-fire method to reestablish positive relationships is to the next right thing, act responsibly, consistently into overtime. If we are taking right action and making good decisions over time, the people love us will certainly come back into our lives.

Yours in sobriety,

Bill Urell

The topic of learning how to deal with the emotions and feelings runs neck-and-neck with improving and repairing relationships, in terms of being the most requested subject.

This Featured Post is the 6th 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’.

I don’t think this is any surprise, because when we’re active in our addiction I think we generate all kinds of unpleasant emotional turmoil within us and affecting those around us. We have, for the most part learned abstinence.  But how to go about repairing ourselves and our relationships with the world around us is a whole other story. This is not easy work, but it can be done.  In fact, I would say needs to be done.

Let’s look at some tools and methods that can get us pointed in the right direction. Don’t get discouraged remember its “progress not perfection”.

Emotions and Feelings

Two things I’m certain of, and that’s people who are active in their addiction, or in early recovery, really have a difficult time with:

1. Emotions and Feelings

2. Relationships

As we all know, alcohol and other drugs have a biological and psychological effect on the brain, especially on neurotransmitters. These effects can continue on for quite some time for after we have stopped using the alcohol or drugs.

Aside from physical symptoms, there may be emotional and cognitive symptoms that you may experience. Just about everybody entering early recovery has noted extreme mood swings. While not particularly pleasant, they are not abnormal in the least.

Sometimes these mood swings can get so extreme they can actually interfere with how well you can function in day to day living. You may be hyper, or in the best of moods one day, on a pink cloud. And shortly there after, even opening your eyes and getting out of bed can be a challenge.

There are no definitive answers to why these mood swings occur, but the best guess is that it is a combination of physiological and psychological factors. One thing that is fairly certain, is the radical degree of mood swings tends to temper and lessen with time.

The time frame for the moderation of mood swings is usually towards the end of the first year recovery, but that is not written in stone.

There Are Some Things You Should Know About Feelings:

Feelings, come about in response to an action or an event. The more dramatic or radical the event the more dramatic or intense the emotion. Usually emotions tend to follow changes. I can’t think of anything more radical than moving from a life of Addiction into one of recovery. Its it’s actually pretty unrealistic not to expect mood swings with the changes we are undergoing.

If feelings are pushed down, suppressed, or ignored, they don’t just go away or disappear.

I think of an old fashioned pressure cooker, like my grandmother had, with that little nob on top that used to hiss and rock back and forth. Well, if you were to screw that pressure relief valve down tight, turn up the heat something’s going to blow up, and it usually comes out sideways. Feelings are the same way stuff them dpwn, turn up the heat and they will blow up…usually at an innocent person. There is an ever increasing body of research and evidence that says that unresolved feelings can actually affect your physical health.

Often, early in recovery we lack the ability to identify our feelings accurately. It is as if we do not have the vocabulary to identify them, you can mistake anger for fear, laughter covering shame, or use the catchall phrase by stating “I’m fine“.

If you do not learn how to identify, own and process feelings and emotions, you may be tempted to return to drinking and drugging. Unfortunately, drinks and drugs are very effective at nullifying unpleasant feelings and emotions.

You can change your feelings. No matter how suddenly they arise, or how strong they may be, you can certainly control your reaction to them and transform then into less damaging actions.

Our second week was spent examining very closely and rigorously, the concept of honesty. Well, honesty and emotions can be linked together, and there’s a term often use called emotional honesty.

If you can develop the concept of emotional honesty, you develop the ability to care about yourself and love yourself. Issues of low self-esteem will improve. If you care about, and love yourself, that will enable you to have functional and fulfilling relationships with others.

Feelings Are Not Facts

Feelings are not facts… OK I give up, what we talking about.

Well, you may feel a certain feeling, you are certainly entitled to that, it is real to you, but that might not be the fact what is going on in reality. Here’s an example: you walk into a meeting, or a room of people,   and feel that everybody’s staring at you, not only that, but nobody likes you.

The fact of the matter is most assuredly, that you walked into the room, maybe everybody’s even looking at you; but it’s a far stretch of the imagination to believe that everybody dislikes you immediately. In reality, some people may be taking immediate liking to you, some might be neutral, and then again, some may actually dislike your first appearance.

Your perceptions and feelings may be completely different from what is really going on.

One of the perils, of not pushing yourself to work through uncomfortable feelings, is staying stuck in the rut of being comfortable and staying with old familiar things. Stunted growth. If you feel that everybody is always staring at you, and disliking you, isn’t it tempting not to venture out or try to meet new people?

Fear is often at their root of reluctance to work on or challenge our feelings. In fact, in the 12 and 12 book of Alcoholics Anonymous it states “self-centered fear is the activator of our character defects”. We will devote an entire section to handling fear in an upcoming module.

Unless we are growing in recovery and “working on feelings and emotions” very little progress will be made in personal growth, forming, or repairing relationships.

Why is this true you may ask? Because…

”The ability to identify, own, and process our feelings determines the quality of our relationships”

How can we possibly enter into a loving relationship but we do not love ourselves? How can we respect another, when we do not respect ourselves?

A huge problem that we face in recovery is to allow your emotional response to other people dictate your behavior. In other words worrying about what people will think if I do this or I don’t do that. Perhaps that is the fear of rejection speaking, or the fear of acting the fool, but in any event, it is part of working with feelings and emotions to own and accept your feelings.

Feelings aren’t right or wrong they just are.

Let’s use the example to illustrate this point. We are all at 12 Step meeting, and Sally walks in 15 minutes late:

Joe sees this and thinks “Who does she think she is, interrupting everybody, doesn’t she have the common decency and respect to be here on time?” He gets angry.

Alison sees Sally walk in and says “Oh my goodness, I haven’t seen her in a long time, I want to talk to her after the meeting.” She is glad.

Barry sees Sally walk again doesn’t know her, and could care less if she is there or not. He is completely neutral.

Now, who is right and who’s wrong? Isn’t it interesting the same event precipitated 3 different reactions or feelings in different people; happiness, anger, and neutrality?

I thought that was a pretty jazzy example, no? But where did these feelings come from? How can the same event spark happiness, anger, and a lack of feeling?

In part, I believe, the first feeling that comes up for you when an event or an action is witnessed is probably based on your experience, your upbringing, and your mood or receptivity. I think questioning “why” a particular feeling sprang up at a particular time is a dead end path.

It Is much more important that you can identify the feeling, own it, and process it appropriately, rather than determine the cause.

The core of all feelings and emotions work has three parts:

1. Identify the feeling

2. Own the feeling

3. Process the feeling

1. Identifying feelings - for people addicted to drugs and alcohol is very common not to be able to correctly or accurately to identify feelings and emotions. I believe a major part of the problem is that we simply have not developed the vocabulary to express feelings. In many therapy groups in which I participated, there’s an exercise called a ‘go round’. Everyone is asked to go round the room and tell the group how they’re feeling in 1 or 2 words. Common answers are: good, fine, shitty etc. Now I’m not dumb, I kind of know what they’re saying, but what is ‘shitty’ to you might not be ‘shitty’ to me.

Another serious difficulty people have when talking about feelings, is that they are often talking about thoughts, explanations and telling stories not simply stating their feelings.

2. Owning our feelings - This is another concept that is sometimes difficult to grasp, but is very important to understand. To have feelings is OK and normal, but they are yours. You must own them. The important point here is that nobody can “make” you feel a certain way. A statement like “you make me so mad when you come home late”, is not accurate when we are talking about owning feelings. A more accurate way to express that is “when you come home late I become mad.” see the difference?

3. Processing our feelings - there’s a lot of literature devoted to the proper expression of feelings. There many tips on how to properly express anger, concern, etc. I will leave it to you to explore this aspect further. I’m going to go one better. Rather than teach you how to properly express your feelings I’m going to give you ideas on how to change your feelings.

“Men are disturbed if not by you events, but by the views which they take of them.”
Epictetus – A.D 55-135

Rational Emotive Behavioral Therapy

Don’t be scared by those $5 words, rational emotive behavior therapy (REBT) was created by Elbert Ellis around 1955. It is based on the same ideas quoted above by freed Roman slave turned philosopher around 2000 years ago.

Is really as simple as ABC.  A + B = C

A) An action or a event occurs, something happens.

B) You form a belief about that action or event. (A)

C) You form an emotional reaction to that belief (B)

Let’s work through an example:

A) My boyfriend said he would call me tonight and he didn’t.

B) He knew was important, he doesn’t care about me anymore.

C) I get angry because all men are rats.

Now, one of the keys to changing your emotions, is to actually change your beliefs about the about the event or action that started the whole process. If we work through the above example: we cannot change the fact that your boyfriend did not call.

What we can, and must do, is a challenge our beliefs (B) about why he didn’t call. Instead of believing that he does not care about me anymore, I can choose to believe that he simply forgot, and on the whole is a pretty decent guy. I can then even choose to feel good about myself for forgiving him.

Can you see how the key is in challenging your beliefs about an action? You could choose to believe all men rats or you could choose to believe that he was forgetful just this once.

I don’t know about you, but if there are two equally plausible beliefs I can have about the situation…All things being equal, I will try to choose the one that causes me the least amount of pain. I hate to bum you out, but there’s one more addition to the equation of ABC, and that is “D”. the D is for Dispute. A+B+C+D.

The whole point of REBT is to get a person changing their irrational beliefs into rational beliefs, that’s where the ‘R’ in REBT comes from. We do that by disputing our beliefs about the action of the situation.

This is a simplified model of REBT. The basic point of the ABC concept is that A (the event) does not cause C (the emotion). The action or the event does not lead directly to an emotion springing up. A leads to B, which is your interpretation or belief about the action in the event, your belief or interpretation then gives rise to the emotion. If you dispute your interpretation of the event you will change your emotion is the outcome of your interpretation.

That may sound a little complicated, but if you go back and look over the example, the key lies with your belief about the action. Make up a few examples of your own and work through them, it will make more sense.

Here’s how I work it: When I dispute my beliefs about the events or actions I tend to ask myself these 3 questions:

1. What is REALLY going on here? Maybe I’ve got it all wrong.
2. How important is this anyway?
3. Do I need to do something about it right now?

Taking the time to answer those three questions has saved me an incredible amount of embarrassment, and amends being owed.

The Three Basic “Musts”

According to REBT, there are three irrational and illogical beliefs that can cause all sorts of aggravation and trouble. Do any sound familiar to you?

1. I “must” get what I want, when I want it. If I don’t want something I’d better not get. If I can’t get what I want it’s a terrible tragedy. Poor impulse control.

2. I “must” win the approval of others for my actions or I am no good and have little value.

3. Everyone “must” treat me exactly the way I want to be treated in a kind fair and considerate manner, if they don’t, they are rats and should be punished.

Acceptance and Peace

If you remember, in previous discussions about addiction we mentioned the fact that we can be in a great deal of denial. Our perception of reality is altered, and we have created fantasies in order to allow us to continue using.
One of the goals of doing work on emotions and feelings is to arrive at a condition of acceptance, specifically an acceptance of reality. That includes the idea that things don’t go the way we want them to all the time. Others don’t behave the way we want them at our request. We (not them) must make some adjustments. Here are tools to help. Here’s what we’re aiming for:

Accepting Yourself Unconditionally:

1. As part of being a human, I will fail occasionally. I have my strong points and my weak points, my good points and my bad points.

2. In spite of my strengths and weaknesses, I am no better nor worse than any other person.

3. It is OK to have flaws, I don’t have to be perfect all the time.

Unconditionally Accepting The People Around You:

1. No one is perfect, and sometimes I will be treated in an unfair fashion.

2. People don’t “have” to treat me fairly.

3. If someone doesn’t treat me well it does not necessarily mean they are rats, or better than me.

Accepting Life On Life’s Terms:

1. Who said life will always work out the way I wanted to? Sometimes things won’t work out according to my plan.

2. Life is not always happy, the joyous, and free, but then again it is not always completely black or gray and unbearable.

3. Life does not “have” to go the way I want it, sometimes it won’t. Sure as the sun will rise tomorrow, all my plans will not come through.

Emotional Honesty

If we combine honesty, together with enhanced ability to handle our emotions, we come up with a very powerful aid to employ toward personal growth and our maturity in recovery, something called the emotional honesty. Emotional honesty means becoming aware of each time our feelings are hurt, and attending to the distress that it causes at the time it occurs. By correctly identifying the feeling, owning it as our own, and changing it into something less harmful, we greatly reduce the chance that an undealt with emotion can turn into a relapse trigger.

Emotional honesty means taking responsibility for what we feel rather than taking seeking a method for escaping it.

We need to:

1. Stay in the present, not the past, or future

2. Do the next right thing, and let go of outcomes.

3. Stay positive

4. Be open to and willing to change, make mistakes, admit when we’re wrong, and grow. This is what is to be human.

In Closing:

I believe one of the most difficult tasks involved in our growth in addiction recovery is to do your emotions and feelings work. The satisfaction and growth in this area it does not come overnight, it can take weeks, months, and years.

A gentle word of caution… is not to superimpose your own time frame over your work on emotions feelings and relationships. In other words, we think things should be happening quickly or right away. We might have unrealistic time frame expectations. Healing and growth in this area can often take much longer than we anticipate.

“To me, there are three things we all should do every day. We should do this every day of our lives. Number one is laugh. You should laugh every day. Number two is think. You should spend some time in thought. And number three is, you should have your emotions moved to tears, could be happiness or joy. But think about it. If you laugh, you think, and you cry, that’s a full day. That’s a heck of a day. You do that seven days a week, you’re going to have something special.”
-Jim Valvano-

“Take control of your consistent emotions and begin to consciously and deliberately reshape your daily experience of life.”
-Anthony Robbins-

“They may forget what you said, but they will never forget how you made them feel.”
-Carl W. Buechner-

“You can close your eyes to the things you do not want to see, but you cannot close your heart to the things you do not want to feel.”
-Unknown-

Bill Urell

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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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Electronic cigarettes

I was rummaging around used bookstore and discovered an author’s writings I know very well from a completely different feel than the personal development section that I was looking in. The author is Dr Joe Vitale and she wrote a book called “Life’s Missing Instruction Manual”.

I started flipping through it because it is composed of two or three snippets per page which makes it very easy to read, my kind of book. I was absolutely astounded with the earthy, life-changing information provided in a very simple form.

I am at a crossroads in my life and was looking into personal development. The little piece that caught my eye was this:

Achieving Your Goals Is Easy:

How to achieve your goals easily:

1.    You must know what you want.
2.    You must feel it as if it’s already achieved.
3.    You must do the next thing for you achieve it.

It makes perfect sense in an elegantly simple way.

I believe honesty is the heart of any addiction recovery plan.

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If we do not have a realistic, clear and honest vision of ourselves, our problems, and what we want to accomplish, we’re could be in a great deal of difficulty.

The very fact that we had continued and are active in addiction for so long, is almost proof positive of our ability to delude ourselves. In the light of day, and with a clear mind, how could we possibly believe that we were not doing ourselves, and those around us serious harm by continuing our addiction.

The only way we could allow ourselves to indulge in our using behavior is to create a fantasy around ourselves which essentially made it OK to use. These fantasies were self delusions that were rooted in dishonesty and self deception. For a long time I had wondered what the word delusion means. I thought it meant ‘crazy’, (and there were certainly times I thought I was). I looked it up, and it simply means believing in something that is not true.

For the purpose of this discussion let’s look at honesty not only in terms of being truthful and not lying, but in not deceiving ourselves. Here is a simple definition of honesty:

”Honesty is the absence of the intention to deceive”

I might add that the person most often deceived is ourselves.

“There’s a lot of talk about the importance of being honest in all our affairs and relationships. I really don’t know where to start it’s been so long since I’ve been honest it’s almost easier to lie.”

Being dishonest can easily become the standard of action, or way of life for most alcoholics or addicts. We deceive ourselves and we lied to others. We lie about how much we used, and how often we used.  We hid our feelings and emotions, or became distant from our relationships, perhaps not in all areas, but certainly in terms of our substance use.

We lied about where we went and what we had been doing. It’s a way of staking our claim to our right to continue drinking or using drugs. The lies, self deception, and self delusions were created for the for the purpose of allowing us to continue to use. Somehow we needed it all to make sense.

Sometimes it was not even our intention to deceive. But it is simply that our thought processes had become so clouded and confused and distorted, that our sense of reality was way off base and we no longer made sense.

Many people have discovered that there is a tendency to continue to be untruthful it just doesn’t go away when your substance use stops.

There are two major challenges concerning dishonesty that must be met and overcome in order to enter into a healthy recovery.

1. The dishonesty and lying has to stop. Unfortunately, for many people, this has become a habit. This behavior needs to be ‘unlearned’ and the habit broken.

2. We must also overcome the fear of the consequences of once again being truthful.

Just as the slide into active addiction was gradual for most people, the slide into a state of being dishonest may have been gradual also.  Rome was not built in a day. It seems reasonable to assume that to be returned to the state of being completely honest as the norm will be gradual also.

1. To clear up the web of dishonesty we need to start being truthful with ourselves, firstly. If we cannot stop the self deception, delusion and lying in our own hearts and minds, we
won’t be able to be truthful with anybody else.

2. To grow and have an enriched recovery is not possible without honesty. Continuing on with a dishonest nature, or deceptive behaviors, can eventually lead us back to our old ways.

3. Being completely honest need not mean being cruel with ourselves. It is just as important to it knowledge our good qualities as well as the qualities that need improvement this can be difficult. A great number of people in recovery have difficulty accepting complements, or thinking well of themselves.

4.”Brutal honesty” that causes pain to others is wrong. The steps of AA speak of an exception to honestly making amends by saying “except when to do so would injure them or others”.

5. Let’s be realistic. No one can be perfectly honest with themselves or others at all times. As stated before, if we look at honesty as the absence of the intention to deceive, we must be aware that we may, at times, be fooling ourselves and others without intentionally doing so. We simply may not have developed or become aware of the ability and tools to learn how to correctly evaluate the moods, feelings, and situations we find ourselves in which we find ourselves.

What makes these points and questions so significant for the chemically dependent person in recovery?

Well, first of all the concept of honesty must be an underlying foundation before we can even start entering recovery. If we are deceiving ourselves about the severity and chronicity of our disease, how it has affected ourselves and others, we will be very unlikely to take appropriate action. Here are some typical modes of thought, that are based on dishonesty, self deception, or just lack of experiential context

For example:

1. If I truly believe that I really do not have an addiction (self deception), what sense does abstinence or recovery make? Why should I apply a solution when a problem does not exist? Especially if the solution or course of action involves a good deal of effort.

2. If I assume the role of blaming other people for my substance use, what motivation is there for me to remain abstinent? After all, if you had my___________( fill in the blank), husband, job, anxiety, you would be using too. it is your fault I continue to use, not mine. Therefore since it is not my fault I do not have to fix it. You have to fix what you’re doing.

3. A tightly related position to blaming, is playing the victim. Again, if I am the victim of circumstances, be it people, places, or things, I can easily get stuck, and not be willing to change. this is a particularly dangerous form of self deception because the reality is life goes on. bad things happen, good things happen, but casting yourself in the role of a helpless victim takes away motivation for change. There is an old saying, “Poor me, poor me, pour me another drink.”

Common Blocks To Honesty

What is so difficult about being honest even when we want to be?

The first reason ….is that we have developed an integrated and complete lifestyle around which dishonesty has been an integral core.

We have come to lie about our drinking or using to the point where we believe our own fabrications ourselves. That makes it difficult for people to communicate or dispute us. Dishonesty has saturated our emotions, minds, and has come to dominate our behavior and actions.

In other words, we had developed a complete life style and we system based on this honesty, delusion, and distorted truths. It had become an integral part of us. We had become so emotionally dishonest we lost the ability to identify, own, and effectively process our feelings and emotions. (This is an entire future topic). To change the very fabric of a belief system will require constant attention, persistence, and perhaps most important of all… change.

The second reason …. is fear.

There is a certain risk that is involved in being honest and frequently we fear the consequences and pain (mostly to ourselves) that may occur if we’re honest. This type of fear is referred to in the 12 steps as self-centered fear the fear that we may lose something we already possess, failed to gain something we want or suffer a loss.

The fear of telling the truth about yourself is almost always groundless. Almost everybody appreciates honesty and sincerity. Your fear can become exaggerated and escalated by worrying more about how people react to you, then by the truth itself.

There is an old saying that says “What other people think about me is none of my business.” Whenever the fear of being honest grips me I tried to remember that. Sometimes, if the people we encounter have difficulty hearing truth and honesty, they may have a problem with it themselves, it may not be us at all.

OK, I’ve seen the light and I’m going to work on becoming honest so everything will be smooth cruising on the recovery road right?

Well, that’s great tiger, but there may be some bumps in the highway…
One of the consequences of having been dishonest and lying to people that we somehow tend to ignore the fact that people may not trust us. This especially applies to family members. How many times in the current the same old song, and why should they believe you now?
After all they say, if you loved me you would have quit sooner. Gulp…I hate that, but from their point of view it makes sense.
I firmly believe that addiction is a disease of isolation. Not only do we lose the trust of people but we also lose their help. At some point, they will stop trying to help and listen to us. And that can make for very lonely life.

Even though that we have sworn that we are done with our addiction and are on the road to recovery, why should they believe us? This can be incredibly frustrating for the person who is sincerely engaged in recovery. “But I really mean it this time.” I believe you, and I sincerely hope it is true. But you have one thing that is undeniably working against you…Are you ready for this, you won’t like it, it’s going to hit you right between the eyes.
Your track record stinks !!!

Blame it on your past behavior; actions speak infinitely louder than words. But let’s move forward. How can people come to believe and trust in you again? The answer is elegant in its simplicity,

To gain peoples trust…Become Trustworthy

The way to become trustworthy is to show consistent action over time. This comes about by “doing the next right thing”, on a consistent basis. It is all about making correct and ethical choices. It will take quite some time for your new found honesty to accept it as normal by the people engaged in relationships with you.

Patience is a quality that surrounds honesty. Again, many of us have been dishonest for so long that despite our intentions to be honest it is difficult to do so. It is also difficult to know the difference between honesty and privacy.

Without active work in trying to grow and progress in our recovery, the tendency is always to slip back into old and established patterns of destructive behavior. In this case being untruthful and self deceptive. A central idea of moving forward into recovery is to change our old established patterns of behavior. One thing that it is very difficult to argue against is that whenever we were doing was not working. We must focus to change those things that need to be changed.

This takes time. It takes time for others to accept our new way of life. It takes time for us to learn how to manage it. It is no small task to change one’s view of the world and ourselves. To move from a position of “everyone’s out to get me and will, we are put on earth to suffer and die” to a position of hope and the realization that happiness may be within our grasp, is the work of a lifetime.

Initially, some of the slogans and sayings I heard in recovery used to drive me bananas. I thought they were trite, for the brain-dead and brainwashed. The reality was that I was not in a position to accept the truth of them.

The slogan that springs to mind when I consider working on the concept of honesty and becoming more and more truthful with myself is this:

The goal is progress not perfection

There’s a certain degree of comfort to be had in that slogan, in that it is OK to make mistakes. By making mistakes we are confirming the ‘diagnosis’ that we’re human. We are said to learn from our mistakes… If that is the case, I may be a certifiable genius, or then again, simply certifiable.