Relapse Prevention; the next step
By: David Paur and Others

Full credit must be given to so many who have fought this fight before us and led the way. We are thankful to those service organizations that also share this journey of care for the addicted. A special thanks to: www.heretohelp.bc.ca who have influenced much of this article.

Finally , you have completed those first, most important stages to recovery, submission, seeking help and completing the best treatment program for you. Or, maybe it simply means you have surrendered and have skipped ahead and are attending some of the many 12 step programs available. This time of discovery and change is not easy. One way or another the addict needs to open up to the past, deal with old wounds and prepare new skills for new living. As there is no known cure outside of divine intervention (which is rarely instant and requires work and commitment) the mountain now faced is RELAPSE. This is where the new work begins, RELAPSE PREVENTION.

The bad news and the good news:

Studies and real experience show that three general conclusions can be drawn:

• You are most likely to relapse in the first three months after making a change.
• Your overall chance of relapsing is high.
• The good news is, a relapse is not the end of the world—it is part of the NATURAL CYCLE of change, a step on the way to lasting recovery.

Our purpose here is to hopefully help eliminate or at least minimize the number of relapses and the effects.

How Does Relapse Happen?

Relapse does not [necessarily] begin with the adoption of old behaviour, as one might think. Actually, falling back into your old pattern is the last step of the relapse process. Outlined below is one model of how a relapse happens. It is important to think about your own behaviour, and previous relapses that you may have experienced. If you are able to recognize the different steps of your relapse experiences, you will be better prepared to address this risk in the future. What is most important to recognize is that the process provides you with opportunities to intervene at several points along the way.

Something happens:

Sometimes referred to as a “trigger,” the initial something can be an event, a feeling, a situation, or a person. It can literally be anything—good or bad, inside or outside you. A bad day at work, running into one of your old “using” friends, or achieving a goal and feeling proud and hopeful are all examples of the “something” that happens.

You interpret it:

The something that happens triggers a core belief that you hold about yourself. This often comes in the form of a message that you say to yourself, consciously or subconsciously. These message beliefs are unique from person to person, but could be statements such as “I am a complete failure” “I don’t deserve success” or “I need to celebrate.”

Cravings: These self-destructive interpretations lead to cravings. Cravings are the psychological and physical desire to engage in your old harmful behaviour (this may be smoking a cigarette, having a drink, going to the casino or any other harmful response you want to avoid).

Permission-giving thoughts: Your cravings could lead you to thoughts that allow you to give yourself permission to engage in the old behaviour. These thoughts can take many forms. A few examples might be: “I need to smoke a joint to calm down,” “I’ve been exercising pretty well. This weekend I’ll just sit in front of the TV,” “I deserve to treat myself, I’ve had a bad day,” or “I have not been drunk for 3 months. I’m strong enough to handle going to that party.”

Action: At this point in the cycle, you take the steps necessary to engage in the old pattern or give yourself an excuse for not engaging in your new pattern. This could be calling your old dealer, stocking up for the weekend, “dropping in” on a friend you know is always supplied, or inviting an old friend over so that you cannot make it to your exercise class.

Harmful behaviour: You finally engage in the old pattern (e.g. using a drug you had been abstaining from, getting drunk at a party, wasting the weekend in front of the TV).

The most important thing that you can do to avoid relapse is to develop a plan for your recovery. The most successful businesses have a clear mission statement, as well as a very focused plan for how they will achieve their goals. It is equally important for an individual, striving to live a healthy lifestyle, to develop a plan to guide them towards success. A significant part of this plan, particularly early in the recovery process, is minimizing your risks for relapse.

High-Risk Situations

Just about anything can be a relapse risk, and what may be the highest risk areas will differ greatly from person to person. The first step to take in your relapse prevention plan is to begin to identify those situations or circumstances that will be the highest risk factors for you. High risk situations can be that “something” that happens in the relapse cycle outlined above.

High-risk situations can be internal or external in origin. Some examples of internal high risk situations can include: feeling depressed, boredom, loneliness, being tired, having that Friday afternoon excitement at the end of the day on payday, or pride over an accomplishment achieved. Some examples of external risk factors could include: an argument with your partner, a call from an old using friend, money stress, hearing a radio commercial, or a sporting or social event.

As you begin to reflect on your own life, it would be a good idea to make a list of your risk factors as you think of them, which you can continue to add to as time goes on. What things are most likely to happen in your life? What circumstances or events have been associated with your harmful behaviour? Your list doesn’t need to be inclusive at this point; perhaps listing the first 5 or 10 risks that come to mind may be a good place to start.

Once you have created a list of your personal risk factors, it is time to develop a plan for each of these. Your plan should be very specific, and can consist of more than one response to each high-risk situation that you have identified. Here is an example of how this might look:

• Phone call from Bob: I will state my abstinence commitment, and tell Bob I cannot see him any longer; I will take a clean friend with me and meet Bob at Starbucks for 30 minutes only; I will discuss with my sponsor.
• Feeling depressed: I will go for a 30 minute walk; I will call people on my phone list, until I reach someone to talk to; I will write a list of 10 things that I am grateful for.

Developing a written plan helps in more than one way. It gives you an opportunity to commit your actions in writing to yourself. It allows you to be prepared, thus increasing your sense of control over the course of your own life. It also minimizes the likelihood that you will be caught off guard, which can be the most dangerous time for a relapse to occur.

Cravings:

Cravings can occur in response to high-risk situations, or can occur of their own accord, triggered by a physical or psychological cue. Cravings, while not limited to, are most often associated with, substance use. Cravings can also occur during sleep, in what are sometimes referred to as “using dreams.” This is when you may wake up and have the feeling that you have used your drug of choice.

It is important for you to understand that when you experience physical cravings, the chemicals in your brain are involved. These chemicals can change in the same way they do when you use your drug of choice. Therefore, you may feel like you do either right before, or during drug use. It is common for people to feel their heart racing, experience a change in the taste in their mouth, or begin to sweat. It is important to understand this, and to know that these feelings will pass in a short period of time.

What is most important when you experience cravings, as with high-risk situations, is to have a clear plan for how you can respond to these cravings. Cravings are a natural and ongoing part of the recovery experience. They can continue to occur long after you have stopped using your drug of choice. Your brain needs time to develop new responses to the situations and events that triggered your drug use. The only way for these new responses to develop is for you to practice doing something different than using each time you experience a craving. Over time and with practice, cravings will occur less often, and feel less powerful, because you have developed different ways to respond to them.

Additional Ways to Support Your Recovery

While relapse prevention work is critical to the process of recovery, it is also important to build positive skills and patterns of behaviour that support and enhance your recovery process. Here are some simple suggestions that you can explore:

• Healthy eating. If you eat well-balanced, nourishing meals, your body is better prepared to deal with daily stresses.
• Get enough sleep. Sleep allows your body time to strengthen, rebuild and allows you to be clear headed and functioning at your best.
• Exercise regularly. Exercise has many health benefits including building strength, increasing stamina, and lowering the risks for many health conditions. Exercise also helps you flush out toxins, and increases levels of endorphins, your “feel-good” hormones, both of which are beneficial to relapse prevention.
• Stay connected. It is important to have positive social contacts in your life, both on the phone and in person. Work at building a network of people who support your recovery goals, and include them in your recovery plans.
• Practice meditation or relaxation skills. Stress, anger, frustration or boredom are all potential risk experiences. Relaxation skills such as meditation are great ways to combat negative feelings.
• Journaling. Writing down your thoughts, experiences and discoveries can be a powerful practice.
• Self-monitor. It can be useful at the end of each day to evaluate how you are doing. What went well? What would you have liked to have done differently? What did you accomplish today? What feelings did you experience throughout the day? These kinds of questions can be useful to continue to shape your plan for your own recovery.
• Reward yourself! It is crucial that you recognize the hard work it takes to make changes in your life. You need to honour your efforts. A nice meal out, a new CD, a bubble bath or an hour at your favorite hobby are examples of rewards that you can provide for yourself.
• Keep slips in perspective. If you do succumb to old patterns, make the most of this experience. While it is important to recognize the serious impact this can have on your recovery, it can be used as a valuable opportunity to evaluate where you may not have planned or acted carefully enough. You can use this experience to strengthen your recovery, if you choose to do so.

Keys to Relapse Prevention

• Handle day-to-day feelings and problems as they happen. This is called “PROCESSING”. Learn to deal and put away each concern one at a time as they happen. This way, pressure and stress don’t build up, new disciplines are developed and none of these concerns get away to cause trouble another day.
• Live life in the moment. Stay in the moment dealing with and enjoying each moment of each day, one at a time. We learn from our past, NOT live in them. Plan for the future then live for it by focusing on “just for today.”
• Keep your life in balance. This reduces stress and helps you find enjoyment again with friends and family without alcohol or drugs. Try new activities, reward yourself for small successes, and have nutritious food.
• Gain support and trust. Family, friends, coworkers, counsellors can help you watch out for warning signs, help you handle stress and support your goals.
• Recognize relapse thoughts and feelings RIGHT WHEN THEY HAPPEN! Do not put them off. Tie up your ship right where it is and deal with those thoughts and feelings now! Your only goal is to get safe, secure and finally back to that serenity place in your soul.
• Identify and plan for high-risk situations. Plan ahead what you will say and do and have several back-up strategies in case one doesn’t work.
• Finally, it’s about People, Places & Things. Choose what is healthy; remember “garbage in garbage out.” So seek healthy new people (mentors), places and things.

Finally:

It’s your choice now which road to travel. It’s about your priority. You might ask yourself “is it for me?” or “ it’s a big task, how can I make it?” Recovery and the work involved may be the last thing you really wish to do at this time but it is the one and first thing you need to commit to. There are so many other more pleasant areas of life such as a career, romance, travel, money or success as you see it. If you don’t treat your addiction first and foremost all you become is an addicted … (just add any of the above.) Sooner or later the goal or dream will collapse and all you have left is the addiction, right back where you started from. Why not do the job right from the beginning. ABOVE ALL ELSE, your recovery must come first. The good news is, take little steps one day, one moment at a time!

Make no mistake this is a battle!
Surprisingly, it takes surrender to win it.

For more information or help contact:
Angels Community Support Network at:
604.677.6565 or Email: david@angelscommunity.com

Some Sources:

Angels Community Support Network (April 06) http://www.angelscommunity.com/article_themanyfacesofaddiction.shtml

Alberta Alcohol and Drug Abuse Commission. Relapse prevention: Planning for success. corp.aadac.com/alcohol/the_basics_about_alcohol/
alcohol_brochures_relapse_prevention.asp

Gorski, T. & Miller, M. (1986). Staying sober: A guide for relapse prevention. Independence, MO: Independence Press.

Marlatt, G.A. & Donovan, D.M. (2005). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York: Guilford Press.

Prochaska, J.O., Norcross, J.C. & Diclemente, C.C. (1995). Changing for good: A revolutionary six-step program for overcoming bad habits and moving your life positively forward. New York: Avon Books.