Relapse Prevention Skills
Getting sober from mood altering substances is a huge accomplishment. Staying Sober requires ongoing and significant effort. The better one understands addiction and the relapse process, the more likely it is that he or she will engage in the activities that will help to maintain sobriety.
Chemical and biological changes occur in the body and brain during active addiction that allow addiction to progress from early experimental use to a later, more compulsive type of use. Changes in the body and brain lead to changes in thinking, emotions, behavior and lifestyle. These changes, in turn, lead to countless problems with the legal system, relationships with family and friends, health and impairment problems, job losses, financial problems, accidents, child custody problems, problems with mood and temper regulation, profound losses and intense feelings of guilt, shame and inadequacy, and distortions in thinking and perceiving reality. The thought distortions prevent a person with addiction from seeing the very logical connection between the substance use and the consequences. These changes work together to allow a person to continue in addiction, often at the horror and amazement of loved ones; sometimes with the unintended help of loved ones who can get caught in the process themselves.
Relapse prevention skills are those skills that help an addict anticipate and cope effectively with the very real potential for relapse. Coping skills can be cognitive or behavioral. Cognitive skills have to do with the way a person thinks that can help or hinder efforts to stay sober. Behavioral coping strategies are things a person can do that will enhance the person’s ability to cope and ultimately to stay sober. Learning to apply specific coping skills to preventing relapse or maintaining sobriety is relapse prevention. Developing a plan based on an individual’s increased awareness of his or her own specific strengths and vulnerabilities is a relapse prevention plan.
Relapse is a Process
One of the first tasks in relapse prevention is to understand that relapse is a process, not an event, and it begins with a thought that ultimately leads to picking up to drink or use again.
A person attempting to stay sober will likely report that the relapse “just happened” or happened unexpectedly. In reality, the relapse may have begun days ago with a single thought, such as “There’s no reason I can’t hang out with my drinking buddies. Just because I’m sober doesn’t mean they have to be.” Or, “I’m strong enough now. I can handle being around my buddies again, without picking up. Anyway, they’re my friends.”
Following the thought(s) are some actions that eventually lead to the relapse. The person may initiate contact with their friend, just talking on the phone at first, then eventually meeting each other for a sober activity, then before he knows it someone has passed a drink or a joint, then he picks it up automatically without even thinking about it except that one hit can’t hurt or wtf, then while they’re a little buzzed and their inhibitions are low, they’re very easily persuaded to snort a line, hit a joint or drink a shot, and before they know it they’re on a 3 day binge until they crash, then wake up thinking, “Oh shit!”
Then comes the shame and guilt, and attempts to cover up the slip, which leads to feeling lousy about himself and irritable with friends and family, who are mad at him for blowing them off again and breaking yet another promise, and then he calls his friend once more but with a real case of the fuckitz this time, and off they go again, then a few days later he wakes up in jail and doesn’t remember how he got there or where his car is, but if the cops weren’t harassing him, his wife nagging, the kids demanding, and the boss expecting so much he wouldn’t be there.
If he’s fortunate, he will be court ordered to treatment where he will learn that familiar people, places and things are “triggers” to a conditioned neurobehavioral response that is experienced as an overwhelming, irresistible, uncontrollable craving or urge. While the “trigger” can be avoided and the user can learn ways to cope with “triggers,” once the cravings start and begin to build momentum, relapse is inevitable. A person, who knowingly exposes himself to a trigger, has already decided to use.
Coping with High-Risk Situations
Another relapse prevention task is to identify and learn to cope with high risk situations such as intense or unstable emotional states, interpersonal conflict and social pressure. While there are some situations that are generally high risk for anyone in recovery, it is important to also recognize situations that are a particular challenge to this particular addicted person. For example, the acronym HALT is used as a way to remember that being Hungry, Angry, Lonely or Tired is a risk for most people in recovery. A person may have a particular problem or stressor that is high risk for them, but not everyone. If a person has a history of trauma or a traumatic loss, a particular sight, sound, smell or sensation can be high risk for that person that wouldn’t affect another person at all.
Since many people who become addicted have a pattern of avoiding feelings and using substances to numb feelings, or as a misguided way to cope with feelings, a significant aspect of relapse prevention is learning to cope with feelings. One person may struggle with anger and domestic violence, while another struggles with depression and anxiety, and others with trauma and loss. In fact, studies have shown that 60% of women in treatment for substance use disorders and 40% of men in treatment have co-occurring trauma related symptoms. Sometimes the trauma occurred before the substance use, sometimes during active substance use, and often before and during. A significant loss can often be related to the onset of substance use and with an increase in use. Mood and anxiety disorders and other mental health conditions often co-occur with substance use, and need to be treated and stabilized to prevent relapse.
Problems with interpersonal relationships and social pressures also need to be addressed in order to prevent relapse. Many people began using in adolescence which is developmentally the time many social and relationship skills are learned. Often these skills are not developed resulting in some emotional, social and interpersonal immaturity. In the case of multi-generational alcoholism and addiction, the person may not have had role models available to teach the skills. A lack of skills in communication, anger management, assertiveness, setting boundaries and limits, conflict resolution, problem solving, parenting, etc. can result in a host of relationship, marital and family problems that could be significant “triggers” for relapse and contribute to a poor recovery environment.
Other Aspects of Relapse Prevention
Learning to cope with urges and cravings and building confidence in one’s ability to cope with them are key components to preventing relapse. Learning ways to minimize damage and reduce the impact of negative consequences can help. In the example above where the addict continued to use and make a bad situation worse, the addict and their family can learn to think and respond more effectively to a lapse that will prevent additional damage. Staying engaged in treatment and recovery even after a relapse occurs is paramount. It’s easy to get discouraged and quit, and can be a real challenge to examine what led to a relapse and what can be done next time to prevent it. It’s helpful to know that when a person has a lapse they don’t have to fall all the way to the bottom again. They can get back up and realize that even though they’ve slipped some, they’ve still come a long way from where they were. Lastly, a recovering person needs to create a more balanced lifestyle. It is common for people in recovery to substitute addictions. Instead of staying out drinking all night to avoid dealing with some problems at home, the addict might pick up extra hours at work or take up a hobby that is used as an escape to avoid problems in much the same way as substances were used. On the other hand, and this is often a problem for family members, the person in recovery does need to spend time engaging in recovery activities such as attending meetings, going to group, or meeting with a sponsor. The family often expects the recovering person to spend more time at home and with them, and gets frustrated when the person spends so much time doing the things he needs to do to stay sober.
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