Relapse Prevention Group: Reducing Stress

It is raining harder and the temperature is colder.  The wipers and defroster work.  The streets are slippery.  I am driving slower as I leave the parking lot and head home.  The moon is nearly full but barely visible.  I am warm and calm.
It is raining harder and the temperature is colder. The wipers and defroster work. The streets are slippery. I am driving slower as I leave the parking lot and head home. The moon is nearly full but barely visible. I am warm and calm. | Source

Co-occurring Substance Use and Trauma

Due to confidentiality in a therapy group, the names and situations identified in this story are fictitious.  They are typical of situations that might be shared in a similar therapy group.  Any resemblance to an actual situation is coincidental, yet not surprising. 


In a treatment group for substance use disorders, 60% of women and 40% of men are likely to have co-occurring trauma symptoms.  Sometimes the traumatic event precedes the substance use and sometimes it is a result of the substance use.  In order to maintain sobriety from substance use, it is necessary to also seek treatment for trauma symptoms.  In order to recover from trauma symptoms, it is necessary to maintain sobriety.  


I am leaving the premises of my day job at a Fortune 500 corporate office location in an affluent suburb north of the city.  Home is a scenic six mile drive east into a more rural area that was booming with suburban sprawl a few years ago.  I am driving into the sunset en route to an urban, blue collar town that is further north and west of the city; a thirty five minute drive that I have been making two to three times a week for the past three years.  The steel mill closed several years ago, and most of the men in town are unemployed.  Many of the women with children are on assistance.


It’s cold.  I’m tired.  I have to stop for gas.  It’s drizzling and has been overcast all day.  It is getting dark especially early tonight because of the dense clouds.  Traffic is not too heavy, but my car is making a funny noise.  I arrive at the counseling center and stop to fix a pot of coffee for the group and pick up my attendance book.  It’s a court ordered relapse prevention group for indigent and habitual substance offenders.


Jenna is early.  Last week she was depressed and irritable.  Tonight she is more hopeful.  She shares her good news about the progress she is making toward reunifying with her children.  She celebrates seven months clean from crack.  Group members trickle into the group room one at a time. The sign in sheet is passed around. The opening go-around begins.  Social chatter stops and the group rules are in effect; one person talks at a time, what’s said in group stays in group, show respect to self, others and property, etc. 


Usually there is a theme or issue identified during the opening go-around that the group works on.  Sometimes there is not.  On those occasions, we work more from the book.  The topic tonight is, “Reducing Stress.”  The objective is to identify stressors and work at reducing them in order to prevent relapse.  I am concerned that if no one wants to work tonight, we will speed through the topic without really getting the full therapeutic benefit of the topic.  My concerns are unfounded.


Item two of ten on the worksheet relates to staying in the present by avoiding excessive guilt about the past and anxiety about the future.  Todd shares about the traumatic loss of his father, and the difficulty he has with intrusive thoughts and dreams about their motorcycle trip turned fatal.  Justin shares about his mother’s suicide four months ago; that this time was an apparent accidental overdose after several failed attempts at suicide in the past. 


Steven is able to talk about his trauma for the first time without crying, and seems surprised to learn that other people have experienced traumatic events as well.  Even though he wasn’t drinking on this particular occasion, he was involved in a motor vehicle accident ten years ago in which he was driving a semi truck and an elderly woman failed to stop at an intersection.  He still has visions of seeing her face as her body hit his windshield and was thrown quite a distance.  He began to drink heavily to quiet the visions. Even though he wasn’t drinking and didn’t cause his trucking accident, he had felt guilty about it and responsible for it.  He believes he should have seen it coming; if only he had been more alert.  He never drove a truck again.  Last year he was involved in a drunken driving crash.  He was injured and has problems with chronic pain.  The alcohol that stilled his earlier crash memories helped him manage chronic pain.  He started group two months ago, has two months sober, and has a great deal of pain.      


Megan is quiet and appears upset.  She shares that she too has experienced a traumatic loss, but is not able or willing to share about it at this time.  Jenna had shared in a previous group about her childhood trauma, and was able to identify and share with the group that the memories and nightmares are symptoms of PTSD, and even though their trauma is different from hers, their symptoms are the same.  Harry’s trauma events occurred in Iraq.  He can’t afford medications, and doesn’t want to go to VA.  He just wants to complete his court and legal requirements.  He does seem comforted to know that others experience similar symptoms, and does acknowledge having trauma symptoms.  Once again, Shawn was not able to relate to the topic.  With the exception of his arresting event, his life is “normal” and he doesn’t have any “drama” like everyone else.  He is a college student and his situation is different.  He got a second DUI and accepts that attending group is part of the consequences he needs to pay for breaking the law. 


I share my reflection that current stressors were not identified in the opening go-around, yet past stressors were easily identified when asked what interferes with being able to stay in the here and now.  Group members share what they “got from group tonight” in the closing go-around, and recite the Serenity Prayer before leaving.  I finish my paperwork, lock up and set the alarm on my way out. 


It is raining harder and the temperature is colder.  The wipers and defroster work.  The streets are slippery.  I am driving slower as I leave the parking lot and head home.  The moon is nearly full but barely visible.  I am warm and calm.  

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Comments 8 comments

Happyboomernurse profile image

Happyboomernurse 6 years ago from South Carolina

This was beautiful and compelling- as if the reader is right in there with the group. It was also very educational.

You seem so well suited for the work you do and I always learn something from your hubs. This one reminded me to remain compassionate and remember that people struggling with these issues have a lot of emotional pain, often from past traumas. Sometimes the traumas are due to their substance abuse which ironically makes it even worse due to the level of guilt. God bless your attempts to lead them back to a place of healing and to give them skills to cope with stress.

Dim Flaxenwick profile image

Dim Flaxenwick 6 years ago from Great Britain

Excellent hub. Thank you. Sad that so many people need this kind of help these days.

kimh039 profile image

kimh039 6 years ago Author

@happyboomernurse. thanks so much for the positive comments; especially that you felt you were right there. the style is more of a story than my usual research based, non fiction style; so i wasn't sure how it would come across. It is easier to be compassionate when you're face to face with someone who is making an effort to do the right thing. It is easy to judge too when you see the damage addiction can do.

kimh039 profile image

kimh039 6 years ago Author

@Dim. Thanks for stopping by to read and comment. I really appreciate that. Yes, it's sad; especially when the addictive substance is prescribed, which is more and more common with pain and anxiety pills. People who have worked all their lives are no longer able to work because of their addiction. Some develop addictions for the first time in their retirement. very sad.

vrbmft profile image

vrbmft 6 years ago from Yucaipa, California

What a "nice" slice of your day. I hate the word "nice" but it seems to fit here. I know it really was raining and your car was really making a funny noise, but both the weather and your car are great metaphors for the stress we experience or can experience facilitating such a group. These groups can be very draining and even traumatizing. The truck driver and the woman's face on the windshield--My worst nightmare--but a skateboarder or a teen dressed in black crossing the street in front of my office as I leave especially if I leave at dusk when it is harder to see dark and shadowy objects.

I appreciate you portraying the group members as people. Some times we are the only people in their lives who see them and treat them as fellow human beings and sometimes, therapists get so caught up in their boundaries and righteousness, they don't do it either.

Anywho, a nice slice of Kim's day and wonder-filled work.

Thanks for sharing it.


kimh039 profile image

kimh039 6 years ago Author

Thanks Vern. I don't like "nice" either! But "nice slice of my day" is ok! Thanks. Weather, car problems, economy, etc - acute and ongoing external stressors can take a toll over time. I wonder if checking out what that noise is would decrease or increase stress! It could be an "invitation" as you call it in your hub! I can't do much about rain or the economy, but I could get my car checked out! It would be really stressful if it stopped running!

vrbmft profile image

vrbmft 6 years ago from Yucaipa, California

Think of it this way. If the car stopped running, you wouldn't hear the noise anymore!! I know, not funny!! I am driving a 1989 Celica GT which maybe someday will be a cool car, but now it is still a piece of lousy car!! Putting some money into it, but it does get to me where I need to go ALMOST! Sometimes I have to borrow a car and I have a good friend who lets me do that. Wow! Imagine that. Your group is lucky to have you.

Take care


kimh039 profile image

kimh039 6 years ago Author

:) It reminds me of The Little Engine That Could. I think I can, I think I can.....Have a great day, Vern. I'm going to see my body mechanic today to see what effects stress has had on my body this year!

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