"Relapse Prevention" was presented by Robin Edison, M.Ed., LPC, NCC, CAAC; Dawn Farm Downtown Program coordinator. This program discusses the dynamics of relapse, the warning signs that lead the chemically dependent person into a relapse, and strategies to prevent relapse and help handle high-risk situations. This program is part of the Dawn Farm Education Series, a FREE, annual workshop series developed to provide accurate, helpful, hopeful, practical, current information about chemical dependency, recovery, family and related issues. The Education Series is organized by Dawn Farm, a non-profit community of programs providing a continuum of chemical dependency services. For information, please see http://www.dawnfarm.org/programs/education-series.
2. Quote from Staying Sober by Gorski and Miller (p.35) “Relapse and recovery are intimately related. You cannot experience recovery from addiction without experiencing a tendency toward relapse. Relapse tendencies are a normal and natural part of the recovery process. They are nothing to be ashamed of. They need to be dealt with openly and honestly. If they are not, they grow stronger. Relapse tendencies are a lot like poison mushrooms or mold. They grow best in the darkness. The light of clear accurate thinking tends to kill relapse tendencies very quickly.”
3. Definitions of Relapse The process of returning to drinking or using drugs after a period of sobriety A return of the signs and symptoms of a particular disease (medical)
4. Myth #1 Relapse is an event defined by an individual returning to use alcohol and/or drugs.
5. Fact Relapse is a process. Returning to using or drinking is actually the completion of the process. It begins with slight and often unseen changes in behavior, attitude and beliefs.
6. Relapse is a process, not an event. These slight and often unseen changes begin when an individual slips back into old ways of thinking and behaving. Left unchecked, over time, (days, weeks, year) those changes in behavior, attitudes and beliefs begin to convince an individual, either consciously or unconsciously, that a return to relapse makes sense.
7. Where do checks come from? There are warning signs and symptoms you can learn to recognize and to warn you that there is a danger of relapse. You can also learn tools to interrupt or change the process at any time.
8. Relapse Prevention Explores these changes in attitudes, beliefs, and thinking patterns that an individual would exhibit prior to returning to chemical use. Knowing the relapse warning signs helps cut the process short without having the end result of actually returning to chemical use.
9. Myth #2 The individual will see a relapse coming and will be able to stop it. “If I get too far off the recovery trail, I’ll see it and change my behavior.”
10. Fact Actually, individuals often describe a relapse as a “flash,” “shock,” or “surprise.” Examples of relapse stories Why does this happen?
11. Disease of Perception The disease of perception tells the addict or alcoholic that what he or she is doing is ok and finds ways to justify behaviors, attitudes and thoughts. In recovery, individuals learn to see themselves through the feedback they receive from others.
12. Disease of Perception Individuals need to surround themselves with relationships with people who will hold them accountable and point out concerning changes in behaviors, attitudes or thought patterns. You can’t trust that you’ll see a relapse coming. You have to trust others to help you along the recovery path.
13. Myth #3 “Once I’m on the recovery road, I won’t use alcohol or drugs again.” “It will never happen to me.” “I know I won’t use again. I don’t want to.”
14. Fact Actually a large number (40-60 percent) will return to alcohol and/or drug use in the first year What are some possible reasons for this?
15. Biopsychosocial Model Just as the disease of addiction affected the physical, emotional, social and spiritual aspects of an individual’s life, the road to relapse may have signs that appear in all areas of one’s life. Recovery is much more than not using. It’s a biopsychosocial healing process and a commitment to change and growth.
16. Path of Relapse The path is different for each individual. Usually several warning signs are present. There is no particular order in which they may appear.
17. Path of Relapse The time element for warning signs not being dealt with and a return to using substances will vary according to the individual. The symptoms are different in everyone. There is no crystal ball.
18. “Dry Drunk” You can relapse into old behavior and ways of thinking without returning to drugs and alcohol. Relapse begins long before the individual actually uses a substance. An individual cannot be using substances and be in full relapse mode.
19. “I slipped.” Be careful of using this phrase to minimize a relapse SLIP = Sobriety Losing Its Priority “Do not look where you’ve fallen, look at where you slipped.”
21. Behavior Changes Not attending 12-Step meetings Changes in meeting schedule Not working the 12 Steps Withdrawal from support system Forgetting the basics No accountability Dishonesty Increased stress Recovery tools not being used to find solutions Involved in romantic relationship too soon (defocusing from recovery)
22. Support Community Not attending 12-Step meetings Changes in meeting schedule Not working the 12 Steps Withdrawal from support system Not attending recovery activities No accountability
23. Dishonesty Dishonesty played a crucial role in the success of the addiction. “Secrets keep you sick.” Often begins with a pattern of unnecessary little lies Rationalizing begins – making excuses for doing what we know we should not do The Big Book and 12 Steps emphasize rigorous honesty.
24. Slippery People & Places “If you keep going to the barbershop, sooner or later you’ll wind up with a haircut.” “If you don’t want to slip, stay out of slippery places.” Relapse is often triggered by relapse cues: sights, sounds, & situations that are connected with drinking or using Video: HBO Series Addiction
25. HALT Hungry, Angry, Lonely & Tired Irregular eating habits, restless sleeping, and/or loss of daily structure can all lead to depression and/or mood swings The importance of self-care (bio-psycho-social model)
26. Stress Stress is cumulative At some point in recovery, the problems of everyday life return and with them come many of the circumstances which caused the individual to use in the past. Consequences of a recent relapse or period of using can add additional stress Ignoring stress can lead to unmanageable situations and increase likelihood of a relapse Emotional backpacks
27. Relationships & Isolation Relationships in early recovery can be sobriety-threatening due to emotional highs and lows. Isolation gives the opportunity to get stuck in irrational thinking and/or engage in self-pity.
29. Complacency “I’m feelin’ good!” Begin to minimize the severity of the disease & effort needed to stay in recovery Putting self and recovery at risk Relapse often happens when an individual lets his or her guard down. Work the First Step DAILY
30. Resentment Big Book of Alcoholics Anonymous refers to resentment as “the number one offender” because “it destroys more alcoholics than anything else.” Anger with the world in general, with specific individuals, and/or with self Adds to tension, stress, and isolation Continue to work 4th and 5th Steps with sponsor
31. Guilt and Shame Strong feelings of worthlessness may surface Remembering all the bad things I’ve done (guilt) Individual may come to believe that I am bad (shame) Why bother? Working Steps 4 and 5; working with therapist
32. Control No control over people, places, and things Leads to frustration; things aren’t going my way “Acceptance is the answer to all of life’s problems.”
33. Impatience Things aren’t happening fast enough; others aren’t doing what they should be doing fast enough Demand instant gratification Setting expectations too high for early recovery only takes away from one’s serenity I’ve changed – why hasn’t everyone else? “Trust the process.”
34. BUDD = Building Up to Drink or Drug BUDDing = sudden changes in mood, which if not dealt with, will lead to relapse Changes begin in small ways, often unrecognizable, but gradually grow into a serious risk for relapse Usually detected by others
36. What to do? Early recognition Acceptance Action
37. Changes in Thoughts Denial Glamorizing Substituting drugs Feeling “cured” Being all-knowing Convincing self it was just a phase Weak foundation of the first 3 Steps
38. Changes in Thinking Begin to think recovery program isn’t as important as it used to be Things are going well. I don’t need to put in as much effort. Spend more time focusing on others
39. Being All-Knowing Plays down the effort truly needed to stay in recovery Individual starts to think he or she has all the answers for self and others When no one can tell us anything, we begin to ignore suggestions or advice from others. Lose humility in the face of a powerful disease “Half measures avail us nothing.”
40. Biggest Warning Sign Addicts overestimate their recovery and underestimate the power of their disease.
41. Interrupting the Relapse Process Stabilization Self-assessment Relapse Education Warning Sign Identification & Management Involvement of Significant others Prevention Planning
43. Assessment Identify recurrent patterns of problems that led to past relapses and resolve the pain associated with those problems. Reconstruct present problems, life history, alcohol and drug use history and the recovery relapse history.
45. Warning Sign Identification & Management Surrounding self with people who will provide honest feedback about the warning signs Developing coping strategies to deal with the warning signs, including the irrational thoughts, unmanageable feelings & self-defeating behaviors If you know a dog bites, treat it accordingly.
46. Family Involvement Addiction is a FAMILY DISEASE Addict/Alcoholic needs treatment for addiction. Family members need treatment for coaddiction/codependency. Al-Anon, Families Anonymous, ACOA
47. Warning Signs for Coaddiction Loss of daily structure Lack of personal care Inability to effectively set and maintain limits Indecision Compulsive behavior Fatigue/Lack of rest Return of unreasonable resentments Feelings of loneliness & isolation Health problems Return of tendency to control people, situations and things Defensiveness Self-pity Scapegoating Lack of Al-Anon attendance Return of fear and general anxiety Failure to maintain interpersonal support system Alcohol and/or drug use
48. Gorski & Miller’s Family Recovery Plan Stabilization Assessment Education Warning Sign ID Family Validation of Warning Signs Family Relapse Prevention Plan Inventory Training Communication Training Review of Recovery Program Denial Interruption Plan Relapse Early Intervention Plan Follow-up & Reinforcement
49. Early Recovery & Family Relationships Be careful about setting expectations of acceptance or understanding from family Hurt, resentment, suspicion of new behavior and lifestyle may exist Family may have adjusted their own behavior in unhealthy or enabling ways to accommodate for addict’s actions Healing takes time.
50. Prevention Back to the basics Continue with attendance and involvement in AA meetings Service work / Home group Work the 12 Steps with sponsor Frequent contact with sponsor Accountability with others Continued therapy support / self-awareness
51. Planning If an individual in recovery must be in a high-risk or sobriety-threatening situation, then it’s important to plan for it. Don’t set yourself up. Watch out for pride. Plan for before, during and after
52. Personal Emergency Relapse Plan Allows others to help support recovery Holds individual accountable A person cannot achieve recovery alone.
53. Relapse, Now What? Stop using Call Detox, if needed Safety from continuing use is the first priority Turn to support system immediately Ask for help Share feelings surrounding relapse – be honest
54. Wrap-Up Prevention = Plan = Action Know the power of the disease Surround yourself with accountable relationships and listen! Allow yourself to be uncomfortable Remember that recovery is a process “Relapse and recovery are intimately related.”
57. Contact Information Robin Edison Dawn Farm Downtown Program Coordinator 544 N Division Ann Arbor, MI 48104 734-769-7366 redison@dawnfarm.org
Notas do Editor
Relapse requireswork. You cannot stop working and changing your behavior and continue to stay sober and clean.A RECOVERY PROGRAM DOES NOT HAVE A FINISH LINE.What do I mean by “left unchecked?”
This is the purpose of…
Just as a note: Abstinence is NOT recovery. Abstinence is prerequisite to recovery, which is difficult and emotional work.So recovery is a commitment to a different lifestyle, one that involves growth and change.
Which is why all relapse red flags should be taken seriously.
Examples: Some individuals exhibit relapse behaviors and return to using within a matter of hours or days. I have seen others exhibit behaviors for weeks, months, even years before a return to using substances. Problem is: there is no way to tell which individual will exhibit which signs and if, and when, they may return to using.Sure, I have those clients who make the choice to prioritize recovery in most of their life decisions. More often than not, I see individuals take some risks in early recovery, make choices to enter into relapse risky behaviors. What is there to do? I have to respect their choices, their recovery journey.At the end of the day, there is no crystal ball. We can’t tell the future. The individual in recovery makes choices every day on where he or she falls on the recovery and relapse path.
The recovery community usually refers to this as being a dry drunk.Example: someone in recovery winds up not using but fighting, stealing, sexualizing, getting arrested, selling drugs, etc.This is part of the relapse process and explains that even w/o using an individual can be in full relapse mode.
Another term you may here in the recovering community is “He or she slipped.”Be careful: could discourage the individual from really identifying the warning signs that preceded the relapse.This term simply points out the difference between a long series of binges and a single using episodeEither way – they are both a relapse that an individual can learn fromUsed appropriately, it sets the stage for relapse prevention planning…
Men and women with healthy recovery programs have discovered that they can’t stay sober by themselves – they need others.“Oh I still go to 5 mtgs a week. Come to find out they’re going to meetings where they know no one and avoiding their sponsor. No one here knows me so they can’t hold me accountable and/or see change that is concerning.One client reported not using his support system after leaving tx. He just socialized with his roommates in transitional housing. There was no balance and all of a sudden his support network was comprised of people with less than six months sober. This is dangerous b/c chances are he is not getting honest, accountable feedback on a regular basis. Balance in recovery support network – friends but also making connections with members of the community with strong, solid recovery
Early recovery can be a roller coaster of emotions. The positive changes and outcomes of being in recovery can bring hope and energy to one’s life.At some point, the stresses of life return.Consequences: legal, financial, family, loss of job, housing, family/children, divorceStress cannot be erased from life. An individual needs to learn to manage it!! If an individual does not learn how to manage stress, he or she is more likely to return to old habits and ineffective ways of coping with problems. All of us carry around an emotional backpack where we stuff our unresolved feelings and emotions. Some of us have larger backpacks than others. When we stuff too many unresolved feelings into our backpack, it can lead to an emotional breakdown, which may lead an individual in recovery back to using. The individual experiences a Loss of HOPE and doesn’t reach out for help.That’s why it is so important to focus on the basics!Example: cancer patient new in recovery – all these expectations
Pretty strong statementThe world is not giving me what I want; others are not acting the way I want; and I am angry at my inability to behave the way I want toHow many of us have been so angry with someone and when we stopped to take an honest look at it, we were more frustrated that it bothered us in the first place?If an individual is holding onto resentments, he or she tends to feel stressed out, angry and is more likely to avoid people and recovery.
Guilt – Relapse can happen when an individual begins to feel the emotions that had been numbed with alcohol and/or drugs.Addicts and alcoholics aren’t comfortable with feelings and don’t necessarily know how to cope or deal with them!Remember: Recovery is a process. You can’t use alcohol and drugs to cope with feelings/life for 10 years and then expect to be able to learn to cope and deal with all those feelings in 10 months. One day at a time.
Then there’s impatience, which is very similar. Trying to control the outcome of something. Setting expectations of how things should be. One’s serenity is usually proportional to an individual’s level of expectations for self and others. Impatience can also lead to resentments for others. If I continue to expect that my 3 year old is going to do as I say all the time, I set myself up for impatience, insanity and loss of serenity.Lose patience and sense of one day at a time. No longer accept that progress comes in small, positive steps. I want it now!The world is not obligated to pay individuals in recovery because he or she decided to be sober. You can’t expect others to change their lifestyles just because you decided to change yours.
Idea from The Change Company to address changes in attitudesOTHERS usually detect these changes before the individual experiencing them.
Taken from The Change Companies resource
Early recognition – watch for changes in mood; learn to accept suggestions of sponsor and support communityAcceptance – Accept reality that symptoms exist If I accept that it exists, then I need to do something about it.Brings individual to action Back immersed in recovery (sponsor, meetings, 12 Steps, Big Book/readings, spirituality, gratitude, etc)
Actually individuals with long-term recovery usually encourage individuals to increase his or her recovery involvement/commitment as they gain more sober time.Example: client who relapsed every few years; created a list of ways he plans to increase his recovery involvement/commitment every 6 months; counterintuitive to manyFocus on others: I got this. Take the focus off self and privately judge those around me. Keep these judgments to myself unless others confront me. Then I try to turn the tables by criticizing them. Very common struggle in aftercare groups
Recognize that your actions over time will make a larger statement than any spoken promises.Concentrate on your own behavior and allow time for healing.Everyone begins a recovery/healing process at different times and experiences it individually, just as addicts do in recovery.