So i did some research and came across this article on relapse prevention.
Relapse Prevention and the Five Rules of Recovery
3 stages of relapse
EMOTIONAL RELAPSE
SIGNS OF EMOTIONAL RELAPSE:
- BOTTLING UP EMOTIONS
- ISOLATING
- NOT GOING TO MEETINGS
- GOING TO MEETINGS/NOT SHARING
- FOCUSING ON OTHER PEOPLE’S PROBLEM OR FOCUSING ON HOW OTHER PEOPLE AFFECT THEM
- POOR EATING/SLEEPING HABITS.
COMMON DENOMINATOR: POOR SELF CARE.
SELF CARE MATTERS, CRITICAL.
POOR SELF CARE - HALT
HUNGRY, ANGRY, LONELY, TIRED.
For most individuals, self-care is about emotional self-care. Clients need to make time for themselves, to be kind to themselves, and to give themselves permission to have fun
These topics usually have to be revisited many times during therapy: “Are you starting to feel exhausted again? Do you feel that you’re being good yourself? How are you having fun? Are you putting time aside for yourself or are you getting caught up in life?”
Another goal of therapy at this stage is to help clients identify their denial. I find it helpful to encourage clients to compare their current behavior to behavior during past relapses and see if their self-care is worsening or improving.
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My thoughts:
SO E, THIS ONE FEELS FAIRLY OBVIOUS. MY SELF CARE IS WORSENING FOR SURE. I THINK THERE’S NO COINCIDENCE WHEN I LESSENED MY GAMING AUGUST 3RD - OCOTOBER, I DIND’T HAVE ISSUES, I WAS PRIORITIZING REST AGAIN (SELF CARE), I WAS GETTING MY SWIMS IN. THINGS WERE MOVING FORWARD. WHEN THAT STOPPED, I’VE HAD 4 SETBACKS. SO THERE’S THAT.
The transition between emotional and mental relapse is not arbitrary, but the natural consequence of prolonged, poor self-care. When individuals exhibit poor self-care and live in emotional relapse long enough, eventually they start to feel uncomfortable in their own skin. They begin to feel restless, irritable, and discontent. As their tension builds, they start to think about using just to escape.
**YIKES! THAT IS MY LIFE! BEING UNCOMFORTABLE IN YOUR OWN SKIN!! 100% THAT’S ME. RESTLESS, IRRITABLE, DISCONTENT, CHECK CHECK CHECK. THEN YOU START TO WANT TO ESCAPE. **
MENTAL RELAPSE
In mental relapse, there is a war going on inside people’s minds. Part of them wants to use, but part of them doesn’t. As individuals go deeper into mental relapse, their cognitive resistance to relapse diminishes and their need for escape increases.
These are some of the signs of mental relapse [1]: 1) craving for drugs or alcohol; 2) thinking about people, places, and things associated with past use; 3) minimizing consequences of past use or glamorizing past use; 4) bargaining; 5) lying; 6) thinking of schemes to better control using; 7) looking for relapse opportunities; and 8) planning a relapse.
Helping clients avoid high-risk situations is an important goal of therapy. Clinical experience has shown that individuals have a hard time identifying their high-risk situations and believing that they are high-risk. Sometimes they think that avoiding high-risk situations is a sign of weakness.
Clinical experience has shown that occasional thoughts of using need to be normalized in therapy. They do not mean the individual will relapse or that they are doing a poor job of recovery. Once a person has experienced addiction, it is impossible to erase the memory. But with good coping skills, a person can learn to let go of thoughts of using quickly.
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Physical Relapse
Finally, physical relapse is when an individual starts using again. Some researchers divide physical relapse into a “lapse” (the initial drink or drug use) and a “relapse” (a return to uncontrolled using)
But more importantly, it usually will lead to a mental relapse of obsessive or uncontrolled thinking about using, which eventually can lead to physical relapse.
Most physical relapses are relapses of opportunity. They occur when the person has a window in which they feel they will not get caught. Part of relapse prevention involves rehearsing these situations and developing healthy exit strategies.
When people don’t understand relapse prevention, they think it involves saying no just before they are about to use. But that is the final and most difficult stage to stop, which is why people relapse. If an individual remains in mental relapse long enough without the necessary coping skills, clinical experience has shown they are more likely to turn to drugs or alcohol just to escape their turmoil.
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Cognitive Therapy and Relapse Prevention
Cognitive therapy is one of the main tools for changing people’s negative thinking and developing healthy coping skills
The negative thinking that underlies addictive thinking is usually all-or-nothing thinking, disqualifying the positives, catastrophizing, and negatively self-labeling [9]. These thoughts can lead to anxiety, resentments, stress, and depression, all of which can lead to relapse.
Cognitive therapy and mind-body relaxation help break old habits and retrain neural circuits to create new, healthier ways of thinking
Fear
Fear is a common negative thinking pattern in addiction [14]. These are some of the categories of fearful thinking: 1) fear of not measuring up; 2) fear of being judged; 3) fear of feeling like a fraud and being discovered; 4) fear of not knowing how to live in the world without drugs or alcohol; 5) fear of success; and 6) fear of relapse.
A basic fear of recovery is that the individual is not capable of recovery. The belief is that recovery requires some special strength or willpower that the individual does not possess. Past relapses are taken as proof that the individual does not have what it takes to recover [9]. Cognitive therapy helps clients see that recovery is based on coping skills and not willpower.
How individuals deal with setbacks plays a major role in recovery. A setback can be any behavior that moves an individual closer to physical relapse. Some examples of setbacks are not setting healthy boundaries, not asking for help, not avoiding high-risk situations, and not practicing self-care. A setback does not have to end in relapse to be worthy of discussion in therapy.
Recovering individuals tend to see setbacks as failures because they are unusually hard on themselves [9]. Setbacks can set up a vicious cycle, in which individuals see setbacks as confirming their negative view of themselves. They feel that they cannot live life on life’s terms. This can lead to more using and a greater sense of failure. Eventually, they stop focusing on the progress they have made and begin to see the road ahead as overwhelming [16].
setbacks are a normal part of progress. They are not failures. They are caused by insufficient coping skills and/or inadequate planning, which are issues that can be fixed [8]. Clients are encouraged to challenge their thinking by looking at past successes and acknowledging the strengths they bring to recovery [8]. This stops clients from making global statements, such as, “This proves I’m a failure.” When individuals take an all-or-nothing, dichotomous view of recovery, they are more likely to feel overwhelmed and abandon long-term goals in favor of short-term relief. This reaction is termed the Abstinence Violation Effect [8].
Becoming Comfortable with Being Uncomfortable
More broadly speaking, I believe that recovering individuals need to learn to feel comfortable with being uncomfortable. They often assume that non-addicts don’t have the same problems or experience the same negative emotions. Therefore, they feel it is defensible or necessary to escape their negative feelings. The cognitive challenge is to indicate that negative feelings are not signs of failure, but a normal part of life and opportunities for growth. Helping clients feel comfortable with being uncomfortable can reduce their need to escape into addiction.
The Stages of Recovery
Recovery is a process of personal growth in which each stage has its own risks of relapse and its own developmental tasks to reach the next stage [2]. The stages of recovery are not the same length for each person, but they are a useful way of looking at recovery and teaching recovery to clients. Broadly speaking, there are three stages of recovery. In the original developmental model, the stages were called “transition, early recovery, and ongoing recovery” [2]. More descriptive names might be “abstinence, repair, and growth.”
Abstinence Stage
It is commonly held that the abstinence stage starts immediately after a person stops using and usually lasts for 1 to 2 years [1]. The main focus of this stage is dealing with cravings and not using. These are some of the tasks of the abstinence stage [2]:
- Accept that you have an addiction
- Practice honesty in life
- Develop coping skills for dealing with cravings
- Become active in self-help groups
- Practice self-care and saying no
- Understand the stages of relapse
- Get rid of friends who are using
- Understand the dangers of cross addiction
- Deal with post-acute withdrawal
- Develop healthy alternatives to using
- See yourself as a non-user
The tasks of this stage can be summarized as improved physical and emotional self-care. Clinical experience has shown that recovering individuals are often in a rush to skip past these tasks and get on with what they think are the real issues of recovery. Clients need to be reminded that lack of self-care is what got them here and that continued lack of self-care will lead back to relapse.
Repair Stage
In the second stage of recovery, the main task is to repair the damage caused by addiction [2]. Clinical experience has shown that this stage usually lasts 2 to 3 years.
In the abstinence stage of recovery, clients usually feel increasingly better. They are finally taking control of their lives. But in the repair stage of recovery, it is not unusual for individuals to feel worse temporarily. They must confront the damage caused by addiction to their relationships, employment, finances, and self-esteem. They must also overcome the guilt and negative self-labeling that evolved during addiction. Clients sometimes think that they have been so damaged by their addiction that they cannot experience joy, feel confident, or have healthy relationships [9].
- Use cognitive therapy to overcome negative self-labeling and catastrophizing
- Understand that individuals are not their addiction
- Repair relationships and make amends when possible
- Start to feel comfortable with being uncomfortable
- Improve self-care and make it an integral part of recovery
- Develop a balanced and healthy lifestyle
- Continue to engage in self-help groups
- Develop more healthy alternatives to using
- Clinical experience has shown that common causes of relapse in this stage are poor self-care and not going to self-help groups.
Growth Stage
The growth stage is about developing skills that individuals may have never learned and that predisposed them to addiction [1,2]. The repair stage of recovery was about catching up, and the growth stage is about moving forward. Clinical experience has shown that this stage usually starts 3 to 5 years after individuals have stopped using drugs or alcohol and is a lifetime path.
This is also the time to deal with any family of origin issues or any past trauma that may have occurred. These are issues that clients are sometimes eager to get to. But they can be stressful issues, and, if tackled too soon, clients may not have the necessary coping skills to handle them, which may lead to relapse.
These are some of the tasks of the growth stage [1,2]:
- Identify and repair negative thinking and self-destructive patterns
- Understand how negative familial patterns have been passed down, which will help individuals let go of resentments and move forward
- Challenge fears with cognitive therapy and mind-body relaxation
- Set healthy boundaries
- Begin to give back and help others
- Reevaluate one’s lifestyle periodically and make sure the individual is on track
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Clients often want to put their addiction behind them and forget that they ever had an addiction. They feel they have lost part of their life to addiction and don’t want to spend the rest of their life focused on recovery. They start to go to fewer meetings.
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As life improves, individuals begin to focus less on self-care. They take on more responsibilities and try to make up for lost time. In a sense, they are trying to get back to their old life without the using. They stop doing the healthy things that contributed to their recovery.
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Clients feel they are not learning anything new at self-help meetings and begin to go less frequently. Clients need to understand that one of the benefits of going to meetings is to be reminded of what the “voice of addiction” sounds like, because it is easy to forget.
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People feel that they should be beyond the basics. They think it is almost embarrassing to talk about the basics of recovery. They are embarrassed to mention that they still have occasional cravings or that they are no longer sure if they had an addiction.
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People think that they have a better understanding of drugs and alcohol and, therefore, think they should be able to control a relapse or avoid the negative consequences.
The Five Rules of Recovery
This section is based on my experience of working with patients for more than 30 years in treatment programs and in private practice. Experience has shown that most relapses can be explained in terms of a few basic rules [4]. Teaching clients these simple rules helps them understand that recovery is not complicated or beyond their control. It is based on a few simple rules that are easy to remember: 1) change your life; 2) be completely honest; 3) ask for help; 4) practice self-care; and 5) don’t bend the rules.
The most important rule of recovery is that a person does not achieve recovery by just not using. Recovery involves creating a new life in which it is easier to not use. When individuals do not change their lives, then all the factors that contributed to their addiction will eventually catch up with them.
What do most people need to change? There are three categories:
- Change negative thinking patterns discussed above
- Avoid people, places, and things associated with using
- Incorporate the five rules of recovery
Rule 2: Be Completely Honest
Addiction requires lying. Addicts must lie about getting their drug, hiding the drug, denying the consequences, and planning their next relapse. Eventually, addicted individuals end up lying to themselves. Clinical experience shows that when clients feel they cannot be completely honest, it is a sign of emotional relapse. It is often said that recovering individuals are as sick as their secrets. One of the challenges of therapy is to help clients practice telling the truth and practice admitting when they have misspoken and quickly correcting it.
How honest should a person be without jeopardizing his or her work or relationships? Clients are encouraged to understand the concept of a recovery circle. This is a group of people that includes family, doctors, counselors, self-help groups, and sponsors. Individuals are encouraged to be completely honest within their recovery circle. As clients feel more comfortable, they may choose to expand the size of their circle.
Probably the most common misinterpretation of complete honesty is when individuals feel they must be honest about what is wrong with other people. Honesty, of course, is self-honesty. I like to tell patients that a simple test of complete honesty is that they should feel “uncomfortably honest” when sharing within their recovery circle. This is especially important in self-help groups in which, after a while, individuals sometimes start to go through the motions of participating.
Rule 3: Ask for Help
Most people start recovery by trying to do it on their own. They want to prove that they have control over their addiction and they are not as unhealthy as people think. Joining a self-help group has been shown to significantly increase the chances of long-term recovery. The combination of a substance abuse program and self-help group is the most effective [22,23].
There is one benefit of self-help groups that deserves special attention. Guilt and shame are common emotions in addiction [26]. They can be obstacles to recovery, because individuals may feel that they have been damaged by their addiction and they don’t deserve recovery or happiness. Clinical experience has shown that self-help groups help individuals overcome their guilt and shame of addiction by seeing that they are not alone. They feel that recovery is within their reach.
Mind-body relaxation plays a number of roles in recovery [4]. First, stress and tension are common triggers of relapse. Second, mind-body relaxation helps individuals let go of negative thinking such as dwelling on the past or worrying about the future, which are triggers for relapse. Third, mind-body relaxation is a way of being kind to oneself. The practice of self-care during mind-body relaxation translates into self-care in the rest of life. Part of creating a new life in recovery is finding time to relax.
you got this!! Be brave! Be bold!
