Relapse Prevention

RELAPSE PREVENTION
“Relapse is a Process, NOT a Singular Event”

Abdullah Baniyameen
baniyameen@aol.com
July 1, 2009

A DEFINITION OF RELAPSE:

۩ Relapse is a process, not a singular event. The essential point we need to remember about relapse is that it is a process with identifiable symptoms.

۩ Many times we try to find the “reason” why we relapse, maybe a fight with our spouse, employer et cetera. We now know that a relapse usually is started by many different events or feelings and is characterized by our inability to cope with the stress these generate.

۩ Return to drinking or using is the end of a relapse process. As we progress in a relapse process, many negative attitudes, behaviors and feelings are produced.

۩ We must at one time find relief from this stress; hence, resorting to use alcohol or drugs seems to be a reasonable choice.

۩ Relapse is a progressive emotional and behavioral process / dynamic. Just as our active illness is progressive, so is our relapse process. Once we are in a relapse process, it doesn’t “just go away.” The only to work our way out is to confront this dynamic consciously and interrupt its further progression. Relapse is a normal part of recovery. Our goal is to see the dynamic in its early stages and interrupt it, rather than trying to “never let it happen again.” We can stop the process before it has major effects on our recovery.

۩ Relapse is an internal process. The progression of our relapse process happens within us. Many times this is characterized by an unhealthy change in our attitude and behavior. Often times our inability to respond in a healthy way, to stress and life’s struggle is greatly diminished and we are left with a bundle of unresolved feelings and situations. This serves as the building block of our next point.

۩ Relapse process allows the symptoms of our active illness to become reactivated. Due to our diminished ability to cope with stress and emotions effectively, we often begin compensating through “old behavior.” Our denial, defensiveness, withdrawal, et cetera becomes the most familiar and available coping skills at our reach. This inevitable reaction may be an unconscious process but allows the dynamic to further deepen and threaten our sobriety and good mental health.

۩ The relapse process can be seen through our behavior. As individuals, we tend to behave in a generally consistent way. When our relapse process is active, it will begin to alter our behavior patterns, as describe above. Therefore, an effective point to begin recognizing our relapse process is through our external behavior.

COMMON CAUSES:

1. Availability of substance,
2. Codependent is evident,
3. Divorce in family,
4. Deficits in care givers – aftercare staffing,
5. Dissatisfaction of life,
6. Family misconception about substance use,
7. Incest/Abuse,
8. Inability to maintain relationship,
9. Lack of self-control / confidence,
10. Lack of constructive and recreational activities,
11. Lack of knowledge,
12. Lack of family support,
13. Lack of aftercare services,
14. Environment, place or school,
15. No primary treatment program,
16. Old negative peer groups,
17. Poverty,
18. Social skills deficits,
19. Social stigma,
20. Self-esteem deficits,
21. Too much money, time or trust,
22. Unemployment.

FUNDAMENTAL ELEMENTS OF ADDICTIVE DISORDER: “SOFIA”:

SPIRITUAL AND EMOTIONAL NEEDS:

• Excessive of Guilt, Shame.
• Morally Bankrupt.
• Life Seems Meaningless.

OLD REFERENCE:

• People,
• Places,
• Things,
• Events.

FAULTY BELIEF SYSTEM:

• Safe use,
• I/We Don’t Recover,
• Mistaken Belief of Use,
• Self-defeating Core Belief.

INADEQUATE COPING SKILLS:

• Managing Emotional Discomfort,
• Awareness Deficits,
• Arrestment of Possible Threats.

ADDICTIVE PERSONALITY:

• Dishonesty,
• Manipulative,
• Non-caring/Deniability,
• Impulsive/Compulsive,
• Tolerance Deficits.

RELAPSE VARIABLES:

AFFECTIVE VARIABLES:

• Minor Depression,
• Anger,
• Euphoria, etc.

BEHAVIORAL VARIABLES:

• Impulsive,
• Reactivation of Denial, etc.

COGNITIVE VARIABLES:

• Attitudes towards recovery,
• Preoccupied, etc.

ENVIRONMENTAL VARIABLES:

• Social and family stability deficits,
  People, Places, Things, Events.

INTERPERSONAL VARIABLES:

• Social skills deficits.

PHYSIOLOGICAL VARIABLES:

• Cravings,
• Physical complaints.

SPIRITUAL VARIABLES:

• Life lacks meaning,
• Guilt,
• Shame,
• Emptiness, etc.

TREATMENT RELATED VARIABLES:

• Attitude of care givers,
• Inadequate treatment.

PREVENTING RELAPSE:

1. Monitoring Warning Signs.
2. Inventory Checklist.
3. Self Assessment.
4. Involvement With Significant Others.
5. Continuity of Support Groups.
6. “Essential to Know” Attitudes.
7. Lifestyle Changes.
8. Maintenance.
9. Stabilization.
10. Service.

FUNDAMENTAL ISSUES TO CONSIDER;

۩ DETECTING SELF – DEFEATING CORE BELIEFS:

• Better to please others than to please myself.
• I am not capable or worthwhile.
• I don’t deserve love.
• I must be the best.
• My partner and I should enjoy the same things.

۩ DETECTING NEUROTIC GUILT AND HEALTHY GUILT:

• Did I ignore information already in my possession that would have help me avoid harming someone?
• “If others have problems, it’s my fault”.
• “If I’m a good parent, my children will be perfect”.

۩ LEARNING ABOUT CRAVINGS:

• Cravings are triggered by external factors we can control.
• Cravings do not represent a physical need.
• Craving fade overtime if we do not give in to them.
• We can view cravings as feedback – reminders to use coping skills.
• Even people who are skilled at coping with HRS experience cravings.

۩ SEEING THE LINK BETWEEN TRIGGERS & CRAVINGS:

• Hearing music you used to listen to while using chemical or substance.
• Seeing people you used to associate using of chemical or substance.
• Passing by joint or old references.
• Finding old paraphernalia stashed in a closet.
• Meeting someone you used to have sex with when you were high.
• Remembering the taste and smell of chemical & substance, & the like.

۩ DEALING WITH DIRECT PRESSURE:

• “Oh come on. One sip won’t hurt you.
• “You must be a real wimp if you can’t handle one innocent sip”.
• “I’m your friend. I won’t let you have more than one.”
• “You think you’re better than me, don’t you?”
• “It’s not that deep, after all your cycle falls the week later.

۩ DEALING WITH CHRONIC SHAME:

• I often worry about how I look.
• I am very concern about what other people think of me.
• I have trouble handling criticism.
• I worry about what I’ll do wrong.
• I don’t belong.
• I don’t think I’m as good as other people I know.

TREATMENT INTERVENTION:

۩ EXPERIENTIAL LEARNING:

• Role Playing,
• Psychodrama,
• Behavioral Rehearsal,
• Recovery Assignments,
• Theme Writing,
• Worksheet Assignments.

۩ COGNITIVE REFRAMING:

• Coping Imagery,
• Reframing Reactions to any threats of possible Lapse, Relapse.

۩ LIFESTYLE INTERVENTIONS:

• Exercise,
• Relaxation,
• New Hobbies,
• Recreational,
• Social Activities.

TREATMENT PROCESS:

۩ PRE-TREATMENT:

• The recognition of addiction that comes as a result of treatment is part of a treatment process.

ISSUES TO CONSIDER:

• Potential symptoms of acute withdrawal (AWS). Understanding recovery and relapse is a process.

۩ STABILIZATION:

• The major motivational life crisis that caused substance or chemical abusers to enter this period of stabilization.

ISSUES TO CONSIDER:

• Abstinence is a prerequisite. Post acute withdrawal symptoms (PAWS).

۩ EARLY RECOVERY:

• Healing period may be difficult for some due to the aftereffects of one’s addictions.
• It will manifest itself through numerous symptoms of post acute withdrawal.

ISSUES TO CONSIDER:

• Assessment of treatment needs.
• Early intervention verses adverse consequences.
• Daily, weekly initial recovery planning.
• Degree of frequency.

۩ MAINTENANCE:

• Recovery from chemical dependency is a lifelong and lifestyle process. It can’t be arrested overnight.

ISSUES TO CONSIDER:

• Developed a relapse prevention strategy.
• Establishing recovery network.
• Enrolled in a fellowship that promotes a continuity of recovery care.
• Developing an open relationship with the surrounding.

۩ MIDDLE RECOVERY:

• Cleansing can be maintained in this period with a less restricted recovery program than in the early pre treatment.

ISSUES TO CONSIDER:

• Understanding and Learning of High Risk Situation.
• Internal & external causes of returning to chemical use.
• Managing and coping warning signs to interrupt any potential return to chemical or substance use.

۩ LATE RECOVERY:

• Essential course of habilitation required to achieve in reconstructing healthy belief and character.

ISSUES TO CONSIDER:

• Managing and coping warning signs to interrupt any potential return to chemical use.
  Developing social, occupational and recreational networking.
  
  

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