MYTH:
- MOST ADDICTS CONSIDER DRUG USING AS SOMETHING SO PLEASURABLE THAT NOTHING COMPARES TO IT.
- LIFE IN THE ADDICTS’ WORLD IS FULL OF HARDSHIP, YET, IRONICALLY THEY FIND IT VERY CONTENDING.
- TO SOME OF THEM, GOING IN AND OUT OF TREATMENT HAS BECOME PART OF THEIR LIFESTYLES.
- THIS IS SO BECAUSE THEY SELDOM OBTAIN PLEASURE OR SATISFACTION FROM CONVENTIONAL ACTIVITIES.
- THEY BELIEVE THAT LIFE WILL NEVER BE MEANINGFUL WITHOUT DRUGS!
- NOT EVERYONE CAN COPE WITH PROLONGED BOREDOM AND DISCONTENTMENT IN LIFE.
- RECOVERING PERSONS SHOULD LOOK FOR ALTERNATIVE SOURCES OF PLEASURE AND HAPPINESS.
- THEY HAVE TO LEARN TO EXPERIENCE JOY AND SATISFACTION WHEN ENGAGING IN CONVENTIONAL ACTIVITIES -- EXERCISING, WORKING, STUDYING, BEING WITH FAMILY, PRAYING, READING, DOING COMMUNITY SERVICE, ETC.
- THEY NEED TO BE PATIENT FOR THAT JOYFUL AND SATISFYING EXPERIENCE MAY NOT COME INSTANTLY.
FACTUAL MYTH:
- Recovering persons should look for alternative sources of pleasure and happiness. They have to learn to experience joy and satisfaction when engaging in conventional activities -- exercising, working, studying, being with family, praying, reading, doing community service, etc.
- They need to be patient for that joyful and satisfying experience may not come instantly.
A HOUSE WOULD NOT BE SAFELY HABITABLE IF THE MAIN PILLAR WAS NOT STRONG ENOUGH.
A recovering person may not develop SELF–RESILIENCE should he/she depends more on EXTERNAL MOTIVATION than on the INTERNAL MOTIVATION.
MAIN CAUSE OF RELAPSE:
- Having a powerful positive expectation about drug effects.
- Failure to recognise any high risk situations.
- Poor coping strategies.
- Not having an established social support network.
- Lack of experience living without drugs.
- Unprepared to handle “a slip”.
COMMON CAUSES OF RELAPSE:
- Faulty outcome expectancy.
- Ignorant of high risk situation.
- Coping skills deficits.
- Limited social support.
- Discontentment being sober.
POSITIVE EXPECTATION ABOUT DRUG EFFECTS:
- Sometimes only limited or half-hearted efforts are made to establish the negative expectation about drug effects that the positive one remain powerful and dangerous.
- At the same time, the positive expectation of abstinence is not well established to overpower the negative one.
FAILURE TO RECOGNIZE:
- Unprepared to face recovery challenges, the recovering persons may easily succumb to triggers in dangerous situations.
- The result is they break the resolution to remain abstinent and chose drug-using as a means of resolving the crisis.
POOR COPING STRATEGIES:
- Recovering persons may have learnt various techniques of facing recovery challenge but often in real life situations they simply unable to apply them effectively.
- Without having the efficacy to use them, preventing a relapse incidence may only happen by chance.
DEFICITS IN SOCIAL SUPPORT NETWORK:
- Inability to disclose and inferiority inhibit recovering persons from making creative moves in getting continuous support from various sources.
- Without it they do not get forewarned when their warning signs are flaring; they do not have sufficient practical guidance, genuine concern and honest feedback; role models, reliable companions and recovery partners.
LACK OF EXPERIENCE LIVING WITHOUT DRUGS:
- Having little experience in making new achievements and acquiring skill – based satisfaction prevent recovering persons from being convinced that living drug – free is fulfilling.
UNPREPARED TO HANDLE A SLIP:
- Limited knowledge and experience related to slips makes recovering persons unfamiliar with any rescue or remedial services and that delay them from getting immediate intervention.
- Guilt and shame often pull them down towards relapse and back into the vicious cycle.
COPING WITH RELAPSE:
- Outcome expectancy.
- Risk Management.
- Effective coping strategies.
- Expansion of social networks.
- Wholesome normative lifestyle.
- Ability to handle incident of slip.
OUTCOME EXPECTANCY:
- Establishing positive expectation of abstinence.
- Establishing negative expectation of drug use.
- Self – talk / self – affirmation.
- Developing an obsession for recovery (Statement of Commitment).
- Forming a recovery vision.
- Creating ‘HELL MEMORIES’.
ESTABLISH POSITIVE SOBRIETY EXPECTATION:
- Using ‘self–talk’/‘self–affirmation’:
o “I’ll be close with my family again.”
o “I may continue my education.”
o “I’m sure life won’t be as hard as before.”
o “I may be active in my soccer club again.”
o “I won’t get into a conflict with others.”
ESTABLISH NEGATIVE EXPECTATION ABOUT DRUGS:
- Using ‘self–talk’/‘self–affirmation’:
o “I don’t need that kind of life anymore!”
o “I might be infected with HIV!”
o “Sooner or later I’ll be troubling my parents!”
o “My girl friend might walk out on me!”
o “I may be readmitted into a rehab centre. I’m so tired of it!”
DIMINISHING NEGATIVE EXPECTATION OF ABSTINENCE:
- Using ‘self–talk’/‘self–affirmation’:
o “There are friends who really want to be clean.”
o “If I really change, they’ll trust me back.”
o “If I make a real effort, I won’t fail.”
o “Everyone supports my striving for recovery.”
o “Without drugs, my life may still be happy.”
STRATEGIES:
- Using ‘self–talk’/‘self–affirmation’:
o “That one time may lead to a relapse.”
o “Drug high is far from a real happiness.”
o “The consequence may be fatal this time!”
o “One sip / one puff is as bad as a slip.”
o “Taking pot, an alcohol or psychotropic pill as a substitute means my addiction is not yet over.”
IMAGINE HOW AN ARDENT FAN SPEAKS ABOUT HIS/HER IDOLIZED POP GROUP OR MOVIE STAR.
PICTURE YOURSELF LISTENING TO A SPEECH BY AN ACTIVIST.
RECALL ANY EVENT WHEN YOU WERE LISTENING TO A SERMON OR A RELIGIOUS TALK DELIVERED BY A MULLAH / A PRIEST / A SWAMI / A MONK.
AN ARDENT FAN, AN ACTIVIST AND A PREACHER, WHAT IS COMMON IN THE WAY THEY SPEAK?
- Enthusiastic and with strong feelings.
- Sincere, from the gut.
- Knows the subject well.
- Very forceful and convincing.
- Consistent.
A RECOVERING PERSON SHOULD SPEAK ABOUT HIS/HER RECOVERY IN A SIMILAR MANNER.
MEANINGFUL ACTIVITIES AS A WAY OF DISTRACTION:
- READING,
- WATCHING TV,
- WATCHING VIDEO,
- KARAOKE,
- PRAYING,
- VIDEO GAMES,
- SPORTS,
- PAINTING,
- CALLING FRIENDS,
- EATING,
- INDOOR GAMES,
- BROWSING OLD PHOTOS,
- WRITING,
- CLEANING UP,
- WASHING CARS/ BIKES,
- FAMILY OUTING,
- HOBBIES,
- CHATTING ON THE INTERNET,
- SURFING THE INTERNET,
- RELAXATION THERAPY.
STRATEGIES:
Visualization:
A METHOD OF DELIBERATELY USING IMAGERY TO MODIFY BEHAVIOUR, FEELING OR INTERNAL PHYSIOLOGICAL STATE;
VISUALIZATION NOT ONLY CAN HELP YOU TO ACT IN WAYS THAT IS LIKELY TO LEAD TO SUCCESS, BUT CAN ALTER SUBTLE INTERNAL PHYSIOLOGICAL STATES AS WELL. (O.C. Simonton, 1980)
DRUG URGES PENETRATE THE SELF THROUGH THE FIVE SENSES;
Therefore, the verbal images should contain sensory words wherever appropriate (visual, auditory, olfactory, etc.)
A VISUALIZATION SESSION SHOULD HAVE 03 PARTS:
- Preliminary relaxation (5 -15 minutes).
- The visualization itself.
- Instructions for returning to an alert state of mind.
VISUALIZING ONE RIDING A BIKE DOWNHILL ALONG A STRETCH OF WINDING ROAD, BEING CHASED AFTER BY A FIREBALL PASSING THROUGH A FARM AND CROSSING A SMALL STREAM; AT A CERTAIN POINT, TAKING A SUDDEN TURN, DODGING THE FIREBALL THAT FLIES ON INTO OBLIVION; ENDING UP IN A VILLAGE CALLED ‘TRANQUILLITY’; THE FIREBALL SYMBOLIZES A DRUG CRAVING.
FORMS OF AVOIDANCE:
- Re – Scheduling; changing the Time.
- Re – Timing; changing the Duration.
- Re – Routing; changing the Route.
- Re – Sequencing; changing the Order.
- Re – Programming; changing the Activities.
- Re – Grouping; changing the Social Circle.
GROUP DISCUSSION:
- Identify common dangerous situations for addicts in your area, especially any that are related to your own culture, society or specific local conditions.
- Describe your experiences in handling relapse cases and making crisis interventions. What has seemed to help the most and the least?
- Design a ‘Relapse Intervention Checklist’, that is, all the things staff should know from or about any client who experiences a slip or relapse.
- DETERMINE THE CAUSES OF RELAPSE~PRIMARY, SECONDARY.
- EXAMINE REALISTIC OPTIONS FOR SOLVING THE CRISIS.
- DRAW A PLAN OF ACTION~STEPS, PRIORITIES.
- FIX THE NEXT APPOINTMENT.
RELAPSE, CRISIS DIRECTLY RELATED TO DRUG USE:
- DRUGS:
o Type,
o Dose,
o When,
o Frequency.
- PSYCHOLOGICAL:
o Current symptoms.
o Precipitating event.
o Mood, lifestyle change.
o Self – inflicting tendency.
o Eating, sleeping disorders.
- COPING ABILITY:
o Personal strength & weaknesses.
o Support network.
o Limitations:
i. Finance,
ii. Housing, etc.
- REFRAMING:
o Clear picture of he related events.
DEBRIEFING:
- RECALLING AND RELATING THE RELAPSE INCIDENT:
o Figuring out the causes of relapse.
- DETERMINING THE NECESSARY MEASURES TO IMPROVE RELAPSE PREVENTION SKILLS:
o Drawing new insight and cognition from the incident.
- SPECIFYING THE FORM OF REDEMPTION.
- SETTING A CONTINGENCY PLAN:
o Re – developing self – efficacy.
- GETTING BACK ON THE RECOVERY ROUTE -- BASED ON THE GOALS:
o Doing special assignments. - MONITORING AND EVALUATING PROGRESS.
SUGGEST GUIDES FOR CARE GIVERS:
RELAPSE FANTASY OR COVERT MODELLING:
GUIDING A CLIENT TO VISUALISE A DANGEROUS SITUATION AND PICTURE HIM/ HER GETTING OUT OF IT SUCCESSFULLY.
RELAPSE REHEARSAL OR OVERT MODELLING:
GUIDING CLIENTS TO SIMULATE A DANGEROUS SITUATION AND PRACTISE WAYS OF GETTING OUT OF IT,
PROGRAMMED RELAPSED:
A carefully planned exposure to a real dangerous situation in the company of reliable senior recovering peers, its impacts on the clients are later discussed in a group session and assessed by a clinical staff. It has to be done a few times until a client is confident enough to try getting into the situation on his own.
RESPONSE TO STRESSORS
- REPLACING IRRATIONAL BELIEFS WITH RATIONAL ALTERNATIVES,
- RELAXATION THERAPY,
- ANXIETY REDUCTION THERAPY:
o Visualization,
o Deep – Breathing Exercise,
o Meditation, Acupuncture,
o Progressive Muscle Relaxation,
o Thought Stopping, etc. - SPIRITUAL ENHANCEMENT:
o Prayers,
o Doing Good Deeds,
o Preaching.
POSITIVE PLEASURE:
Recovering persons need to learn how to derive real pleasure from conventional activities. It does not come automatically. Sound life goals and a realistic plan to achieve them; provide the drive to strive on. Engaging in conventional activities helps them to adopt the mainstream values and facilitates their social reintegration. Recovery maintenance relates with the contentment gained from a responsible drug – free life.
SOCIAL SUPPORT NETWORK:
Recovering persons need to maintain their involvement in a peer support group for a long time. They have to make amend to the family to acquire familial support. Then, they have to work on expanding their support network to speed up their validation process. Recovery maintenance corresponds with the extent of their identification with positive social groups.
STEPS IN RESPOND TO RELAPSE:
- STOP THE SLIDE IMMEDIATELY,
- CONDUCT A DEBRIEFING AND DETERMINE WHAT WENT WRONG,
- DETERMINE THE AREAS FOR IMPROVEMENT AND DRAW AN IMPROVISED PLAN/ STRATEGY,
- OFFER ENCOURAGEMENT AND SUPPORT.
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