One of the first “coping skills” addicts must learn is Relapse Prevention.
This requires addicts to thoroughly understand the entire process of relapse. It doesn’t matter whether one is addicted to drugs, alcohol, gambling, sex or anything else. The process or sequence of events is the same and the prevention skills and activities are the same.
1. The Relapse Sequence
Relapse is not a sudden uncontrollable impulse that suddenly attacks without warning. This is usually how addicts in denial may explain away their “slip” but it is in fact a process which takes some hours and may even begin weeks in advance of the actual relapse.
There are 3 basic stages of relapse
(a) The Trigger
The trigger is an event or scene which the addict associates with using. Discovering triggers requires some thought and a skilful sponsor will help to dig them out. Mostly triggers seem innocuous. These are some examples from addicts themselves;
One addict described a white-marbled top coffee table on which he used to cut lines of cocaine for snorting. It took quite a while before he recognized that seeing any marble-topped tables “triggered” his craving and eventual relapse.
Another addict describes how he used to buy his drugs at strip-clubs. For years after coming into recovery, he still had cravings and it wasn’t until he realized they were being triggered by any scenes on TV of stripping, girly-magazines on a store display rack, passing a strip club or hearing music associated with stripping.
Other triggers may be a yelling spouse, parent or sibling, particular foods (hey, who doesn’t associate the “munchies” with pizza?) psychedelic music or just about anything that causes a “Pavlov Response” (Pavlov, a Russian Psychiatrist, rang a bell every time he fed his dogs until eventually the dogs would start salivating at every ring of the bell, even when they knew there was no food. In exactly the same way, just seeing or hearing a “trigger” leads to craving.)
(b) The “Insanity” Stage
Once triggered, there is a longer period or stage during which the addict reverts to “addictive thinking“, Thoughts that are insane, become reality. Even the reasons for “quitting” are forgotten.
“Just one sip won’t hurt me”
“I’m not really going to use, I just want to be around old friends, familiar places etc.”
“I’ve beaten this up to now, I can do it again.”
“This time I’ll only do it once”
From there, it is a short trip to the “planning” stage.
“Where can I find some money?”
“Where can I go to use/drink etc.”
“When will I do this?”
“What lies must I prepare?”
(c) The Relapse
Once relapse occurs, all rational thinking flies out the window. The addict reverts to a full-blown addiction again often described as “going out” again. The addict may be “out there” from a few hours to a few years!
Never-the-less, it is vital that addicts do not give up on themselves just because they relapsed. Many do because of fear of what their family and friends will say. Some “stay out” because their families “freak out” and scream and yell when discover the slip.
To the families of addicts I say;
1. Be supportive after a relapse.
2. Be firm and encourage a return to his or her program.
3. Discuss the situation with the addict’s sponsor.
4. Avoid painful recriminations, accusations and threats.We don’t yell at someone who has an illness.
2. Relapse is a Part of Recovery!
It is strange to say this, but, relapse does have a positive side. Every episode of relapse must become a learning experience. Instead of rejecting them when they slip, addicts must be supported and helped. The skillful sponsor will help the addict to discover what happened.
“What were you doing when you first thought about using? Who were you with? What were you thinking? Where were you exactly? etc.”
When we have those answers, we even dig further.
“Explain what was happening in your life in the 24 to 48 hours before you had this first thought? When did you last go to a meeting/speak with your sponsor/work your program?”
Every addict has a “pattern” to their relapsing which soon becomes apparent. Triggers can be identified and a coping skill can be built into the addict’s “prevention plan” for each trigger.
To the addicts I say, “Relapse is a normal part of recovery. (I am not giving you permission to relapse though.) If you do slip, get up, dust yourself off and get back to your recovery!”
4. Prevention Plans
As soon as there is a trigger, addicts must take out their preplanned “Prevention Plan” and act on it.
If the addict delays this, for even a few minutes, they may move into the insanity stage from which there may be no return. The idea is to arrest the impending relapse immediately, before “the beast” takes over.
The following are activities which have proved to be successful. Write them down and keep them on your person at all times. As soon as you recognize a trigger, take it out and do “whatever it takes”.
(If you send your email address to quit@sprint.ca , I will send you a three-panel “Prevention Plan” brochure, in Word format, which is ideal for this purpose.)
MY PREVENTION PLAN
I MUST CALL FOR HELP! … NOT IN A FEW MINUTES BUT RIGHT NOW!
I MUST CALL FOR HELP! … BECAUSE I AM POWERLESS ON MY OWN!
I MUST CALL FOR HELP! … BECAUSE RELAPSE IS NOT AN OPTION!
I MUST CALL FOR HELP! … BECAUSE PEOPLE WANT TO HELP ME!
Part One – Immediately Do the Following;
1. Normalize (the situation) – Keep telling yourself “It is quite normal to crave. The feeling is part of Recovery and it WILL pass.”2. Visualize - See the craving as a wave that will soon trickle out on the seashore.
3. Be Positive - Verbalize out aloud “I CAN cope with it!” Or “I WILL beat it!” over and over like a mantra.
4. See Past It - Visualize all the bad consequences you have noted.
5. Avoid WTF Syndrome - Be aware that “What the f ****” thinking is the biggest cause of relapse. Don’t go there!
6. Journal - Write out all your immediate thoughts and feelings now! Don’t wait!
7. Get Support - Tell someone what you are experiencing.
8. Distract - Do anything that is NOT related in any way to your craving.
9. Substitute - Drink a sweet soft drink or eat some sweet food.
10. Evacuate - Leave the current area or change the situation you’re in. Don’t delay for even a minute!
11. Breath - Take deep breaths – in through your mouth, out through your nose. Oxygen-load your brain!
12. Delay – Put-off all decisions to give in to your craving for the next 15 minutes. Then repeat and repeat!
Part Two – These are my triggers – Avoid them;
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Part Three – These are people I must call now!
Name 1. _ _ _ _ _ _ _ Telephone Number _ _ _ _ _ _
Name 2. _ _ _ _ _ _ _ Telephone Number _ _ _ _ _ _
Name 3. _ _ _ _ _ _ _ Telephone Number _ _ _ _ _ _
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Part Four – These are the reasons I quit in the first place
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Part Five – These are the meetings I must go to today
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Tell someone you are craving as soon as you arrive at the 12 Step meeting. Don’t keep things to yourself. Don’t wait!!
Part Six – If I Relapse This is what will happen to me.
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Part Seven – If I Relapse This is what will happen to my family/spouse/children.
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After a relapse, the most important work is asking;
What happened?
What have I learned from this?
What must I do differently next time?
