Replapse Prevention for Substance Abusers

I am a retired substance abuse counselor who has gained a knowledge of the recovery process through work and personal associations. I believe that there is a need for specific relapse prevention skills. That's what my blog is all about.
Please read on to learn more.

One of the most critical challenges faced by substance abusers after they have completed treatment is avoiding a return to drinking or drugging. This is an especially significant challenge because most treatment centers offer relatively short programs that are not fully adequate in time length. The average is 30 days.

Some offer aftercare programs, according to what insurance will pay for. And AA and NA programs offer free support meetings.

These are helpful options, but recovering people need a specific plan for preventing relapse. In order to develop a plan, a person must first understand the difference between abstinence and sobriety. They also need to learn healthy communication skills.

ABSTINENCE
Recovery is a process that requires work, and the first stage of recovery is abstinence - avoiding use of alcohol and drugs. In this step we learn what we need to do in order to get and stay healthy.

SOBRIETY
Sobriety is abstinence plus redeveloping mental,physical and spiritual health. I will cover some coping skills that will help you stay sober.
Now that you are clear about the difference between these two, let's move on to the specifics.

Coping skills
- Coping with stress in healthy ways. Learn to recognize when tension builds up. When that happens, do something to help you unwind. Take deep breaths. Give yourself positive suggestions, like "I'm OK, I'll get through this". "Everything will work out-this is not a big deal". Or, "God is in charge-all is well."

- Do something physical, such as taking a walk or doing something around the house.

- Expressing feelings in healthy ways. When you talk to family and friends about something that is bothering you, practice presenting it in a way that avoids blaming and "shoulds".

Example:
"When you say something that sounds critical I feel angry. "
It's best to say I FEEL this way when.... Rather than trying to make it the other person's problem. It's all about taking responsibility for your feelings and actions.

- When something is bothering you, stop and think before you speak. Take a deep breath. Ask yourself "what's really bothering me right now ?"

- Once you identify the problem, ask yourself if it is a situation that you can do something about. repeating the serenity prayer to yourself will help you decide. God grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference.

- Identifying negative, self-defeating thinking.

Spirituality As Part of Coping Skills

Coping skills must involve spirituality. Spirituality is defined by YOU, but it should be oriented to inner resources such as meditation or prayer. Developing spirituality involves learning how to develop the power of the mind to direct thoughts and behavior. At this point I will explore specific tools that will help you achieve that.

* Affirmations: brief, positive statements centered in the NOW that say what you want to accomplish.

Examples may include:

1) I am powerless over my alcohol/drug use. I cannot control it.

2) I believe that I can achieve lasting sobriety.

3) I can achieve lasting sobriety with the help of my Higher Power.

4) When of myself I cannot see a way to heal, I know my Higher Power shows me the best way.

Consider that addiction is a thinking problem as well as a drinking/using problem. By learning to change your thinking you can enhance your recovery process. AA says that relapse begins with "stinking thinking" - old thought patterns that say "drinking/using will help me cope with this problem". Or "I'm not an alcoholic, I only drink on weekends". "I can have one drink and stop", "I am a social drinker/user, I am capable of control".

Addiction can cause brain dysfunction that distorts feelings. Irrational thinking and poor judgement can distort circumstances and make you feel like a victim. Feeling like a victim can trigger relapse.

These ideas and suggestions are certainly not the be-all of relapse prevention. There are many good books on the subject. Listed below are some of the best authors.

* David and Merlene Miller

* Terence Gorski

* Alan Marlattt

*Father Joseph C. Martin

*Earnie Larsen

Watch for my e-book on relapse prevention on WizIQ

Mental Health Problems and Substance Abuse

Many people with substance abuse problems also have mental health problems, some that existed before they began drinking or drugging. This is called dual diagnosis. Some people begin abusing alcohol or drugs to "medicate" themselves, to change the way they feel. At this point we need to review the mental health problems that are most likely to drive individuals to self medicate.

1)Depression
2)Bi-Polar Illness
3)Obsessive Compulsive Disorder
4)Attention Deficit Disorder

A large percentage of individuals with substance abuse problems also have dual diagnoses, many of which have gone untreated. Some will readily admit that they used alcohol or other drugs to "mellow out". This can create a chicken-or-egg situation in which the substance abuse depletes the level of endorphins and serotonin that the brain produces. When production of these chemicals is depleted,it can exacerbate the mental health problem, causing people to use more alcohol or drugs to achieve the same effect that it did originally.

Lets look at the symptoms of each of these mental health problems in an effort to support a fuller understanding for the family and friends of those who have them.

Depression: a lack of interest in things you were once enthusiastic about,sleeping to much or not enough,loss of appetite, feelings of hopelessness, irritability and sometimes suicidal thoughts.

Bi-Polar Illness: Extreme mood swings from feeling euphoric and being hyperactive to
extreme depression. Mood swings can cycle between these two opposites every few days or several weeks.

Obsessive Compulsive Disorder: Thought patterns that compel you to do odd or repetitive things like frequent hand washing, constantly checking on things that don't need frequent attention,irrational fears, or religious beliefs that God will
punish you for something that is unrelated to moral issues. A good summary of this is feeling that you can't NOT do something.

Attention Deficit Disorder: This is an inherent and genetic brain dysfunction that is present from birth. Characterized by hyperactive behavior, unusally high need for constant stiumlation, difficulty concentrating, focusing and following through with routine tasks. People with this disorder had trouble paying attention and sitting still in school as children.

These descriptions are just sketches,and not everyone has all of the symptoms. In some cases the characterstics can overlap with each other. Check with your mental health professional if you think you or someone you love has these symptoms.

People with dual diagnoses need mental health care as well as substance abuse treatment, and their recovery can be complicated and more lengthy.

Does Someone You Love Drink or Take Drugs ?

If someone in your circle of family and friends drinks too much or takes drugs, your first inclination is a desire to help that person. You may have tried talking to them in a concerned way. You may have even resorted to pleading or nagging. If so, you have since learned that neither does any good.

The reason it doesn't is of course, that you can't change or control another person. This leaves you with another question: what do I do now ? The answer to this question involves a learning process that will provide you with valuable tools for coping with a substance abuser that may just save your sanity.

Let's start by talking about substance abuse as an illness. Once a person has been taking drugs or drinking excessively for a period of time, they build up a tolerance to the substance. At that point they need more just to get the same effect. As a result the brain becomes dependent on the drugs or alcohol. That's when the person becomes addicted, and they can't stop using the substance without help or support Let me repeat the MOST important part of this: there is nothing you can do to change the situation if that person does not want to stop.

A simple and effective rule to apply to this situation is the 3 C'S:

1. You didn't Cause it
2. You can't Control it
3. You can't Cure it


Now we need to look at how substance abuse affects the family and loved ones of the abuser. Those close to a substance abuser want to do something to help them. But, in the process of trying to help, they end up feeling crazy, which is why living with a substance abuser can be "crazy-making".

My intention here is to provide information that will help you understand that substance abuse is a disease that affects not only the person drinking or drugging, but everyone in their circle of family and friends. If you apply this to your daily life and your interactions with that person, you will eventually stop worrying and attain a degree of peace of mind.

Applying this information does not mean that everything will be OK. It simply means that you will learn to detach from worrying and trying to control things. It will free your mind so you can start thinking more clearly about what is best for YOU to do.

The buzz word here is DETACH.That doesn't mean you stop caring about someone. It means that you are fully aware that you can't do anything to change them, and you stop trying. After you have lived with a substance abuser for a while, they have become the focus of your attention. You have allowed their problems to affect your serenity, and your attention has been focused on solving their problems or relieving their pain. You need support in order to detach.

Actually the substance abuser has become the focus of the entire family's attention.
In the process of all this, you begin to lose your self esteem and your sense of self worth from being excessively focused on someone outside of yourself. The substance abuser's problems become the most important thing in your life. There is a term for this: codependency. Codependency is an illness, just as addiction is an illness.

A family affected by substance abuse develops dysfunctional coping skills in order to survive. These dysfunctional skills involve a set of behavior characteristics that involve roles that family members play in their reaction to the abuser.

These are the roles:
1. Caretaker
2. Hero
3. Scapegoat
4. Mascot
5. Lost Child

These are the details of the roles:

CARETAKER: This is usually the spouse of the abuser, or the parent if the abuser is a teenager or young adult living with them. They are constantly trying to "fix" the person and their problems. They feel an enormous amount of shame and guilt for the problem, and may try to cover it up with families and friends. They are the one who calls the abuser's employer if the person can't go to work because of alcohol sickness: a hangover. They are the person who cleans up the problems and messes that the person's behavior creates.

HERO: The Hero is most often the oldest child who has had to clean up after the problems of the abuser. They feel overly responsibile for the addicted person. They usually grow up too soon and are older than their age

SCAPEGOAT: This child is one who gets blamed for things they didn't do. They become the escape valve for the family,often diverting the attention off of the family problems created by the abuser

MASCOT: This is the clown of the family. They have learned that doing funny, cute things eases the tension when the abuser is present and/or under the influence of the alcohol or drugs.

LOST CHILD: This child tries to escape from the family problems by simply disapearing
into their rooms, reading or some other activity that keeps them away from the abuser. This is also an emotional or physical self-protection strategy.

Obviously, not all families have four members in addition to the abuser. When that iis the case, one child often plays more than one role. Families of substance abusers overcompensate for the disorder, develop excessive sensitivity to others' need and guess at what normal is.

One VERY vital thing that families of substance abusers can learn is allowing that person to take consequences of their behavior. If that was to happen, the abuser would have to make a choice: stop drinking and drugging or suffer severe consequences. If no one cleans up after them, makes excuses, or tries to cover up the problem, the abuser can't continue for long on their current path.

It is important to remember that a substance abuser CAN make choices if faced with consequences. If the entire family detaches from their behavior the chances are strong that they will choose to get help.

The following is a list or resources and support groups that are available in your community or online:

Alanon
Alateen
Families Anonymous
Codependents Anonymous
National Council of Alcoholism and Drug Dependence

If you live in a rural community or on a Native American Reservatiion where none of these resources are available, you can choose to start your own group. If you contact NCADD online or by phone you can get guidelines for 12 step support groups.
The support and help that you get from others in the same situation as you can help you follow these guidelines.

Watch this site for online classes that will soon be available for families of substance abusers.