Relapse prevention, Part 1

I’ve written about my two years (1991-93) as a ward psychologist on the fledgling Detox/Rehab Ward of the University Hospital of the West Indies (UHWI), in Kingston Jamaica. When I started my Peace Corps tour of service, the ward had no treatment model other than the medical model, supported by Twelve Step meetings (Alcoholics Anonymous, Narcotics Anonymous). I introduced a relapse prevention curriculum that was adopted by the ward staff. When I recently checked out the UHWI Detox/Rehab Ward (now called the Addiction Treatment Services Unit) online, I was delighted to see that it’s still using a relapse prevention model. My Peace Corps legacy was a relapse prevention manual that I wrote for use on the ward. A Returned Peace Corps Volunteer who’d served at UHWI years after my departure told me that the manual had still been in use  when he was there.

A relapse prevention approach to recovery works well within the medical model, which – like Twelve Step programs – regards addiction as a disease. I introduced the patients on the ward to the relapse prevention model in my psycho-educational groups. Addiction, I said, is a chronic, progressive, relapsing disease that is ultimately fatal, if the disease progression isn’t arrested. Chronic means it doesn’t just go away at some point. Progressive means it gets worse over time. Relapsing means that most addicts will relapse multiple times before establishing long-term sobriety – if they ever succeed in doing that.

One of the advantages of the medical (or disease) model of addiction is that it helps some alcoholics/addicts to understand why they can’t control their drinking and/or drugging: they have a disease. Guilt and self-blame don’t generally help people to come to terms with their addiction. The medical model tells addicts that while they can never be “cured” of their chronic disease, they can halt its progression and stay in long-term recovery. This is why alcoholics in AA programs still refer to themselves as alcoholics, even if they haven’t had a drink in many years. They’re not ex-alcoholics, they’re in recovery. They may have stopped the disease progression, but they remain at risk of relapse. As any recovering addict will tell you, recovery happens one day at a time.

If you’re an addict, relapse prevention means learning what puts you at risk of relapsing. There are myriad ways that people who are struggling to stay in recovery unconsciously set themselves up for relapse. The first step in creating a personalized relapse prevention plan is to identify your triggers for relapse. Triggers can be people, places, things, activities, attitudes, emotions or thoughts. Different people have different triggers.

Recovering alcoholics may have to sever relationships with their old drinking buddies and stay away from bars and parties where alcohol is served, at least in early recovery, possibly permanently. If a lover is still drinking/using, a person in recovery may have to end the relationship. A recovering crack cocaine addict may need to stay away from the places he used to score and use, and might be triggered by the sight of a crack pipe or the smell of cocaine being smoked. Stress, anger, anxiety and depression might trigger a relapse. Thoughts like, “I’ll never drink again unless ________” can be a set-up for relapse, as can euphoric recall – dwelling on thoughts about the good times you used to have getting high, before you became addicted.

The second step in creating a relapse prevention plan is knowing in advance what you’re going to do instead of using, once you’ve been triggered. That might be going to a Twelve Step meeting, calling your sponsor, or checking yourself into Rehab. If you don’t have a plan for what you’ll do when you’re triggered, you’re probably going to relapse. A slip – defined as a single episode using your drug of choice or a bridge drug – need not become a relapse, if you have a plan and act on it. All too often, when an alcoholic gives in to temptation and drinks a six-pack after an extended period of sobriety, she thinks “I blew my recovery! I may as well go to the liquor store.” If, instead, she goes to an AA meeting or calls her sponsor, and admits what she’s done, she may prevent the slip from becoming a full-blown relapse. I used to quote an African proverb I’d heard somewhere: “If you want to avoid falling where you have fallen before, don’t examine where you fell, but where you slipped.”

I don’t mean to suggest that everyone with an addiction problem has to join a Twelve Step program and go to meetings for the rest of their lives, although for  some that may be exactly what they need to do. I’m convinced that there’s more than one road to recovery. I’ll write more about relapse prevention in another post.

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