Clinician Resource


relapse-elephant-in-the-rooWhen you are helping people begin their recovery, all of your instincts tell you to act like a sports coach.  You want the addict or alcoholic to feel empowered, prepared to fight against the strength of their addiction, ready to beat the odds.  So often they begin from a broken place, and your prayer is that they will experience the healing necessary to push back against their cravings and emerge victorious.  Our role models come from “Remember the Titans” and “Chariots of Fire,” and our language grasps at adjectives designed to inspire and encourage.

From this perspective, it is hard to think about relapse, and even harder to talk about it.  Isn’t this a sign of failure?  If we discuss relapse are we not conceding defeat?  Do we strip away all important motivation if we talk about the possibility that the drugs and alcohol could win another round?  All too often the possibility of relapse is the elephant in the room that everyone wants to ignore.

As difficult as it is to talk about both the victories and the losses that are found on the road to recovery, we do no service if we focus only on the bright side.  Relapse happens, and by ignoring it we actually weaken the person who is striving to succeed.  To avoid a future decent into the abyss of drug and alcohol abuse, the person in recovery must know what to do if they find themselves dangling on the edge.

You may recall the heroic effort of the Olympic skater who fell hard and smashed into the boards at the Sochi games.  He lay on the ice for a few seconds, not moving, and the audience thought his skating was over.  But he got up, and continued as if nothing had happened, completing his routine to a standing ovation.  While we want everyone in recovery to succeed, we want them to know how to get up if they fall during their journey.

Plan BA peculiar human tendency is the common assumption that if we slip we have failed.  I know a woman strongly committed to a diet designed to help her overcome obesity and regain her health.  She was doing very well, and was justly proud of her accomplishment.  One day she lost her resolve and ate a large piece of cake that was not on her diet.  A brisk walk around her neighborhood would have addressed the extra calories with no harm done.  However, she immediately admitted defeat; she had failed, and soon began to eat in excess, regaining all of the lost weight.

We must help people recovering from addiction prepare so that if they slip their descent is not long and hard.  They must be helped back on their feet, continuing their journey toward a better life.  Relapse provides a brief moment to learn from one’s errors and keep moving forward — but this rarely happens without preparation. A critical piece in every recovery must be the plan for what to do in the event of relapse.  If you fall, how do you get up and continue?  Whose help will you need to avoid turning a lapse into a perilous crash?

I suggest an essential part of every recovery program is a “relapse plan.”  What happens if you being to use drugs and alcohol again?  The strategy must be prepared in advance and ready for action, because there is very little time between wrong action and the descent into a full-blown addiction.

A relapse plan has three main components.  It must have support people ready to take action at the first sign of relapse.  It must have consequences that are clearly spelled out.  And very importantly,  the person in recovery must give authority to their support people to “do what must be done” to help get the recovery back on track.

Ann’s plan was well thought out.  She asked her parents to take her car, stop all support, and inform her friends, sponsor and counselor if she failed a drug test or refused to take one.  She also requested that they do nothing to enable her, demanding that she enter a program and pass a drug test before she could reenter their home.  Ann asked her sponsor to plan an intervention and get her to a meeting right away.  She asked her friends to stand firm, not allowing her to be with them, or to come to them for support until she had her recovery back on track. Her counselor was the “point person,” with permission to speak freely with family and friends. Ann knew that she could not trust her own thoughts when she was using, so she made sure that every door would be closed except the one that led back to recovery.
Planning for relapse is not an admission of defeat, but a way to strengthen the odds for victory.  The recovering addict and alcoholic needs to be ready to learn from failure and move forward, rather than allowing relapse to put progress into reverse.  The best military plans include a contingency if there must be a retreat.  Failing doesn’t mean the battle is over, it just proves that if something is really important, it is rarely achieved without a determined effort to overcome the obstacles encountered along the way.

 

Michael Campbell, Co-Founder & President, St. Joseph Institute.

 

When we acknowledge that addiction is a brain disease it becomes easier to understand that there is a battle going on inside the addict’s head.  They hear the “voice of the disease” saying that they need drugs and alcohol to cope with life, or they really don’t have a serious problem, or what they do is no one’s business. And then there is the “voice of recovery,” reminding them of the consequences that have come from their use of drugs and alcohol, their inability to make wise choices, and the knowledge that “just one” will never be enough.

This battle inside an addict’s head intensifies at the beginning of treatment.  Addiction uses manipulation, dishonesty and denial to protect itself, and when the use of drugs and alcohol stops, the addiction fights back.  There are unpleasant physiological symptoms, increasingly strong cravings, and intense thoughts and dreams about using.  It is at this stage that tough love is often necessary to keep someone on the path to recovery.

All too often we see addicts wanting to leave rehab within the first week of treatment. Many think “I can do this on my own,” even when the individual’s past experiences prove otherwise.  Staying in treatment for those first few weeks and learning how to begin a strong recovery are not easy. Quitting crosses the mind of most.

Consequences Help Overcome AddictionIn these times, it is crucial for family and friends to stand strong as well.  If they want the person they care about to stay in treatment and change his or her life, they must resist the temptation to believe the manipulation and lies.  A great way to do so is to create consequences for quitting, such as revoking financial support, housing or even friendship. Failing to do so is like abandoning the fight against addiction before it has really begun.

Joe provides a good example:

After five days in detox he was feeling better than he had in years, his family could hear a new person on the phone, and excitement for a new life began to grow.  Joe said all the right things about how “this time will be different” and how he was ready to be a new man.  He argued that he did not need to stay in treatment; he was ready to start his new life now. So he left.

Two weeks later Joe relapsed.  It wasn’t that he had been intentionally insincere, but he was nowhere near ready to begin recovery on his own.  He had not learned the necessary skills to think in new ways, nor had he established a support network to help him manage the challenges of recovery.  A month later, Joe admitted defeat, and began addiction treatment for a second time.

Marie’s story does not have a happy ending:

Ten days into her treatment for a heroin addiction, she begged her mother to come and get her. She missed being at home, she would never use drugs again, and it would be different this time. During each phone call she used tears and pleading. Even though Marie’s counselor explained to her mother the pattern of manipulation, and how Marie needed to push harder to get beyond her cravings, she did not want her daughter to be sad.  Two weeks after Marie’s mother picked her up she died from a drug overdose.

Recovery should not be a negotiation.  For many people it is a life or death decision to fight a disease that destroys families, careers, relationships and lives.  Everyone who cares about someone trying to break free from addiction must be ready to stand strong.  There must be consequences for abandoning the fight – because they motivate the addict to win.

Try these: “If you leave treatment early you cannot come home.”  “Our relationship will end if you are not prepared to stop using drugs and get help.”  “Don’t expect me to pick you up or offer support if you don’t make a sincere effort to stop.”

These are the resolutions that help people overcome times of weakness and stay strong in recovery.  Without consequences, the addict will often choose the easy way out.

Before your loved one goes into treatment, decided what the consequences of quitting will be. Don’t be afraid to be tough – because you are fighting the addiction as well – and draw a very hard line.  By standing firm, you are showing your true love, and you may end up saving someone’s life.

If you had a disease that could kill you without an operation, my guess is that you would diligently seek a well-qualified surgeon with an excellent track record in hopes of saving your life.  Why then do people often select a treatment program for drug and alcohol addiction without equal dedication?  While addiction is a powerful disease with the potential to destroy families, careers, reputations and lives, many people base their search on unimportant criteria. All too often a rehab facility is selected based on its nearby location or proximity to a warm beach, rather than its approach & proven ability to help people establish a solid recovery.

Seven questions are listed below that address critical areas of addiction treatment.  Ask yourself these questions while searching for and selecting a rehab facility.  Hopefully they will help you make an important, possibly life-saving decision.

Individual Counseling is Often More Effective than Group Counseling

  1. What is the treatment program approach? Lecturing alone doesn’t work, nor do scare tactics, and there is no “program” that offers a proven cure.  The treatment should seek to understand the issues that drive an individual’s addiction and help them find resolution. It should also provide the understanding and skills that are necessary to live life differently. This includes identifying the risk factors and “triggers” that fuel their addiction and developing strategies to address these in a new and better way.
  2. Does the treatment program have enough one-on-one therapy?  Group therapy can be very useful, and although it is used by most addiction rehabs, it has important limitations.  The personal issues that often fuel addiction – trauma, low self-esteem, grief, resentments, etc. – are usually more effectively addressed on an individual basis.
  3. Does the program identify mental health issues & address these in treatment? Research suggests that approximately 70% of those seeking addiction treatment have mental health issues that need to be considered.  In so many situations, these issues are the “real problem” and addiction is the “symptom.
  4. Do the staff & educators have advanced degrees and demonstrable experience? When a drug and alcohol treatment program recognizes the importance of the mental health issues, they hire staff with the necessary expertise.  Licensing boards are beginning to require that addiction counselors have at least a Master’s degree.
  5. Is there a “holistic” approach that looks at all aspects of a person’s life in defining a path to lasting sobriety? Recovery from addiction requires that life be lived differently.  The sources of stress, relationship conflicts, poor boundaries, emotional dependency issues and the home environments are among the many issues that must be considered in creating a plan for the future.  Recovery requires changes that address the areas of life that must improve so that a person can experience more joy, more passion, more happiness, and more peace.
  6. Is the treatment facility committed to helping build a strong & sustainable plan for recovery? Rehab is but the first step in a life-long journey out of the dark place created by addiction.  The development of a plan for the future is critical.  It must provide the support, change, accountability and professional help necessary to avoid relapse. 
  7. Has the facility thoroughly investigated your insurance coverage and what the financial costs will be if your benefits are denied? Insurance companies do not like paying for addiction treatment and have dozens of clever strategies to avoid responsibility.  Checking the benefits is only the first step.  The important work is the research to determine whether the insurance company has criteria that will prevent the payment of these benefits, or will terminate treatment before it is complete.

Addiction treatment is about saving lives and changing lives.  However, like every industry, it has the “good, the bad, and the ugly.”  Choosing a facility requires dedicated research and resolve to make the best possible decision.

By Michael Campbell

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