Getting sober from addiction is a two-stage process. The first stage is purely physical. Detox and treatments at the rehab can reduce and eventually eliminate the craving in the body for alcohol and drugs. Healthy foods, medications, and physical activities can de-stress the body and restore normal health within a few weeks. The second stage is psychological (emotional and mental). It is considered to be complex for the patients because it is poorly understood, often ignored, and especially undervalued. This relapse guide focuses on the wholesome approach to relapse prevention through the five-point program for everyday life, one day at a time.
Powerlessness: Many of the recovering addicts may still believe their physical and mental illness is only momentary. They may often see, hear and read about relapsed patients going insane or dying due to repeated substance abuse. But still, they may think they are exceptional. They may try to change the substance, place, people (co-users), quantity, and other conditions, so they could control the substance intake and enjoy the experience. Every new attempt leads to one more failure and accumulated agony. Psychologists call it as powerlessness over substance dependence.
Unmanageability: Life during recovery may be more unmanageable for the recovering addicts because the supporting crutch (substance) is missing. Irritation, restlessness, and discontentment start increasing. Maladjustment to life (with others) and discontentment that life is not going in their way (self-centered thinking) leads to unmanageability.
Relapse: The ultimate result is relapsing. It may not happen as long as they are within the Rehab premises, because of the secure feelings they provide. Patients are absolutely free from physical, mental, and emotional disorders. What happens once they go out into the world of apathy, ignorance, dominance, discrimination, and prejudice (as assumed and hallucinated) contains the root causes of discontentment and relapse.
Acceptance: A recovering addict has to accept his powerlessness over the substance and the present unmanageability of life. A clear vision that his body and mind can no longer take the beatings of substance impact is stated to be the real roots of recovery. It is also the first point in this relapse guide.
Acceptance is of course not easy. Denial comes naturally. Some may accept after hitting the rock bottom. Others may go on the path of substance abuse without knowing where the rock bottom is. However, a person in a rehab center will know where and when he hits the rock bottom. Thanks to the treatments and psychotherapy sessions, millions have been saved from entering the no-return zones of insanity and death.
Not Alone: Relapse can happen to anyone at any time during recovery and after. People have relapsed after 15 to 20 years of sobriety. A patient should know that he is not the only one to relapse. The feelings of remorse, self-pity, self-condemnation, and guilt can become fuel for the next relapse. Hence, a patient should avoid such feelings.
Willingness: Millions of patients have tried to use their will power to stay away from substances, or to use in a limited quantity. Nearly all of them have failed due to the acquired mental twist and powerlessness. The willingness to say sober and accept help from known resources (ex: Rehab and detox centers) are the only requirements for the patients. Once they do it, the path to progressive sobriety will automatically become visible. The next level of recovery is to the willingness to walk on the path of recovery as shown by the Rehab centers. It is also the Second point in this relapse recovery guide.
Consistency: Inconsistency is the hallmark of a typical addict and alcoholic. Disregard to promises (to others and self), procrastination of actions (to stay sober), lethargy, unrealistic goals, unreasonable expectations (from others and self), are the main defects in thinking. So, there is a need for consistency in following the recovery programs (of Rehab Centers) is highly essential.
Unconditional-Sobriety: Conditional sobriety is always dangerous. The patient may think”I will stay sober if my wife loves me more, if my children are more, if my friends and colleagues respect me more, if I get what I wish, etc).” If any of the Ifs fail to materialize, he may become unwilling to stay sober. Unconditional willingness to stay sober is stated to be the only way to effective relapse prevention.
How: The next points of this relapse guide can show how to achieve and sustain all the requirements to make an effective and practical relapse prevention plan.
Acceptance of addiction problem is only the starting point of one’s recovery program. Everyday life can be a tough and challenging task for the recovering patient. The majority of issues are related to psychological disorder acquired during extended substance abuse. Hence, psychologists suggest giving top priority to all the signs of relapse related to mental and emotional problems.
Signs of Relapse: Most of the relapses don’t happen overnight. The signs may start with something like the unwillingness to continue with post-treatment medications and therapy. Sometimes it may turn into resistance. The patient may stop going to counseling and meetings. He may show signs of irritation, restlessness, and discontentment. Family members may find him unapproachable and lonely (even when he is amidst family members). Mood variation, refusal to go to work, and refusal to communicate could be the other symptoms.
Fear is stated to be the biggest sign of relapse. It can be related to realistic threats (financial instability, broken relations, uncertain future, rejection, etc) and unrealistic threats (coping with sober life, identity loss, loneliness, etc). The mind of an addict can multiply the fear factors and magnify their intensity every moment.
External Stimuli: Taunting remarks, comparison with healthy and better-earning friends, reminders of his past mistakes, and comments on current physical and mental conditions are some of the probable external stimuli, which can fuel the signs of relapse. Frequency and pace of relapse can increase beyond the scope of control.
The recovering addict has to observe the signs of relapse every day. He may even split the observation into every hour if needed. He can make a list of emotional signs like anger and resentment, irritation, restlessness, and discontentment, etc.
Anger: It may start at any point, from not getting his coffee on time, to non-cooperation from family members, colleagues, and friends, and even strangers. It is better to get away from the place or the person who may be the cause of anger for a few minutes, hours, or even days. Avoidance can reduce anger to a certain extent. But the emotional bitterness may hang on. He can call his sponsor or the psychologist (in the recovery program) and share his bitter feelings.
Resentment: For most of the addicts, anger may quickly turn into life-long resentments. Hidden tit-for-tat against wife (she had left him when in rehab, fought with him, refused to give money for substance, etc), boss (threatening to terminate, dominating, etc), friends (being too friendly with his wife, not offering substance when needed, etc), his math teacher in high school (for insulting him in the classroom), and others can be high risk factors. Psychologists suggest that he should let go of the past and start living in the present.
Resentments are stated to be the first enemy of a recovering addict. Many of the addicts have a strong memory (though they may often suffer from a momentary lapse of memory like misplacing things) since their childhood. Their mind can hang onto any of the negative event or people at any moment.
He can make a list of people whom he resents with the reasons he can think. Discuss with his psychologist, sponsor, and in his recovery group. They can offer practical suggestions to dilute the resentments and take them out of the mind. It is a continuous process, which he may have to do every day, or whenever the resentments start to rise.
Fear: inaction and lethargy can cause fear factors to multiply. Most of the recovering addicts may face financial insecurity. They are often unable to work long enough (consistently) to make the ends meet. Pending bills, rent, credit card debts, and other expenses create panic. Inability to cope with stress, they may think of using the substance to escape from facing reality.
Do the thing first you fear the most is a saying which is aptly applicable for the recovering addict. He can take the initiative by talking to the concerned people and authorities (landlord, Cable-TV, residential gas company, etc) to borrow more time for payment. Meanwhile, he can start searching for a new job or restore his lost job. Initially, he may not be willing to do it and postpone it.
Talking to the psychologists or sponsor can help. They can help him to overcome lethargy and start moving. Most of the addicts have a starting problem. Once the start is made, there is no stopping them. Facing the challenges and working hard are the two inborn qualities among many addicts. They are only masked by the fear factors acquired during substance abuse.
Inconsistency: All the initiatives taken so far can vanish into thin air, because of inconsistency. Most of the addicts may have the tendency to work hard for two or three days a week. Then they disappear. It had been the tendency during substance abuse which continues during recovery.
One option is to keep working at a slow and steady pace. Instead of working for 18 hours for four days and then conking off for the next 10 days, it is better to work for six hours every day. Two things may prevent it from happening.
Adrenaline-Rush: Urgency to make up for the losses (financial and material) during the using days within a fortnight or a month is one factor. It may push the addict to become workaholics. The second factor is physical and mental stress. A body and mind damaged due to years of substance abuse don’t recover in a hurry. But the recovering addict refuses to accept his limitations.
He has to go through a series of counseling sessions at the rehab where he stayed during treatments. The psychologists can help to balance the work-life equation. He may also talk to his sponsor and others in the recovery group. It may take more time than his expectations. Psychologists can teach him patience and persistence during counseling.
Sex: overindulgence of abstinence during the substance abuse period might have created an imbalance in his natural sex-drive. Consistent craving and denial by the partner (or spouse) can be another triggering point of relapse. The best-suggested solution is to consult the psychologist. He may suggest a natural way of venting out his frustrations and resentments without negatively affecting or harming others.
Appetite-Loss: In the initial stages of substance-use (ex: marijuana), the potential addict might have experienced a sharp rise in his appetite, especially for meat and sweets. As he progressed into hard substances, his appetite might have declined and reached a near starvation stage at times. Loss of essential fluids might also cause loss of energy, stamina, and strength.
Appetite-Restoration: The first step is to restore the appetite. He has to start eating nutritious foods and consume essential fluids. The key is to avoid hunger because it can trigger a relapse without his conscious awareness. Initially, he may not be able to eat properly due to appetite loss. His family can ensure timely food consumption. Consuming plenty of fresh water and fruit juices can restore the appetite.
He can consult his physician or the doctors at the rehab to prepare a nutrition plan. They can suggest a chart of foods, juices, and supplements for everyday consumption. He has to follow the plan consistently to keep his body healthy and his mind serene and sober.
Avoidance: The recovering addict has to stop visiting the old friends, substance available places, and hangouts where he started and continued his abuse practices. He may change the mode of transport to his workplace by taking a ca, bus, or a metro rail route. He can delete or block all the contacts of using friends.
Companionship: Companionship with people in his family is the most powerful tool for relapse prevention. He has to start interacting with children, wife, parents, and other family members. Confessing his past mistakes and asking forgiveness can fix relations like never before. He has to overcome the “I First” attitude and start listening to wife and children.
Frequent family outings like picnics and tours can recreate the lost bonding among family members. He can start experiencing the true sense of joy and find a purpose for his life.
Counseling: Most of the rehab centers offer post-treatment counseling programs. There are also separate programs for the affected family members like the wife, children, and other family members. They are highly useful to make the family members understand the recovering addict. They will learn how to empathize with his emotions, feelings, and recognize the symptoms of relapse. It can help to prevent the probabilities of relapse significantly.
Meetings: There are many best substance addiction recovery programs in every city in the USA and the rest of the world. Recovering addicts can attend meetings and share their experience. It is where the recovering addict finds the closest companionship. It is because everyone is affected by the common disease called substance abuse.
Listening to others’ sharing can create a deep sense of involvement and bonding. Most of the stories of the addicts may have similarities with his self-experience. Initially, he may wonder (or suspect) if any of the other members were following him and his actions during the substance abuse period. Repeated meetings can bring sanity and serenity gradually, but surely.
Program: The 12-step program can restore the recovering addict’s life back to normalcy. Initially, they may seem strange and straight from the holy books. An addict’s mind usually starts by thinking about the futility of such programs. Sometimes he may even feel aversion. It could be because of the importance given to eliminate the self-centered approach to life and relations. Gradually he may get a sponsor and start working the steps.
Dr. Vikram Tarugu, M.D, is the CEO of Detox of South Florida, Inc and medical professional focused on addiction. A veteran in the medical field with over 25 years of professional experience. He is a consultant for many South Florida Rehab centers. Patients travel from allover the US to seek his help with addiction and Hepatitis C treatment.
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