Coping with Lapses and Relapses

Establishing long term sobriety is hard, and how one manages returns to old behaviors can either enhance this process or greatly jeopardize long term gains.  Gaining some sober time in the sum of weeks or months can feel invigorating and motivating; at times it is easier than it looked, while at others it is a downright battle.  Embarking on the journey of sobriety will bring ups and downs and lapses or relapses can dismantle even the purest of intentions, creating interpersonal conflict, legal/ work issues, and diminish self-worth.  

Progress is not a linear path and will require one to endure the oscillating effects of pleasure and pain.  It is a rarity for someone to determine to make a change in their lives and stick with this change without any reversals.  While this is true with any behavioral change, it is especially so with chemical dependency.  Receiving ultimatums from spouses, parents and bosses and the high consequential costs of relapses adds to the pressures felt to be perfect and to never use again under any circumstances.  It is true that these boundaries can influence abstinence and add in reminding us of the consequences of using, and they also can add to the guilt and shame felt if any deviance from abstinence occurs.  

As it is often said in the recovery field, relapse is a part of the recovery process and can be used as a learning experience.  A relapse refers to a prolonged return to a pattern of use that one is trying to control or quit, and a lapse represents a momentary slip, typically a one-time occurrence.  There are major differences between a lapse and a relapse in terms of how one might want to move forward and adjust their recovery process.  A lapse may entail increasing mutual support meetings or counseling sessions, whereas a relapse may require additional lifestyle changes and safeguards.  The tendency for the individual to beat themselves up over their deviation from recovery is counterproductive and often propels one to use more of their substance as a means of avoidance and emotional support.  

Turning a relapse or lapse into a learning experience and an opportunity to remember the pain and challenges that lifestyle brings can help enhance future recovery and reinvigorate present resolve.  These experiences provide an opportunity to identify both internal and external triggers that may have gone unnoticed before and prompt us to seek additional support we may have been avoiding.  A relapse is not a sign of failure, but a sign to turn a different direction and seek additional approaches.  It can also assist in one deciding whether moderation or abstinence is the right choice for them based on their previous attempts and resultant consequences.  Ambivalence is often tested on the cold hard battlefield of daily experiences and can be overcome through occurrences that cause friction and pressure in our lives as the result of their natural consequences.  The guilt and shame felt do not have to be overly indulged and used as further justifications to get faded.  Instead, those feelings can be used as reminders of why we wanted to make changes in the first place and what we do not want to experience as a result of choosing to drink or use.  If we can objectively look at our behaviors and how they affect those around us, and remember the feelings felt post re-engagement with our substance of choice after determining to make changes, then we can use a relapse or lapse as a catalyst to continue moving in a value driven direction.  

Being Comfortable Feeling Uncomfortable

Getting comfortable feeling uncomfortable, is one of my favorite recovery sayings because I feel it really sums up what is necessary to live a life free from problematic substance use.  Those who use chemicals to change their emotional state may have begun using, as a means of making a fun time even better, but once the consequences of use outweigh the benefits. The addictive behavior or chemical becomes the primary coping mechanism to avoid temporary discomfort.  At this point it may not even be about fun, but an attempt to feel normal and function in day-to-day activities.  

Choosing to reduce ones use, or to be abstinent, will inevitably push the individual to experience varying levels of discomfort since the body and mind have been conditioned to turn to the addiction as an attempt to relieve the discomfort.  For those who have been through this, we know this relief is fleeting at best.  The choice to stop this pattern is not an easy one and requires one to learn new ways of acting and thinking that will assist in developing tolerance of discomfort.  While the minds initial response will want to be to run away from the discomfort and use whatever is quick and easy, following through with this method will only keep us in the throes of the addictive lifestyle we so hope to escape. 

Understanding and accepting that discomfort is a natural part of life, and really any behavioral change, can be uncomforting during this process.  Dietary changes, deciding to wake up earlier, exercise, communicating better with a spouse, are all examples of changes that will be uncomfortable at first and stopping or reducing a chemical addiction is no different.  Remind yourself that change is uncomfortable at first, and over time this change will become more normalized which will therefore gradually reduce the discomfort as it becomes part of your new lifestyle.  

Avoidance is a common feature of addiction and is the antithesis of engaging in the behaviors that will bring you long-term, sustainable happiness.  We start using substances for a conduit to happiness, and paradoxically people choose to stop using substances to regain their happiness.  Learning to cope with discomfort is mandatory to maintain positive changes because discomfort is what we seek to avoid by having a drink, taking a pill, or smoking something.  

There are many ways to deal with discomfort in healthy ways and when done consistently become easier and easier over time.  I have found acceptance, mindfulness, and engagement in distractions to be some of the most powerful tools to get through temporary discomfort.  The mind will want to think about the future and how the discomfort will always be there, but how can you know what the future brings and how you will feel one day, one month or one year from now?  

Almost everyone I know who has been living a sober lifestyle states the urges and cravings diminish over time and many have gotten to the point where their addictive substance no longer holds any sway over their life.  By focusing on the moment at hand, and not projecting our current discomfort to how we will always feel in the future lessens its power and allows us to experience the transitory nature of all feelings.  Here one moment and shifting the next.  By learning to get comfortable feeling uncomfortable, we no longer make demands that “bad” feelings must be avoided and should not be tolerated.  Instead, we accept life has ups and downs and are able to push through these moments without having to turn to a substance to give us short term relief, while incurring long-term consequences as a result of their use.  

Navigating the Holidays

The holidays can be a treacherous time for those wanting to avoid alcohol and other mind-altering substances.  This time can be triggering for several reasons, attending work parties, family gatherings, increased stress, financial strains, and the list goes on and on.  The American Psychological Association has found that the holidays increase stress levels in 41% of women and 31% of men, increasing the risk of unhealthy coping strategies during this time. While the holidays can be a time of happiness and joy for many, others find it stirs up memories of painful pasts and a time for increased isolation.  Here are some suggestions to assist in navigating this time while maintaining sobriety. 

Planning ahead is the best strategy you can implement. If attending work or family gatherings it is important to think through how you will manage these events.  

  • Have an entry and exit plan.  Arrive early, leave early or arrive late and leave early
  • Bring your own drinks and have a drink in hand as often as possible.  This helps alleviate the uncomfortable “may I get you a drink” question.
  • Plan how to refuse a drink offer and practice this beforehand.  Know that you are under no obligation to drink or use.  When offered, look the individual in the eye (this shows you are serious), say no, and then change the subject.
  • Arrange alternative transportation if necessary.  Take an extra vehicle if you need to escape the situation, have Uber, Lyft or a taxi service readily available on your phone. 
  • Bring a supportive friend or family member who knows your situation to help with accountability.  If that is not possible, you can have periodic checks ins with someone via text or a phone call every so often. 
  • Know that you can you leave the gathering at any time an urge becomes too unbearable.  If you need to, step away outside, to an empty bedroom or the bathroom to regroup, take some deep breaths and let the urge pass. 
  • Remember that most people are not as concerned about whether you are drinking or using and are more focused about themselves as opposed to watching what you are doing. 
  • Set up your own plans with friends or loved ones in environments of your choosing and at times of day that drinking or using may be most unlikely to occur. 

While this list is not exhaustive, it offers some suggestions on navigating high risk situations and can hopefully assist you in thinking about the various ways one can manage holiday events and environments.  Staying connected with sober support, making sure to eat well, get rest, exercise and practice stress reducing coping skills will also assist in building overall stress tolerance.  If you need assistance in tailoring a plan more specific to your situation or find the holidays to be particularly difficult to manage drinking or using, give us call, we are here to help.  

Happy Holidays!

Reducing Harms Associated with Substance Abuse

For many who have been using alcohol or drugs problematically, the advice given from loved ones and many mental health professionals is they must remain abstinent from all mind-altering substances and any deviation from complete abstinence is a cause for major concern. This approach to substance abuse follows an all-or-nothing model that does not consider all the gray areas between severe problematic addiction and complete abstinence, and can often have devastating consequences when a slip, or a lapse, occurs.

Harm reduction is about reducing the harms associated with substance abuse. It can be applied to any circumstance where there is less harm, or the potential occurrence of harm, due to specific interventions or actions to reduce, substitute, or replace the use of a harmful substance. In the case of alcohol, if someone were drinking a fifth of vodka a day, and is now drinking a bottle of wine, the harm would be reduced because a bottle of wine has much less alcohol content.  If someone has been using heroin and now strictly uses cannabis, they will have reduced the harm of a potential lethal overdose. 

Harm reduction can come in many forms and will be greatly needed during a time when addiction is expected to climb 100% over the next two years (CCAPP, 2020). For opioid use disorder, there are two main medications, Naltrexone and Buprenorphine, both of which can come in oral or subcutaneous once-monthly injections. Naltrexone can also be used for those who are wishing to stop drinking or reduce their alcohol intake as it helps with cravings and reduces the euphoric effects of alcohol. Often times, people may not want to use medications to help them cut back, taper or assist them in maintaining their abstinence, but harm reduction approaches have been shown to be highly effective when compared with total days sober, and not just total days abstinent (Peele, 2020).  

When working with clients, my goal is to always help them find ways to reduce the harm, or the potential for harm, caused by their problematic use.  Expecting or demanding complete abstinence, when that is not the goal or desire for someone only sets them up for guilt, shame, and a potential self-fulling prophecy if a slip occurs, giving them the opportunity to tell themselves, “See, I knew I would fail at this.” Following a harm reduction model for those who are seeking it or require it based on medical necessity helps individuals build the self-efficacy and belief that they have power to change their behaviors and live a balanced life, free from the grasp of addiction.  

If you or a loved one have been told abstinence is the ONLY WAY, give Realize Recovery a call today and we can discuss options and provide education on the evidenced based treatments that have been proven to work. 

Peele, S. (2020, March 19). So Alcoholics Anonymous Is “Proven” to Work After All? Not So Fast. Retrieved October 12, 2020, from https://filtermag.org/alcoholics-anonymous-cochrane/

The Disease of Addiction Thrives on Isolation (Rep.). (2020, May 12). Retrieved https://www.ccapp.us/application/files/9715/8932/2072/Addiction_Thrives_on_Isolation.pdf

Supporting a Loved One with Addiction

Having a loved one who is struggling with addiction can feel overwhelming, create disharmony in the relationship and feel downright hopeless at times.  The most well-known model used to help someone get into some form of treatment has been the Johnson Intervention method.  Many have seen this model used on various television shows, filled with high drama, intense music and emotional reactions from both the loved ones and the individual struggling with addiction.  This form of intervention typically involves hiring an interventionist who coaches the loved ones on how to effectively confront the addict and set expectations that they either go to treatment or face the reality of not being involved in their loved ones lives anymore, to greater or lesser degrees.  

Research has shown that this approach is effective only 30% of the time and can often decrease the likelihood that treatment will be as effective for the individual who is “forced” to enter treatment (Myers, et.al, 2002). Those who are forced to attend treatment may not be ready to make a change in their behavior and this can cause resentment and resistance during the treatment process.   

Another approach that has not yet hit the main stream world of addiction is called CRAFTcommunity reinforcement and family training.  This approach was created by Robert Meyers and colleagues at the University of New Mexico and has been shown to have a roughly 65% success rate in getting a loved one into some form of treatment.  CRAFT was developed to assist loved ones in learning new effective ways to interact with the substance user in a kind and loving fashion, with the intention of reducing or stopping their substance use or drinking, and encourage them to enter into some form of treatment.  

Since friends and families lives often become completely consumed by their loved one’s addiction, CRAFT emphasizes learning coping skills on how to effectively care for themselves and take back control of their life.  By practicing self-care regularly, LO are better able to handle stress, express their feelings in more tactful ways, and maintain a positive outlook on the situation which influences more helpful interactions that with the struggling individual and increases the chances they will choose to seek treatment. 

While this approach may sound utopian and like all that is done is cater and be nice to the individual who is seemingly causing so much chaos and discord–there is a helpful way to approach the treatment conversations where someone is more likely to be open and receptive to the conversation.  Nagging, pleading and threatening typically don’t work on us when someone wants to get us to engage in something so why would we think it would be helpful to do the same to a loved one?   

Addressing conversations with a loved one, letting them know how you feel, and what you would like to see happen going forward is important.  A few tips below that may be helpful in starting this process.  If you would like further reading on this topic, I suggest reading How to Get Your Loved One Sober, by Robert Meyers and Brenda Wolf.  

  • Do not have conversations with your loved one when they are under the influence.  Remove yourself from the situation and let them know in a calm, matter-of-fact manner that they appear to be under the influence, how it makes you feel, and that you would like to have the conversation when they are sober.  Remove yourself from the situation and do not reinforce their use by spending time with them or engaging in conversation.  No argument or fighting, simply walk away and distance yourself.
  • Address your loved ones use at a time when they are most likely to be receptive, using the PIUS formula to address your wants, needs and feelings.  
    • P:  Positive communication that focuses on what you do like and want for the relationship, not what you don’t like and want them to stop.  Instead of saying “you always ruin dinner by getting drunk”, try “I enjoy having meals with you so much when you are sober”. 
    • I:  use “I” statements to express how you are feeling.  Using I statements lowers the defenses of the other person and allows them to be more receptive because the focus is on your feelings and not on their defects of character
    • U:  show understanding to your loved one’s situation and express how hard it must be to change as an example.  This too helps lower defenses and shows that you are empathizing with their feelings and difficulties. 
    • S:  Share responsibility to some extent for the current circumstances you all find yourselves in.  How can you help and support your loved one during the change process and how has your mindset and behaviors potentially influenced the situation?  While you are taking some responsibility for the problem, you are also taking some responsibility for developing a solution and path to a healthier, more loving relationship. 

If you or a loved one is struggling with problematic substance use, we are here to help you find a solution.  Even if we are not the best fit for you or your loved one, we can help you find someone who is.  

Habits: Friend or Foe?

Habits compel us to act against our better judgment. When changing them, it can seem like the whole world is challenging our intentions.

Changing habits is not easy.  It can seem like as soon as we decide to change a behavior, the whole world conspires to challenge and thwart our courageous intentions.  Habits compel us to act against our better judgment and reason, despite our desire to act differently.  Therefore, habits can be our best friend or our worst enemy, depending on their nature. 

Habits are formed through the continued repetition of a certain thought or action. The behavior or thought then becomes automatic and requires little thought or conscious effort to engage in that activity.  Habits and feelings are closely tied together because there is a sense of normalcy that can be comforting and predictable, while change often feels extremely uncomfortable.  Anytime we want to make a change in our lives, we often must learn to act differently then we feel.  This can be a powerful statement to remind ourselves on a regular basis when working on changing a pernicious habit.  

In the process of early recovery, there are often urges and cravings that can feel compelling and strong.  You may want to have a drink or use your go-to substance to feel differently and avoid the discomfort of feeling uncomfortable.

Unfortunately, I have not heard of, nor know of anyone who has ceased problematic substance use without having to sit with discomfort to a greater or lesser degree.  The more we can get comfortable being uncomfortable, the more we build the habit of acting on our best judgement because we know it is in our best interest long-term.  We began to no longer do what feels good only in the moment yet causes long term suffering, both in our lives, and the people most important to us.  You are probably already practicing this in your life to some extent, and if you have a desire to change problematic substance use, you can start taking positive action right now!  

Forming helpful new behaviors is like building a muscle, the more we work at it the stronger and easier healthy behaviors are to establish.  Keep in mind we must often first establish a new habit before we begin to experience the benefits of this new behavior.  We cannot go to the gym for a few days and expect our body to look and feel the way we want it to or eat healthy for one week and presume we are good to go.  By taking small steps in the right direction to establish a firm habit of exercising regularly, or eating healthier, we create a new lifestyle that can continue to compel us to carry on that helpful habit, even when we feel like acting differently!  By practicing this in your life regularly it will assist your recovery efforts by training you to confidently know that you can do what you set your mind to regardless of how you feel.  

I suggest trying the following formula to make positive habit change a daily routine in your life.  

  • Choose one action you can perform daily that feels uncomfortable doing, but you know will be beneficial for you. 
  • Identify the time of day, specific place to engage in this action, and amount of time you will spend doing it
  • Make this extremely manageable, an action and length of time you are 99% confident you can achieve daily.  
  • Set reminders on your phone or use post-it notes to help you remember your new action
  • Take action today and start engaging even if you feel uncomfortable.  Reminding yourself that you are comfortable, being uncomfortable!

Example:  New behavior is to exercise for at least 5 minuets every day.  I can perform 20 push-ups, 20 squats, and a minute or two of planks.  I will do this each morning as soon as I get out of bed.  

Practicing Mindfulness

If you or someone you know is struggling with problematic drinking or using behaviors, chances are you feel a great deal of stress, anxiety, fear, and depressive thoughts surrounding this behavior. Managing thoughts about cravings, regrets of the past, and fears of the future can feel so overwhelming that engaging in mind-altering chemicals seems like a rational idea. Practicing mindfulness helps avoid the fears of the future and the resentments and regrets of the past by bringing one’s attention to the present moment and a more solutions-focused attitude.  

As I discussed in the previous post about how beneficial mindfulness can be, it begs the question of how does one practice mindfulness when the mind is constantly jumping from one thought to the other? Simple answer: with patience and persistent practice. When we begin to notice our habitual mode of thinking it can be easy to get discouraged because our habitual thinking may be very pessimistic and negative.  That is a good sign you are on the track to changing!  Through mindful awareness of our thoughts we give ourselves the opportunity to choose a different, more helpful thought process. 

Integrating mindfulness into your daily life may not be as hard as it first appears because we are already practicing some mindfulness each day.  Anytime your mind is fully in the present moment and not focused on the past or future, you are practicing mindfulness.  Setting an intention to practice mindfulness can be a helpful first step to push you to make an action plan on how you can be proactive in establishing your new cognitive habit.  Here are some easy and quick ways you begin using mindfulness in your daily life.  

-Showering:  This is an excellent time to put your attention on all the bodily sensations that are felt from washing your hair, scrubbing your body and feeling the relaxing water flow over your skin.  When a thought comes to the mind, calmly and patiently bring your attention back to the flow of the water coursing over your skin.

-Driving: While driving alone focus on the surrounding sights and be fully present absorbing all the visual scenes and sounds around you.  The goal is to observe objectively, without labeling and judging what is happening on the roads.  Simply observe and notice without engaging in judgmental thoughts.  

Eating:  With each bite put your full attention on the taste, texture, temperature, and smell.  You can use this technique with a meal or a dessert item you can really savor slowly.  

Sitting still:  Sit upright in a chair with eyes closed and simply put your attention on your breath.  Watch each inhalation and exhalation with deepest attention.  Challenge yourself to be mindful for three consecutive breaths.  If, and when, a thought comes into your mind, acknowledge the attention has wandered, then calmly and patiently bring it back to the awareness of your breath.  Practice for 3-5 minutes 2-3 times a day.  

Practicing mindfulness changes the structure of our brain, and over time will change the way we think.  Having more conscious control over our thinking and not being dragged aimlessly from thought to thought, we are better able to engage in daily activities with calmness and poise.  You can learn how to consciously choose which thoughts to entertain and which thoughts to simply observe, and then let go.  

Mindfulness – Where is your mind?

Mindfulness: By thinking differently, we develop new neural connections and diminishing the use of old connections, changing the landscape of our brain.

Many of us have heard of the term mindfulness and may feel like we have a general understanding of what mindfulness is about.   Common answers I hear when asking clients what mindfulness means to them are being aware, present, not focusing on negativity, and being in the here and now.  What commonly follows their definition is that mindfulness is very difficult to do regularly, doesn’t help them much, or it is a struggle to practice with so many distractions vying for their attention.  Being someone who has been practicing mindfulness daily for over a decade, I can agree that it is a challenge and a battle.  Just like any other learned behavior or habit change, it takes patience, consistency and determination to establish the habit of mindfulness on a regular basis. 

Why is mindfulness helpful?  Numerous studies strongly suggest that by practicing mindfulness one can lower anxiety and depression, cope with life stressors more effectively, improve life satisfaction and increase one’s sense of self-esteem and many other synergistic health benefits.  While all that sounds good, from a practical standpoint I find mindfulness helps me enjoy each day more fully, the time spent with others and activities I engage in.  The older we get the faster time seems to move. By practicing mindfulness, I find I can retain more information and fully experience each moment.  My attention isn’t concerned about the past (which is associated with regret or depression) or worried about the future (associated with anxiety and fear).  

Mindfulness can be so impactful because it is literally regrooving our brains.  By the simple act of thinking differently, we are developing new neural connections and diminishing the use of old connections, thus changing the landscape of our brain.  This is a subtle change and something that does not happen overnight.  An analogy: look at a picture of yourself 10 years ago, do your notice that you have changed physically?  Most of us would notice specific changes in our appearance when referencing a photo but we did not notice these changes happening daily, in the moment.  The same thing occurs with cognitive changes because they are so subtle, but when we look back a year or more we may notice we are completely different people.   

I’ve trained myself to get in the habit of thinking, where is my mind?  By being in the present moment, focused on the task or activity at hand fully and completely, I can plan for the future, handle stress, interact with others authentically, and live a life with no regrets because I am here now, experiencing the moment and nothing else.  This mindset helps me reflect on the past and what I have learned as well as plan for the future consciously and objectively, if those are things I need to think about.  I am no longer at the mercy of my intrusive thoughts aimlessly dragging me through the mud of regret, resentment, sadness, anxiety and fear.   

Next post we will jump into techniques and strategies for integrating mindfulness into our daily life and how to overcome common roadblocks which continue to pull us into fear, anxiety and depression. 

Coping with Uncertainty

Coping with Uncertainty realize recovery

Living in a world filled with uncertainty can be stressful. Most of us feel our best when we are in a routine; when our routine is uprooted, we feel anxiety and stress. The world at large has recently been “un-routinized” due to the spread of coronavirus. Research shows that people respond to uncertainty differently and those with a higher tolerance for uncertainty are less likely to experience anxiety, low mood, and negative thoughts and feelings. Here are some suggestions for coping with uncertainty and changes in daily routine.

  • Focus on what you can control:  As much as possible, avoid dwelling on things out of your control. While you cannot control the governmental regulations and policies, you can control how much time, energy and attention you put on these matters. Try putting your attention on what you can do to improve yourself, uplift friends and family, and your community. Begin a new daily routine and do your best to stick to it.
  • Remember past successes:  No good or bad thing lasts forever. Reflect on times in your life when adversity came and how you were able to overcome. When fear and anxiety begin to manifest, redirect your attention and remind yourself that you’ve coped with adversity in the past and can do the same now.
  • Stay Productive:  Our minds can only focus on one thing at a time, so by engaging in activities, we can find a reprieve from intruding negative thoughts. With coronavirus quarantines, think about light projects around the house that have been put off in the past and begin working to accomplish those. Watch home workout videos on YouTube and engage in physical exercise at home. This will improve your immune system, release endorphins and help improve sleep.
  • Minimize exposure to news and social media:  When we feel stressed about something, we want answers and information. Constantly checking the news or social media outlets for updates will only increase your sense of uncertainty. Try limiting your exposure and plan one or two times throughout the day to check for updates. It is especially important to avoid news outlets before bedtime.
  • Engage in consistent self-care:  During times of uncertainty, we often forget to take a moment and do something enjoyable for ourselves. During quarantine, consider taking a relaxing bath, sleeping in, take an afternoon nap, order delivery food and watch a movie, ask for a massage from a significant other, etc. However you choose to practice self-care, the important thing to remember is that the activity should be something safe and enjoyable for you.
  • Practice relaxation and mindfulness techniques:  When we are anxious and stressed, we are kick-starting our fight-or-flight response, which sends a cascade of hormones into our system. This response is designed to increase our heart rate, alter blood flow, and decrease activation of our brain’s frontal lobes, where our higher, rational decision-making happens. There are apps you can download, such as Headspace, and plenty of guided exercises on YouTube. 
  • Seek Professional Help:  Despite following these suggestions you may find a heavy burden still exists. Working with a counselor can help you find individual ways to better cope with stress, uncertainty and how to develop a healthy routine.

While we cannot avoid the unexpected, by building our stress tolerance, we can better cope with uncertainty.