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.  

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.