Relapse Prevention in Recovery

Why You Think You’re Bad at Recovery…And How You Can Be Better at Relapse Prevention

Let’s start by acknowledging that recovery is a process, and there isn’t one path that fits everyone. When things don’t work out the way we expected, it is time to adjust, and not feel that we are “bad” at it. If everyone was an expert at relapse prevention, they’d get it right the first time and relapse rates wouldn’t be as high as they are. As an addiction and trauma therapist, I am never surprised when clients share that they believe that they are somehow “doing it wrong” in their recovery. They report self-doubt, shame, or guilt around their past, and fear around their ability to make the changes they plan to make. In reality, if they are feeling challenged, overwhelmed, anxious or unsure about what comes next, they are probably doing things “right.”

Perfection Is Not “A Thing” in Recovery

There is no one path to recovery. Perfection is not expected, or even realistic. The experience is, and should be, completely unique. No, you aren’t bad at recovery, but you might feel like you are not sure how to develop your own recovery and relapse prevention plan and maintain it. The good news is that you don’t have to be perfect, and there are many skills you can learn and supports available for you.  Even better, you get to pick your goals, and you get to work on them one day at a time.  People in recovery are often hard on themselves because challenges seem to confirm our internalized negative view of ourselves; but having a setback doesn’t make you a failure.

How to Not Be “Bad” at Recovery

Recovery involves making changes within ourselves as well as with our relationship with the world we live in.  There are many “parts” of our selves we need to pay attention to in recovery.  For each person, there are individually defined communities of family, household, friends and mentors. There are also individual factors related to community, safety, society, culture, laws, equality, life experiences, spirituality, healthcare, employers, therapists, educators, beliefs, needs, achievements, trust and hopes. Recovery in action means realigning these different parts of ourselves in ways that let us achieve our personal goals, and at our own pace.  Feeling challenged?  Sounds about right.  The good news is that we are the best source of identifying the parts of our lives that are the most important and in need of the most support.

Addiction Is Not A Broken Leg…But It Can Still Be Healed

I tell my clients that the challenges for some parts of recovery can be like a healing a broken leg on your own. Imagine if you went to the emergency room with a badly broken leg, and instead of giving you a cast to hold the bones in place while they heal, the doctor told you to go home and “just do your best not to move your broken leg for six weeks.”

Perhaps staying immobile for weeks is an option for some, but it’s not realistic, and it sets us up to fail despite best efforts. Using substances disrupts your brain, and you cannot immobilize your brain, or your life, while you are healing it and living in it.  Substance use challenges relationships with family, friends, employers, community and virtually every other aspect of your life. Unlike a broken leg, you don’t need to stay immobile in recovery (in fact you can’t); you need a good plan and support team to help you keep moving forward; this is why recovery often gets easier when you break it down into more manageable steps, build a support network, and add a little, or a lot, of self-compassion to the mix.

Addiction Makes You “Bad” at Everything

We know that addiction is a progressive disease of the brain. Experimentation leads to regular use, which leads to dependence and addiction.  As substance use continues over time, it progressively damages parts of our body and our relationships.  By the time we are dependent on a substance, we may physically be unable to stop using without experiencing painful and dangerous withdrawal symptoms.  The damage we do over time to ourselves and others in our lives may not be what we meant to do, but we are still accountable and may be facing consequences.  I meet with clients whose family members are exhausted and “have had enough.”  Some have lost their jobs, lost custody of their children, have criminal charges, have lost their homes and are suffering from incredibly traumatic events.  I think that it may be more accurate to say: “I am “bad” at living the life I want while using.”  Recovery is what brings us back on track and reconnects us with our goals and the joy in life.

Eating the Elephant One Bite at A Time

In early recovery and the “abstinence stage,” we have a lot to manage and a fair number of potential obstacles.  We accept that we have an addiction, make the choice to stop using and take steps toward achieving that goal.  For many, this starts with a detoxification and/or inpatient treatment so that medical symptoms are managed safely.  In that short time (usually between three and seven days), we may also begin to recognize that we need to confront ourselves, practice honesty, learn coping skills for cravings, get active in self-help groups, learn about stages of relapse, change our friends, cope with post-acute withdrawal, find healthy alternatives, and reframe ourselves as “being in recovery.”

Meanwhile, our brains relentlessly continue to send signals that create urges and cravings to use.  It is normal to be overwhelmed, so take things slowly.  Many people enter detox because of a crisis related to their use, and they start to feel conflicting urges to escape the pain as they start to feel emotions again more clearly.  A lot of people “drop out” of treatment at this stage of recovery.  It feels too hard and too scary.  Your mind and your body may get a primitive “fight or flight’ urge and the parts of your brain that want immediate help to feel better can be more powerful than the parts of your brain that want to achieve long term goals.

Withdrawal Makes Everyone “Bad” at Recovery at First

Early recovery may also introduce you to Post Acute Withdrawal Syndrome (PAWS), which often includes aches and pains, confusion, nausea, vomiting, cramping, and headaches.  It can be a very uncomfortable time, but it gets better; the discomfort can be alleviated with a multidisciplinary medical team overseeing the process. PAWS symptoms are physical and psychological.  Symptoms will vary depending on the substance, the length of use and other co-occurring issues. I cannot emphasize enough to my clients how important it is to work with a medical team when stopping use. Abrupt cessation of some drugs can cause serious symptoms including seizures, psychosis, and cognitive problems.  In a medical setting, these symptoms can be monitored and mitigated. I strongly discourage clients from trying to detox on their own because of the health risks as much as the emotional challenges.  Your body and brain chemicals need to readjust, so be kind to yourself and start the journey with professionals who can help reduce the stress significantly and help you connect with treatment.

Making Progress against A Progressive Disease

Once you start treatment, you will also learn more about the different kinds of support and treatments to strengthen your recovery for the first 30 days, 60 days, 90 days and onward.  Quality treatment programs will help you connect from one phase of treatment to the next. Detoxification (detox) is an intensive, hospital-level type of care where medication benefits can be evaluated. You may then need to transition next to residential care (24-hour live-in program), then intensive outpatient (about five hours a day, five days a week), then outpatient therapy (once a week), with self-help and support groups (AA/NA).  Some people need more support than others. Work with your clinician to assess what works best for you.

Gradually, your recovery will get stronger as you build more internal supports (i.e., coping skills) and match them with external support (i.e., support groups, therapy).  Some supports like sober friends and sponsors may be with you for years and become part of your goals and achievements. Focus on the next steps and collaborate with your recovery team to identify the best match for you.  Remember that there is no singular path to recovery, but you can at least know what your next step is. If you are leaving detox, make sure you have established to the next level of treatment that is best for you. This is where your recovery plan takes shape, connecting the dots between where you are now and what your goals are next.  Keep it simple and adjust as needed…and give yourself a little self-compassion.

Creating A Realistic, Actionable Recovery and Relapse Prevention Plan

Many of my clients in recovery already know exactly what they want to change (even if they don’t know how), what their goals are (even if they aren’t sure that they can reach them), who their most important people are and what obstacles they are facing.  This is the start of a great recovery plan.  Recovery affirms the strengths, values, beliefs, goals and dreams of the individual and thus the motivation for recovery.  We start with goals, then we address the obstacles to that goal.  An individual’s recovery plan is unique because it can identify and troubleshoot potential barriers to achieving them. Goals can be short term and long term and you will want to define how you will know when you reach them and what you need to get there.

Setting realistic time frames can help so you can break down steps and activities and stay motivated.  Think of daily steps towards the goal that are achievable and possible barriers.  You may want to make lists of things to avoid, strategies to use when triggered, ways to improve self-care, coping skills you have and want to improve.  You can also list recovery triggers that remind you of the strengths you have, the people who support you, and the things (like music) that change your mood from bad to good.

Relapse Prevention Planning

Recovery plans also build in a relapse prevention plan because not everything goes the way we think it will—this is true of recovery and everyday life.  Drinking and drug use don’t just happen out of the blue. Everyone has high-risk situations that make the urge to use drugs or alcohol harder to overcome.  This is phenomenon is what we call “people, places and things”, which are factors we experience every day, no matter what stage of recovery we are in.  When we know which people, place and things trigger us to want to use, we can plan for recovery triggers to help us stay on track towards our goals.

As much as it helps to know your high-risk situations, you also want to remember how to neutralize the risk. For example, it’s payday, you are bored, work was stressful, you get in a small argument with your roommate, and your old “running” friend calls to invite you to hang out at a party where there will be alcohol and probably drugs; a perfect storm is brewing.  If you have a relapse prevention plan, you might instead have already mapped out that this is a good time to call your sponsor, go to a meeting and check in with a sober friend to see if they want to go bowling or hit the gym. It’s not necessarily what you do but rather the safety net of having a plan to do something or call someonewhen you feel like you need help shifting away from a high-risk situation.  Write down the names of sober friends or supports on a card and leave it in your wallet or purse.  In a stressful moment you may not be able to think of who to call or what their number is fast enough.  My clients will tell me that they “save those numbers in their phones,” which only makes me feel old.  For the record, a list of names on a card in your wallet won’t run out of battery.

Get “Good” at Relapse Prevention

Having a relapse prevention plan makes us think ahead of time, consider possible triggers, and formalize a plan of what to do in the moment.  Thinking about emotional, mental, and physical triggers helps to identify them when they happen and mobilize us into strategies we know can help.  If we can catch ourselves bottling up emotions, isolating, skipping meetings, going to meetings, and not talking, focusing on others, and neglecting self-care it is easier to know that we need to find a way to get help.  Sometimes denial gets in the way because we want something in the moment.  A powerful part of a relapse prevention plan might be to write down “what will I lose if I can’t keep my promise to myself to stay sober.”  I know a lot of people in recovery who were in a dark place where they didn’t care about themselves but thinking about their family who needed them pulled them through a moment where all they needed was a picture of their child in their wallet to pivot away from a high-risk moment (or on their phone, for you non-boomers).

What Do I Do When Relapse Prevention Fails?

We know that addiction is a chronic relapsing disease and that relapse prevention techniques are crucial.  Some people have 35 years recovery; some have two days.  I know clients who demonstrated the most solid recovery and goal achievement anyone could imagine, and life dealt them something unexpected which overwhelmed the coping skills and strategies that they had built.  Relapse rates for addiction are similar to relapse rates for asthma and high blood pressure.  Relapse is a sign that we need to re-adjust and recognize what happened.  We learn from it, we grow from it, and we get stronger from it.  We can’t plan for every possible stressor in our lives, and most certainly, relapse does not mean that you don’t want to stay in recovery or that you don’t have the skills to do it.

One of the strongest people I ever knew had changed his life through recovery in more ways than I could ever imagine and had dedicated himself to helping others achieve sobriety. I saw him go from years in prison to leading treatment groups and becoming someone who helped so many others believe in themselves and their recovery.  His relapse was something he owned, spoke about, adapted to, put behind him and made changes to prevent it from re-occurring.  He will always be a hero to me because he had compassion for others and compassion for himself.  A relapse doesn’t mean you’re bad at recovery, either.

So, No…You’re Actually Not Bad at Recovery

Recovery is you, healing yourself, expecting setbacks, challenging old beliefs, making mistakes, making changes, and continuing to adapt and live your life the way you dream it.  We are the architects of what gives us hope, safety, and reconnection with the things that matter to us.  We may also be survivors of trauma and events that turned our lives into layers of pain that are hard for others to understand.  We live in a challenging world where over 19 million people have addiction, more than 700,000 people have died from an overdose, and since 1990 drug death overdoses have tripled.  About 11 percent of people with addiction actually receive treatment, over 50% of whom do it with their own money, and not insurance.  Despite being a public health crisis, stereotypes and stigma continue to deter people from seeking the help they need.  Shame and guilt can literally drive people to use.  Addiction is a medical condition without the humanizing support it needs to drive prevention, treatment, and lifelong recovery.  If you think you’re “bad at recovery” and think you are failing at something, it may be because you have internalized the public stigmatization of addiction. 

When we blame ourselves, we may find that there are roots to the messages we receive in life.  Parents, teachers, or bosses who criticized us may have created toxic shame that starts an inner dialogue that loops around in our minds daily.  Our power to punish ourselves can lead to self-harm and substance use.  When we are in the pain of disapproval, our thoughts may be that we are not good enough and not deserving.  That negative inner dialogue has incredibly destructive power.  You may feel isolated, hurt, and pressured to be perfect.  Treatment helps us become aware of this inner trap and find self-compassion and healing.  We all make mistakes, we all have regrets; but with a little more kindness, we can move away from that pattern of negative self-talk and find ways to rewrite the story of who we are and find out we are not alone.  Recovery is a lifelong journey full of opportunities and risks…but the risk is more than worth the reward. Call Recovery Unplugged now to start treatment.