Integrating the Tools of Relapse Prevention by Terence T. Gorski

October 19, 2013

Terence T. Gorski
Relapse Prevention and Addiction Expert

For the purpose of this article I want to think about the causes of relapse in a very simple way. Although there are many causes of relapse, sometimes it is helpful to isolate the most important and place the others aside. So let’s look at the three leading causes of relapse – denial, high risk situation, and self-defeating behavior. Let’s start with denial.

Denial as a Cause of Relapse

Many people relapse because of Denial which is the tendency to deal with problems that can cause us to use alcohol or other drugs through the processes of ignoring, minimizing, rationalizing, or blaming. When we ignore a problem we pretend that it doesn’t exist. We deliberately refuse to recognize and to honor what is going on inside of us and around us. When we minimize we mislead ourselves into believing the problem is so small and insignificant that it isn’t worth dealing with. When we rationalize we find good reasons for having the problem and believe that these good reasons will protect us from the damage of our addiction and of relapse. When we blame our problems on other people we can convince ourselves that since the problem isn’t our fault there is no way it can lead us into a relapse .

It is important to know that relapse can occur both during our active addiction and during our recovery. During active addiction our denial convinces us that it’s OK to keep using alcohol and other drugs and we don’t need to start a recovery program. During recovery denial prevents us from recognizing the problems and situations that could cause us so much pain and problems in recovery that using alcohol and drugs to deal with the pain seems like a good idea. Denial, especially rationalization, can keep us from doing the things we really need to do to get well. As a result we build a recovery program that doesn’t meet our real needs in recovery, we experience pain and problems in spite of our recovery program, and then we start believing recovery doesn’t work which gives us the excuse we need to go back to using alcohol and other drugs.

Recognizing and managing denial is a complicated process and that’s why I developed a concise and easy to use workbook, The Denial Management Counseling “ Workbook to help recovering people and their families to understand, recognize and manage denial. The techniques in this workbook can be applied to any repeating self-defeating pattern of behavior. There is also a professional guide that gives a lot of in-depth information that can help make using the workbook more effective.

High Risk Situations as a Cause of Relapse

Once we have learned to manage our denial and see the reality of our addiction, the problems caused by our addiction and what we need to do to recover, the second leading cause of relapse rears its ugly head – High Risk Situations. A high risk situation is anything we experience that makes us want to start using alcohol and other drugs. Most addicts in early recovery have a life that is filled with high risk situations. Just about everybody they know uses alcohol or other drugs. Almost everywhere they go they see reminders of how good it used to be to drink and drug. Worst of all, in early recovery we feel deprived of the one thing that used to allow us to feel better about ourselves, cope with our problems, and have what we believed was the good life.

These high risk situations have become such a common part of our lives that we often don’t see them as what they really are – land mines that can blow up our sobriety and throw us back into the fires of addiction. We usually don’t deliberately put ourselves into a high risk situation. We hit a trigger that activates a habit. Let me explain.

A trigger can be something we see, hear, feel, touch taste or think about that reminds us of the good times we used to have when drinking and drugging. This trigger event activates our euphoric recall and we say to ourselves: “remember how good it used to be when I was drinking and using drugs!” Then we look at our sober life and lock onto to all of our pain and problems while blocking out any of the benefits of recovery. Then we start awfulizing sobriety by saying to ourselves: “Look at how boring, awful and terrible it is to be sober and not be able to have the good life of someone who can drink and use drugs.” Then we use magical thinking and start fantasizing how wonderful it would be to start drinking and drugging again. This activates an automatic pattern of alcohol and drug seeking behavior. This drug seeking behavior draws us into situations were we encounter more reminders of “our good life as an addict.” The drug seeking behavior also takes us away from people, places and things that support our sobriety and help us keep our thinking straight and leads us deeper and deeper into the addictive drinking and drug culture. As a result we surround ourselves with people, places and things that lead us back into denial, feed our delusion that drinking and drugging will make my life better, and eventually put us face to face with our drug of choice.

Remember, getting into a high risk situations is something that most addicts do automatically and unconsciously. In other words we don’t have to think about it or plan it. It just happens. The trigger goes off, the addictive thinking starts, and a series of old habits take control and lead us away from recovery and puts us around people places and things that tell us its stupid to stay sober, its fun to drink and use drugs, and make it easy for us to get started again.

It takes work to identify and learn how to change the addictive alcohol and drug seeking behaviors that lead us into these high risk situations. This is why I developed a The Relapse Prevention Counseling Workbook, which is a step by step guide to identifying and learning how to avoid and manage high risk situations that activate craving and make us want to start using alcohol and other drugs again.

Self-defeating Behavior as a Cause of Relapse

Self-defeating behaviors are things that we do that fail to get us what we need and want and end up causing us unnecessary pain and problems. Self-defeating behaviors have nothing directly to do with drinking or drugging. They do however, cause us so much pain and problems and such a sense of helplessness and hopeless that we come to believe that drinking and drugging is the only way to manage the pain and solve the problems.

When we have serious problems we are at risk of relapse. When we start trying to solve the problems and things keep getting worse, our relapse risk goes up. When the pain and problems get really bad and we start to believe that there is no way top solve them, we are vulnerable to denial and the creation of high risk situations that will justify relapsing back into the use of alcohol and other drugs.

Once again, we don’t consciously start using self-defeating behaviors. We’re in the habit of doing so. Many of us learn these self-defeating behaviors as infants and children in our family of origin. We were taught by our parents or primary care givers that “this is the right way to deal with problem!” We may even have been taught that it is the only way and if we try to solve the problem in another way something awful will happen.

We need to a system for identify and change these patterns of self-defeating behavior. This is why I developed the Relapse Prevention Therapy Workbook which describes ways of identifying and changing these self-defeating behaviors and lifestyle patterns.

So we have three major problems that can cause relapse – denial, high risk situations, and self-defeating behavior and lifestyle patterns.

We also have three workbooks (Denial Management, Relapse Prevention Counseling – Managing High Risk Situations, and Relapse prevention Therapy – Managing Personality and Lifestyle Problems). Each of these workbooks has related self-help material that can make a difference in your recovery and in your life. I hope they can make a positive difference for you and the people you love and care about.

Best Wishes in Your Journey of Recovery

About the Author

Terence T. Gorski is a pioneer in the development of Relapse Prevention Therapy, who has achieved international acclaim for his work. He is considered a leader and authority in the addiction, behavioral health, social services, and correctional industries for his work in recovery and relapse prevention.

 


ARROGANCE HAS A PLACE

October 18, 2013

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Mankind has pulled itself out of the caves and survived the worst of human catastrophes all because one person, at a turning point in history, had the utter arrogance to say no to what everyone else just passively accepted.

Their courage strengthened the resolve of those around them allowing mankind to stumble forward and challenge the beliefs about what was possible. This takes a certain amount of arrogance and denial of the “truth” about what is possible.

On the other side of the argument, the arrogant have led mankind into history’s greatest disasters. It is not the arrogance itself that is the problem. It is how the arrogance is directed.

Bless the arrogant, for in the moments of greatest need, only the arrogant are willing to stand up, spit in the eye of the devil, and move mankind a little bit further along toward higher values and greater kindness, love, and compassion.

Curse the arrogant for, at turning points in history, they stood and spit in they eye of God and led mankind toward destruction, death, and atrocity.

Humility has its place. It takes arrogance to stand in the face of certain death and choose to live.

This form of arrogance is also known as courage.

GORSKI BOOKS: www.relapse.org

LIVE SOBER – BE RESPONSIBLE – LIVE FREE


On Being An Expert

October 15, 2013

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We all start somewhere and arrive at the end of the story in a blink io an eye.

Si if you are going to be an expert, be an expert.

Do it now — before you figure out there really is no such thing.

GORSKI BOOKS


Becoming Friends With Pain and Fear

October 15, 2013

I have learned that pain and fear are both necessary parts of my life.These feelings are early warning signals that I might be in danger. Getting these early warnings is a good thing that can keep me out of trouble.

 

Just as pain is a signal that there might be something wrong with my body that needs attention, anxiety and fear are signals that there is something within or around me that might be dangerous.

By learning to turn pain and fear into friends, I have found that they visit me less often and are less disruptive when they do visit. I rarely feel fear unless there is some indication that there may be a real threat. I have become street smart and pretty good at staying out of harms way.

When I feel fear, I use it as an early warning signal that something is different and I might be in danger. This let’s me detect real threats and take appropriate action.

I have learned to do personal threat assessments whenever I feel anxiety or fear. If there is no threat, the feelings stop. If there is a real threat, I use the fear as a source of energy to respond to the threat.

Read more about dealing with anxiety and fear in recovery in the book: Straight Talk About Addiction by Terence T. Gorski

GORSKI BOOKS: www.relapse.org

LIVE SOBER – BE RESPONSIBLE – LIVE FREE 

The author grants permission to repost, print, and duplicate this note.

 


DSM 5 Substance Use Disorders: A Concise Summary

October 15, 2013

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, commonly referred to as the DSM-V or DSM 5, is the latest version of the American Psychiatric Association’s gold standard text on the names, symptoms, and diagnostic features of every recognized mental illness, including addictions. This edition was published in May 2013, nearly 20 years after the original publication of the previous edition, the DSM-IV, in 1994.

The DSM-V recognizes substance related disorders resulting from the use of ten separate classes of drugs:

1. alcohol,
2. caffeine,
3. cannabis,
4. hallucinogens (phencyclidine or similarly acting arylcyclohexylamines), other hallucinogens such as LSD,
5. inhalants,
6. opioids,
7. sedatives,
8. hypnotics,
9. anxiolytics,
10. stimulants (including amphetamine-type substances, cocaine, and other stimulants), tobacco, and
11. other or unknown substances.

Therefore, while some major grouping of psychoactive substances are specifically identified, use of other or unknown substances can also form the basis of a substance related or addictive disorder.

The DSM 5 explains that activation of the brain’s reward system is central to problems arising from drug use –- the rewarding feeling that people experience as a result of taking drugs may be so profound that they neglect other normal activities in favor of taking the drug. While the pharmacological mechanisms for each class of drug is different, the activation of the reward system is similar across substances in producing feelings of pleasure or euphoria, which is often referred to as a “high.”

The DSM 5 also recognizes that people are not all automatically or equally vulnerable to developing substance related disorders, and that some individuals have lower levels of self-control, which may be brain-based, which predispose them to developing problems if exposed to drugs.

There are two groups of substance-related disorders:
1. Substance use disorders and
2. Substance-induced disorders.

Substance use disorders are patterns of symptoms resulting from use of a substance which the individual continues to take, despite experiencing problems as a result.

Substance-induced disorders are symptoms that can be caused directly by the drug during or immediately after individual episodes of use.

The substance-induced disorders include:

1. Intoxication,
2. Withdrawal,
3. Substance induced mental disorders (including substance induced psychosis, substance induced bipolar and related disorders, substance induced depressive disorders, substance induced anxiety disorders, substance induced obsessive-compulsive and related disorders, substance induced sleep disorders, substance induced sexual dysfunctions, substance induced delirium and substance induced neurocognitive disorders.)

Substance use disorders span a wide variety of problems arising from substance use, and cover 11 different criteria:

1. Taking the substance in larger amounts or for longer than the you meant to
2. Wanting to cut down or stop using the substance but not managing to
3. Spending a lot of time getting, using, or recovering from use of the substance
4. Cravings and urges to use the substance
5. Not managing to do what you should at work, home or school, because of substance use
6. Continuing to use, even when it causes problems in relationships
7. Giving up important social, occupational or recreational activities because of substance use
8. Using substances again and again, even when it puts the you in danger
9. Continuing to use, even when the you know you have a physical or psychological problem that could have been caused or made worse by the substance
10. Needing more of the substance to get the effect you want (tolerance)
11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.

The DSM 5 allows clinicians to specify how severe the substance use disorder is, depending on how many symptoms are identified.

MILD: Two or three symptoms indicate a mild substance use disorder,

MODERATE: four or five symptoms indicate a moderate substance use disorder, and

SEVERE: six or more symptoms indicate a severe substance use disorder. Clinicians can also add “in early remission,” “in sustained remission,” “on maintenance therapy,” and “in a controlled environment.”

The DSM 5 is criticized for combining the the DSM IV categories of substance dependence (addiction marked by a pattern of compulsive use or loss of control) and substance abuse disorders (using in a manner that causes problems but does not have a pattern of compulsive use). The 2011 definition of addiction by the American Society of Addiction Medicine (ASAM) is consistent with DSM IV but not DSM 5.

The DSM IV, like the ASAM definition is based upon the idea that there is a DIFFERENCE IN KIND between substance abuse and dependence/addiction.

The DSM 5 is inconsistent with the ASAM definition because it is based upon the idea that there is only A DIFFERENCE IN DEGREE between abuse and addiction based upon the number of symptoms.

This is a critical difference in the underlying theory of addiction between the DSM IV and DSM 5 and a break in the progressive development of the fundamental concept if addiction which began with the DSM III.

GORSKI BOOKS:

Straight Talk About Addiction


Recovery From Addiction: Gorski’s Operational Definition

October 15, 2013

Recovery from addiction is a developmental process that progresses in six progressive stages:

STAGE O. Active Uncontrolled Addiction

STAGE 1. Transition: Understanding and overcoming the ambivalence of recognizing and personally accepting addiction;

STAGE 2. Stabilization: Regaining the biopsychoscial balance required to maintain abstinence, manage craving, and self-regulate thoughts and feelings;

STAGE 3. Early Recovery: developing the skills to identify and manage addictive and irresponsible behaviors that can cause unnecessary pain and problems in recovery;

STAGE 4. Middle Recovery: Developing the relationships and lifestyle skills needed to support a meaningful, sober, and responsible way of life.

STAGE 5. Late Recovery: Learning to identify and manage core mistaken beliefs about self, others, and the world that interfere with developing and maintaining a sober and responsible way if life.

STAGE 6. Maintenance: Learning the skills necessary for recognizing and managing trigger events, early relapse warning signs, high risk situations, craving, and addiction seeking behavior.

These stages are overlapping and are completed in various time periods depending on the stage of addiction, pre-addictive life skills, level of motivation, type of treatment,the level of family and social support, and time and energy invested by the recovering person.

Relapse often occurs during the recovery process and is best viewed as learning experiences that can build a stronger foundation for future recover. There are skills that recovering people can learn that can increase the ability to stop relapse quickly should it occur.

The Gorski Stages of Recovery and related recovery tasks are fully described in the book: Passages Through Recovery

ON THE INTERNET: Compare The SAMSHA and Gorski working Definitions of Recovery.

1. GORSKI’S WORKING DEFINITION OF RECOVERY
2. SAMHSA’s WORKING DEFINITION OF RECOVERY

Learn more at Gorski Books

Read Passages Through Recovery http://www.amazon.com/gp/aw/d/1568381395


RECOVERY, OBEDIENCE, and AUTHORITY

October 15, 2013

OBEDIENCE_TO_AUTHORITY_01There are too many people in an “obedience trance.” They are standing by waiting for some authority figure to tell them what to do. We are often enslaved by an addiction only to trade it in on some narrow-minded idea of what recovery should be.

Recovery is about taking back your power from addiction, not being crushed by some new ideology. Read, study, learn. Then make up your own mind and take action. It is much easier to beg for forgiveness than to get permission from bureaucratic sources of authority.

When you take independent action without proper permission, don’t be surprised if few people even notice.

In recovery we are responsible for our own life. We can believe what we choose to believe. We can stand on our own doing the next thing we believe to be right. We can keep our head while others are losing theirs. Living a sober and responsible life is about learning to be free.

LIVE SOBER – BE RESPONSIBLE – LIVE FREE

Gorski Books: Gorski Books


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