Relapse Prevention Therapy (RPT) – An Affordable Evidence-based Practice

November 8, 2014

th

By Terence T. Gorski, Author

 

Relapse Prevention Therapy (RPT) is an Evidence-based practiced that is recognized by both the National Registry of Evidence-based Programs and Practices (NREPP) and the National Institute of Drug Abuse. This is important because relapse following drug treatment is quite common and a collection of tools have been forged into a system for both preventing relapse and stopping it quickly should it occur. “RPT is a behavioral self-control program that teaches individuals how to anticipate and cope with the potential for relapse” (NREPP). In addition, RPT serves to normalize relapse as part of the overall recovery process, thus reducing the negative feelings and behaviors that result from a setback. RPT also provided relapse tools and techniques that patients learn early in treatment that can stop relapse quickly should it occur.

The GORSKI-CENAPS Model of RPT brings proven evidence-based practices to recovery and relapse prevention by providing effective and easy to use methods for identifying and managing early relapse warning signs and high risk situations. It also presents methods for planning to stop relapse quickly should it occur. All of the key practices of evidenced-based Relapse Prevention Therapy (RPT) are made available in practical and easy to use workbooks. Training is available to teach the most effective ways to make use the workbooks in individual and group therapy and in support groups. There is also an internationally registry of Certified Relapse Prevention Specialists (CRPS) that are trained to support RPT program implementation.

The Research Supporting RPT Effectiveness

Prevention (RP) is an evidence-based intervention. There is compelling evidence in the literature documenting its effectiveness.

First, let’s look at the results of a meta-analysis of 26 published and unpublished studies with 70 hypothesis tests representing a sample of 9,504 participants. (Irvin et al, 1999)

  • Relapse Prevention (RP) was found to be a widely adopted cognitive-behavioral treatment (CBT) for alcohol, smoking, and other substance use.
  • RP was generally effective, particularly for alcohol problems.
  • RP was most effective with alcohol or polysubstance use disorders combined with the adjunctive use of medication

Validation of Gorski’s Relapse Warning Signs

Though it has enjoyed widespread popularity, Gorski’s post-acute withdrawal syndrome (PAWS) model of relapse has been subjected to little scientific scrutiny. A scale to operationalize Gorski’s 37 warning signs was developed and tested in a larger prospective study of predictors of relapse. Of central interest were: (1) whether the warning signs hypothesized by Gorski are interrelated in a meaningful single factor and (2) whether the hypothesized syndrome would accurately predict subsequent relapses.

A sample of 122 individuals (84 men) entering treatment for alcohol problems was followed at 2-month intervals for 1 year. The Assessment of Warning-signs of Relapse (AWARE) scale was administered at each assessment point, and the occurrence of both slips (any drinking) and relapses (heavy drinking) was monitored during each subsequent 2-month interval. Principal factor analysis was used to study the factor structure of the warning signs.

The results showed that: (1) Of the 37 warning signs, 28 clustered as a robust single factor with excellent internal consistency (Cronbach’s alpha: 0.92-0.93); (2) A conservative evaluation of test-retest stability across 2-month intervals estimated reliability at r = 0.80. (3) After covarying for prior drinking status, clients’ AWARE scores significantly predicted subsequent slips and relapses. Relapse rates for clients with highest AWARE scores, as projected by regression equations, were 33 to 46 percentage points higher than those for clients with lowest AWARE scores, after taking into account prior drinking status.

The conclusion is that this scale of Gorski’s warning signs appears to be a reliable and valid predictor of alcohol relapses. (J. Stud. Alcohol 61: 759-765, 2000)

Relapse Prevention (RP): Controlled Clinical Trials (Carroll 1996)

(1) More than 24 randomized controlled trials have evaluated the effectiveness of cognitive-behavioral relapse prevention treatment on substance use outcomes among adult smokers, alcohol, cocaine, marijuana, and other types of substance abusers. Review of this body of literature suggests that, across substances of abuse but most strongly for smoking cessation,

(2) There is evidence for the effectiveness of relapse prevention compared with no-treatment controls across all drug categories.

(3) Relapse Prevention is most effective at:

  • Treating patients with long histories of chronic relapse after attempting recovery with other treatment methods.
  • Maintaining the positive effects of improvements made during treatment (enhanced durability of effects)
  • Reducing the length and severity of damage caused by relapse episodes when they occur;

(4)      The positive effects of RP are enhanced by patient-treatment matching.

(5) Patient-treatment matching improves outcomes for patients at higher levels of impairment along dimensions such as psychopathology or dependence severity.

Manualized Treatment

Manualized Treatment Improves Effectiveness of treatment (i.e. increases recovery rates, decreases relapse rates, and produces shorter less destructive relapse episodes. The results are achieved while reducing time in therapy.

The primary treatment manuals that help produce these outcomes are:

  1. Starting Recovery With Relapse Prevention Workbook: A workbook designed to integrate basic relapse prevention principles in to the first attempts at addiction recovery.
  2. Cognitive Restructuring for Addiction Workbook: A workbook designed to teach and apply the basic recovery skills of thought management, feeling management, behavior management, impulse control, the use of mental imagery, and a serious of relaxation methods, including mindfulness meditation, that has been proven to enhance the effectiveness of the cognitive component of relapse prevention. This work allows an easy application of RPT methods to a wide variety of additive and mental health problems.
  3. Relapse Prevention Counseling (RPC) Workbook: This is a guide for understanding and managing craving and high risk situations to avoid relapse during the critical first ninety days of recovery.
  4. Relapse Prevention Therapy (RPT) Workbook: This is a guide for helping recovering people with a stable recovery program to identify and manage the personality and lifestyle problems that can so must pain and dysfunction in recovery that self-medication seems like a positive choice. This workbook takes RPT to a deep psychotherapy level.
  5. Problem Solving Group Therapy (PSGT): There are two simple guidelines for using RPT in problem solving groups. There is a Participant Guide to prepare group members with easy to understand information on how to succeed at group therapy and a group leader guide giving in-depth instruction how to start, conduct, and manage common problems that occur in problem solving groups.

When these five practical tools are brought together into a well designed and comprehensive treatment program the quality of care, moral of the staff, and positive long-term outcomes of treatment tend to improve.

WORKBOOKS  USING RELAPSE PREVENTION THERAPY (RPT) – AN EVIDENCE-BASED PRACTICE  http://wp.me/p11fHz-7s

References

The CENAPS Model of Relapse Prevention was originally developed by Terence T. Gorski and continually updated to integrate new research findings. (Gorski 1990, )

Carroll, Kathleen M., Relapse prevention as a psychosocial treatment: A review of controlled clinical trials. Experimental and Clinical Psychopharmacology, Vol 4(1), Feb 1996, 46-54.

Gorski, Terence T., The CENAPS Model of Relapse Prevention: Basic Principles and Procedures, Journal of Psychoactive Drugs, Vol. 22, Issue 2, 1990, pages 125- 133, ON THE INTERNET: http://www.tandfonline.com/doi/abs/10.1080/02791072.1990.10472538

Irvin, Jennifer E.; Bowers, Clint A.; Dunn, Michael E.; Wang, Efficacy of relapse prevention: A meta-analytic review. Journal of Consulting and Clinical Psychology, Vol 67(4), Aug 1999, 563-570.

Miller, William R. and Harris, Richard J.  A Simple Scale of Gorski’s Warning Signs for Relapse, Journal of Studies on Alcohol and Drugs, Volume 61, 2000, Issue 5: September 2000 ON THE INTERNET: http://www.jsad.com/jsad/article/A_Simple_Scale_of_Gorskis_Warning_Signs_for_Relapse/814.html

 

Word Count: 1,253

Macintosh HD:Users:Tgorski:Documents:Docs:0-Articles:HHIP:HHIP_Evidence-Based_2014-11-08.Doc


Trigger Events

August 29, 2014

IMG_0441.JPG

The term “trigger even” is commonly used by people struggling to understand what turns on their addictive thinking, ear lying warning signs (drug seeking behavior), and the strong attraction or need to bet involved in high risk situations. Recovering people intuitively understand the idea of relapse because it is linked to the metaphor of a gun. When you are holding a  load gun and pull the trigger it fires. Addiction, especially in early recovery, is very much a like a loaded gun with a sensitive trigger.

When you pull the addiction trigger, the disease of addiction fires off addictive thinking, automatic addictive or drug seeking behavior, and a craving or urge that pulls you toward high risk situations. One you are in a high risk situation you have put yourself in a HIGH RISK SITUATION which takes you away from recovery support, puts you around people, place, and things that support addictive use and make it easy for you to use. The high risk situation also provides social support to start using and social criticize if you refuse to start using. In a high risk situation there is also usually the false promise that goes like this: “I can use my addictive substance just this once, no one will know, and I can just renew my sobriety tomorrow. That, of course, is a very dangerous way from a recovering addictive to be thinking.

Most recovering people intuitively understand what a trigger is, and can describe exactly what pulled the trigger and what happened after the trigger fired off the movement toward addiction.  The problem is that very few recovering people or professional can tell you what a trigger is.  Events and situations that act as powerful triggers for some people have no effect on others. Even more confusing, on some days a certain situation, like have lunch in a restaurant that serves alcohol, activates a powerful trigger. On other days, haven lunch in the same place with the same people does nothing to pull the trigger that activates craving. Why is this?

Many people mistaken believe that the trigger lives in the external person, place or thing that sets it off. As a result addiction professionals teach recovering people to identify and avoid common trigger events. Rarely do recovery people get a clear explanation of psychobiological dynamics that that make triggers so powerful. Without a clear understanding of the psychobiological dynamics of a trigger event, the only way to learn to many them is through trial and error.

Bob Tyler, in his book Enough Already!: A Guide to Recovery from Alcohol and Drug Addiction, explains it this way:

“If we don’t know what makes a trigger a trigger, the only thing we can teach patients to do is to avoid them. Now, how much success do you think our patients will have avoiding triggers living in this society which is permeated by alcohol and drugs? Probably not very much! Therefore, it is essential that we are knowledgeable about how a trigger actually becomes a trigger so we can teach our patients how to recover from triggers?” Although Bob Tyler talks about “recovering from triggers, and I talk about identifying, managing, and disempowering triggers, our basic concept is the same. Recovering people can learn to identify avoid, manage, and eventual, turn off the ability of the trigger to activate craving and drug seeking behavior. This happens spontaneously as people get into long-term recovery. There are techniques and methods for pan aging and disempowering triggers that can make the process a lot easier.

Trigger Event – Defined

A trigger event as “any internal or external occurrence that activates a craving (obsession, compulsion, physical craving, and drug-seeking behavior)” (Gorski, 1988). let’s break down this definition:

  • “internal” occurrences are thoughts or feelings;
  • “external” occurrences involve the five senses: sight, sound, smell, taste, and touch.
  • In order for something to be a trigger, such an event must be connected in some way to the person’s using alcohol to other drugs.
  • The trigger is stronger if the event happen just before, or simultaneous to, the actual use (Gorski, 1988).
  • The most important thing to know about what makes a trigger a trigger is its connection to the use.

Bob  Tyler explains it this way: “A simple way of explaining this is by relating it to classical (or Pavlovian) conditioning. Ivan Pavlov was a Russian scientist who won the Nobel Peace Prize in 1904 for his research in digestive processes. While studying the relationship between salivation and digestive processes in dogs, he would show a dog meat powder and measure the resulting salivation level of the dog – they did this repeatedly. One day, Dr. Pavlov noticed that when he walked into the lab, that the dog started to salivate even before showing it the meat powder. There appeared to be some connection made for the dog between Dr. Pavlov and the meat powder which caused it to salivate. To study this phenomenon, he added a third variable (a bell) and rang it just prior to showing the dog meat powder and measured the resulting salivation level. He did this repeatedly: bell à meat powder à salivation, bell à meat powder à salivation, etc. He eventually found that he could ring the bell, not present the meat powder, and the dog would still salivate. Thus, there was a connection made for the dog between the bell and the meat powder that prompted the salivation (PageWise, 2002). For our purposes, the bell is the trigger for the dog’s drug of choice – meat powder, which caused the dog to salivate for, or crave, the meat powder. The challenge for the addicted is to identify the bells (triggers) that cause them to salivate (crave) their drug of choice. This will allow them to avoid or manage such triggers until the time in their recovery comes to start recovering from them.”

Disempowering (Recovering from) Triggers

There are three phases in disempowering  a trigger:

  • Phase 1: Avoidance: Make a list of the most powerful triggers that were associated with you drinking and drugging and plan to avoid them.
  • Phase 2: Gradual re-introduction with adequate recovery support: If consciously exposing yourself to a trigger it is best to have a friend in recovery to help you prepare, go through the experience with the trigger, be their to help you get out, and then talk about the experience and the thoughts and feelings that it stirred up.
  • Phase 3: Extinction. Phase I is to “eliminate as many of them as you can, for a limited period of time, until stable” (Gorski, 1988). As stated previously, in very early sobriety, you do not go to bars or other using places, you avoid people who use and drink, and you avoid any other triggers you identify.

“The second phase is a gradual reintroduction of the triggers so that the person can learn how to cope with them” (Gorski, 1988). This does not mean to gradually re-introduce the addict into the crack house or their favorite watering hole, but there are some trigger situations that you should be able to eventually participate in. As stated earlier, alcohol permeates our society and you would have to live a very sheltered life in order to avoid it over the long-term. Therefore, in order to lead any kind of normal life, gradual re-introduction to some trigger situations is necessary. This re-introduction process is best done with the addict’s sponsor or with a therapist or group if they have one. Following is an example of this process in my own sobriety.

The following story reported by Bob Tyler gives and excellent example:

“When I was about 90 days sober and still involved in the aftercare portion of my treatment program, we were invited to the wedding of my wife’s cousin in Chandler, Arizona. I thought: “I’d really like to go!” However, I had learned from past experience that decisions I made on my own in relation to my sobriety were typically bad ones. So I decided to leave it completely up to my group and put it out to them. The consensus was that since I was still working a very strong sobriety program, going to daily meetings, and going with my supportive wife, I could probably stay sober if I created a sobriety plan. The group then proceeded to help me put this plan together.

  • Suggestion 1: Carry a Big Book (Alcoholics Anonymous) onto the plane and read it: The thinking was that since flying on an airplane was a trigger for me to drink, it would be difficult to order a drink while holding a Big Book in my hand. The book has an embossed cover so nobody would know what it was and, if they recognized it, they probably have one and I might meet someone in the program.
  • Suggestion 2: Keep you recovery support system close. If traveling, find out where the lo=cal meetings are and make telephone contact with one or more local members. Have a written plan to go to 12-Step meetings each day and have an accountability system built-in.  I was in Arizona. They had me call the downtown Los Angeles Central Office of Alcoholics Anonymous (AA) to get the number of the central office in Chandler, Arizona. I was to get a meeting scheduled for each day I was there and, if possible, schedule a meeting for the time of the reception so if I got into trouble, I could simply leave the reception and go to a meeting. In fact, this actually happened – here’s a funny little story:
  • Suggestion 3: Have an Emergency Escape Plan if Craving Is Triggered: Bob Tyler went to the reception.  “I found myself talking to my wife’s uncle next to the wet bar at his home.” Bob said.  “Suddenly, someone plopped down a bottle of my favorite whiskey onto the bar right in front of me. After recovering from my slight panic, I excused myself and informed my wife  that I was going to a meeting. She was supportive because I had talked with her about this emergency plan before we left.   Fortunately, I got the address and directions to the from AA’s Central Office before I left. This made it easier for me to go.”

After the meeting, Bob went back to the reception where he noticed “everyone was having a great time dancing. This really looked fun to me, but I had never danced sober before. I always had to have at least a few drinks in me first because I was not a very good dancer and cared too much about what other people thought of me. When I had a few drinks, I felt like I danced like John Travolta and you didn’t think so – too bad!” It’s amazing how many recovering people won;t dance in recovery because they fear it will make them feel stupid and activate a craving. Bob is not alone here. So Bob developed a plan:

He waited for a fast song that he liked, and slid onto the dance floor while playing “air guitar” and, and starting to  dance. “A Van Halen song came on,” says Bob, and I was off and running. Little did I know that just after I left for my meeting, the bride and groom arrived, walked across the portable dance floor, and everyone followed tradition by throwing rice at them. You can imagine what happened next. As I attempted to slide onto the dance floor, my feet hit the rice and came right out from under me. I hit the floor, followed by two of my wife’s female cousins (one of them the bride!) who I managed to take down with me – one of them right onto my lap. I rose to my feet with my beet-red face and, as I looked around the dance floor, I could see my wife’s family’s reaction which I perceived as, “There he goes, he’s drunk again” – and I was probably the only sober person there!”

Alcoholics and other addicts carry with them a reputation for doing stupid things when they are drinking or using. AS a result, any time they make a mistake or try to have fun by being silly, many people with just assume they have stated drinking or drugging again. This can activate shame and guilt and bring back painful members. It’s also easy to feel unfairly judged and to question the value of your sobriety. “If this is how people will always react to me, why bother to stay sober?” Needless to say, this kind of thinking a serious warning that needs to be discussed with your therapist and sponsor.

The other elements of his sobriety plan helped Bob get though this situation sober. He called his sponsor each day discussing everything that happened and how he felt about it. He read the Big Book for a half-hour each evening to keep is sober-thinking brain circuits alive and active., and not going anywhere alone. Upon returning, my group and I processed what worked, and what additional program tools I might have used so I could use them the next time I might have to expose myself to triggers.

Through this process of gradual re-introduction, Bob was able to participate in increasingly more activities in my recovery to the point I can now do almost anything without being triggered. This is due to the third phase of the recovery process called the “extinction process” (Gorski, 1988). As mentioned earlier, triggers become extinguished when repeated exposure to them is connected with not using, rather than using.

Addiction professionals can learn to prepare recovering people for living in a society that is alcohol and drug centered.  The trigger management process, or as Bob Tyler Describes it, Trigger Recovery, can help many recovering people improve the quality of their sober life and reduce the fear and risk of relapse.

References:

Gorski, Terence T. (Speaker). (1988). Cocaine craving and relapse: A comparison
between alcohol and cocaine (Cassette Recording Number 17 – 0157).

Independence, Mo: Herald House/Independent Press.

Pagewise, Inc. (2002). This study in classical conditioning is one of the most renown for its incredible results. Learn about Pavlov’s dogs [Online]. Available Internet: http://ks.essortment.com/pavlovdogs_oif.htm.

Tyler, Bob. (2005) Enough Already!: A Guide to Recovery from Alcohol and Drug Addiction

Books by Terence T. Gorski

Gorski’s book Straight Talk About Addiction describes trigger events in detail.

Gorski, Terence T., Addiction & Recovery Magazine, April 10, 1991

Gorski, Terence T.,  Managing Cocaine Craving, Hazelden, Center City, June 1990


Addiction Can Be Understood and Treated

August 15, 2014

RECOVERY IS POSSIBLE
STRAIGHT TALK ABOUT ADDICTION

IMG_0356-0.JPG

Straight talk means giving clear, honest, and plain-English descriptions of important issues related to addiction, recovery, relapse prevention. Straight Talk means discussion the artistes for addiction — sobriety and responsible living.

This book tells it like it is without a great deal of concern for political correctness or the tentative guarded language that so often hides the truth about addiction, recovery, and relapse.

After 40 years of following the new research and treatment practices for addiction, Terry Gorski became frustrated at the misinformation about alcohol and other drug addictions and the narrow and incomplete approaches to treatment, recovery and relapse prevention.

In this book, Terry provides the best information on the current science-based upon an accurate understanding of what the core addiction syndrome is and what the an effective addiction treatment process needs to look like if it is to increase the chances of recovery and decrease the risk of relapse.

This book is easy to read and loaded with useful information. The book can be quickly read from beginning to end, and then kept as a handy reference to find specific information that can be used as a guide to manage the problems and crises that are so often a part of the addiction and recovery process.

The message is simple: addiction is a biopsychosocial disease. science-based understanding of what the core addiction syndrome is and what the core addiction treatment process needs to look like if it is to increase the chances of recovery and decrease the risk. Here are some of the key ideas developed in depth with the book:

Addiction is a biopsychosocial disease. Bio means biological or of the body, Psycho means psychological or of the mind, Social means the relationships that develop among people and with the social and legal systems that are needed for responsible living.

Biologically, addiction is marked by brain dysfunction that disrupts the reward chemistry of the brain creating cycles of intense euphoria and powerful craving.

Psychologically addicted people slowly adjust their ways of thinking, feeling, acting that allows them to deny and rationalize the problems caused by the it addiction.

Gradually, over time, an addictive beliefs develops that create a powerful denial system. This denial blocks the ability to recognize the addiction, interferes with the ability to ask for and accept help, and creates a deadly spiral of progressively more severe relapse episodes.

Socially, addiction pushes away sober and responsible people while attracting and feeling attracted to addicted and irresponsible people. The result is a tragedy. The addict abuses, disregards, and destroys those who love and try to help them. Active addicts set themselves up to be exploited by other addicted people and are vulnerable to predators who use and abuse them.

Most importantly Straight Talk About Addiction provides hope. Addiction and be understood, recovery is possible, and relapse can be prevented it effectively managed should it occur.

This book is easy to read and understand. It is loaded with useful information. Many people read it from beginning to end to get a comprehensive understanding of addiction, recovery, relapse, and related problems. Many people keep the book handy so they can use it as an easy-access reference to find useful information that can be used to effectively manage addiction-related problems.

The message is clear: Recovery is possible. Relapse can be prevented or effectively managed should it occur. There is hope.

LIVE SOBER – BE RESPONSIBLE – LIVE FREE

Get The Book By Terence T. Gorski
STRAIGHT TALK ABOUT ADDICTION


Using Stress Management In Relapse Prevention Therapy (RPT)

August 3, 2014

thBy Terence T. Gorski, Author

This blog is an excerpt from the book:

Starting Recovery With Relapse Prevention
by Terence T. Gorski. 

GORSKI’S RELAPSE PREVENTION CERTIFICATION SCHOOL (RPCS)
November 10 -14, 2014 at the Hyatt Regency Pier Sixty Six

2301 SE 17th Street Causeway, Fort Lauderdale, FL 3331
Iinformation: Tresa Watson: 352-596-8000, tresa@cenaps.com
Course Description: www.cenaps.com

Stress management is a critical key to staying away from alcohol and other drugs[i] [ii]during the critical first two weeks of recovery.[iii] It is important for people in recovery to learn how to recognize their stress levels and use immediate relaxation techniques to lower their stress. [iv] [v]

Recovering people are especially vulnerable to stress.[vi] There is a growing body of evidence that many addicted people have brain chemistry imbalances that make it difficult for them to manage stress in early recovery. The regular and heavy use of alcohol and other drugs can cause toxic effects on the brain that create symptoms that cause additional stress and interfere with effective stress management.

SEE RELATED BLOGS:
Stress Self-Monitoring and Relapse ,
The CENAPS Model and Mindfulness in Relapse Prevention,  and
Mindfulness Made Simple.

Many people who are in recovery from addiction have serious problems with Post Acute Withdrawal (PAW). PAW is a bio-psychosocial syndrome that results from the combination of brain dysfunction caused by addictive alcohol or drug use, and the stress of coping with life without drugs or alcohol. PAW is caused by brain chemistry imbalances that are related to addiction. PAW disrupts the ability to think clearly, manage feelings and emotions, manage stress, and self-regulate behavior.

PAW is stress sensitive. Getting into recovery causes a great deal of stress. Many recovering people never learn to manage stress without using alcohol or other drugs. Stress makes the brain dysfunction in early recovery get worse. As the level of stress goes up, the severity of PAW symptoms increase. As PAW symptoms get worse, recovering people start losing their ability to effectively manage their stress. As a result, they are locked into constant states of high stress that cause them to go between emotional numbness and emotional overreaction. Since high stress is linked to getting relief by self-medicating stress with alcohol or other drugs, high stress gets linked with the craving for alcohol or other drugs. So one of the first steps in managing craving is to learn how to relax and lower stress without using alcohol or other drugs.

The severity of PAW depends upon two things: the severity of brain dysfunction caused by addiction and the amount of stress experienced in recovery. The first two weeks of recovery is the period of highest stress in recovery. This high stress occurs before you have a chance to learn how to manage it in a sober and responsible way. Since you cannot remove yourself from all stressful situations, you need to prepare yourself to handle them when they occur. It is not the situation that causes stress; it is your reaction to the situation.

According to the National Institute on Drug Abuse, exposure to stress is one of the most powerful triggers for relapse to substance abuse in addicted persons, even after long periods of abstinence. Stress can cause a problem drinker to drink more, a person using prescription medication to use more than prescribed, and an illicit drug user to get more deeply involved in the drug culture than they could ever imagine. The high stress of the first two weeks of recovery can activate powerful cravings that make people want to start self-medicating with alcohol or other drugs in spite of their commitment to stop and stay stopped.

There is a simple tool called The Stress Thermometer that can help you to learn how monitor your stress. There is a simple immediate relaxation technique called Relaxed Breathing that can help you noticeably lower you stress in two to three minutes. First, let’s talk about the Stress Thermometer.

The Stress Thermometer

The Stress Thermometer is a self-monitoring tool that teaches people to become aware of their current stress levels, notice increases and decreases in stress at different times, and encourages the use of immediate relaxation techniques to lower stress as soon stress levels begin to rise. The Stress Thermometer makes it possible to manage stress before craving for alcohol or other drugs is activated. Lowering stress can also lower cravings. Lowering cravings can help you to turn off denial and addictive thinking. (More about this later).

The concept of using a stress thermometer came from thinking about how we use a temperature thermometer to measure our body temperature. When we take our body temperature we use a thermometer to tell us accurately and objectively what our body temperature is. When we use a stress thermometer, we use a system for self-monitoring our stress levels that can tell us accurately and objectively how high our stress levels are.

The stress thermometer is divided into four color-coded regions: blue – relaxation, green – functional, yellow – acute stress reaction, and red – trauma reaction.

What the Stress Levels Mean

Low Stress/Relaxation: Stress levels 1, 2, and 3. These stress levels are coded blue because they are cool and relaxing.

  • Stress Level 1: Deeply Relaxed/Nearly Asleep: At Stress Level 1 you are in a state of deep relaxation and nearly asleep. Your mind is not focused on anything in particular and you feel like you are waking up in the morning to a day off and can just let your mind drift in the deeply relaxed state.
  • Stress Level 2: Deeply Relaxed/Not Focused: As you come back from a state of deep relaxation you enter Level 2, during which you stay very relaxed, but begin to notice where you’re at, what is going on around you. You can stay in that state and just be aware and deeply relaxed. Eventually we will either go back down to Level 1 and then perhaps falls asleep or else you will move up to Stress Level 3.
  • Stress Level 3: Deeply Relaxed/Focused:At stress level 3 you get focused and start to think about getting yourself back into gear and getting going. In other words, you are getting ready to “kick-start your brain” so you can move into a functional stress level to begin getting things done.

By practicing the Relaxed Breathing Technique (this will be explained on page 19) most people can learn to put themselves in a relaxed state (Stress Level 1, 2, or 3), stay there for a few minutes, and then come back feeling refreshed and relaxed. It is important to remember that this will take time and practice. In our culture people are taught to work hard and burn themselves out. People don’t get much training on how to relax. People who get a euphoric effect from using alcohol or other drugs don’t need to. When they get the “right amount” in their system they shut down their stress chemistry, turn on the pleasure chemistry, and feel relaxed.

It is important to practice relaxation four times per day. I recommend linking it to meals: Take five minutes in the morning before breakfast, five minutes at lunch, five minutes at dinner, and five minutes to relax before going to sleep. Taking these stress breaks will make it easier for you to stay at a functional stress level and bounce back quickly from high stress situations.

With that in mind, let’s look at the “Functional Stress levels.”

Functional Stress: Stress levels 4, 5 & 6 designate the zone of functional stress. They are coded green because green is a color that represents “go”.  At stress levels 4, 5, and 6 we are experiencing stress levels that are high enough to give us the energy to get started, keep going, and get things done. The stress, however, is not so high that in interferes with what we are doing.

  • Stress Level 4: With effort we get Focused and Active.
  • Stress Level 5: We operate at high performance, a state of free flow with little or no effort.
  • Stress level 6: We can keep on going but it takes effort and we notice we are getting tired. It’s called free flow with effort. This is a good time to take a short break if you can to get your stress level back down to a level five.

Acute Stress Reaction: Stress levels 7, 8, and 9 are coded yellow. The color yellow represents caution. At stress levels 7, 8, and 9 we are experiencing an acute stress reaction. The word “acute” means immediate and severe. The good thing about acute stress is that if we notice it early and know how to relax, by taking a short break and using a relaxed breathing technique for example, we can lower our stress and get back into the functional zone. When we enter stress level 7 it means that our immediate levels of stress have gotten so high that we can’t consistently function normally. We’re in danger.

  • Stress level 7: Space Out: at a stress level 7 we space out. Our mind goes somewhere else and we don’t even know we were gone until our mind comes back on task.
  • Stress level 8: Driven and Defensive: at stress level eight we are driven and defensive. Our stress chemical has been activated and we are running on an adrenaline rush that is keeping us compulsively on task. The problem is that if someone or something interrupts us we become defensive and can easily move into stress level 9.
  • Stress level 9: Overreaction/Survival Behavior: at stress level 9 our automatic survival behavior takes over. The three basic survival behaviors that everyone has are: fight (irritated, angry, agitated); flight (anxious, fearful, panicked); and freeze (we feel an agitated sense of depression and indecision. We freeze up and can’t make a decision or move.) On top of these three core survival behaviors we learn more sophisticated survival behaviors from our family of origin, life experiences, education or special training in stress management, emergency management, martial arts, or combat. For that training to automatically come into play, we must have practiced it over-and-over again until it became habitual. In sports, emergency services, police work, and military operations these are called trained response. When our stress hits level ten our brain won’t allow us to rise to the situation. The emergency brain response will always lower us to the level of our training. In an emergency, all we can rely on are our automatic responses that we learned to perform on cue without having to think about it.

Traumatic Stress Reaction: Stress levels 10, 15, and 20 are coded red. Red is for stop. At this point our stress levels are so high that our brains and minds are at risk of shutting down. There are three levels of stress that can occur in the red zone of traumatic stress.

  • Stress level 10: Loss of Control: We automatically start using our survival behavior and we can’t control it. We are on automatic pilot and we will go through our learned survival responses one-by-one. This means we will cycle through stages of extreme anger (fight), extreme fear (flight, and extreme inner conflict or ambivalence (freeze). It is important to remember that all people with serious alcohol and drug problems have conditioned themselves with a survival behavior called “seek and use drugs to handle this.” So it is not unusual for a person at a stress level ten to get into drug seeking behavior and start using alcohol or other drugs.
  • Stress level 15: Traumatic Stress: At level 15 our high stress overloads the brain and we mentally disconnect from what is happening to us. Our stress is so high that we can’t stay consciously connected with out bodies. We may go into a state of daze, shock, and dissociation. Our mind can start to play tricks on us and things around us may seem bigger, or closer or farther away than they really are. We may start feeling confused and disoriented. It may seem like we are moving in slow motion. Some people feel like they have floated out of their bodies and it seems like they are watching themselves go through the experience.
  • Stress level 20: Collapse/Psychosis: When our stress levels hit a level 20 our brains can’t take the high level of stress and fatigue. We may collapse, enter an exhausted state of stupor or restless sleep, move into a vivid fantasy world or a world of memories or dreams, or become unconscious.

Any time people experience a “level 10 plus” state of stress; it will take a while after the stress stops for our brain to start functioning normally. When this is a short-term period of adjustment it is called an “acute trauma reaction.” When in it is a longer-term reaction it is called post traumatic stress disorder.

If you have ever experienced a “level 10 plus” stress experience – which can happen when you are the victim of crime, accidents, caught in a burning house, participating in combat, having been assaulted, etc. – it is important to discuss these experiences with your doctor or therapist. This is especially important if the high stress experience you had causes problems that you did not have before it occurred.

The Stress Thermometer

Developed By Terence T. Gorski (© Terence T. Gorski, 2011)
www.cenaps.com; www.relapse.org; www.facebook.com/GorskiRecovery

Level 20: Dissociation/Unconsciousness: I get dissociated and feel like I am floating out of my body. Things seem unreal, and I eventual pass out.
Level 15: Traumatic Stress: Stress overloads the brain and we go into a state of daze, shock or dissociation. We may feel like we are floating out of our bodies and watching ourselves go through the experience.
Level 10: Lose Control: Fight = Anger-based, Flee = Fear-based, Freeze = Depression-based.
——————————–The Brain Shift Gears ——————————–
Level 9: Overreact: Anger, fear, or compulsion get out control & starts running our intellect.
Level 8: Get Defensive: Automatic defenses are used; we start acting out compulsively. The ability to think becomes a servant to hidden fear, anger, & depression. Strong craving and urges to fight, run, hide, find a rescuer, blame others, or lose motivation & hope.
Level 7: Space Out: My brain can’t handle the stress, turns off for a second, and I gone blank and don’t even realize it until my brain turns back on a few seconds later.
——————————– The Brain Shift Gears ——————————–
Level 6: Free Flow Activity With Effort I’m getting tired and have to push myself to keep going.
Level 5: Free Flow Activity With No Effort: I’m totally into what I’m doing and get lost in the process. I’m on automatic pilot.
Level 4: Become Focused and Active With Effort: I make a decision to dig in and get to work. It takes an effort to get started.
——————————– The Brain Shift Gears ——————————–
Level 3: Relaxed – Aware But Not Focused: I’m relaxed and aware of what’s going on around me. I’m beginning to realize that I need to get going.
Level 2: Very Relaxed – Not Aware & Not Focused: I’m so relaxed that I’m not aware of what’s going on around me. I’m disconnected and don’t want to notice anything.
Level 1: Deeply Relaxed – Nearly Asleep: I’m so deeply relaxed that I’m drifting in and out of a dreamy type of sleep state filled with active fantasy or daydreaming.
The Most Important Stress Management Tool is
The Conscious Awareness of the Rise and Fall of Your Stress Levels.
This is Achieved Through Self-monitoring.

 

Measuring Levels of Stress

Notice that you are measuring your personal perception of stress, which is a combination of three things: (1) the intensity of the stressor (the situation activating stress); (2) your ability to cope with or handle the stressor; and (3) your level of awareness while you are experiencing the stress.

It is possible for you to score yourself very low on the stress thermometer even when your stress is very high. This can happen because: (1) you are distracted and involved in something else (like managing the crisis causing your stress); (2) your stress is so high that you are emotionally numb and don’t know what you are feeling; (3) if you have lived with such high stress for such a long time that you consider it normal; and (4) you have trained yourself to ignore your stress.

The first step in learning how to manage your stress is to learn how to recognize and evaluate your level of stress and by learning how to quickly get back into a low stress level by using a Relaxed Breathing Technique. Let’s start by looking at how you can improve your stress awareness.

 

Improving Stress Awareness

The best way to learn to be aware of your stress level is to get in the habit of consciously monitoring your stress level. You can do this by using a mental tool called The Stress Thermometer, (page 17). The first step is to imagine that you have an internal stress thermometer that starts in the pit of your stomach and ends in your throat. The lowest reading on the stress thermometer is zero and represents a deep sense of relaxation that is so complete that you want to fall asleep. At a stress level seven or eight, your stress becomes so intense that you start shutting down, getting defensive, or avoiding the issue that is causing the stress. If you can’t manage or get away from the stressful situation, at a level ten you lose control and start believing that you can’t handle the situation and that you or someone you love may be hurt or killed. These extreme feelings of stress are called trauma.

When most people hit a stress level of seven or higher they are not able to respond to constructive criticism or to make sense out of their emotional experiences. At stress levels between seven and nine most people start acting compulsively, overreact to things going on around them, and start using automatic habitual survival behaviors that may or may not solve the problem and lower stress.

This is why it is so important for you to learn to recognize your stress levels when they start hitting a level seven and learn how to quickly lower them. You can do this by using an immediate relaxation response technique called Relaxed Breathing any time you notice your stress hitting a level seven or above. So you have four goals in this exercise:

(1)        To learn how to get into the habit of noticing when your stress is getting up to a level seven or eight;

(2)        To learn how to quickly lower your stress by using the Relaxed Breathing Technique;

(3)        To figure out what is happening and how you are thinking and feeling about what is happening that is causing your stress to go up; and

(4)        Manage the stressful situation by responsibly getting out of the situation or learning how to manage your thoughts, feelings, and behaviors that will allow you to stay cool and relaxed even tough you are in a tough situation.

Monitoring Your Stress – Body Awareness

Body awareness is a technique that allows you to recognize how your body physically reacts to stress. It can be a powerful skill to use in stress management because as you notice the stress in different parts of your body, you will start to relax the part of the body you are noticing. With enough practice your body will automatically start identifying and releasing stress before you become consciously aware of it. Muscle tension is the primary way your body let’s you know that you are experiencing stress. Consciously using a systematic body awareness technique whenever you think about it and at least four times per day will start you on the road to teaching your body to automatically recognize and release stress. Here’s how the technique works:

Begin by closing your eyes. You will concentrate on one muscle group at a time, tensing and releasing and being aware of how tight the muscle is as you focus on it. If the muscle feels tight as you begin, this may indicate you store stress in this muscle. Begin with focusing on your toes and slowly move up your body. Tighten your toes and release, flex your calves and release, tighten your thighs and release, tighten your stomach muscles and release, fist your hands and release, tense your shoulders and release, clench you jaw and release, squint your eyes and scrunch your face and release. Any time you encounter tension in a muscle, record that muscle tension and be aware that you are holding stress there. This will help you in developing a personal stress reduction plan and using exercises and techniques to release pent-up tension.

Reducing Your Stress – Relaxed Breathing

There are a number of different relaxation methods. For the purpose of this workbook I am going to teach the easiest and most effective. It is called Relaxed Breathing. It is so effective that military, police and firefighters are taught to use it to lower their stress when responding to emergencies. Here’s how it works:

Relaxed Breathing, often called combat breathing in the military or tactical breath by police and emergency responders, is designed for both before and during stressful times to calm you down and help you relax. In terms of the stress thermometer, relaxed breathing is used before a stressful situation to calm you down and get you ready to be at your best. It is used during a stressful situation to keep your stress from going above that critical Level 7, where your brain turns off and automatic defensive behavior and cravings kick in.

Early in recovery, thinking about and talking about your use of alcohol or other drugs will cause some of your highest stress. The catch 22 is this – if you don’t talk about it, the thoughts will keep coming back like a ghost in the night that haunts moments that should be quiet and restful. Each time you expel the ghost by refusing to think and talk about the “real problems” the ghost goes away for a little while and comes back stronger. Your denial and resistance is strengthened, the intensity of your craving goes up, and your ability to think rationality about what you need to do goes down. As a result the voice of this “stress ghost” grows into a full-blown “stress monster” that can literally take your brain hostage and make you believe that self-medication with alcohol or other drugs is the best or only way to get back in control of yourself and your life.

Step 1: The first thing you need to do is to convince yourself that you can manage and reduce stress without having to self-medicate. There is another way. That way involves learning how to control your breathing.

Step 2: Practice relaxed breathing in a safe environment when you are not stressed. Just go through the steps and get used to them.

Step 3: Get used to rating your stress level. Initially you may need to use the stress thermometer, but with a few times of practice (four times per day for three or more days) the use of the scale will be an automatic tool that you will use whenever you check out you stress level.

Step 4: Take control of the process by stressing yourself out and then relaxing yourself using the relaxed breathing technique.

Sit in a quiet place where you will not be disturbed for ten or fifteen minutes. Take a deep breath and do a quick body checks. Then on a sheet of paper write the word START and underneath or next to it rate your stress level.

For example, I would do a body check and write: START = 6. I am still relaxed and able to think and respond, but I am tired and on the edge of spacing out.

Step 5: Stress yourself out! Your heard what I said. Think about the things you usually think about that raise your stress. Be sure to beat yourself up about your drinking and drugging, how stupid you were, the problems it has caused and how you will never-ever be able to repair the damage you have done to your life. Stop the process before your stress hits a level 9 or 10 and you go running out of the room. Then write the words: AFTER STRESS and rate your stress level. Most people find it easy to raise their stress.

For example, after beating myself up for about 60 seconds I would write: AFTER STRESS = 8. I feel myself driving myself and notice the thoughts start to take on a life of their own. If someone interrupts me at this moment I could easily over-react.

Step 6: Relax yourself! You heard me. Do what you need to do to relax. This is the problem for many people, especially people who use alcohol, prescribed medication, or other drugs regularly and heavily. They can stress themselves out easily enough, but other than self-medication they have no way to calm themselves down. So try this:

Take a deep breath and hold it for a moment until your lungs feel just a little uncomfortable, hold your breath for a moment, and then exhale all the way out. Hold your breath for a moment with your lungs empty and then slowly inhale again. Start to breath a slow rhythmic count of four: “INHALE– two- three – four; HOLD – two – three – four; EXHALE – two – three – four; HOLD – two – three – four. Then start the cycle over by inhaling to the count of four. Repeat the cycle five times. Imagine the stress gathering in your lungs as you inhale and hold. Imagine the stress releasing from your mouth as you exhale and hold. That’s it.

Now rate your stress again. Look at the stress thermometer and see what happened. Then write the words: AFTER followed by your stress rating.

For example I would write: AFTER RELAXING = 4 (remember I’ve been practicing a long time). So the record of my session looks like this:

START =6; AFTER STRESS = 8; BREATHING REPS = 5; AFTER =4.

Don’t force yourself to relax, just do the relaxed breathing, and focus on counting and imaging the stress leaving your body ever time you exhale.

Practice four times per day, at breakfast, lunch, dinner, and before bed. Keep track of your progress. Use relaxed breathing if you notice your stress going up during any of the following exercises.

Footnotes

[i] Stress and increased Relapse Risk: Stress is an important factor known to increase alcohol and drug relapse risk. This paper examines the stress-related processes that influence addiction relapse. First, individual patient vignettes of stress- and cue-related situations that increase drug seeking and relapse susceptibility are presented. Next, empirical findings from human laboratory and brain-imaging studies that are consistent with clinical observations and support the specific role of stress processes in the drug-craving state are reviewed. Recent findings on differences in stress responsivity in addicted versus matched community social drinkers are reviewed to demonstrate alterations in stress pathways that could explain the significant contribution of stress-related mechanisms on craving and relapse susceptibility. Finally, significant implications of these findings for clinical practice are discussed, with a specific focus on the development of novel interventions that target stress processes and drug craving to improve addiction relapse outcomes.

  • Reference: The role of stress in addiction relapse. Curr Psychiatry Rep.  2007; 9(5):388-95 (ISSN: 1523-3812) Sinha R. Department of Psychiatry, Yale University School of Medicine, 34 Park Street, Room S110, New Haven, CT 06519, USA
  • Stress Identification and Management: Stress as verified by clinical observations, patient self-reports, and subjective and behavioral measures have been correlated depressive symptoms, stress, and drug craving during withdrawal. All of theses factors predict future relapse risk. Among neural measures, brain atrophy in the medial frontal regions and hyperreactivity of the anterior cingulate during withdrawal were identified as important in drug withdrawal and relapse risk. This study suggests that stress management would be helpful in preventing relapse especially during the period of withdrawal

[ii] Stress Identification and Management: Stress as verified by clinical observations, patient self-reports, and subjective and behavioral measures have been correlated depressive symptoms, stress, and drug craving during withdrawal. All of these factors predict future relapse risk. Among neural measures, brain atrophy in the medial frontal regions and hyperreactivity of the anterior cingulate during withdrawal were identified as important in drug withdrawal and relapse risk. This study suggests that stress management would be helpful in preventing relapse especially during the period of withdrawal.

[iii] The Role of Stress In Addiction: Both animal and human studies demonstrate that stress plays a major role in the process of alcohol and drug addiction and that a variety of stressors can increase both self-reported stress and measures of biological stress. Among neural measures, brain atrophy in the medial frontal regions and hyperreactivity of the anterior cingulate during withdrawal were identified as important in drug withdrawal and relapse risk. This study suggests that stress management would be helpful in preventing relapse especially during the period of withdrawal.

Reference: New findings on biological factors predicting addiction relapse vulnerability. Curr Psychiatry Rep.  2011; 13(5):398-405 (ISSN: 1535-1645) INTERNET: http://reference.medscape.com/medline/abstract/21792580

[iv] Stress and Addiction: Stress plays a major role in the process of drug addiction and various stressors are known to increase measures of craving in drug dependent human laboratory subjects. Animal models of stress-induced reinstatement of drug-seeking have also been developed in order to determine the neuropharmacological and neurobiological features of stress-induced relapse.

  • Reference: Pharmacologically-induced stress: a cross-species probe for translational research in drug addiction and relapse. Am J Transl Res.  2010; 3(1):81-9 (ISSN: 1991) See RE; Waters RP. Department of Neurosciences, Medical University of South Carolina, Charleston SC USA.

[v] Stress-Induced Craving and Cognitive Behavioral Therapy: The Division of Clinical Neuroscience, Medical University of South Carolina, Charleston, South Carolina 29425, USA. (backs@musc.edu) has found that stress-induced craving and stress reactivity may influence risk for substance use or relapse to use. Interventions designed to manage stress-induced craving and stress reactivity may serve as excellent adjuncts to more comprehensive treatment programs. The purpose of this study was to (1) tailor an existing, manualized, cognitive-behavioral stress management (CBSM) intervention for use in individuals with substance use disorders and (2) preliminarily evaluate the effects of the intervention using an experimental stress-induction paradigm. Twenty individuals were interviewed and then completed a psychological stress task, the Mental Arithmetic Task (MAT). After this, participants were assigned to either the CBSM intervention group or a non-treatment comparison group. Approximately 3 weeks later, participants completed a second MAT. In contrast to the comparison group, the CBSM group demonstrated significantly less stress-induced craving (p<.04) and stress (p<.02), and reported greater ability to resist urges to use (p<.02) after the second MAT. These findings are among the first to report on the use of an intervention to attenuate craving and stress reactivity among individuals with substance use disorders. Although preliminary, the findings suggest that systematic investigation of interventions specifically targeting stress management in individuals with substance use disorders should be undertaken.

  • Reference: Source: Back SE, Gentilin S, Brady KT. Cognitive-behavioral stress management for individuals with substance use disorders: a pilot study J Nerv Ment Dis. 2007 Aug;195(8):662-8

[vi] Research Society On Alcoholism: This report of the proceedings of a symposium presented at the 2004 Research Society on Alcoholism Meeting provides evidence linking stress during sobriety to craving that increases the risk for relapse. The initial presentation by Rajita Sinha summarized clinical evidence for the hypothesis that there is an increased sensitivity to stress-induced craving in alcoholics. During early abstinence, alcoholics who were confronted with stressful circumstances showed increased susceptibility for relapse. George Breese presented data demonstrating that stress could substitute for repeated withdrawals from chronic ethanol to induce anxiety-like behavior. This persistent adaptive change induced by multiple withdrawals allowed stress to induce an anxiety-like response that was absent in animals that were not previously exposed to chronic ethanol. Subsequently, Amanda Roberts reviewed evidence that increased drinking induced by stress was dependent on corticotrophin-releasing factor (CRF). In addition, rats that were stressed during protracted abstinence exhibited anxiety-like behavior that was also dependent on CRF. Christopher Dayas indicated that stress increases the reinstatement of an alcohol-related cue. Moreover, this effect was enhanced by previous alcohol dependence. These interactive effects between stress and alcohol-related environmental stimuli depended on concurrent activation of endogenous opioid and CRF systems. A.D. Lê covered information that indicated that stress facilitated reinstatement to alcohol responding and summarized the influence of multiple deprivations on this interaction. David Overstreet provided evidence that restraint stress during repeated alcohol deprivations increases voluntary drinking in alcohol-preferring (P) rats that result in withdrawal-induced anxiety that is not observed in the absence of stress. Testing of drugs on the stress-induced voluntary drinking implicated serotonin and CRF involvement in the sensitized response. Collectively, the presentations provided convincing support for an involvement of stress in the cause of relapse and continuing alcohol abuse and suggested novel pharmacological approaches for treating relapse induced by stress.

  • Reference: George R. Breese, Kathleen Chu, Christopher V. Dayas, Douglas Funk, Darin J. Knapp, George F. Koob, Dzung Anh Lê, Laura E. O’Dell, David H. Overstreet, Amanda J. Roberts, Rajita Sinha, Glenn R. Valdez, and Friedbert Weiss. Stress Enhancement of Craving During Sobriety: A Risk for Relapse, Alcohol Clin Exp Res. 2005 February; 29(2): 185–195.

See the related blog: Stress Self-Monitoring and Relapse

Stress Management Is Used In The Gorski Relapse Prevention Certification School (RPCS)

Relaxation Training and Mindfulness Meditation are a big part of Relapse Prevention Therapy (RPT). When patients are under high levels of stress, their ability to understand, integrate, and use new skills is diminished. Gorski RPT teaches therapists how to use a form of immediate relaxation training to keep clien’s stress low during the session. It also teaches them to use relaxation methods in the moment so they are more likely to use them in real-life events. For an overview of how relaxation training and a simple tool called the stress thermometer can be used with RPT check out Terry Gorski’s Blog:

GORSKI’S RELAPSE PREVENTION CERTIFICATION SCHOOL (RPCS)
November 10 -14, 2014 at the Hyatt Regency Pier Sixty Six

2301 SE 17th Street Causeway, Fort Lauderdale, FL 33316
For further information: Tresa Watson: 352-596-8000, tresa@cenaps.com 

SEE RELATED BLOGS:
Stress Self-Monitoring and Relapse ,
The CENAPS Model and Mindfulness in Relapse Prevention,  and
Mindfulness Made Simple.


Family and Relapse

July 30, 2014
20140730-220128-79288398.jpg

Families Recover Together

By Terence T. Gorski
Author and Trainer

This Article is excerpted from: “Staying Sober- A Guide To Relapse Prevention By: Terence T. Gorski

In many cases the addict is the first family member to seek treatment. Other family members become involved in order to help the alcoholic get sober. Many family members refuse to consider the fact that they also have a problem that requires specialized treatment. These family members tend to deny their role in their addicted family and scapegoat personal and family problems upon the addicted person. They develop unrealistic expectations of how family life will improve with their loved one getting abstinent. When these expectations are not met, they blame the addict for the failure, even though he or she may be successfully following a recovery program. Their attitudes and behaviors can become such complicating factors in the addict’s recovery that they can contribute to the process of relapse and even “set-up” the addict’s next “episode of use.”

On the other hand family members can be powerful allies in helping the addict prevent fully engaging the relapse process. Relapse Prevention Planning utilizes the family’s motivation to get the addict sober. As family members become involved in relapse prevention planning, a strong focus is placed upon co-addiction and its role in the family relapse process. Family members are helped to recognize their own co-addiction and become actively involved in their own treatment. Addiction is a family disease that affects all family members, requiring everyone to get involved in treatment. The addict needs treatment for addiction. Other family members need treatment for co-addiction.

The term “co-addiction” is sometimes used to refer only to the spouse of an addict and other terms are used to refer to other family members. We are using the term “co-addict” to refer to ANYONE WHOSE LIFE HAS BECOME UNMANAGEABLE AS A RESULT OF LIVING IN A COMMITTED RELATIONSHIP WITH AN ADDICTED PERSON.

Co-addiction is a definable syndrome that is chronic and follows a predictable progression. When persons in a committed relationship with an addicted person attempt to control drinking, drug use, or addictive behavior (over which they are powerless), they lose control over their own behavior (over which they can have power) and their lives become unmanageable.

When you try to control
What you are powerless over
You lose control
Over what you can manage.

The person suffering from co-addiction develops physical, psychological, and social symptoms as a result of attempting to adapt to and compensate for the debilitating effects of the stress of living with someone who is addicted. As the co-addiction progresses, the stress-related symptoms become habitual. The symptoms also become self-reinforcing; that is, the presence of one symptom of co-addiction will automatically trigger other co-addiction symptoms. The co-addiction eventually becomes independent of the addiction that originally caused it. The symptoms of co-addiction will continue even if the addicted person in the family becomes sober or joins AA/NA, or the co-addict ends the relationship.

The condition of co-addiction manifests itself in three stages of progression.

Early Stage: Normal Problem Solving and Attempts to Adjust

The normal reaction within any family to pain, to crisis, and to the dysfunction of one member of the family is to do what they can to reduce the pain, ease the crisis, and to assist the dysfunctional member however possible in order to protect the family. These responses do not make things better when the problem is addiction, because these measures deprive the addicted person of the painful learning experiences that bring an awareness that his/her addiction is creating problems. At this stage, co-addiction is simply a reaction to the symptoms of addictive disease. It is a normal response to an abnormal situation.

Middle Stage: Habitual Self-Defeating Responses

When the culturally prescribed responses to stress and crisis do no bring relief from the pain created by the addiction in the family, the family members TRY HARDER. They do the same things, only more often, more intensely, mores desperately. They try to be more supportive, more helpful, more protective. They take on the responsibilities of the addicted person, not realizing that this causes the addict to become more irresponsible.

Things get worse instead of better and the sense of failure intensifies the response. Family members experience frustration, anxiety, and guilt. There is growing self-blame, lowering of self-concept, and self-defeating behaviors. They become isolated. They focus on the addict’s addictive behavior and their attempt to control it. They have little time to focus on anything else. As a result they often lose touch with the normal world outside of their family.

Chronic Stage: Family Collapse and Stress Degeneration

The continued habitual response to addiction in the family results in specific repetitive, circular patterns of self-defeating behavior. These behavior patterns are independent and self-reinforcing and will persist even in the absence of the symptoms of addictive disease.

The things the family members have done in a sincere effort to help have failed. The resulting despair and guilt bring about confusion and chaos and the inability to interrupt dysfunctional behavior even when they are aware that what they are doing is not helping. The thinking and behavior of the co-addict is OUT OF CONTROL, and these thinking and behavior patterns will continue independent of the addiction.

Co-addict degeneration is bio-psycho-social. The ineffective attempts to control drinking and drugging behavior elevate chronic stress to the point of producing stress-related physical illnesses such as migraine headaches, ulcers, and hypertension. This chronic stress may also result in a nervous breakdown or other emotional illnesses. Out-of-control behavior itself is an addiction-centered lifestyle that pervades all life activity, even that which seems unrelated to the addiction. Social degeneration occurs as the addiction focus interferes with relationships and social activity. Spiritual degeneration results, as the focus on the problem becomes so pervasive that there is no interest in anything beyond it, particularly concerns and need related to a higher meaning of life.

Recovery from co-addiction means learning to accept and detach from the symptoms of addiction. It means learning to manage and control the symptoms of co-addiction. It means learning to focus on personal needs and personal growth, learning to respect and like oneself. It means learning to choose appropriate behavior. It means learning to be in control of one’s own life.

Because it is a chronic condition, co-addiction, like addiction, is subject to relapse. But a condition of co-addict relapse may be more difficult to identify. Without an ongoing recovery program and proper care of oneself, old feelings and behaviors thought to be under control may surface and become out of control. Life again becomes unmanageable; the co-addict is in relapse mode.

RELAPSE WARNING SIGNS FOR CO-ADDICTION

From the observation of counselors who have worked with recovering family members, relapse warning signs for the co-addicted significant other have emerged. The following list has been compiled from these observations.

1. Situational Loss of Daily Structure. The family member’s daily routine is interrupted by a temporary situation such as illness, the children’s schedule, the holidays, vacation, etc. After the event or illness, the significant other does not return to all of the activities of his or her recovery program.

2. Lack of Personal Care. The significant other becomes careless about personal appearance and may stop doing and enjoying small things that are “just for own personal enjoyment.” The person returns to taking care of others first and self second or third.

3. Inability to Effectively Set and Maintain Limits. The significant other begins to experience behavioral problems with the children or roommates. Limits that are being set tend to be too lenient or too rigid and result in more discipline problems.

4. Loss of Constructive Planning. The significant other begins to feel confused and overwhelmed by personal responsibilities. Instead of deciding what is most important and doing that, he or she begins to react by doing the first thing that presents itself, while more important jobs go undone.

5. Indecision. The significant other becomes more and more unable to make decisions related to daily life.

6. Compulsive Behavior. The significant other experiences episodes during which he or she feels driven to do more. Whatever has already been done does not seem to be enough.

7. Fatigue or Lack of Rest. He or she becomes unable to sleep the number of hours necessary to feel rested. When sleep does occur, it is fitful.

8. Return of Unreasonable Resentments. The significant other finds himself or herself mentally reviewing persons or events that have hurt, angered, or been generally upsetting. As these are reviewed, the significant other relives the old emotions and feels resentments about them.

9. Return of the Tendency to Control People, Situations, and Things. As the co-addicted significant other feels less control over life, he or she begins openly to try to control and manipulate other people or situations. The addicted person may be the prime target, but does not necessarily have to be.

10. Defensiveness. The co-addicted person may not totally approve of some of his or her own actions, but when challenged about them will openly justify the actions in a sharp or angry way.

11. Self-Pity. The co-addict begins to dwell on problems from the present or the past and in turn begins to magnify them. The significant other person may ask, “Why does everything always happen to me?”

12. Overspending/Worrying about Money. The significant other may be very concerned about the family finances, yet impulsively spends money in order to “feel better.” He or she becomes convinced that what was purchased was deserved, but ends up feeling guilty and even more trapped.

13. Eating Disorder. The significant other “loses” his or her appetite to the point that even favorite foods are not appealing. Or the significant other may begin to overeat, regardless of appetite, in order to feel better. The overeating satisfies for only a very short time, or not at all.

14. Scapegoating. There is an increasing tendency to place the blame on other people, places, and things. The co-addict looks outside of self for the reasons why he or she is feeling bad.

15. Return of Fear and General Anxiety. The significant other begins to experience periods of time when he or she is nervous. Situations that previously did not cause fear or anxiety are now causing those emotions. The significant other may not even know the source of the nervousness.

16. Loss of Belief in a Higher Power. The significant other begins to lose belief in a higher power, whatever it may be. There is a tendency to rely more on self-alone, or to turn to the addict for strength and the solutions.

17. Attendance at Al-Anon Becomes Sporadic. The significant other changes the pattern of Al-Anon meeting attendance. He or she may go to fewer meetings, thinking there isn’t time, the meetings aren’t helping, or are not needed.

18. Mind Racing. The significant other feels as though he or she is on a treadmill that is going too fast. In spite of attempts to slow down, the mind continues to race with the many things that are undone or the problems that are unsolved.

19. Inability to Construct a Logical Chain of Thought. The significant other tries to solve problems and gets stuck on something that would normally be simple. It seems that his or her mind does not work anymore, that it is impossible to figure out the world. As a result, he or she feels powerless and frustrated with life.

20. Confusion. The significant other knows they are feeling out-of-sorts, but don’t know what is actually wrong.

21. Sleep Disturbance. Sleeplessness or fitful nights become more regular. The more the person tries to sleep, the less he or she is able to. Sleep may come, but it is not restful. The significant other looks tired in the morning instead of rested.

22. Artificial Emotion. The co-addict significant other begins to exhibit feelings without a conscious knowledge of why. He or she may become emotional for no reason at all.

23. Behavioral Loss of Control. The co-addict begins to lose control of his or her temper especially around the addict and/or the children or roommates. Loss of behavioral control is exhibited in such ways as over-punishing the children, hitting and yelling at the addict, or throwing things and tantrums.

24. Uncontrollable Mood Swings. Changes in the co-addict’s moods happen without any warning. The shifts are dramatic. He or she no longer feels somewhat down or somewhat happy, but instead goes from feeling extremely happy to extremely low.

25. Failure to Maintain Interpersonal (Informal) Support Systems. The co-addict stops reaching out to friends and family. This may happen very gradually. He or she turns down invitations for coffee, misses’ family gatherings, and no longer makes or returns phone calls.

26. Feelings of Loneliness and Isolation. The co-addict begins to spend more time alone. He or she usually rationalizes this behavior – too busy, the children, school, job, etc. Instead of dealing with the loneliness, the co-addict becomes more compulsive and impulsive. The isolation may be justified by convincing him or herself that no one understands or really cares.

27. Tunnel Vision. No matter what the issue or situation might be, the co-addict focuses in on his or her opinion or decision and is unable to see other points of view. He or she may become close-minded.

28. Return of Periods of Free Floating Anxiety and/or Panic Attacks. The co-addict may begin to re-experience, or experience for the first time, waves of anxiety that seem to occur for no specific reason. He or she may feel afraid and not know why. These uncontrollable feelings may snowball to the point that he or she is living in fear of fear.

29. Health Problems. Physical problems begin to occur such as headaches, migraines, stomach aches, chest pains, rashes, or allergies.

30. Use of Medication or Alcohol as a Means to Cope. Desperate to gain some kind of relief from the physical and/or emotional pain, the co-addict may begin to drink, use drugs, or take prescription medications. The alcohol or drug use provides temporary relief from the growing problems.

31. Total Abandonment of Support Meetings and Therapy Sessions. Due to a variety of reasons (belief that he or she no longer needs the meetings, immobilizing fear, resentment, etc.), the co-addict completely stops going to support meetings or to therapy or both.

32. Inability to change self-defeating behaviors. While there is recognition by the co-addict that what is being done is not good for himself or herself, there is still the compulsion to continue the behavior in spite of that knowledge.

33. Development of an “I Don’t Care” Attitude. It is easier to believe that “I don’t care” than it is to believe that “I am out of control.” In order to defend self-esteem, the co-addict rationalizes, “I don’t care.” As a result, a shift in value system occurs. Things that were once important now seem to be ignored.

34. Complete Loss of Daily Structure. The co-addict loses the belief that an orderly life is possible. He or she begins missing (forgetting) appointments or meetings, is unable to have scheduled meals, to go to bed or get up on time. The co-addict is unable to perform simple acts of daily function.

35. Despair and Suicidal Ideation. The co-addict begins to believe that the situation is hopeless. He or she feels that options are reduced to two or three choices: going insane, committing suicide, or numbing out with medication, and/or alcohol, drugs or maladaptive, perhaps compulsive behavior.

36. Major Physical Collapse. The physical symptoms become so severe that medical attention is required. These can be any of a number of symptoms that become so severe that they render the co-addict dysfunctional (e.g., an ulcer, migraines, heart pains, or heart palpitations).

37. Major Emotional Collapse. Having seemingly tried everything to cope, the co-addict can conceive no way to deal with his or her unmanageable life. At this point the co-addict may be so depressed, hostile, or anxious that he or she is completely out of control.

RELAPSE PREVENTION FOR THE FAMILY

While each family member is responsible for his or her own recovery and no one can recover for another, the symptoms of addiction and co-addiction each impact upon the relapse potential of the other. Even if the alcoholic/addict is no longer drinking or using and no longer experiencing the alcohol/drug-related symptoms of the disease, the post acute withdrawal symptoms affect and are affected by co-addiction. Both the symptoms of post acute withdrawal and the symptoms of co-addiction are stress sensitive. Stress intensifies the symptoms and the symptoms intensify stress. As a result, the recovering addict and the co-addict can become a stress-generating team that unknowingly and unconsciously complicates each other’s recovery and create a high risk of relapse.
What can family members do to reduce the risk of their own relapse and the risk of relapse in the recovering addict? They can become informed about the addictive disease, recovery, and the symptoms that accompany recovery. They must recognize that the symptoms of post acute withdrawal are sobriety-based symptoms of addiction rather than character defects, emotional disturbances, or mental illness. At the same time they must accept and recognize the symptoms of co-addiction and become involved in Al-Anon and/or personal therapy as they develop plans for their own recovery.
Clinical experience with relapse prevention planning in a variety of treatment programs has indicated that the family can be a powerful ally in preventing relapse in the addict. In 1980, relapse prevention planning was modified to include the involvement of significant others including family members. This significantly increased effectiveness. With further clinical experience, however, other problems became apparent. Many family members refused to participate in relapse prevention planning. Other family members participated in a manner that was counterproductive.

In 1983 relapse prevention planning was expanded to include relapse prevention in both the addicted person and the co-addict. The newly designed relapse prevention planning protocol utilizes the family’s motivation to get the addict sober. As family members become involved in relapse prevention planning, a strong focus is placed upon co-addiction and its role in family relapse.

Family members are helped to recognize their own co-addiction and become actively involved in their own treatment. Addiction is presented as a family disease that affects all family members requiring them to get treatment.

All members of an addicted family are prone to return to self-defeating behaviors that can cause them to become out of control. An acute relapse episode can occur with an addict or a co-addict family member.

Like addicts who develop serious problems even though they never use alcohol or drugs, the co-addict often becomes dysfunctional even though the addict is sober and working an active recovery program.

It is important to protect the family from the stress that may be generated by the symptoms of post acute withdrawal experiences by the recovering person and to cooperate in plans to protect the recovering person from stress created by symptoms of co-addiction.

Remember that none of you became ill overnight. Recovery will, likewise, take place over a long period of time. Develop a plan to prevent personal relapse and support relapse prevention plans for the recovering addict.

Family Relapse Prevention Planning is intended to help prevent acute relapse episodes in the recovering addict, to prevent crisis in the co-addict, to develop a relapse prevention plan for both the addict and co-addict and to develop an early intervention plan to interrupt acute relapse episodes in both the recovering addict and the co-addict. For the addict this involves interrupting problems that are caused both by Post Acute Withdrawal (PAW) Syndrome in the sober addict and by alcohol or drug use in the addict who has returned to drinking or using. For the co-addict this involves interrupting the co-addiction crisis.

The family needs to work with a counselor to establish a formal relapse prevention plan that will allow them to support each other’s recovery and to help intervene if the relapse warning symptoms get out of control.

The family relapse prevention planning protocol consists of twelve basic procedures. These are:

1. Stabilization: The first step in relapse prevention planning is to stabilize both the addict and the co-addict. The addict is stabilized through the process of detoxification or treatment of post-acute withdrawal symptoms. The spouse is stabilized by treating the co-addict crisis, through detachment from the addicts crisis, by regaining a reality-based perspective, and the development of some basic personal strengths. This often requires attendance at Al-Anon and professional counseling.

2. Assessment: Prior to developing a relapse prevention plan it is necessary to evaluate the addict, the co-addicts, and the family system. The evaluation should assess the current problems of each family member, their willingness and ability to initiate a personal recovery program, and their willingness to become involved in a program of family recovery.

3. Education about Alcoholism, Co-addiction, and Relapse: Accurate information is the most powerful of all recovery tools. The addict and the family must learn about the disease of addiction, the condition of co-addiction, treatment, and relapse prevention planning. This education is best provided to the family as a unit in multiple family classes. It is helpful if separate group therapy programs accompany the education for each family member. The addict should enter an addict group, the adult co-addict should enter a spouse’s group, and the co-addict children should enter a children’s group. It is in these group treatment sessions that individual recovery of all family members is initiated.

4. Warning Sign Identification: Both the addict and the co-addict need to identify the personal warning signs that indicate that they are becoming dysfunctional. Again, this is best done in a group setting. The addict is better able to identify relapse-warning signs when working with other addicts. Co-addicts are best able to initially identify relapse-warning signs when working with other co-addicts. Relapse warning sign lists for addiction and co-addiction are useful guides for personal warning sign identification.

5. Family Validation of Warning Signs: After each family member has developed a personal list of warning signs and reviewed these in his or her group, a series of family sessions is scheduled. During these sessions all family members present their personal lists of warning signs and ask for feedback. Other family members discuss the warning signs, help assess fi they are specific and observable. New warning signs may be added to the list based upon the feedback of others. Since each family member has a list of warning signs that precede acute relapse episodes there is no identified patient. All participate from a position of equality. They essentially say to each other, “We have all been equally affected, in various ways, by addictive disease.”

6. The Family Relapse Prevention Plan: Family members discuss each of their warning signs, how the family has dealt with those warning signs in the past, and what strategies could be effectively used in the future. Future situations in which the warning signs are likely to be encountered are identified. Strategies for more effective management of the warning signs for each family member are discussed. During this process a great deal of role playing and problem solving occurs. Problems are often identified that are taken back to the separate therapy groups for further work.

7. Inventory Training: All member of the family receive training in how to complete a morning planning inventory and an evening review inventory. These focus heavily upon time structuring, realistic goal setting, and problem solving.

8. Communication Training: The family members must learn to communicate effectively in order for a Relapse Prevention Plan to work. The family is trained in the process of giving and receiving feedback in a constructive and caring manner.

9. Review of the Recovery Program: All family members will report to the family the recovery program that they have established for themselves. This focus here is, “How will you and I know that I am doing well in my recovery?”
All are invited to express their recovery needs and point out their progress in treatment.

10. Denial Interruption Plan: Both addiction and co-addiction are diseases of denial. Most of the denial is unconscious. Neither the addict nor the co-addict realizes that they are in denial when it is happening. It is important to take the reality of denial into account early. Each family member should be asked the question, “What are other people in your family supposed to do if they give you feedback about concrete warning signs and you deny it, ignore the feedback, or become angry and upset?” Each family member should recommend specific plans for dealing with their own denial. This open discussion sets the stage for intervention should denial become a problem in the future.

11. The Relapse Early Intervention Plan: Addiction and co-addiction are prone to relapse. Relapse means becoming dysfunctional in recovery. For the recovering addict relapse may ultimately lead to alcohol and drug use, or it may simply mean that the person becomes so depressed, anxious, angry, or upset that he is dysfunctional in sobriety. For the co-addict relapse means the return to a state of co-addict crisis that interferes with normal functioning. Once family members enter an acute relapse episode they are out of control of their thoughts, emotions, judgements, and behavior. They often need the direct help of other family members to interrupt the crisis. Many times they resist this help. They act as if they do not want help even though they desperately need it. The family is instructed in the process of intervention. Intervention is a method of helping people who refuse to be helped. This intervention training has resulted in a radical decrease in the duration and severity of relapse episodes in family members.

12. Follow-up and Reinforcement: Addiction and co-addiction are life-long conditions. The symptoms can go into remission but they never totally disappear. They rest quietly, waiting for a lapse in the recovery program to become active again. It is important that the family maintain an ongoing recovery program including AA/NA, Al-Anon, and periodic relapse prevention checkups with a professional addiction counselor.

This Article is excerpted from: “Staying Sober- A Guide To Relapse Prevention By: Terence T. Gorski

<


Listening

July 25, 2014

20140725-195609-71769452.jpg

By Terence T. Gorski
Author
GORSKI BOOKS: www.relapse.org

People, regardless of gender, tend to hear what they want to hear. This tendency leads to many conflicts and a great deal of miscommunication.

Solving the problem begins with an honest self-exploration of our own willingness and ability to seek first to understand what others are saying before we seek to be understood.

Listen carefully and with your full attention. Check to make sure you have correctly understood by repeating what you heard and asking if you got it right.

Think before you speak. Be sure you have something worthwhile to say. Then say it clearly, calmly, compassionately, and with conviction.

Yelling makes you seem foolish even if you are right. People seem foolish when they are right at the top of their lungs. Breath deeply and become calm and centered when discussing important issues.

“Seek first to understand, then to be understood.” ~ Stephen Covey

If you want other people to take you seriously, you need to make others feel that they are listened to, understood, and taken seriously. This lead them to trust you and this increases the possibility that they will listen to, understand and take you seriously. Communication that starts with active empathetic listening skills tend to build a cycle of progressive openness and trust the deepens the process of feeling connected to others in recovery.

Trust is the foundation of all honest communication. To gain the trust of others we must me trustworthy within ourselves. Trust is built slowly, step-by-step by shared progressive self-disclosure.

GORSKI BOOKS: www.relapse.org

LIVE SOBER – BE RESPONSIBLE – LIVE FREE


Adolescent Relapse Prevention

June 13, 2014

20140613-183453-66893006.jpg

By Terence T. Gorski, Author of
The Adolescent Relapse Prevention Workbook

This article describes the differences between adolescent and adult substance abusers that can lead to relapse and presents practical suggestions for matching the unique needs of adolescent substance abusers to relapse prevention strategies in order to decrease the rate of relapse.

Adolescent chemically dependent patients relapse at a much higher rate than adults. Studies[1] indicate that approximately 42% of adolescents who complete inpatient treatment for chemical dependence maintain total abstinence from alcohol or other drugs during the year following treatment. This is much lower than the 66% abstinence rate reported for adult inpatient programs with similar treatment philosophy and geographic locations.

Seventy-eight per cent of adolescents who relapse (45% of all adolescents treated) do so during the first six months of recovery. The good news is that 77% of those who made it through the first six months of recovery without relapsing maintained their abstinence for the entire year. Of the patients who relapsed during the first six months, 28% were abstinent for the second six months. Of those adolescents who relapse (58% of all adolescents treated), approximately 40% (23% of all adolescents treated) have short-term and low consequence relapses and rapidly return to sobriety. The other 60% (34% of the population) have long-term, high consequence relapses.

Reasons For Adolescent Relapse

There are significant differences between adult and adolescent chemical addictions and the failure to recognize these differences can be an important contributor to adolescent relapse.[2] Most chemically dependent adolescents have three coexisting problems that increase relapse risk:

(1) Chemical Addictions (Adolescent Substance use Disorders)

(2) Normal Problems With Adolescent Development, and

(3) Adolescent Mental Disorders.

Adolescent Substance Disorders

Many chemically dependent adolescents relapse because they fail to recognize that they are chemically dependent and need to abstain from alcohol and drugs. This is especially true for adolescents who are in the early stages of their addiction or lack a long history of alcohol and drug related problems.

Forcing early stage adolescents into harshly confrontational inpatient programs against their will can create high relapse rates after discharge. Many of these adolescents go into compliance and passively resist treatment and, although on the surface many appear to be model patients, after discharge they rapidly return to alcohol and drug use because they have failed to recognize and accept their addiction.

Recovery rates can be improved by using outpatient motivational counseling techniques and substituting intensive outpatient treatment for inpatient treatment.

Some adolescent programs focus exclusively upon the chemical addiction while minimizing or ignoring problems with normal adolescent development or adolescent disorders which can lead to relapse. Many adolescent programs, for example, set behavioral standards that would be appropriate for adults but are inappropriate for adolescents in certain stages of development.

Since the onset of chemical addiction causes many adolescents to stop normal emotional development, treatment centers can overcome this problem by assessing the stage of adolescent development and setting appropriate behavioral expectations and treatment goals.

Normal Problems With Adolescent Development

It can be easy to forget that adolescent substance abusers are children who are not capable of functioning up many adult standards. Normal adolescence is a difficult period of adjustment. Hormones go on-line and start to rage. Social relationships become more complicated. Pressure from peers to conform and pressure from parents and teachers to excel can weigh heavily on many if not most teenagers.

Effective adolescent treatment programs take the stage of adolescent development into account and design treatment plans that are appropriate to the adolescent’s current developmental level. Failure to do so can significantly increase the risk of relapse.

Adding educational approaches to the recovery and relapse prevention process can go a long way to preventing relapse for adolescents in the school environment. [4]

Coexisting Psychosocial Problems

Typical chemically dependent adolescents have three major life problems in addition to their chemical addiction to contend with when they enter treatment.[3] The most common problems include school problems (58%), dysfunctional relationships with one or both parents (38%), parental substance abuse (35%), physical abuse (30%), sexual abuse (37% of females and 5% of males), depression (29%), and suicide attempts (16%). If left untreated, these other problems can create ongoing pain and dysfunction which lead to relapse.

While treating these other problems, however, it is important to keep an addiction focus. To treat these other problems without helping the adolescent to recognize the role that their alcohol and drug dependence has in creating and maintaining these problems can also contribute to relapse.

An effective relapse prevention approach is to provide balanced treatment for adolescents that focuses upon diagnosing and treating their chemical addiction, the normal tasks of adolescent development that they need to cope with in sobriety, and other major life problems that can jeopardize sobriety.

Selecting The Appropriate Treatment Setting

It is important that adolescents be matched to an appropriate treatment setting. There is the mistaken belief that the preferred treatment setting for all adolescents is a long-term inpatient treatment environment.

Many adolescents, especially those in the earlier stage of addiction with less severe coexisting problems and supportive families, do better in outpatient environments where they can maintain their academic and family lives than in long-term inpatient programs that disrupt the normal course of their lives. For adolescents with late stage chemical addiction with numerous severe, coexisting problems and little or no family support, inpatient treatment may be necessary.

The Role Of Outpatient Treatment In Relapse Prevention

Ongoing outpatient treatment is vitally important in preventing adolescent relapse. The majority of adolescents relapse in the first six months with the second highest risk period being the second six months. Adolescents who are not involved in outpatient treatment that includes family involvement for at least one year following discharge from inpatient are at high risk of relapse.

Failure To Teach Warning Sign Identification & Management

The final factor that contributes to an increased relapse rate among adolescents is the failure of many treatment centers to teach the adolescent patients and their families how to identify and manage relapse warning signs.

Relapse is a process that begins long before adolescents begin drinking and drugging again. There are progressive and predictable warning signs that indicate that the adolescent is getting into trouble with his or her recovery.

The typical sequence of warning signs normally begins when a situational problem triggers the adolescent to react with old addictive ways of thinking. The addictive thinking creates painful and unmanageable feelings. In order to cope with these feelings, the adolescents begin reverting to alcohol and drug seeking behaviors which put them back in contact with other adolescents who are drinking or drugging. Once in this environment, return to use is inevitable.

Teaching adolescents and their families to recognize and intervene upon the early warning signs can prevent unnecessary relapse. Helping the adolescent, the family members, and other concerned persons to intervene as soon as addictive use begins can help assure that adolescents will experience short-term and low consequence relapses.

References

[1] Harrison, P.A. and Hoffmann, N. G. (1989), CATOR Report: Adolescent Treatment Completers One Year Later, Ramsey Clinic, St. Paul, MN, pp. 47-48.

[2] Bell, Tammy, Preventing Adolescent Relapse – A Guide For Parents, Teachers And Counselors, Herald House/Independence Press, Independence, Missouri, 1990

Treatment Completers One Year Later, Ramsey Clinic, St. Paul, Minnesota, p. 40.

[3] Harrison, P.A. and Hoffmann, N. G. (1989), CATOR Report: Adolescent

[4] Adding Education to the Relapse Prevention Model: http://www.addictionpro.com/article/adding-education-model 

The Adolescent Relapse Prevention Workbook

About the Author

Terence T. Gorski is internationally recognized for his contributions to Relapse Prevention Therapy. The scope of his work, however, extends far beyond this. A skilled cognitive behavioral therapist with extensive training in experiential therapies, Gorski has broad-based experience and expertise in the chemical dependency, behavioral health, and criminal justice fields.

To make his ideas and methods more available, Gorski opened The CENAPS Corporation, a private training and consultation firm of founded in 1982. CENAPS is committed to providing the most advanced training and consultation in the chemical dependency and behavioral health fields.

Gorski has also developed skills training workshops and a series of low-cost book, workbooks, pamphlets, audio and videotapes. He also works with a team of trainers and consultants who can assist individuals and programs to utilize his ideas and methods.

Terry Gorski is available for personal and program consultation, lecturing, and clinical skills training workshops. He also routinely schedules workshops, executive briefings, and personal growth experiences for clinicians, program managers, and policymakers.

Mr. Gorski holds a B.A. degree in psychology and sociology from Northeastern Illinois University and an M.A. degree from Webster’s College in St. Louis, Missouri. He is a Senior Certified Addiction Counselor In Illinois. He is a prolific author who has published numerous books, pamphlets and articles. Mr. Gorski routinely makes himself available for interviews, public presentations, and consultant. He has presented lectures and conducted workshops in the U.S., Canada, and Europe.

The Adolescent Relapse Prevention Workbook


%d bloggers like this: