THE RELAPSE PREVENTION CERTIFICATION SCHOOL (RPCS) – 2015

August 8, 2015

Earn 44 CEUs, In 5 Days, for $695!
  Instructed By: Terence T. Gorski and Dr. Stephen F. Grinstead

November 9-14, 2015

Ft. Lauderdale, FL

Terence T. Gorski’s advanced relapse prevention training has been “a turning point” in both the professional and personal lives of many former participants. The Gorski schools began in 1982 in Chicago, IL. Since that time, over sixty schools have been conducted with over 4,000 people completing the training.

This advanced clinical skills training experience is designed for professional therapists who are good and want to get better. It may be the most challenging and effective training that you have ever attended.

Upon completion of this training, participants will be able to develop comprehensive Relapse Prevention Plans for identifying and managing both high risk situations in early recovery and the core personality and lifestyle problems that lead to relapse in later recovery, after initial stabilization.

The Gorski Relapse Prevention Certification School (RPCS) is continuously updated with the latest research and uses a proven training method that includes:

(1) Brief Lectures that explain the purpose of each technique and why it is important;

(2) Clinical Demonstrations of each RP technique,

(3) Role Play to practice and receive feedback on your use of each technique,

(4) Small Groups to discuss progress, problems, and applications to your personal style;

(5) Discussions of how to apply the techniques in your professional setting.

Do you want to take your current clinical skills and integrate them with new and powerful approaches for identifying and managing the high-risk situations and core personality and life-style patterns that lead to relapse? If you do, this is the training for you!

Important Notice: An optional RPT Competency Certification that requires the completion of a competency portfolio and an additional fee.

Training Fee: The cost of the training is $695 for the five-day training experience (travel, meals, and lodging are not included in this fee).

Florida Location: HYATT REGENCY PIER SIXTY SIX, 2301 SE 17th Street Causeway Fort Lauderdale FL 33316 USA Telephone: 1-954-525-6666 on November 10-14, 2014 (Special hotel rates will be available for those who register early!

For information and Registration:
Tresa Watson at 1-352-596-8000 or tresa@cenaps.com

Website: www.cenaps.com


THE DEFINITION OF RELAPSE 

May 10, 2015

By Terence T. Gorski

Here are the key points of the definition of relapse from a wide variety of internet dictionaries :

To experience a relapse means:

1. The return of a disease or illness after partial or full recovery from i

2. To suffer a deterioration in a disease after a period of improvement.

3. To fall back into illness after convalescence or apparent recovery

4. To have a deterioration in health after a temporary improvement.

5. To fall or slide back into a former state of illness or dysfunction.

6. To regress after partial recovery from illness.

7. To slip back into bad habits or self-defeating ways of living; to backslide after a period of progress.

8. To fall back into a former state, especially after apparent improvement.

Origin of the word RELAPSE: the word relapse comes from the Middle English word “relapsen,” and from Latin meaning to to “forswear” (to promise or swear in advance that a change will be made.   A combination of the words: relb or relps-, came to mean to fall back gradually; or to slide back without being able to stop ones self (as could happen when trying to move up a slippery or muddy hill.

The word relapse results from a linguistic process called “nominalization” which means to describe a process (like loving someone or relating to someone) into a thing (like love or relationship).

It is important to do a “cross-walk” between 12-Step language (i.e. dry drunk leading to a wet drunk) and the language of cognitive behavioral therapy (the process of falling back into an illness, condition, or habitual problem behaviors that ends in the act of drinking, drugging, or acting out an addiction or habitual self-defeating behavior.

Using an “addictive release” provided by an addictive drug or behavior is often seen as the start of a “relapse episode,” a single discreet episode of addictive use.

A relapse episode is usually preceded by stressful events (triggers), that raise stress and activate old self-defeating and addictive ways of thinking, feeling, acting, and relating to other people.

Marlatt distinguished between a lapse (a short term and low consequence episode of addictive use) and a relapse (a return to a previous state of out-of-control addictive acting out usually accompanied by a return of secondary problems related to the addiction.

I believe in a Twelve-Step Plus Approach that matches the needs of individual recovering people with a strong recommendation to attend 12-Strep Programs and to participate in other treatment activities (professionally supervised) and recovery activities (peer supported and community based) that meet individual needs, promotes long-term recovery, and uses appropriate relapse prevention methods. There is no wrong door into recovery. There is no wrong treatment or recovery activity if it helps people to live a sober and responsible life filled with meaning and purpose.

Language Programs The Brain,
Focuses The Mind, and
Motivates Behavior.

Think clearly to get results in recovery!

~ Terry Gorski Blog: www.terrygorski.com

~ Terry Gorski, via www.facebook.com/GorskiRecovery

www.relapse.org

— PERMISSION IS GRANTED TO REPRODUCE OR REPOST —

 


Relapse Prevention and Chemically Dependent Offenders 

March 2, 2015

By Terence T. Gorski

Review Gorski’ Books and Publications

From the mid 1970’s to the late 1980’s I worked extensively on projects involving the criminal justice system.

My primary focus was upon setting up programs lower recidivism to substance use and crime. During this project I interviewed many current and released prisoners, correctional and probation officers, and drug court judges.

The project resulted in the development of the three manuals related to relapse prevention among offenders that are still used in many correctional programs and training I institutes.

These are:

1. An Executive Briefing On Addicted Offenders for Judges and Policy Makers.

2. A Guide for Counselors, Therapists, and Criminal Justice Professionals;

3. The Relapse Prevention Workbook Chemically Dependent Offenders (for use by offenders);

4. Relapse Warning Signs for Criminal Behavior;

5. High Risk Situations for Incarcerated chemically Dependent Behaviors.

I also made the book available through the government printing office: https://www.ncjrs.gov/pdffiles1/Digitization/152332NCJRS.pdf

Here is the link to  blog page that briefly describes the information that we have. The publications are old, but the content has stood the test of time. All protocols within these workbooks are based evidenced-based practices of Relapse Prevention Therapy as certified by the National Registry for Evidence-based Programs and Practices (NREPP). The work books have been extensive used in the correctional system both behind the bars and in the community for over twenty-years. They are still valid because: They are based upon a rock-solic foundation of Cognitive-Behavioral Therapy (CBT), they utilize proven principles of Relapse Prevention, and the system is manualized making it easy to use consistently within a program.
We can make the workbooks available on a license tt individual facilities in reproducible PDF files that can be copied within the facility for use with the clients. If you are interested in obtaining a PDF License please email Tresa Watson tresa@cenaps.com or call here at 352-596-8000.

My Depression Management Plan

January 16, 2015

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By Terence T. Gorski
Author

Read Terry Gorski’s Book: Depression and Relapse

Major depression is a serious problem for many people, including people in recovery from alcoholism and other chemical addictions. Many people suffer from depression in recovery and I was no exception. After more than twenty-five years of sobriety, depression nearly took me down.

I figured out a way to manage it. Part of the process of figuring out what to involved researching depression and writing a book about what I learned from the process. The book Depression and Relapse.

I wrote this blog today because I have friend suffering from depression in recovery. I wrote a summary of the things I did to help myself get through the dark times. I thought it might be helpful to others.

Let me know what you think. If you have survived serious depression and used some tools or techniques that helped but aren’t listed here, add them in a comment and be sure to identify yourself and a link to your blog or website so I can properly reference the source. It might help send some traffic your way. So, let’s get on with it.

To manage my severe depression I had to self-monitor it’s severity four times per day (breakfast, lunch, dinner, and before bed).
I used a ten point scale:

0 = No Depression/Normal Mood;

1 – 3 = Mild Depression: It is a nuisance, but I can put it out of my mind and do all of my acts of daily living.

4 -7 = Moderate Depression: It is a nuisance but at times is so severe and drains so much energy that at times I can’t stay focused on my normal daily tasks. At other times I can.

7 -9 = Severe Depression: I get yo and try to function but I usually can’t complete my daily acts of living so I shrink my world by avoiding things.

10 = Disabling: The depression is so bad that I can barely function at all. I can’t get out of bed, I can’t do basic tasks, and no matter what anyone says or does I feel buried by the depression.

I kept a log four times per day and started looking for pattens. I noticed my depression would move through my life in up-and-down cycles. There were times of the day when I was more depressed no matter what was going on. There were other times of the day when the depression wasn’t as bad. I began to see that there were predictable cycles to the severity of my depression symptoms.

I noticed that the depression started to increase and get worse at certain times of the day. Knowing this allowed me to anticipate when I would be the most depressed and avoid scheduling important things during those times. I also learned the times when I tended to be the least depressed and most functional. This allowed to plan my most important activities during those time.

I also noticed weekly cycles. On certain days of the week I would be more depressed than on others. In other words, I could anticipate the really bad days and the better days.

I began doing things to try and manage the depression symptoms. I kept it simple:

– I scheduled alone time for 15 – 30 minutes a day and just distracted myself with pleasant mindless things.

– I took a twenty minute walk each day.

– I started to do brief (3 – 5 minute) sessions of mindfulness meditation.

Here is how I did it: https://terrygorski.com/2013/12/30/mindfulness-made-https://terrygorski.com/2013/12/30/mindfulness-made-https://terrygorski.com/2013/12/30/mindfulness-made-simple/

I also used a meditation technique called Magic Triangle Relaxation Methof. It is described here: https://terrygorski.com/2014/05/08/magic-triangle-relaxation-method/

It wasn’t easy to manage the depression and most people didn’t understand what I was going through. They would ask me: “Why don’t you just snap out of it?” The answer was easy: “I can’t because I have a depressive illness!”

Many of the people I knew were really angry because I wasn’t able to work as hard or be there for them in the ways I was before I got depressed.

One of the things that kept me going was the research that showed how serious episodes of clinical depression tend to run a course of about nine to eighteen months. Each major depressive episode tends to go through three stages:

Stage 1: Gradual increase in the frequency and severity of depression symptom episodes.

Stage 2: The period of most frequent and intense symptoms. This is the stage where most people seek help because the depression is causing life problems. It’s much better to recognize depression in stage one and make managing the emerging symptoms as a top priority. When I did this I found stage 2 would to be shorter and the depression symptoms less severe and disabling. Yes, I had more than one ride on this roller coaster to dark side of depression. I learned from each ride and used it to make the next ride shorter and more manageable.

Stage 3: A period of gradual Symptom reduction until a normal mood (whatever that is) returns.

What I found is that I had always suffered from a chronic low-grade form of depression called Dysthymia. I also discovered depression ran in my family so I considered low grade depression to be normal.

I also paid attention to my automatic thoughts that made my depression worse. I figured out how to actively challenge my automatic depressive thinking. Both my personal experiences and the research I reviewed on the cognitive therapy of depression were the same:

1. There are automatic thoughts that made my depression worse.

2. When I let these depressive thoughts bounce around in my brain my depression kept getting worse.

The depressive thoughts that make depression worse are:

1. This is awful (Awful means worse than it could ever be).

2. This is terrible (terrible means that there will be serious losses of everything that I value).

3. It’s always been this way, I’ve never had a single moment in my life when I wasn’t depressed.

4. It will always be this way. I won’t ever be able to feel better.

5. I can’t stand the way I feel! (Although it is obvious I could stand it because what else could I do?)

6. I can’t do anything about it. There is nothing I can do to make the symptoms even in a little bit better.

7. I am helpless and hopeless in the face of my depression.

8. There is nothing I can do! I can’t do anything to manage the depression or make myself feel even a little bit better for a few minutes.

9. Being depressed proves that I am no good as a person.

10. My depression has robbed me of everything I value and has made me a helpless, useless, crazy person.

Before I figured all of this out, I became suicidal. I felt the compulsion to end myself. The impulse to commit suicide was so strong and persistent it was difficult to resist.

I had to tell close friends about it. I put all potential suicide tools in the hands of friends with clear instructions not to let me have them back. This included my guns, and anything in the medicine cabinet that could be lethal. There are many over-the-counter medications that can kill you with as few as thirty pills. 

How did I know this? The Internet is a wonderful tool for the suicidal. I put the prescription medications I was taking in the hands of someone else who would give me the daily doses of prescribed medication.

Recognizing and managing my suicidal preoccupations and compulsions is a story for another time.

I also used prayer and meditation. This helped me to transcend or rise above the worst symptoms of depression and to find a meaning in my suffering.

It is important to remember that THIS TO SHALL PASS. Depression is not forever and there are things you can do to reduce the severity and duration of depressive episodes.

Read Terry Gorski’s Book: Depression and Relapse

The exercises in the COGNITIVE RESTRUCTURING FOR ADDICTION WORKBOOK can be easily applied to depression.

The principles of 12-Step Programs can also be helpful. See Understanding the Twelve Steps.


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

November 8, 2014

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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

 

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CERTIFIED RELAPSE PREVENTION SPECIALISTS (CRPS)

September 2, 2014

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An Evidence-based Program and Practice

By Terence T. Gorski, author,

Find A CRPS Near You

Find a CRPS providing services in your area. Click Here. Most provide a minim of thee services on a fee for service bases:

1. RP Counseling and Therapy:

Direct RP services for recovering people and their families in developing and supervising relapse prevention plans. Some do this in individual sessions and others in groups.

2. Clinical Supervision/Case Consultation:

Clinical supervision in RP for professionals in the community working with relapse prone people. Again, some do this in individual supervision and some use group supervision.

3. Training and Presentations On Relapse Prevention and Related Area:

Many of our Professionals who have earned their CRPS do. Wide variety of training events for professionals and recovering people in the community.

I have found the members of the Association of Relapse Prevention Specialists to be dedicated and competent professionals with big hearts. They are just plain good and trustworthy people.

You can locate a certified Relapse Prevention Specialist near you by visiting the CENAPS Website: Certified Relapse Prevention Specialists (CRPS)

 

Supervision.http://www.cenaps.com/The_Cenaps_Corporation/Certified_Specialists.html Supervision.

The Relapse Prevention Certification school id conducted ever November in Fort Lauderdale FL
BECOME A CERTIFIED RELAPSE PREVENTION SPECIALIST (CRPS):

 

 


Trigger Events

August 29, 2014

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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


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