Relapse and Recovery
A client with whom you are working relapses. S/he expresses feelings that s/he is a failure, will never be able to get clean and sober, and that maybe s/he hasnt hit bottom yet. How would you respond to help this client?
Prevention
In your opinion what are the most critical components to a prevention plan? If you were asked to develop a prevention plan, what would you include?
Parents and Prevention
If you were writing a letter to send home to parents of children at risk, what would you include in your letter?
CLASS NOTES
Relapse and Recovery
Five Stages of Behavioral Change
(FCB text pages 64-65)
PrecontemplationPrecontemplators are not seriously considering changing their behaviors in the next six months. They are very resistant to change and are very often unaware that a problem exists. Family, friends and coworkers may be aware there is a problem. Precontemplators are often described as being In Denial. They avoid reading, discussing or thinking about the negative consequences of not changing. Some
precontemplators
may have attempted
change
in the past and failed, thus becoming demoralized or hopeless in their problem.
ContemplationContemplators are aware that a problem exists and are seriously thinking about doing something about it. But, they have not yet made a commitment to action. They see as many disadvantages as advantages to making a change. They may feel stuck. They often remain ambivalent for a long time. They may speak of having a problem I am thinking about working on. They may procrastinate taking an action for years.
PreparationIn the preparation stage, some behavioral change catches up with intention. Individuals want to take action in the near future. They develop a plan of action. They may have identified a therapist they can see, a book they can read, a class they can take, and/or a self-help group they can join.
ActionThe greatest observable change takes place in the action stage. In the action stage, people have implemented their plan and have made changes in their life. Vigilance against relapse is critical in this stage. Consistent behavior is very important.
MaintenanceIn the maintenance stage, people have sustained their new behavior for at least six months. They work at preventing relapse and maintaining the changes made in the Action stage. They are confident in their new behaviors. They are careful not to backslide.
The FCB text reviews the concept of Recovery Management in pages 22-24. The three phases
in
the Recovery process:
pre-recovery identification and engagement,
recovery initiation and stabilization (recovery activities/treatment), and
recovery maintenance (post-treatment recovery support services).
There are three types of recovery capital:
personal recovery capital
family/social recovery capital, and
community recovery capital. (White & Cloud, 2008).
Relapse is covered
in
pages 114-117 in the FCB text. Terrence Gorski is one of the preeminent scholars in the field of relapse prevention. You may want to explore the Terrence Gorski website for more information about his model of relapse prevention.
Gorski categorized persons with substance use disorders into three relapse-related groupings:
1. recovery prone
2. transitionally relapse prone; and
3. chronically relapse prone.
When counseling about relapse prevention, it is helpful to discuss:
Relapse Warning Signs
Relapse Triggers
High-risk situations
Relapse Warning Signs
Relapse warning signs are subtle indicators that a person may be at risk of a relapse, that can be identified and acted upon BEFORE a person actually relapses. Some common relapse warning signs are covered on page 117 of the FCB text, and include:
Life Changes Marriage/Divorce, job change or promotion, financial problems.
Extreme moods Depression, elation, irritability, numbness,
mood-swings
.
Denial Denial of a problem, overconfidence.
Loss of control Life events feel out of control or overwhelming.
High Risk
Situations
Stress
Relapse Irresistible urges and cravings, romancing the thought of using.
Relapse Triggers
Relapse triggers may be any stimulus that starts someone thinking about a relapse. For
some
it may be a certain song or food associated with past use. For example, spicy chicken wings, raw oysters, or pizza may be associated with beer. Grateful Dead or Pink Floyd music may be associated with marijuana use. The unique smell of a marijuana cigarette wafting across a crowded street may be a relapse trigger. Watching a football game with friends, or even seeing a TV commercial showing a perfect, frosty-mugged dew-dropped glass of foamy beer can be a trigger!
High-risk situations
Many high-risk situations are avoidable, but some are not. Clients should be counseled about how they will successfully avoid or endure
high risk
situations. Hanging out in bars or going to clubs are
high risk
situations. Hanging out with using friends is a
high risk
situation. Attending a family wedding where there will be an
open-bar
is a
high risk
situation.
If one must attend a high-risk event, such as a family wedding, a good relapse prevention plan will include survival behaviors such as:
Attending an AA/NA Meeting before and/or after the event
Calling to check-in with the AA/NA Sponsor or another AA/NA
peer
during the event
Carrying a ginger-ale or other nonalcoholic drink so no one offers you a beer
Taking a sober friend with you, if possible
Having an escape plan to leave early, if necessary.
Steps of Relapse Prevention Planning
Stabilization
Assessment
Patient Education
Warning Sign Identification
Review of recovery
Inventory training
Involvement of others
Relapse does not
equal
failure!
Relapse is a natural part of the recovery continuum. Relapse is not recommended, and many will recover without experiencing
relapse
. However, when relapse does occur it is viewed as an opportunity to reassess what was working, what wasnt working, and as an opportunity to strengthen ones recovery.
Terrence Gorski, regarding treatment programs that expel clients who relapse, once pointed out that we do not refuse to treat heart patients who have a second heart attack. We dont tell them, Go six months without a heart attack and well consider treating you again.
Prevention
Read Chapter 6: pages 150-161 in the FCB text.
The National Institute on Drug Abuse (NIDA) has a very good 58-page booklet entitled Preventing Drug Use Among Children and Adolescents: A Research-Based Guide for Parents,
Educators
and Community Leaders. It can be ordered free of charge or you can follow the link to view it online.
Kinds of Prevention: Primary, Secondary and Tertiary View this link Institute for Work and Health
Prevention
If one accepts that the earlier the intervention, the more likely a positive outcome, then one becomes aware of how crucial prevention is in the field of recovery.
Primary Prevention Strategies
Build awareness of the dangers of substance abuse
Promote good parenting skills
Build academic/vocational skills
Provide mentoring and positive role-modeling
Develop and mobilize communities to positive change
Strengthen community norms
Community Risk Factors
Availability of drugs
Availability of firearms
Community norms favorable toward drug use, firearms and crime
Media portrayals of violence and drug use
Transitions and mobility (delinquency and school drop-out)
Low neighborhood attachment and community disorganization
Family Risk Factors
Read the FADAA Hand-Out: Family Risk and Protective Factors
Family history of the problem behavior
Family management problems
Family conflict
Favorable parental attitudes and involvement in the behavior
School Risk Factors
Early and persistent antisocial behavior
Academic failure in elementary school
Lack of commitment to school
Individual/Peer Risk Factors
Alienation, rebelliousness, and lack of bonding to society
Friends who engage in the problem behavior
Favorable attitudes toward the problem behavior
Early initiation of the problem behavior
Biological/physiological factors
Parents and Prevention
It
is
well documented that parents play the most vital role in whether or not their children abuse drugs or alcohol. But many parents are ill-informed about the nature of substance abuse and how it impacts their children.
Many parents:
Believe that alcohol/drug abuse is a national problem, but may be unaware their own children are at risk.
May be
unaware their own children are exposed to drugs/alcohol at an early age.
May have little information about drugs and their effects.
May find it difficult to talk to their children about drugs.
May think their children dont have the money for drugs.
May accept limited drug use among adults.
Usually
abstain from drug or excessive alcohol use.
Believe parents should take the lead in preventing drug use by their own children.
