305 – Relapse Prevention | Journey to Recovery Series

Journey to Recovery Series: Relapse Prevention
Presented by: Dr. Dawn-Elise Snipes
Executive Director, AllCEUs
Host: Counselor Toolbox
Objectives
~ Define Relapse, Relapse Triggers and Relapse Warning Signs
~ Explore the Function of Relapse and Differentiate from Resistance
~ Identify Essential Components for a Relapse Prevention Plan
Stages of Relapse Prevention Planning
~ Stabilization
~ Assessment of the situation and any negative patterns or problems that contributed to past relapses are identified
~ Relapse Education: The person and his or her supports must understand the process of relapse
~ Warning Signs Identification and Management
~ Trigger identification and Management
~ Recovery Planning: Putting it Together
~ Mindfulness Training: to anticipate, evaluate, and avoid high-risk situations.
~ Family Involvement.
~ Follow up: Recovery is never static.

What is Relapse
~ Relapse is a return to a prior state of functioning
~ Relapse stages (Cognitive Triad)
~ Emotional
~ Mental
~ Physical
~ Relapses often start long before the person has a return to the prior state.
~ Backward chain a depressive episode
~ Backward chain a smoking relapse
~ Relapses indicate that the old way is more rewarding than the new way. Why? What was missed?
~ Relapse prevention planning means developing a recovery based lifestyle that includes emergency plans.

Relapse Prevention Plan
~ Why did you use/eat/gamble/get depressed etc?
~ What other strategies do you have to cope?
~ When you are not symptomatic, what is different?
~ Why do you want to change? (MEEPS)
~ What triggers your unpleasant mood or desire to use? (MEEPS)
~ How can you prevent and mitigate each one
~ What potential obstacles do you envision and how can you deal with them?
~ What are some old behaviors, thoughts or feelings that warn you that a relapse might be coming?
~ What are your expectations about relapse?

Relapse Prevention Plan
~ What does a RML look like for you?
~ Imagine that it’s your last day on earth. What would you do? Who would you spend it with? Would you be satisfied with the way your life turned out? If not, what do you wish you had done?
~ Who are your helpful social supports?
~ What is your mindfulness plan?
~ What is your self-care plan?
~ Mental
~ Emotional
~ Environmental
~ Physical
~ Social
Essential Skills
~ Mindfulness
~ Vulnerability Prevention
~ Distress Tolerance Skills
~ Urge Surfing
~ ACCEPTs & IMPROVE
~ Unhooking
~ Coping Skills
~ Radical Acceptance: “This is really uncomfortable, but at least my withdrawal symptoms will go away within a few days.”
~ Problem solving
~ ABCs
~ Behavior Modification

Essential Skills
~ The 4 Ds
~ Delay – Cravings and emotions crest in about 20 minutes.
~ Distract – Craving/distress time passes more quickly when engaged in a distracting activity for a few minutes.
~ Deep breathing (De-Stress) – Deep breathing exercises and focused mindfulness can keep you from making rash decisions.
~ De-Catasrophize –
~ Challenge your thoughts
~ What are the facts for and against? (Do I have enough info to make a judgement?)
~ Is this emotional reasoning?
~ Am I focusing on just one aspect of the situation?
~ What parts are in my control?
~ Am I confusing high and low probability events?
Essential Skills
~ Relapse Prevention Card
~ Fold a paper into four squares:
~ On the first square, write The Four Ds (Delay, Distract, Deep Breathe, De-Catastrophize
~ On the second square, write 3 to 5 distraction ideas
~ On the third square, write 3 or 4 of your most significant reasons for wanting to recover
~ On the fourth square, write some negative but accurate predictions for what will happen if you stop following your recovery plan.

Relapse Triggers
~ Relapse triggers are stimuli or conditions that prompt the person to think about or start returning to the previous state of functioning
~ Mental
~ Emotional
~ Environmental (Visual, Olfactory, Auditory)
~ Physical (Pain, exhaustion, poor nutrition)
~ Social (Peer pressure, relationship challenges, low self-esteem)
Relapse Warning Signs
~ Emotional
~ Isolation
~ Irritability
~ Blaming others
~ Withdrawal from support groups
~ Focusing on others’ problems
~ Bottling emotions
~ Guilt
~ Feeling helpless and hopeless

Warning Signs
~ Mental
~ Drug or alcohol cravings
~ Lying
~ Pessimism and negativity
~ Poor concentration
~ Difficulty making decisions

Warning Signs
~ Physical
~ Changes in sleeping
~ Changes in eating
~ Increased pain
~ Restlessness
~ Fatigue
~ Slowing or heaviness
~ GI Distress

Warning Signs
~ Other Warning Signs
~ I feel like I have a secret but I don’t know what it is
~ I get quiet around my friends for no particular reason
~ I’m so preoccupied that I stumble over my words or make other goofs for no obvious reason
~ I get hung up on compulsive activity like mindlessly playing Solitaire for hours on end
~ I think of reasons not to do the things I need to for recovery like get to bed on time, exercise, or be mindful.
~ When I get to some obvious trigger situation, I don’t quickly avoid it or block it
~ I get gloomy for no visible reason
Warning Signs
~ Other Warning Signs
~ I get irritable, harsh, unfair, or aggressive for no reason I can explain
~ I suddenly feel like a doormat and let people walk all over me
~ I feel like I’m going to get revenge on people soon
~ I cut people out of my life and isolate myself
~ I feel as if some doom is impending
Relapse Thoughts
~ Address Relapse Prone Thoughts (Strengths and Dialectics)
~ I am disappointed in recovery. (I was promised a rose garden)
~ I’m a bad person. (I should do the world a favor and disappear)
~ My life is unmanageable. (relapsing/using will really help me get on top of it, yeah)
~ Nobody cares (or will know) whether I relapse or not. (I’m nobody)
~ The person who wants me to change is a jerk. (So why bother)
~ The person who caused my relapse is a jerk. (So I'll relapse and make him/her feel guilty)
~ Recovery is too hard. I am afraid people will expect too much from me
Relapse Thoughts
~ Address Relapse Prone Thoughts (Strengths and Dialectics)
~ The world is against me. (It’s hopeless)
~ There’s nothing the matter with me. (So why do I need a recovery program? I just need to get my push through.)
~ Trying to change myself or my life is pointless. (Screw it!)
~ My recovery is ironclad. (I don’t have to work my program anymore)
~ By relapsing, I’ll really get even. (At my funeral they’ll be sorry — if anybody shows up)
~ Certain people want me to relapse. (And I will oblige them)
~ I can’t handle my shame and guilt. (So I’ll add to my shame and guilt by relapsing)
Relapse Thoughts
~ Address Relapse Prone Thoughts (Strengths & Dialectics)
~ I can’t handle the emotional pain. (So I’ll make it worse)
~ I’ll never be able to undo all the harm I’ve done to other people or the mistakes I made. (So I should forever punish myself)
~ I’m just a defective person. (I’ll never get it together, why try?)
~ I’m making no progress, it’s hopeless. (I might as well give up)
~ I’m powerless against this. (I might as well stop fighting it)
~ I’ve made up my mind I’ll never relapse; case closed. (So why bother working any kind of recovery program?)
~ It’s all hopeless. (Might as well check out)
~ If I get better, then I might not be able to tolerate another relapse.