Relapse Prevention

[ClayTheScribe]

Below is a link to a great article in TIME on falling off the wagon and fighting urges. My favorite line: "It helps for people to remind themselves that if they can resist an addictive urge once, it will become easier and easier to do it again in the future."

Any truth to that?

Why Falling Off the Wagon Isn't Fatal - TIME

[dgillz]

In my personal experience, yes it gets easier.

[CarolD]

Time also had an interesting article..."How We Get Addicted"

How We Get Addicted - TIME

BTW...
The title of the link you posted ....is not
true for alcoholics. Many of us do not live
thru a relapse or restart our sober time.

It was obviously pointed towards food addiction.

Not to say his research is without merit.
Behavior modification techniques are not new.

I was sober when SMART appeared. I did use their
CBT with good results for an issue...not my alcoholism.

Everyone should try everything to get healthy.

[CarolD]

Yes Clay....the longer I was sober my cravings lessened
both in frequency and intensity. They had vanished by
the end of 2 months.

In early sobriety....I timed my cravings.

They were 5-7 minutes in duration.
Not too long too endure discomfort
.
Soooo....I took action.
Walked...rushed my teeth... Drank cold water...Hard candy

I also think it helped that I was following an eating plan
based on hypoglycemia.....and attending AA daily. ...

All my best Thanks for sharing

[sfgirl]

Really good article! A few things struck me:

Marlatt discovered that people who considered the act of smoking a single cigarette after their quit date to be a complete defeat and evidence of an innate and permanent lack of willpower were much more likely to let a momentary lapse become a full-blown relapse.

In the beginning of my sobriety I thought about sober time very loosely. I couldn't quite commit in my head or heart to sobriety being permanent but I also didn't want it to just be an experiment. So I was just sort of riding it out day by day. When it got more real, I relapsed. I went out one night and drank. When I sat down to think about it, I felt it was because part of me wanted to feel like I could do this (being sober/getting sober/recovery) and not be perfect. I wanted to know that one night of a mistake wasn't going to ruin my life or my recovery and that was true. I was not derailed. I learned and went on. Now my recovery is much, much stronger and me going out will probably not happen. But I do think that looser attitude towards relapse helped me get back on the horse.

Also, says Marlatt, "most people think that if they have urges or cravings, there's something wrong, that you're not supposed to have them." In fact, they are a normal part of habitual behavior. "Notice and accept them," he says, and be mindful of when and why they occur...Marlatt teaches a technique called "urge surfing" as a way to cope. "The urge is like a wave," he says. "It goes up and down. You don't try to get rid of it, but accept it and let it pass."

This is really solid advice. Also for me this does not only pertain to urges but also "bad feelings." As addicts I feel we have this desire to move away from feeling bad. In recovery sometimes we think because we are sober we should always be feeling happy. I have not found this to be true. I had to wade through a lot of buried emotional pain. Noticing and accepting BOTH URGES AND FEELINGS is extremely helpful and is a skill that you develop more and more the more you get sober.

it will become easier and easier to do it again in the future.

Yes, especially if you practice the mindfulness he talks about.

Marlatt uses the acronym SOBER to instruct patients on how to deal with a slip or fight off the urge to do so. The S stands for stop: pause for a moment and consider what you are doing. O means observe: think about what you are sensing, feeling and experiencing, and what events led to the situation. B is for breathe: take a few deep breaths. Then, expand your awareness and remind yourself of what will happen if you keep repeating the unwanted behavior and how you will feel afterward. R stands for respond mindfully: remember that you have a choice, that you are not powerless, and that you don't have to continue the undesired behavior.

I also dig this and think it to can be applied to more areas of recovery than just urges.

[Lenina]

sfgirl,

Good post! Thank you!

Love,

Lenina

[sfgirl]

Clay I think you turned me on to my new addiction specialist hero. Dr. Marlatt, the doctor quoted in the article, devised and is studying this new program for getting sober called Mindfulness-Based Relapse Prevention (MBRP) which mixes mindfulness techniques (think vipassana meditation) with cognitive behavioral therapy. Sounds to me like my perfect program:

What's New in Science - The Daily of the University of Washington


I think this is really true which is basically why I said the thing above about surfing the bad feelings as well as the urges, and that too gets much easier...

"We found that the number-one trigger for relapse for people who have been through treatment for alcohol and drugs is negative emotional states," said G. Alan Marlatt, a psychology professor and the director of the Addictive Behaviors Research Center. "If people are feeling bad, and if they've used drugs in the past to make themselves feel better in the short term by getting high, then, unless they've figured out or been taught other ways to cope with these negative emotions, they're a big trigger."

[Pilgrim]

Im an alcoholic. Relapse prevention doesn't make sense to me. I did not have the ability to control my drinking. I had lost all choice. Sometimes I could manage for a while but the day always came when I drank again.

Triggers? Try waking up. Breathing. I drank no matter what. It did not make sense when people said to me I drank for emotional reasons alone. Something physical was going on too.

If I had enough control to prevent a relapse, I wouldn't be an alcoholic.

[ClayTheScribe]

Originally Posted by Pilgrim

Im an alcoholic. Relapse prevention doesn't make sense to me. I did not have the ability to control my drinking. I had lost all choice. Sometimes I could manage for a while but the day always came when I drank again.

Triggers? Try waking up. Breathing. I drank no matter what. It did not make sense when people said to me I drank for emotional reasons alone. Something physical was going on too.

If I had enough control to prevent a relapse, I wouldn't be an alcoholic.

What did end up working for you, AA? I guess I thought a major component to recovery was relapse prevention, doing things and thinking a different way to avoid relapsing. Mindfulness and CBT is what's keeping me sober today.

Speaking of mindfulness, for those experiencing bad feelings and depression in recovery, a wonderful, science-based book is called The Mindful Way Through Depression. It combines mindfulness and CBT. Has helped me out a lot, though I can't find it in my room!

[Dee74]

As Carol said, alcoholics often do not survive relapses, so I read this article, in this context, with considerable caution....

There's an old Australian saying 'better to be hung for a sheep than a lamb'...I used it many times - it's the 'screw it' principle that the article talks about.

Maybe, for me, after two years of recovery, I mightn't nowadays say 'screw it' if I did drink, and I could and would successfully modify my behaviour and not 'derail'....

but I can't rely on 'mights'....I have a long history that suggests it won't end well....and I have a life that depends on me being, and staying, sober.

I did agree with the cravings and urges ideas tho...and yes - like any learned skill, it does get easier to resist urges the more you do it....

D

[Pilgrim]

Hi Scribe,

It depends what you mean by AA. If you mean the format of discussion meetings and group therapy then no. That didn't work for me at all. That is fellowship alone and while some heavy drinkers can stop just by going to meetings, I couldn't stop that way either.

I was beyond human help. Im human so that includes me. I couldn't help myself at all around alcohol. No one else could either. Human help also includes meetings and treatment and counseling. For those who can stop without what I discovered when I took the steps then that's wonderful. But if someone is an alcoholic of my type, true recovery based on human resources is not something I have seen or experienced. Maybe someone on this site will relate to that.

[CarolD]

Well....
I know the AA 12 Steps were an effective
method that changed my alcoholic behaviors

By living them ..I am a recovered alcoholic.....

I sincerely hope each of you can find the joy
of living addiction free. Your way need not be mone.
:ghug

[keithj]

I'm an alcoholic. My own experience, born out of years of trying to stop drinking, informs me that I have lost the power of choice in taking a drink. If thought stopping techniques, snapping little bands around my wrist, thinking the drink through, reminding myself of the consequences of the last drink, or any other way of thinking myself out of a drink would have worked, I would happily do them. I've got amazingly strong will power and strength in other areas of my life. For me, that will power proved useless in being sober. Anything I can think myself out of, I can think myself into. It's just the limitations of this particular human brain.

Instead, the fight is over. I lost. I recovered through AA's 12 steps. End of story.

[bugsworth]

I think that there is no doubt that learning to resists urges makes us stronger. Our brain is like any other muscle in our body...it gets stronger with use. Learning how to move thru our emotions without alcohol takes practice...the more you practice the easier it becomes. Thanks for the link!

[spittake]

Originally Posted by bugsworth

...the more you practice the easier it becomes.

And, the better you are at it!

[tommyk]

I like what the article states.

With me, all I have to do is break the current bad train of thought.

My mind can only think of one thing at a time (even though it seems like I can have 1,000 thoughts running through my head, it's not true).

I use different tools to break the bad train of thought.

The bad train of thought becomes less and less frequent.

[ClayTheScribe]

Originally Posted by Pilgrim

Hi Scribe,

It depends what you mean by AA. If you mean the format of discussion meetings and group therapy then no. That didn't work for me at all. That is fellowship alone and while some heavy drinkers can stop just by going to meetings, I couldn't stop that way either.

I was beyond human help. Im human so that includes me. I couldn't help myself at all around alcohol. No one else could either. Human help also includes meetings and treatment and counseling. For those who can stop without what I discovered when I took the steps then that's wonderful. But if someone is an alcoholic of my type, true recovery based on human resources is not something I have seen or experienced. Maybe someone on this site will relate to that.

Sorry I'm a journalist, so I'm persistent. What has worked for you, Pilgrim, if anything?

[Zencat]

Marlatt uses the acronym SOBER to instruct patients on how to deal with a slip or fight off the urge to do so. The S stands for stop: pause for a moment and consider what you are doing. O means observe: think about what you are sensing, feeling and experiencing, and what events led to the situation. B is for breathe: take a few deep breaths. Then, expand your awareness and remind yourself of what will happen if you keep repeating the unwanted behavior and how you will feel afterward. R stands for respond mindfully: remember that you have a choice, that you are not powerless, and that you don't have to continue the undesired behavior.

I like that, especially the respond mindfully. Regardless of what I think or believe ultimately its my behavior that revels my true intent. For me changing my behavior first and then the mind will follow.

[sfgirl]

Originally Posted by keithj

I'm an alcoholic. My own experience, born out of years of trying to stop drinking, informs me that I have lost the power of choice in taking a drink. If thought stopping techniques, snapping little bands around my wrist, thinking the drink through, reminding myself of the consequences of the last drink, or any other way of thinking myself out of a drink would have worked, I would happily do them. I've got amazingly strong will power and strength in other areas of my life. For me, that will power proved useless in being sober. Anything I can think myself out of, I can think myself into. It's just the limitations of this particular human brain.

I agree in general with what you are saying about thinking. I think that rational thinking can be very tricky in making decisions when it comes to alcohol because all of the sudden your little addict brain can come in and take over and for me at least it took a very long time to be able to even know that I had an "addict voice."

However, I am not sure to what exact techniques from the article you are referring but I don't think that any of them are about "thinking". For me personally something like "urge surfing" is much more about just allowing yourself to feel the feeling, accept it, notice it, and allow it to pass through your body without take the action. In fact, what you don't want to do is engage in any sort of linguistic thought or entertain any sort of action related to the feeling. And when he talks about reflecting on things mindfully, I take it much in the way that mindfully is used in the Buddhist tradition, which is very similar. It is not the cognitive brain per se that is doing the action but the other part, in fact one could argue the spiritual center. I am sure that Wikipedia will do a better job at explaining mindfulness than I could ever get at so here it is

Mindfulness - Wikipedia, the free encyclopedia

I just wanted to draw that important distinction. I do not in anyway think that the article is advocating one to out-think one's cravings.

[Pilgrim]

Hi Scribe,

I am pleased you are curious and I am more than happy to pass on my experience. My experience isn't original. Thousands have gone before me.

I can't describe it better than the Big Book so please forgive me if I quote from there. Regarding whether or not we (real alcoholics) can use our own mental powers to control our drinking:

"...these drinkers are abnormal, but everybody hopefully awaits the day when the sufferer will rouse himself from his lethargy and assert his power of will.

The tragic truth is that if the man be a real alcoholic, the happy day may not arrive. He has lost control. At a certain point in the drinking of every alcoholic, he passes into a state where the most powerful desire to stop drinking is of absolutely no avail. "

and

"The fact is that most alcoholics, for reasons yet obscure, have lost the power of choice in drink. Our so called will power becomes practically nonexistent. We are unable, at certain times, to bring into our consciousness with sufficient force the memory of the suffering and humiliation of even a week or a month ago. We are without defense against the first drink"

and

We alcoholics are men and women who have lost the ability to control our drinking. We know that no real alcoholic ever recovers control.

Once more: The alcoholic at certain times has no effective mental defense against the first drink. Except in a few cases, neither he nor any other human being can provide such a defense.

Again, from the Big Book: "Strange as this may seem to those who do not understand—once a psychic change has occurred, the very same person who seemed doomed, who had so many problems he despaired of ever solving them, suddenly finds himself easily able to control his desire for alcohol, the only effort necessary being that required to follow a few simple rules".

The rules I followed are in 20 pages of the Big Book. There are clear cut instructions which worked for the first one hundred who wrote the book and it has worked for many more since then.

That's what I did and that's what I do. I am recovered. I am sane around alcohol.

BB Quotes, 1st. Edition

[spittake]

Originally Posted by sfgirl

For me personally something like "urge surfing" is much more about just allowing yourself to feel the feeling, accept it, notice it, and allow it to pass through your body without take the action. In fact, what you don't want to do is engage in any sort of linguistic thought or entertain any sort of action related to the feeling.

This takes lots of practice, too. Unsurprisingly, it's going to be very difficult at first. If we practice mindfulness techniques when we aren't in the midst of an urge, we will be much better equipped to use it when the urge hits. It's a little like using calming techniques to stave off a panic attack; that's damn near impossible to accomplish unless you've practiced it beforehand.

[Ready2Live]

Awesome thread!! Clay, thank you for starting this one; and thank you all for your invaluable input. I have much more understanding of the urges now. I am likening it to childbirth. Breathe through the pain (urge); don't panic, understand that it will pass and what's on the other side (i.e. new life; sobriety) makes every "pain" more manageable.

[Bamboozle]

Rational thinking isn't the problem...if an addicted person finds reasons to drink, he/she is not thinking rationally. It's a way to make excuses. I did it all the time and always justified it. I self-medicated...but I didn't care that there are healthy ways to treat mental illness.

Being accountable helps me to stay sober:

1. If I drink my meds will not be effective.

2. If I drink along with my meds I may be putting my health at immediate risk.

3. If I drink I have to fess up to my therapist...and she’d be pissed.

4. If I drink I will not be able to do my photography.

5. If I drink I will not be able to be responsible at work in a supervisory position.

This is the short list…I can think of a lot more to add.

The only thing I’m missing from drinking is the escape and feel good moments…but that was just a way to avoid my illness and my problems…thereby making everything worse.

Now I actually have a shot at a better life. I know there are few guarantees, but if I fall down the drinking hole I know for certain my life will go to absolute sh!t right before death.

In a nut shell, my relapse prevention is therapy and SR...and reflection.