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Old 10-02-2008, 08:32 AM   #1 (permalink)

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Relapse Prevention Planning

Relapse Prevention Planning

Proper action on the part of the alcoholic and key persons in his or her life can prevent or interrupt relapse before the consequences become tragic. Planning for relapse minimizes its destructive potential. Alcoholics can utilize intervention skills at any time before drinking becomes out of control if they are prepared to recognize and understand the relapse process.

The alcoholic is ultimately responsible for all behaviour and decisions that accompany relapse. The alcoholic pays most heavily for relapse. Many alcoholics relapse because they don't understand the process and don't know what types of behaviour change are necessary to prevent it. Most relapse in alcoholism is unnecessary. It stems from lack of knowledge.

Alcoholism is a disease prone to relapse. If you had heart disease your family would know the warning signs and what to do in case of heart attacks. The same would be true if you were diabetic or epileptic. Any condition with high relapse potential should be treated with respect. The relapse pattern should be systematically explored and prevention tactics individually designed.

Proper relapse prevention plans can give you and the concerned people in your life a deep-seated sense of security. All involved can know that they are doing everything that is necessary to prevent relapse. They can develop a plan and a checklist of warning signs. As long as you follow that plan and watch for warning signs, you can be confident that recovery is following a successful course.

An essential part of the treatment process is the establishment of a relapse prevention plan. The plan should include the individuals in your life. Each person should be informed of the potential for relapse and their responsibility and appropriate action if you demonstrate early signs of relapse. The steps of relapse prevention planning are:

1. Stabilization: The first step in preventing relapse is stabilizing from the relapse that has just occurred or, if this is your first time in treatment, stabilizing your sobriety.

2. Assessment: If this is your first time in treatment, you need to assess whether you are ready for relapse prevention planning. Do you believe that you are really alcoholic and that you need to change your lifestyle? If you are not sure, you need to work on these issues before you are ready to develop a relapse prevention plan. You have to believe that you have a disease that is subject to relapse before you can do what is necessary to prevent that relapse. If you have relapsed previously, then you need to cooperate with your therapist to assess that relapse and other relapses you may have experienced to determine what contributed to the relapse process and what could have prevented it.

3. Education About the Relapse Process: You need to learn about recovery and relapse. You need to understand the sobriety-based symptoms and what it takes to manage those symptoms. You should review the 37 warning signs of relapse and learn to describe examples of the general process and specific symptoms.

4. Warning Sign Identification: Develop a list of warning signs or indications that you may be in risk of drinking. The warning list should be developed from past experiences with relapse warning signs. Try to identify at least ten specific and clear indicators that you are moving away from productive and comfortable living and beginning to set yourself up for relapse.

5. Review of Recovery Program: Recovery and relapse are opposite sides of the same coin. If you are not in the process of recovering, you are in the process of relapsing. A good recovery program is necessary to prevent relapse. Has your previous recovery program been working for you? How can it be improved? Develop a new recovery program based on what has worked for you and what has not worked for you in the past.

6. Inventory Training: Any successful recovery program involves daily inventory. AA Step 10 says, “Continued to take personal inventory and when we were wrong promptly admitted it." The alcoholic must learn to challenge himself in his day-to-day living patterns. "Am I living up to my own standards and values? Are those standards and values realistic? Am I acknowledging my alcoholism and managing its symptoms? Am I attending to my overall health needs?" For a relapse prevention plan you should design a special inventory system that monitors the warning signs of potential relapse. Develop a way to incorporate this inventory system into the fabric of day-to-day living. The key issue is this: You now know the personal warning signs. How are you going to determine if any of these symptoms have been activated in your life?

7. Interruption of the Relapse Warning Signs: It is now important to establish new responses to the identified warning signs of relapse. Determine what you are going to do about each symptom when you are able to recognize that it is working in your life. And practice each new response until it becomes a habit. The response must be available in times of stress. Only habits are dependable in times of stress. You must practice in times of low stress until the response becomes a habit.

8. Involvement of Significant Others: Make a list of all the people with whom you have daily contact. Select from that list those people that you think would be important in helping you stay sober and avoid a relapse. Determine how each person has interacted with you in the past when you have shown symptoms of relapse. Has it been helpful or harmful to your sobriety? What could they have done that would have been more helpful to your staying sober? Now determine what you would like each of these people to do the next time symptoms of relapse are recognized. Bring the key people in your life together for a meeting. Explain to them your list of personal warning signs and form a contract with each support person as to what they will do when relapse symptoms are recognized and what they will do if you begin drinking.

9. Follow-up and Reinforcement: Recovery from alcoholism is a way of life. Since relapse prevention planning is part of the recovery, it too must become a way of life. Relapse prevention must be practiced until it becomes a habit. We are all enslaved by our habits. The only freedom we can find is to choose carefully the habits to which we allow ourselves to become enslaved.

For the recovering alcoholic, it is especially true that there is freedom in structure. It is only in the habit and structure of a daily sobriety program that the alcoholic can find freedom from enslavement to alcohol.

Relapse is a process. A process is different from an event. When an event has taken place, it is unchangeable. A process can be changed or interrupted at any time. It is ongoing; it is occurring; it is not fixed in time. To see a process as an event blocks change. Death is an event; grief is a process. To experience grief as an event locks you into grief as though it were the event of death.

Relapse is not an event; it is subject to change or interruption. Relapse begins long before the first drink. There are warning signs and symptoms that pave the way. These symptoms can act as early warning signals to alcoholics and their families. By understanding the process, unnecessary pain can be avoided. Proper action by alcoholics and the key people in their lives can prevent relapse or interrupt the relapse before the consequences become tragic.

Points to Remember:

1. Most people do not make it after the first attempt at sobriety.

2. People get drunk because they fail to do what is necessary to stay sober.

3. There are a variety of behavioural setups which make a return to drinking an alternative in spite of known consequences.

4. Relapse begins long before the first drink. There are 37 warning signs of relapse.

5. Proper action by you and the key people in your life can prevent or interrupt relapse before the consequences become tragic.

6. A relapse prevention plan is an important part of treatment.

Reprinted from: St Joseph's Hospital
Box 5000-203, 1176 Nicholson Rd, Estevan, SK.S4A 2V6
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Old 10-02-2008, 10:57 AM   #2 (permalink)
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Don't drink .... works really good for me.
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Old 10-02-2008, 11:04 AM   #3 (permalink)
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I had to find the 37 warning signs.

The Phases and Warning Signs of Relapse

Terence Gorski & Merlene Miller

Phase1: The Return of Denial. During this phase the alcoholic becomes unable to recognize and honestly tell others what he/she is thinking or feeling. The most common symptoms are:

1. Concern about Well Being. The alcoholic feels uneasy, afraid, and anxious. At times he/she is afraid of not being able to stay sober. This uneasiness comes and goes and usually only lasts a short period of time.

2. Denial of the Concern. In order to tolerate these periods of worry, fear and anxiety, the alcoholic ignores or denies these feelings in the same way he/she had at one time denied the alcoholism. The denial may be so strong that there is no awareness of it while it is happening. Even when there is an awareness of the feelings, they are often forgotten as soon as the feelings are gone. It is only when the alcoholic thinks back about the situation at a later time that he/she is able to recognize the feelings of anxiety and the denial of the feelings.

Phase2: Avoidance and Defensive Behaviour. During this phase the alcoholic doesn’t want to think about anything that will cause the painful and uncomfortable feelings to come back. As a result he/ she begins to avoid anything or anybody that will force an honest look at self. When asked direct questions about well being, he/she tends to become defensive. The most common symptoms are:

3. Believing “I’ll never drink again” The alcoholic convinces self that he/ she will never drink again and sometimes will tell this to others, but usually keeps it to self. Many are afraid to tell their counsellors or other AA members about this belief. When the alcoholic firmly believes he/she will never drink again, the need for a daily recovery program becomes less important.

4. Worrying about Others Instead of Self. The alcoholic becomes more concerned about the sobriety of others than about personal recovery. He/she doesn’t talk directly about these concerns but privately judges the drinking of friends and spouse and the recovery programs of other recovering persons. In AA this is called “working the other guy’s program”.

5. Defensiveness. The alcoholic has a tendency to defend self when talking about personal problems or his/her recovery program even when no defence is necessary.

6. Compulsive Behaviour. The alcoholic becomes compulsive ( stuck, fixed or rigid) in the way he/she thinks and behaves. There is a tendency to do the same things over and over again without a good reason. There is a tendency to control conversations either by talking too much or not at all. He/ she tends to work more than is needed, becomes involved in many activities and may appear to be the model of recovery because of heavy involvement in AA 12 step work and chairing AA meetings. He/she is often a leader in counselling groups by “playing the therapist”. Casual or informal involvement with people, however, is avoided.

7. Impulsive Behaviour. Sometimes the rigid behaviour is interrupted by actions taken without thought or self control. This usually happens at times of high stress. Sometimes these impulsive actions cause the alcoholic to make decisions that seriously damage his/ her life and recovery program.

8. Tendencies towards Loneliness. The alcoholic begins to spend more time alone. He/she usually has good reasons and excuses for staying away from other people. These periods of being alone begin to occur more often and the alcoholic begins to feel more and more lonely. Instead of dealing with loneliness by trying to meet and be around other people, he or she becomes more compulsive and impulsive.

Phase 3: Crisis Building. During this phase the alcoholic begins experiencing a sequence of life problems that are caused by denying personal feelings, isolating self and neglecting the recovery program. Even though he/she wants to solve these problems and works hard at it, two new problems pop up to replace every problem that is solved. The most common symptoms are:

9. Tunnel Vision. Tunnel vision is seeing only one small part of life and not being able to see “the big picture”. The alcoholic tends to look at life as being made up of separate unrelated parts. He/she focuses on one part without looking at the other parts or how they are related. Sometimes this creates the mistaken belief that everything is secure and going well. At other times this results in seeing only what is going wrong. Small problems are blown up out of proportion. When this happens, the alcoholic comes to believe he/she is being treated unfairly and has no power to do anything about it.

10. Minor Depression. Symptoms of depression begin to appear and to persist. The person feels down, blue, listless, empty of feelings. Oversleeping becomes common. He/she is able to distract self from these moods by getting busy with other things and not talking about the depression.

11. Loss of Constructive Planning. The alcoholic stops planning each day and the future. He/she often mistakes the AA slogan “ One day at a time” to mean one shouldn’t plan or think about what he/she is going to do. Less and less attention is paid to details. He/she becomes listless. Plans are based more often on wishful thinking (how the alcoholic wishes things would be) than reality (how things really are).

12. Plans Begin to Fail. Because he/she makes plans that are not realistic and does not pay attention to details, plans begin to fail. Each failure causes new life problems. Some of these problems are similar to the problems that occurred during drinking. He/she often feels guilty and remorseful when problems occur.

Phase 4: Immobilization. During this phase, the alcoholic is totally unable to initiate action. He/ she goes through the motions of living, but is controlled by life rather than controlling life. The most common symptoms are :

13. Daydreaming and Wishful Thinking. It becomes more difficult to concentrate. The “if only” syndrome becomes more and more common in conversation. The alcoholic begins to have fantasies of escaping or “being rescued from it all” by an event unlikely to happen.

14. Feelings that nothing can be solved. A sense of failure begins to develop. The failure may be real or it may be imagined. Small failures are exaggerated and blown out of proportion. The belief that “I’ve tried my best and sobriety isn’t working out” begins to develop.

15. Immature wish to be happy. A vague desire to “be happy” or to have “things work out” develops without the person identifying what is necessary to be happy or to have things work out. Magical thinking is used : wanting things to get better without doing anything to make them better.

Phase 5: Confusion and Overreaction. During this period the alcoholic can’t think clearly. He/ she becomes upset with self and others, becomes irritable and over reacts to small things.

16. Periods of confusion. Periods of confusion become more frequent, last longer, and cause more problems. The alcoholic often feels angry with self because of inability to figure things out.

17. Irritation with friends. Relationships become strained with friends, family, counsellors and AA members. The alcoholic feels threatened when these people talk about the changes in behaviour and mood that are becoming apparent. The conflicts continue to increase in spite of the alcoholic’s efforts to resolve them. The alcoholic begins to feel guilty and remorseful about his/her role in these conflicts.

18. Easily Angered. The alcoholic experiences episodes of anger, frustration, resentment, and irritability for no real reason. Overreaction to small things becomes more frequent. Stress and anxiety increase because of the fear that overreaction might result in violence. The efforts to control self adds to the stress and tension.

Phase 6: Depression. During this period the alcoholic becomes so depressed that he/she has difficulty keeping to normal routines. At times there may be thoughts of suicide, drinking or drug use as a way to end the depression. The depression is severe and persistent and cannot be easily ignored or hidden from others. The most common symptoms are:

19. Irregular Eating Habits. The alcoholic begins overeating or under eating. There is weight gain or loss. He/ she stops having meals at regular times and replaces a well balanced, nourishing diet with “junk food”.

20. Lack of desire to take action. There are periods when the alcoholic is unable to get started or to get anything done. At those times he/she is unable to concentrate, feels anxious, fearful, uneasy, and often feels trapped with no way out.

21. Irregular sleeping habits. The alcoholic has difficulty sleeping and is restless and fitful when sleep does occur. Sleep is often marked by strange and frightening dreams. Because of exhaustion, he/she may sleep for twelve to twenty hours at a time. These “sleeping marathons” may happen as often as every six to fifteen days.

22. Loss of daily structure. Daily routine becomes haphazard. The alcoholic stops getting up and going to bed at regular times. Sometimes he/she is unable to sleep, and this results in over sleeping at other times. Regular mealtimes are discontinued. It becomes more difficult to keep appointments and to plan social events. The alcoholic feels rushed and overburdened at times, and then has nothing to do at other times. He/ she is unable to follow through on plans and decisions and experiences tension, frustration, fear, or anxiety that keep him/her from doing what should be done.

23. Periods of deep depression. The alcoholic feels depressed more often. The depression becomes worse, lasts longer, and interferes with living. The depression becomes so bad that it is noticed by others and cannot easily be denied. The depression is most severe during unplanned or unstructured periods of time. Fatigue, hunger, and loneliness make the depression worse. When the alcoholic feels depressed, he/she separates from other people, becomes irritable and angry with others, and often complains that nobody cares or understands what he/ she is going through.

Phase 7: Behavioural Loss of Control. During this phase the alcoholic becomes unable to control or regulate personal behaviour and a daily schedule. There is still a heavy denial and no full awareness of being out of control. His/ her life becomes chaotic and many problems are created in all areas of life and recovery, The most common symptoms are:

24. Irregular attendance at AA and Treatment meetings. The alcoholic stops attending AA regularly and begins to miss scheduled appointments for counselling or treatment. He/she finds excuses to justify this and doesn’t recognize the importance of AA or treatment. He/ she develops the attitude that “AA and counselling aren’t making me feel better, so why should I make it a priority?” “Other things are more important.”

25. Development of an “I don’t care” attitude. The alcoholic tries to act as if he/ she doesn’t care about the problems that are occurring. This is to hide the feelings of helplessness and a growing lack of self respect and self confidence.

26. Open Rejection of Help. The alcoholic cuts self off from people who can help. He/ she does this by having fits of anger that drive others away, by criticizing and putting others down, or by quietly withdrawing from others.

27. Dissatisfaction with life. Things seem so bad that the alcoholic begins to think that he/she might as well drink because things couldn’t get worse. Life seems to have become unmanageable since drinking stopped.

28. Feelings of powerlessness and helplessness. The alcoholic develops difficulty in “getting started”, has trouble thinking clearly, concentrating, thinking abstractly, and feels that he/she can’t do anything and begins to believe there is no way out.

Phase 8: Recognition of Loss of control. The alcoholic’s denial breaks and suddenly he/ she recognizes how severe the problems are, how unmanageable life has become, and how little power and control he/she has to solve any of the problems. This awareness is extremely painful and frightening. By this time he/ she has become so isolated that there is no one to turn to for help. The most common symptoms are:

29. Self Pity. The alcoholic begins to feel sorry for self and often uses self pity to get attention at AA or from family members.

30. Thoughts of social drinking. The alcoholic realizes that drinking or using drugs would help him/her to feel better and begins to hope he/ she can drink normally again and be able to control it. Sometimes these thoughts are so strong that they can’t be stopped or put out of mind. There is a feeling that drinking is the only alternative to going crazy or committing suicide. Drinking actually looks like the sane and rational alternative.

31. Conscious Lying. The alcoholic begins to recognize the lying , the denial and the excuses but is unable to interrupt them.

32. Complete loss of self confidence. The alcoholic feels trapped and overwhelmed by the inability to think clearly and take action. This feeling of powerlessness causes the belief that he/ she is useless and incompetent. As a result there is the belief that life is unmanageable.

Phase 9: Option reduction. During this phase the alcoholic feels trapped by the pain and inability to manage his/her life. There seem to be only 3 ways out, insanity, suicide or drug use. He/ she no longer believes that anyone or anything can help them. The most common symptoms are :

33. Unreasonable Resentment. The alcoholic feels angry because of the inability to behave the way he/she wants to. Sometimes the anger is with the world in general, sometimes with a particular person, and sometimes with self.

34. Discontinuance of all treatment and AA. The alcoholic stops attending all AA meetings. Those taking Anabuse will forget to take it or deliberately avoid taking it regularly. When a helping person is part of treatment, tension and conflict develop and become so severe that the relationship usually ends. The alcoholic drops out of counselling even though he/she needs help and knows it.

35. Overwhelming Loneliness, Frustration, Anger and Tension. The alcoholic feels completely overwhelmed. He /she believes there is no way out except drinking, suicide or insanity. There are intense fears of insanity and feelings of helplessness and desperation.

Phase 10: Acute Relapse Episode. During this phase the alcoholic becomes totally unable to function normally. He/she may use alcohol or drugs or may become disabled with other conditions that make it impossible to function. The most common symptoms are:

36. Loss of behaviour control. The alcoholic experiences more and more difficulty in controlling thoughts, emotions, judgements, and behaviours. This progressive and disabling loss of control begins to cause serious problems in all areas of life. It begins to affect health and well being. No matter how hard he/she tries to regain control it is impossible to do.

37. Acute Relapse Episode. The alcoholic experiences periods of time when he/ she is totally unable to function normally. These periods become more frequent, last longer, and begin to produce more serious life problems. The relapse cycle is ended with a serious crisis which causes the person to become totally unable to function for a period of time due to one or more of the following:

A. Degeneration of all life areas. The alcoholic may become unable to contribute to the work, social, family, and intimate areas of life. As a result, all life areas suffer due to neglect.

B. Alcohol or drug Use. The alcoholic may begin to use alcohol or other drugs as a means to escape the pain and desperation. There may be an attempt to control drinking by limiting the amount or attempting one short term binge. The ability to control drinking is soon lost. This sometimes happens very quickly. Sometimes it occurs after a period of controlled drinking. The alcoholic returns to out-of –control drinking with symptoms experienced during the last period of alcoholic drinking.

C. Emotional Collapse. The alcoholic may become emotionally unable to function, may overreact, or become emotionally numb, or cry, or fly into a rage for no reason at all.

D. Physical Exhaustion. It may become impossible for the alcoholic to continue to function due to physical exhaustion.

E. Stress Related Illnesses. The alcoholic may become physically sick due to the severe stress that has been occurring over a long period of time.

F. Psychiatric Illness. The alcoholic may develop a severe psychiatric illness such as psychosis, severe anxiety, or severe depression. The psychiatric illness may be so severe that it forces the alcoholic into treatment.

G. Suicide. The alcoholic may become suicidal and may attempt or actually commit suicide.

H. Accident Proneness. The alcoholic may become careless and unable to take normal precautions in acts of living resulting in a sequence of accidents. These accidents may take the form of car accidents, falls, burns etc. Often the accidents are life threatening or cause serious injury.

I. Disruption of Social Structure. The alcoholic may be unable to maintain involvement in normal life activities and may become socially unable to function.

Constructing a Personalized Warning Sign List

1. Check three to five warning signs from the list above that you find most interesting for you.

2. In your own words, rewrite the summary title of the warning sign that you have checked. The summary title is the word or short phrase at the beginning of each warning sign.

3. Write a brief paragraph that describes in your own words each of the warning signs that you have selected.

4. Read your warning signs (as you have written them) to an addictions counsellor, your A.A. sponsor, or a friend, and ask for feedback. Rewrite the warning signs if they are unable to understand clearly what you mean.

5. Review the list every morning and every evening to remind yourself to look for the presence of these warning signs.

6. Discuss the list with your friends and family and ask them to tell you if they see any of the warning signs appearing in your life.

7. If you notice a warning sign, evaluate your need to get help.
As from a fire aflame thousands of sparks come forth,
even so from the Creator an infinity of beings have life and to him return again.
-- Maitri Upanishads
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Old 10-03-2008, 12:35 AM   #4 (permalink)
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Something I have never been able to understand in my 10 years of soberity is that on any given day I can have any of these signs and sometimes more than one. I.e. five at a time.

This stuff is great, in terms of information and as a guide, but too much naval gazing can be harmful.

I am into the business of living
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