It is critical that patients, their families and friends prepare for the possibility of lapse and relapse. The preparation should include early detection of a lapse and establishment of steps to keep that problem from becoming a full-blown relapse. Two sets of activities can reduce the likelihood of relapse and reduce the severity if it does occur.

Treatment-Related Preparation

A good addiction treatment program prepares patients to:

• recognize they have a problem that will require continued management and monitoring
• learn and practice some of the fundamental skills needed to recognize and overcome the urge to use or drink when these situations emerge
• be engaged in a continuing care program such as AA and receive regular monitoring of substance use through urine screening or breathalyzer
• receive periodic phone calls or in-home visits following care to monitor their recovery

These generic elements of effective planning during treatment are among the best clinical practices available to forestall lapse. This planning should involve families so they can better understand the treatment issues, be prepared to support the recovery plan and be aware of signs of lapse.

Post-Treatment Preparation

To prevent and contain relapse the family should agree to fully participate in planned continuing care activities. Families and all concerned others can take five helpful steps:

• Have copies of the continuing care plan prominently displayed to reduce ambiguity and promote full communication and response.
• Early in formal treatment, ask the family member in treatment to describe in writing some of the very early signs and behaviors that may lead to his/her lapse and relapse. For example, he/she might write something like “I will begin hanging out with my friend Jimmy,” “I will not do my homework” or “I will stop attending AA meetings.” As the family member undergoes continuing care, regularly refer to these written descriptions to monitor the recovery process.
• During formal treatment, as the individual thinks about relapse scenarios, ask what s/he thinks should be done when early relapse signs emerge. Use these words to develop a contract that includes an action plan the family will follow when any of these signs surface. For example, s/he might write “take my cash and credit cards,” or “increase the urine screens.” Be prepared – before the relapse happens – to take the type of actions contracted.
• Receive and display the results of post-treatment urine screens. Discuss any positive results openly and honestly.
• Monitor and support changes that are consistent with a drug-free lifestyle. In other words “catch him doing something good” and then support it appropriately.

Even effectively treated people with addictions will confront unexpected situations after they leave a treatment program and return to their home environment. These situations may produce intense periods of craving to re-use alcohol and other drugs. Lapse, defined as re-use of alcohol or drugs at least once following treatment, occurs in at least 50% of those who complete treatment. The most dangerous period for lapse is the first 3-6 months after completion of formal treatment. Relapse, defined as return to excessive or problematic use, is less common, occurring in approximately 20-30% of those who complete formal care in the prior year.

It is critical that patients, their families and friends prepare for the possibility of lapse and relapse. The preparation should include early detection of a lapse and establishment of steps to keep that problem from becoming a full-blown relapse. Two sets of activities can reduce the likelihood of relapse and reduce the severity if it does occur.

Treatment-Related Preparation

A good addiction treatment program prepares patients to:

• recognize they have a problem that will require continued management and monitoring
• learn and practice some of the fundamental skills needed to recognize and overcome the urge to use or drink when these situations emerge
• be engaged in a continuing care program such as AA and receive regular monitoring of substance use through urine screening or breathalyzer
• receive periodic phone calls or in-home visits following care to monitor their recovery

These generic elements of effective planning during treatment are among the best clinical practices available to forestall lapse. This planning should involve families so they can better understand the treatment issues, be prepared to support the recovery plan and be aware of signs of lapse.

Post-Treatment Preparation

To prevent and contain relapse the family should agree to fully participate in planned continuing care activities. Families and all concerned others can take five helpful steps:

• Have copies of the continuing care plan prominently displayed to reduce ambiguity and promote full communication and response.
• Early in formal treatment, ask the family member in treatment to describe in writing some of the very early signs and behaviors that may lead to his/her lapse and relapse. For example, he/she might write something like “I will begin hanging out with my friend Jimmy,” “I will not do my homework” or “I will stop attending AA meetings.” As the family member undergoes continuing care, regularly refer to these written descriptions to monitor the recovery process.
• During formal treatment, as the individual thinks about relapse scenarios, ask what s/he thinks should be done when early relapse signs emerge. Use these words to develop a contract that includes an action plan the family will follow when any of these signs surface. For example, s/he might write “take my cash and credit cards,” or “increase the urine screens.” Be prepared – before the relapse happens – to take the type of actions contracted.
• Receive and display the results of post-treatment urine screens. Discuss any positive results openly and honestly.
• Monitor and support changes that are consistent with a drug-free lifestyle. In other words “catch him doing something good” and then support it appropriately.

By: Thomas McLellan PHD

Walking Away Isn’t Quitting

When you walk away from your family, it should never be as a result of the desire to quit. Whether you are the recovering addict or the spouse of the newly-sober individual, your reasons for leaving must be based on the best interests of all concerned. The decision should come after all other options have been thoroughly explored, and/or you’ve come to the realization that by staying, you’re doing more harm than good – harm to you, your spouse and your family.

Let’s take an example. Jennifer, mid-30s, is the live-in partner of Woody, 40. They have no children but prior to Woody’s stay in rehab for cocaine and alcohol addiction, they’d talked about getting married and starting a family. Jennifer is an artist who works from home, an only child whose parents are deceased. Woody’s mother is an alcoholic and his father a compulsive gambler. His two younger brothers, Alex and Tim, early 30s, are heavily into street drugs. Money has always been an issue in Woody’s family and he witnessed many explosive arguments at home growing up. Jennifer worships Woody, but doesn’t know how to relate to him now that he’s home from addiction treatment. He’s often silent, not the talkative person she so enjoyed, and he doesn’t want to socialize anymore. Her own work is suffering, since she feels compelled to watch over Woody all the time, afraid that he might slip. They haven’t had sex since before he went into rehab and Woody says he no longer wants children. In fact, Woody’s so different now that Jennifer feels trapped in a relationship she doesn’t want.

Clearly these two individuals are experiencing a great deal of difficulty adjusting to Woody’s new sobriety. The couple isn’t married, so there would not be any legal issues to untangle should they decide to split. Woody and Jennifer may benefit from continued counseling, if they’d go. It appears, however, that their finances are constrained, so professional couple’s therapy probably isn’t in the cards. Woody needs to resume attendance at his 12-step meetings (Alcoholics Anonymous and Cocaine Anonymous) – even though he says he doesn’t like the people there and it’s not helping him. Jennifer could find help through Al-Anon or Nar-Anon, but she seems unlikely to go.

Perhaps in this instance, Jennifer and Woody should part ways – at least until Woody is more firmly rooted in his sobriety and has a solid game-plan for his future. Staying together now could mean the relationship continues to disintegrate to the point of irreconcilable differences. For his part, Woody should attempt to see things from Jennifer’s perspective. If she truly means anything to him, he will put aside his own concerns and resolve to set her free. He needs to heal himself before he can open up to Jennifer or any other woman. Jennifer, on the other hand, needs to let go of her guilt and have the courage to stand up to Woody. She needs to be free of Woody’s needfulness.

Display Respect and Love

It’s not as easy as that, however. Walking away involves striving to achieve a delicate balance of resolve and independence, and needs to be accomplished with a display of respect and love.

In other words, you don’t need to have a shouting match to get your point across. Two people should be able to sit down together, or with a counselor present, and discuss their wants and needs in a civil manner. No matter how rough things have been, or how many hopes and dreams have been shattered, the decision to split can be amicable. Sometimes, however, the hurt has been so profound that one partner is unable to see anything good in the other. In such instances, the split should occur as quickly and with as much dignity as possible.

Let’s take another example. Bradley, 58, is married to Lynnette, 43. The couple have three young children, two girls, ages 11 and 15, and one boy, 17. Bradley has been doing his best to take care of the children while his wife was in treatment for compulsive sexual behavior, alcoholism and prescription drug addiction. This was Lynnette’s third time at rehab. Bradley has a good job, is a loving father, but has been repeatedly hurt by Lynnette’s affairs and blatant refusal to be a mother. In fact, she’s often been verbally and physically abusive to the children while she’s drunk and high – most often when she returns from one of her sexual liaisons. Bradley’s at the end of his patience. Lynnette refuses to change, and has stated on more than one occasion that she wants out.

Bradley’s most important consideration is the welfare of his children. While he believes in marriage for life, in this case, he has come to realize that Lynnette is not the partner for him. He and Lynnette should work out the details for her departure, making sure that the children are not negatively affected by the discussions and arrangements. Bradley’s best bet is to remain as respectful of Lynnette as possible, and show her cordiality, if not love, as she leaves the family.

Source: Drug Addiction Treatment

When the time came that I began to go through the twelve steps I had been clean and sober for over three months and still felt disconnected from God.  The first step was to admit that I was powerless over drugs and alcohol and that my life had become unmanageable, which was easy for me.  However the second step was no easy feat, “We came to believe that a power greater than ourselves could restore us to sanity.”  I went over and over the words in my head and tried to think what it meant to me and how I could relate to this concept of a power greater than myself.  My sponsor told me that she had a similar experience when she was a newcomer and that all that I needed at that time was to believe that there was something in the universe that was more powerful than me.  I had heard of people using the fellowship of Alcoholics Anonymous as their Higher Power because they felt that the group was more powerful than they were alone.  That idea made sense to me and for the time being it would suffice.  I was hopeful that in time my relationship to God would blossom and develop as was the experience of others in AA.

I remember the very first AA meeting that I attended when I was only 16 years old.  I arrived about fifteen minutes early and was nervous as I walked toward the crowd gathered outside the community center where the meeting was being held.  The first thing that I noticed was that I was by far the youngest person there which didn’t really bother me because I was desperate for a change in my life.  My drug and alcohol abuse had come to a point where I lost control and I knew that I needed help to conquer my addiction.

The room was dark and crowded and I have to admit I was intimidated by the fact that everyone seemed to know each other.  A woman introduced herself to me and asked if it was my first meeting.  She offered to be my temporary sponsor and explained that she could help introduce me to the program as far as where the local meetings were and to help me in my early recovery.  I was fresh out of detox and still shaky so I accepted the guidance and figured out soon after that a sponsor is also someone who takes you through the twelve steps of recovery.  Overall I didn’t retain much from that first meeting but the thing that stuck with me was how welcoming and friendly everyone was and that while I entered the meeting very anxious I left with a feeling of calm and well-being.