Treating Methamphetamine Addiction Utilizing the Developmental Model of Recovery Presented by

Treating Methamphetamine
Addiction Utilizing the
Developmental Model of Recovery
Presented by
Chip Abernathy, LPC, CAC
www.ridgeviewinstitute.com
Addiction
Substance dependence – addiction – is a brain disease
characterized by loss of control over psychoactive substances.
This loss of control causes problems in all areas of the
addict’s life: physically, psychologically, socially, and
spiritually. Addiction causes harm to the person’s family and
to society as well.
Substance dependence (addiction) is a chronic, progressive,
relapsing, incurable and potentially fatal disease if left
untreated.
Methamphetamine
Methamphetamine is a stimulant drug with a very high potential
for misuse and addiction.
Treatment-seeking stimulant users often have some common
behaviors that include, but are not limited to…
† Extreme financial irresponsibility
† Lack of routine self-care behaviors (e.g. eating, sleeping,
dental hygiene, bathing)
† Excessive sexual behavior
† Severely deteriorated employment/educational performance
† Escalating irresponsible behavior to family and spouse
(excessive spending for drugs, failure to care for children)
Methamphetamine
Some common mental and emotional states that are often present
with methamphetamine users during treatment include, but
are not limited to…
† Dissatisfaction with life
† Intense anxiety, fear, guilt, and shame over medical, fiscal,
legal, and personal relationships
† Anergia (lack of energy) and anhedonia (inability to feel
pleasure) during periods of abstinence
† Anger, paranoia, and irritability
† Low frustration tolerance
Meth users seeking treatment services are often skeptical and
ambivalent about treatment, and come across as resistant.
Special Considerations in Treating
Methamphetamine Addicts
It is important to stay aware of special considerations in the
treatment of whatever type of substance dependence that is
presented. Assessment for co-occurring mental disorders
should always be a part of the assessment process.
After stopping using, meth addicts commonly experience…
† Cognitive impairment
† Anxiety
† Depression
Treatment outcomes improve if the client’s mental health
problems are addressed during treatment. Treatment of meth
addiction can be just as successful as treatment for any other
substance.
Assessment Considerations
People with substance dependence enter treatment with various
problems, including co-occurring disorders, and widely
different levels of…
† Insight
† Motivation
† Resources
All of these factors need to be considered and addressed on an
individual basis with each person.
Treatment Planning:
General
Treatment planning needs to include consideration of the addicted
person’s
† Presenting problems
† Possible detoxification needs; look into concurrent use of
other drugs including alcohol
† Level of functioning/stability
† Motivation for change
† Risk of relapse
† Mental status
† Psychosocial stressors including living environment
Treatment Planning
Assessment Considering Stage of Recovery
As part of the ongoing assessment process that occurs during
treatment, providers need to determine as accurately as
possible (which includes exploration of past recovery
attempts) the person’s
† Current stage of recovery
† Tasks within that stage of recovery that have been
accomplished
† Tasks that still need to be accomplished
† Past difficulties accomplishing identified recovery tasks
† Potential problems regarding accomplishing those tasks now
Treatment Planning:
Goals, Objectives and Interventions
Once the stage of recovery assessment process is complete,
treatment providers need to have treatment plans that specify
† Treatment goals
† Treatment objectives for the addicted person
† Interventions that the providers will perform to help the
person achieve their treatment objectives
Treatment plans should be modified as needed during treatment,
and should be presented in behavioral terms that are easy for
the addicted person to comprehend.
Recovery
Recovery means living a meaningful and comfortable life without
the need for alcohol or other drugs. In recovery we
† Move from dependence on substances to…
full physical, psychological, social and spiritual health
† Stop using and begin to heal the damage done to our bodies,
minds, relationships and spirit
Recovery is more than just healing the damage. It is living a
lifestyle that promotes continued physical, psychological,
social and spiritual health.
Recovery Skills
The skills necessary for long-term recovery are all directed at
finding meaning and purpose in life.
Recovery is…
† A way of thinking, a way of acting, and a way of relating to
others.
† It is a philosophy of living.
† It requires the daily effort of working a recovery program.
Gorski’s Developmental Model of
Recovery
Recovery is a developmental process during which we
go through a series of stages. It is a gradual effort to
learn new and more complex skills. We do not use,
no matter what, and we do our best to solve
problems that we encounter. Sometimes we
succeed, sometimes we fail. Whatever the outcome,
we learn from the experience and try again.
Beliefs Upon Which Gorski’s Developmental
Model of Recovery (DMR) are Based
1.
2.
3.
4.
Recovery is a long-term process that is not easy.
Recovery requires total abstinence from alcohol and
other drugs, plus active efforts towards personal
growth.
There are underlying principles that govern the
recovery process.
The better we understand these principles, the easier
it will be for us to recover.
(Continued)
Beliefs on which Gorski’s DMR
are Based (Continued)
5.
6.
7.
Understanding alone will not promote recovery; the
understanding must be put into action.
The actions that are necessary to produce full
recovery can be clearly and accurately described as
recovery tasks.
It is normal and natural to periodically get stuck on
the road to recovery. It is not whether you get stuck
that determines success or failure, but it is how you
cope with the stuck point that counts.
The Stages of the Developmental
Model of Recovery
To understand recovery, it is helpful to divide the
process into stages. These six stages are
† (1) Transition,
† (2) Stabilization
† (3) Early recovery
† (4) Middle recovery
† (5) Late recovery
†
(6) Maintenance
Transition Stage
The Beginning of Recovery
The major theme of the transition stage is giving up the need to
control alcohol or other drug use.
During the transition stage we
Recognize we have problems with alcohol or other drugs, but
we think we can solve them by learning how to control our
use.
This stage ends when we
† Recognize we are not capable of control – that we are
“powerless” over our addiction – and that we need to stop
using in order to regain control of our lives.
†
Transition Stage Goals
Three major goals need to be accomplished
during the transition stage:
† Recognize that we have lost control over our
use of alcohol and/or other drugs
† Recognize that we can’t control our use
because we are addicted
† Make a commitment to a program of recovery
that includes the help of others
Transition Stage Tasks
The transition stage of recovery starts while the
addicted person is still using.
The tasks that need to be accomplished in order to
consider the transition stage complete are:
1.
Development of motivating problems
2.
Failure of normal problem solving
3.
Failure of controlled use strategies
4.
Acceptance of the need for abstinence and the need
for help
12 Step Programs
Although the 12 Step Program is not the only way to recover from addiction, it
is the most effective way, and the most way often recommended by
treatment centers .
Programs that are geared towards having the 12 Step Program be the primary
agent of change in treating addiction, and work in combining that with
professional addiction counseling, psychiatric care when needed, and
medical care when needed, are going to be effective and successful
programs.
†
Alcoholics Anonymous (AA) has been in existence since 1935.
†
Narcotics Anonymous (NA) has been in existence since 1953.
†
Crystal Meth Anonymous (CMA) is relatively new, but is helpful for
many meth addicts.
The 12 Steps of Narcotics Anonymous
1.
2.
3.
4.
5.
6.
We admitted that we were powerless
over our addiction, that our lives had
become unmanageable.
We came to believe that a Power greater
than ourselves could restore us to sanity.
We made a decision to turn our will and
our lives over to the care of God as we
understood Him.
We made a searching and fearless moral
inventory of ourselves.
We admitted to God, to ourselves and to
another human being the exact nature of
our wrongs.
We were entirely ready to have God
remove all these defects of character.
7.
8.
9.
10.
11.
12.
We humbly asked Him to remove our
shortcomings.
We made a list of all persons we had
harmed, and became willing to make
amends to them all.
We made direct amends to such people
wherever possible, except when to do so
would injure them or others.
We continued to take personal inventory
and when we were wrong promptly
admitted it.
We sought through prayer and
meditation to improve our conscious
contact with God as we understood Him,
praying only for knowledge of His will
for us and the power to carry that out.
Having had a spiritual awakening as a
result of these steps, we tried to carry
this message to addicts, and to practice
these principles in all our affairs.
Transition Stage and 12 Step Recovery
From a 12 Step recovery prospective, we gear treatment towards
helping those with addictive disease work the first three steps
during the transition stage.
Step One:
Step Two:
Step Three:
I can’t handle my drug using anymore
Help is available from other people and a Higher
Power
It is wiser to turn my life and will over to a
loving power greater than myself, than to a
destructive power greater than myself
Stabilization Stage
The major theme of the stabilization stage is recuperating from
damage caused by addictive use.
† We physically recover from acute withdrawal and post acute
withdrawal.
† We learn to manage addictive preoccupation.
† We learn to manage stress, emotions, and problems.
† We develop hope and motivation.
With methamphetamine addiction, the stabilization stage of
recovery can be particularly challenging due to the severity of
cognitive impairment caused by methamphetamine usage.
Post Acute Withdrawal and Addictive
Preoccupation
Post Acute Withdrawal Syndrome
starts after acute withdrawal
ends. This syndrome often lasts
for several months.
Symptoms include difficulty with…
†
Thinking clearly
†
Remembering
†
Stress management
†
Emotion management
†
Sleeping restfully
†
Physical coordination
Addictive Preoccupation is a type of
delusional thinking associated
with being a sober
addict/alcoholic and includes…
†
Euphoric recall (recalling only
the positives about using)
†
“Awfulizing” sobriety (focusing
on only the negatives about
sobriety)
†
Magical thinking about future
use (thinking using will
somehow make things better)
Left unattended, this becomes
obsession, compulsion and
craving.
Management of Post Acute Withdrawal and
Addictive Preoccupation
Some things that are helpful for
management of Post Acute
Withdrawal include, but are not
limited to, …
†
Having a structured lifestyle
†
Getting enough rest
†
Healthy diet and eating habits
†
Regular exercise
†
Social support, esp. AA/NA
†
Deep-breathing relaxation skills
†
Emotion management skills
†
Conflict management skills
†
H.A.L.T. – Don’t get too
Hungry, Angry, Lonely or Tired.
In addition to 12 step program coping
skills, such as calling on others
and a Higher Power, some things
that are helpful for managing
Addictive Preoccupation
include, but are not limited to, …
†
Euphoric recall – Force yourself
to remember specific negative
experiences involving using.
†
“Awfulizing” sobriety – Force
yourself to consider positive
things about recovery.
†
Magical thinking about future
use – Force yourself to consider
what would actually happen if
you used.
Cognitive Impairment
and Uncomfortable Emotional States
Methamphetamine use causes cognitive impairment and
very uncomfortable emotional states that can last for
several months after stopping use of the drug.
After stopping using, stimulant dependent individuals
are often…
† Frightened
† Disoriented
† Anxious
† Ashamed
Treatment Considerations
Considering Stabilization Needs
Treatment providers need to provide
† Thorough but brief assessments
† Clear orientation to treatment
† Clear expectations
Involving supportive significant others whenever
possible helps with problems that can occur
due to cognitive impairment and emotional
damage caused by meth addiction.
Matrix Model and First Months of Recovery
The Matrix Intensive Outpatient Treatment for People With
Stimulant Use Disorders is particularly well-suited for people
in the first few months of recovery from methamphetamine
dependence.
It is presented in such a way that addicts and their families can
more easily grasp key recovery concepts by
† Helping to simplify some of these rather complicated
concepts, and
† Helping to show how they all fit together
They will use these tools throughout their lives in recovery.
Attitude and Behaviors
of Treatment Providers
Treatment providers should strive to be
† Warm
† Friendly
† Calm
† Empathic
† Engaging
† Not harshly confrontational
† Straightforward
† Nonjudgmental.
An Important Area of Focus
During Stabilization Stage
Providers need to help addicts…
† To begin regaining control of their thinking,
emotions, and actions through teaching sober
coping skills
† To connect with others in recovery, and
† To find hope.
Early Recovery
The major theme of the early recovery stage is internal
change related to addiction and recovery.
In early recovery we…
† Demystify the miracle that has started to occur
through working the first three steps by continuing
with further step work
† Begin to consciously understand our addiction, and
what is required of us if we are to stay in recovery
(Continued) ….
Early Recovery
(Continued)
In early recovery we…
†
†
Learn the words and concepts necessary to
understand what has happened to us and what we
need to do to maintain the positive change
Are able to explain the recovery process to others by
the end of the early recovery stage
Early Recovery
Recovery requires two kinds of change:
1.
Unconscious – a subtle change in feeling and belief that
motivates us to change what we do.
2.
Conscious – an understanding of the laws and principles that
create and maintain the change.
Working Steps 4 – 7 of AA/NA with the help of a sponsor (an
experienced member who serves as a personal mentor in
recovery) during early recovery provides an excellent way
for this process to occur.
Early Recovery Tasks
The tasks that need to be accomplished in early
recovery are…
† Full conscious recognition of addictive disease
† Full acceptance and integration of the addiction
† Learning non-chemical coping skills
† Short-term social stabilization
† Developing a sobriety-based value system
Early Recovery Goals
During the early recovery stage, we work to…
† Understand the role our addiction played in our lives and to
accept that.
† Resolve the pain it caused.
† Develop a value system that is part of our new life in
recovery.
With diligent effort, early recovery tasks usually take about 6 to
18 months to complete.
Middle Recovery
The major theme of middle recovery is external change (repairing
the lifestyle damage caused by addictive use and developing a
balance lifestyle).
The goal of middle recovery is to learn to function well in the
family, in intimate relationships at work and with friends, and
to learn to handle the ordinary ups and downs of life. We
strive for balance.
Successfully completing all the tasks of the early recovery stage
provides the foundation needed to move successfully into and
through middle recovery.
Middle Recovery
Achieving Lifestyle Balance
By the end of early recovery, most of us…
† Are regularly involved in 12 step recovery (beyond simply
attending meetings)
† Are possibly in therapy
† Have developed adequate coping skills to stay employed,
manage being in a relationship with someone, manage our
finances reasonably well, and not break laws
In early recovery, our attention has been on our number one
priority – not drinking or using other drugs and learning the
skills necessary to stay sober.
We are now coping on a day-to-day basis, but we do not have a
well-balanced or satisfying lifestyle.
Middle Recovery
Making a Choice
During middle recovery, our lives are much better than they were
during active addiction, but we still have a great deal of work
to do.
Middle recovery confronts us with a major choice: Do we begin
to rebuild our lifestyle, using recovery principles, or do we
try to avoid making any real changes?
At this point, some people get stuck, while others move ahead.
Those who get stuck stop the recovery process. The thinking
is: “I’m not using and I’m going to meetings! That’s all I
need to do!”
Middle Recovery
Resolving the Demoralization Crisis
Those who have the courage to move ahead are willing to
confront reality. They are willing to pay the price to develop a
balanced lifestyle and find meaning and purpose in sobriety.
This period can be a big letdown. We begin to ask the question,
“Why did I stay clean all this time, and do all this work, if I
still have all these problems?” Resolving that letdown is one
of the tasks of middle recovery. It is a period of high risk for
relapse.
To resolve this demoralization crisis, we need a strong belief that
it is possible to repair past damage and create a better life.
Middle Recovery
Repairing the Damage
The next task of middle recovery is repairing the damage caused
by our addiction. We make amends for harm we have caused.
We do it because of a universal principle of recovery that has
guided us thus far and continues to guide us throughout our
lives in recovery:
We are not responsible for our disease but we are responsible
for our recovery.
Steps 8 and 9 of AA/NA address making amends. To amend
something is to change it. We do not simply apologize for
harm done; we also do what we can to make things right.
Middle Recovery
Keep Doing the ‘Next Right Thing’
In middle recovery we build on the recovery skills, recovery
principles, and sobriety-centered value system that we have
worked hard to establish up to this point. We work towards
always trying to do the ‘next right thing.’ Some of the things
that help us do this include, but are not limited to, …
† Actively and deliberately taking care of our health physically,
psychologically, and spiritually
† Taking responsibility for our actions
† Asking for help when needed and being helpful to others
† Using good judgment in all major life areas
† Dealing with life’s ups and downs without using
Middle Recovery
Establishing Lifestyle Balance
Establishing lifestyle balance is an overall goal of middle
recovery. Relapse occurs during this stage when recovering
people are unwilling or unable to step out of the comfort zone
of early recovery and to take on and accomplish the
increasingly difficult tasks of middle recovery described thus
far.
Another part of establishing this lifestyle balance is stepping out
beyond the 12 step fellowship and having relationships with
people outside the program who help to continue to bring
meaning and purpose to our lives.
Completing Middle Recovery
We are prepared to move forward into late recovery when we…
† Have completed the tasks of middle recovery
† Continue to take personal inventory and promptly admit it
when we are wrong (Step 10 of AA/NA)
† Are using recovery principles and skills to manage our
thinking, feeling, actions and relationships
† Are active participants in meaningful relationships both
inside and outside the 12 step fellowship
† Continue to live our lives in a way that demonstrates that we
keep our recovery our top priority, even when it is difficult
Late Recovery
The major theme of the late recovery stage is growing beyond
childhood limitations.
We enter what Gorski describes as late recovery when we, in
spite of all the progress we’ve made, we really don’t feel
happy. We might be wondering, “Is this all there is to
sobriety?”
Late Recovery
Dealing with Family of Origin Issues
The cause of unhappiness and dissatisfaction with our lives after
middle recovery is often caused by growing up in a
dysfunctional family.
In dysfunctional families we learn self-defeating ways of coping
with life that can lower the quality of our recovery and
increase the risk of relapse.
Late recovery is a time to free ourselves from the beliefs,
uncomfortable feelings and patterns of behavior that we
learned as children.
Late Recovery
Recognizing Childhood Problems
Those of us who came from healthy families move through late
recovery quickly and without a great deal of pain.
If we were raised in a dysfunctional family, however, the process
is more difficult.
Leaning some of the differences between how healthy families
and dysfunctional operate can be helpful when examining our
own experience during childhood.
Healthy vs. Dysfunctional Families
A Few Differences
Healthy, functional families teach by
example that we …
†
Can look honestly at ourselves
and the world around us
†
Don’t have to be perfect; we can
be ourselves, even with flaws
†
Can express our thoughts and
feelings, whether pleasant or
unpleasant to express
†
Can value our ability to assess
and solve problems
†
Can rely on others to treat us
with respect and dignity
Unhealthy, dysfunctional families
teach by example that we …
†
Cannot trust our perceptions or
feelings
†
Should never express honest
thoughts and feelings about what
is wrong in the family
†
Can usually expect to be
disappointed
†
Should perceive the world as
threatening, unsafe, and
contradictory
†
Need to be rigid and inflexible in
order to survive
Common Problems
in Late Recovery
10 common problems that often need attention in late recovery
are:
1.
Personal problem solving: We have difficulty solving
important personal problems but are able to solve similar
problems for other people.
2.
Inability to manage feelings: We have difficulty managing
our feelings and emotions.
3.
Rigid behavior: We have rigid habits that make it difficult to
change our behavior when we need to.
4.
Rescuing: We rescue or save others to the extent that it
causes us problems.
Common Problems
in Late Recovery (Continued)
5.
6.
7.
8.
9.
10.
Complying: We quietly fit in by doing what other people
expect.
Entertaining: We entertain others in order to divert attention
from problems.
Peacemaking: We must assure that there is peace at any
cost.
Self-sacrificing: We tend to accept the blame for the
problems of others
Troublemaking: We make trouble by acting out and tend to
disrespect or break rules.
Blaming: We tend to blame others for our problems.
Approaching Common Problems
in Late Recovery
The 10 common problems just noted have two things in common:
†
They are all related to what we learned in our family of
origin.
†
We feel compelled to continue to act out these problems
even though we know better.
We need to ask ourselves some questions about each of these
common problems:
1.
How often we experienced each behavior as a child
2.
How often we currently experience it at home or at work
3.
If this is a problem we feel we need to work on in recovery
Working on Problems
in Late Recovery
In the earlier stages of recovery, we have worked on family of
origin issues through working the 12 steps and managing the
related problems the best we could.
When self-defeating thinking, attitudes, and patterns of behavior
persist, and life is not satisfying even though we are working
a good program of recovery, we should seriously consider…
† Continuing to work a 12 step recovery program – and…
† Getting involved in professional counseling or therapy
Finishing Late Recovery
and Moving On to the Maintenance Stage
Remember that family of origin issues do not cause addiction.
Addiction is caused by a combination genetic susceptibility
and the use of alcohol or other drugs. People from both
functional and dysfunctional families become addicted.
In late recovery we need to remember that recovery is possible
but it requires work. We must…
† Be willing to examine the effects of our childhood on our
lives,
† Be willing to change, and then
† Do the work necessary to change.
Maintenance Stage
The final period of recovery is maintenance. It lasts a lifetime.
The major theme of the maintenance stage of recovery is
balanced living and continued growth and development.
We will need to…
†
Continue keeping recovery our top priority, which includes
not using, attending AA/NA regularly, working the 12 steps,
calling our sponsor, and helping others
†
Do a daily inventory and correct problems as needed
†
Have a strong commitment to grow in our recovery
Continuing Step Work
Steps 10, 11 and 12 of AA/NA become a priority in the
maintenance stage.
In step 10, we continue to take personal inventory, examining our
attitude, our motives, and our behavior. We promptly take
corrective actions as needed.
In step 11, we continue to develop an ever-increasing awareness
of spirituality; we search out our unique meaning and purpose
in recovery.
In step 12, we practice the principles of recovery in our daily
lives, always remembering “We keep it by giving it away.”
Maintaining a Recovery Program
Even after many years of good recovery, we need to never forget
that addiction is a disease that is… incurable, chronic,
progressive, relapsing and potentially fatal if not attended to
on an ongoing basis.
We don’t have to do anything to relapse; we simply must not do
what we need to do to recover, and the disease does the rest.
Fortunately, what we need to do to recover in the maintenance
stage is basically the same things we learn to do as
newcomers. We “keep it simple” in our recovery program.
Effective Day to Day Coping
In maintenance, we are not problem-free, but we are…
† Learning to manage the problems of ordinary living
efficiently.
We don’t stop having problems, but we…
† Upgrade to better problems, and we
† Become better at solving problems.
When we are working a good program, we can respond from a
position of self-confidence and self-worth, rather than from a
position of insecurity and fear.
Continued Growth and Development
Human beings are designed to seek truth, meaning and purpose in
life. We constantly strive for…
† More understanding
† New challenges
† Forward movement in our lives
We are not free to choose whether or not we grow and change.
But we are free to choose the direction of that growth and
change.
Dry Drunk
When we stop growing, a dry drunk is just around the corner. A
dry drunk means that we are not using, but we are miserable
from not working our program.
†
†
†
†
Stress builds up
Eventually Post Acute Withdrawal symptoms emerge
The relapse process begins, with relapse warning signs
getting progressively more severe if not managed with good
recovery principles and skills
A chemical relapse can occur if warning signs are continually
ignored or not managed
When Continued Growth
is Difficult
Even for those of us with long-term, good recovery, we can
return to dealing with stuck points in recovery with denial and
evasion. Old, self-defeating ways of coping can reappear.
During difficult times such as these during the maintenance stage,
we know how to take responsibility for our recovery by…
† Not using no matter what, and paying attention to our
thinking, feelings, actions, and relationships (personal
inventory)
† Being open to growth and accepting that we are fallible
human beings
† Doing the best we can with what we have
Coping with
Changes and Complications
As we get older in recovery, we must learn to cope with the
normal changes that occur as part of the aging process. We
need to do that simultaneously with keeping our recovery as
our top priority. So… How do we do that?
One day at a time, we…
† Remember who we are, what we are, and where we came
from by having relationships with others in recovery and by
sticking with the “basics” – not using, going to AA/NA,
working the steps, calling our sponsors, and having conscious
contact with our Higher Power
† Learn from our own experience and the experience of those
who came before us
† Stay teachable
Relapse:
A Process, Not an Event
Relapse is the process of becoming so dysfunctional in recovery
that we eventually see our only options as
† Suicide,
† Emotional collapse,
† Or return to alcohol or other drug use.
One way to distinguish a chemical relapse, versus simply
returning to using again, is that the following elements are
present:
† We see our substance use as being a serious problem
† We make a commitment to ourselves or others that we will
stop using
† We stop using and attempt to stay stopped
High Risk Factors
and Trigger Events for Relapse
1.
2.
3.
4.
5.
6.
High Risk Factors
High-stress personality
High-risk lifestyle
Social conflict or change
Poor health maintenance
Other illness
Inadequate recovery
program
1.
2.
3.
4.
5.
Trigger Events
High-stress thoughts
Painful emotions
Painful memories
Stressful situations
Stressful interactions with
other people
A Few Common Relapse Warning Signs
Early and Middle Stage
Internal Dysfunction
Early Warning Signs
1.
Difficulty with…
2.
Thinking clearly
3.
Managing feelings
4.
Remembering
5.
Managing stress
6.
Sleeping restfully
7.
Physical coordination
8.
Shame, guilt, hopelessness
External Dysfunction
Later Warning Signs
1.
Avoidance and defensive
behavior
2.
Crisis building
3.
Immobilization
4.
Confusion and
overreaction
5.
Depression
Relapse Warning Signs
Late Stage Warning Signs/ Lapse, Relapse
Loss of Control
Still Later Warning Signs
1.
Poor judgment
2.
Inability to take action
3.
Inability to resist
destructive impulses
4.
Conscious recognition of
loss of control
5.
Option reduction
6.
Emotional or physical
collapse
Chemical Lapse/Relapse
Return to Using
1.
Initial use of alcohol or
other drugs
2.
Severe shame, guilt and
remorse
3.
Loss of control over use
4.
Development of health and
life problems
Coping with Stuck Points
in Recovery
Each of us will get stuck in our recovery from time to
time. Getting stuck in recovery is neither good nor
bad; it simply is.
Those of us who are successful in recovery cope with
our stuck points through a process of recognition
and problem solving.
Coping With Stuck Points in Recovery
We learn how to recognize we are having a problem and that we
are stuck in our recovery.
We …
† Accept that this is OK, knowing that as fallible human
beings, we reserve the right to not have all the answers.
† Detach from the problem while we seek help from others.
Finally, when we are prepared, we take responsible action.
The Relapse-Prone Style
of Coping with Stuck Points
Denial and Evasion
(The relapse-prone style)
Evade/deny the stuck point
Stress
Compulsive behavior
Avoid others
Problems escalate
Evade/deny new problems
The Recovery-Prone Style
of Coping with Stuck Points
Recognition and Problem Solving
(The recovery-prone style)
Recognize a problem exists
Accept that it is OK to have problems
Detach to gain perspective
Ask for help
Respond with action when prepared
References
Alcoholics Anonymous. Alcoholics Anonymous (The Big Book, third edition).
New York: Alcoholics Anonymous World Services Office, 1976.
Center for Substance Abuse Treatment (CSAT). Treatment for Stimulant Use
Disorders. Treatment Improvement Protocol (TIP) Series, Number 33.
DHHS Pub. No. (SMA) 99-3296. Rockville, MD: Substance Abuse and
Mental Health Services Administration, 1999.
Center for Substance Abuse Treatment (CSAT). Client’s Handbook: Matrix
Intensive Outpatient Treatment for People With Stimulant Use Disorders.
DHHS Pub. No. (SMA) 06-4154. Rockville, MD: SAMHSA, 2006
Center for Substance Abuse Treatment (CSAT). Family Education Manual:
Matrix Intensive Outpatient Treatment for People With Stimulant Use
Disorders. DHHS Pub. No. (SMA) 06-4153. Rockville, MD: SAMHSA,
2006
Evans, K.; Sullivan, J.M. Dual Diagnosis, Counseling the Mentally Ill
Substance Abuser, Second Ed. New York: The Guilford Press, 2001.
References
Gorski, T.T. Passages Through Recovery: An Action Plan for Preventing
Relapse. Center City, MN: Hazelden, 1989.
Gorski, T.T. Staying Sober: A Guide for Relapse Prevention. Independence,
Missouri: Independence Press: 1986.
Leshner, A.I. Addiction is a Brain Disease. Issues in Science and Technology
Online, 2001.
Narcotics Anonymous World Service Office. Narcotics Anonymous (The
Basic Text, fourth edition). Van Nuys, CA: World Service Office, Inc.,
1987.
Rosack, J. Meth users should target mood-disorder symptoms. Psychiatric
News Volume 39 Number 5, p. 50, American Psychiatric Association,
2004. http://pn.psychiatryonline.org/[Accessed 1-8-07].