Relapse Prevention

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Backward Steps to Addictive Behavior

Parent Category: Tool Chest Relapse Prevention

Just as recovery is a process and not an event, so is relapse. As a part of your relapse prevention plan, cultivate your awareness of these common backward steps toward addictive behavior.backwards_steps

TRIGGERS – External, interpersonal, and intrapersonal.

Which areas are the riskiest for you?

Which do you have the most difficulty combating?

Rate each category from 0-10 (where 10 is the riskiest or most difficult).

a.____ Conditioned responses in certain settings

b.____ Unpleasant emotions

c.____ Unpleasant physical sensations

d.____ Pleasant emotions

e.____ Pressure from others

f. ____ Conflict with others

g.____ Socializing

h.____ Testing personal control

IMAGINING/FANTASIZING – Start to imagine what it would be like to… how you would feel, how you would think and act … then…

UNHELPFUL THINKING – Irrational beliefs, cognitive distortions, and rationalizations that you used to convince yourself to take the backward step.

a.___ Negative exaggeration; awfulizing; catastrophizing.

b.___ Self-downing / self denigration.

c.___ Rationalizations:

“It won’t really matter.”

“I deserve it.”

“I will only have one.”

“It’s been a long time.”

d.___ Low frustration tolerance (LFT):

“I can’t stand it.”

“It’s awful.”

e.___ The Tyranny of the Shoulds:

“It shouldn’t be so hard.”

“I shouldn’t have this problem.”

“S/he shouldn’t speak to me that way.”

“The world stinks, and it shouldn’t!”

PLANNING

– “I’ll just go down to the store and buy a bottle.”

– “I’ll finish this project and then go to the bar.”

– “I’ll take some money out of my other account.”

– Others:_____________________________________________________

ACTING – Behaviors that lead to UNDESIRABLE OUTCOMES (list them)

Teach yourself how to respond at each step. Even though it gets harder to intervene at each step along the way, it can be done. Practice rehearsing relapse preventive self-talk in SMART Recovery group meetings (role-playing is an excellent exercise), out loud at home, into a tape recorder, or in writing.
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Forward Steps to Recovery

Parent Category: Tool Chest Relapse Prevention

compass

1. Thought Stopping: I’m not going to think about that; I’ve already made my decision.

2. Thought Substitution: I’m in danger – I’d better be alert; I think I’ll call Bob; I think I’ll plan my vacation.

3. Debating/Disputing/Challenging Your Addictive Voice: Where is the evidence? Is this thought or belief true or valid? How does this thought or belief serve my best interest?

4. Coping Statements: This feeling will eventually pass; It’s hard, but not too hard; Condemn the behavior, not the person.

5. Positive Affirmation: I have said no to myself before – I can do so again; I’m going to treasure my sobriety; Even if I have lapsed, I can
accept myself.

6. Review of Goals (Desirable Outcomes): I want to stop drinking – it’s my goal; I have already decided that I want to keep my relationship with my wife; I want to go home sober.

7. Review of Negative Consequences (Undesirable Outcomes): Eventually, I will lose my job; I can’t take two drinks without taking several more and getting drunk; My relationships will suffer.

8. Do Written Homework (Problem Sheet, ABC Sheet, or Drinking Sheet).

9. Refraining: Look at the situation from another angle or another person’s viewpoint. Look at the benefits of choosing not to engage in the addictive behavior.

10. Rational-Emotive Imagery: Imagine yourself behaving or feeling differently about the situation. Close your eyes and practice responding to someone in a different, more rational, more effective manner.

Using Constructive Relapse-Preventive Actions

1. Get involved in a project or a recreational activity.

2. Walk the other way.

3. If there are any remaining liquor, drugs, sweets, or other addictive substances in the house, throw them out or flush them down the toilet.

4. Call a friend.

5. Fill in a worksheet.

6. Do something intentionally to lift your spirits other than drinking or drugging: e.g., climb a mountain, go for a brisk walk.

7. Have some seltzer or other non-alcoholic beverage.

8. Go to a SMART Recovery meeting.

9. Read a chapter from Ellis and Velten’s When AA Doesn’t Work for You or another REBT self-help book.

10. Divert/enjoy yourself: Exercise, go for a walk, watch TV, play a game, cook, take a hot bath, have a cup of coffee, read the newspaper, listen to music.

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Relapse Prevention: Activities you may enjoy

Parent Category: Tool Chest Relapse Prevention

CHORES AND USEFUL TASKS (such as Cleaning, Cooking, Dishwashing, Ironing, Sewing).

EXERCISES (such as Jogging, Nautilus, Walking, Aerobic Dancing, Stretching or Aerobic Exercises, Shadow Boxing, Skipping Rope, Yoga, Weightlifting).

FOOD ACTIVITIES (such as Baking, Cooking, Barbecuing, Preparing Gourmet Meals, Shopping for Food).

GAMES (such as Bridge, Checkers, Chess, Go, Jigsaw Puzzles, Monopoly, Poker, Pinochle, Scrabble, Crosswords, Anagrams).

GRAPHIC ARTS (such as Cartooning, Drawing, Lettering, Mechanical Drawing, Painting, Photography, Silkscreening).

HANDICRAFT ACTIVITIES (such as Basketmaking, Bookbinding, Crocheting, Embroidering, Knitting, Leatherworking, Dressmaking, Decoupage, Needlepoint).

HUMOROUS ACTIVITIES (such as Cartooning, Improvisation Games, Charades, Jesting, Joke-making, Playing Practical Pranks and Jokes, Punning).

MARTIAL ARTS (Akido, Jujitsu, Judo, Karate, Fencing, Wrestling).

OUTDOORS ACTIVITIES AND SPORTS (such as Birdwatching, Gardening, Crabbing, Fishing, Canoeing, Sailing, Hunting, Walking, Ice-skating, Skiing, Rowing, Hiking).

PERFORMING ARTS (such as Dancing, Ballet, Mime, Acting, Improvisation, Modern Dance, Tap Dance, Singing).

PERSONAL GROWTH (Self-help Books, Workshops, Lectures, Skills-learning, Career Development).

READING (Fiction, Novels, Plays, Poems, Nonfiction).

SCIENTIFIC ACTIVITIES (such as Anatomy, Biology, Herpetology, Physics, Medicine, Zoology, Anthropology, Psychology, Sociology).

SOCIALIZING ACTIVITIES (such as Conversing, Group Activities, Attending or Giving Parties, Rap Sessions).

SPECTATING (watching Movies, Plays, Sports, Pageants, Circuses).

SPORTS (such as Baseball, Basketball, Golf, Gym, Football, Hockey, Dancing, Tennis, Skating, Running, Volleyball).

STUDYING ACADEMIC SUBJECTS (such as Art History, History, Language, Math, Music, Science, Social Science).

TRADES AND CRAFTS (such as Bricklayer, Builder, Carpenter, Foreman, Factory Worker, Gardener, Mechanic, Machinist, Police Officer).

VENTING FEELINGS (such as Punching Pillows, Yelling, Talking, Writing, Expressing Good Feelings).
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Relapse Prevention: Trigger Homework Sheet

Parent Category: Tool Chest Relapse Prevention

1. What was the trigger?

2. How were you feeling just before you felt like drinking or drugging?

3. What were you telling yourself just before you started to drink or drug? (Look for additional, hidden thoughts.)

4. What did you do?

5. Which thoughts led to which addictive feelings and behaviors?

6. What was the chain of thoughts, feelings, and actions?

7. What could you have told yourself?

8. What could you have done?

9. What emotions could you have pushed yourself to feel?

10. How do you feel now about what happened?

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How to Deal with Backsliding

Parent Category: Tool Chest Relapse Prevention

Relapse Prevention

Man with awful headacheAccept your backsliding as normal – as something that happens to almost all people who at first improve emotionally and then fall back. See it as part of your human fallibility. Don’t make yourself feel ashamed when some of your old symptoms return, and don’t think that you have to handle them entirely by yourself and that it is weak for you to seek some additional help from others about your renewed problems.

When you backslide, look at your self-defeating behavior as bad and unfortunate, but refuse to put yourself down for engaging in this behavior. Use the highly important REBT principle of refraining from rating yourself or your being and of measuring only your acts, deeds, and traits. You are always a person who acts well or badly- and never a good or bad person. No matter how badly you fall back and bring on your old disturbances again, work at fully accepting yourself with this unfortunate or weak behavior and then try- and keep trying- to change your behavior.

Go back to the ABC of REBT and clearly see what you did to fall back to your old symptoms. At A (Activating Events) you usually experienced some failure or rejection. At rational belief B, you probably told yourself that you didn’t like failing and didn’t want to be rejected. If only you had stayed with the rational beliefs, you would have only felt merely sorry, regretful, disappointed, or frustrated. But if you felt disturbed, you probably then went on to some irrational beliefs (IBs) such as: “I must not fail! It’s horrible when I do!” or “I have to be accepted!” If you reverted to these IBs, you probably felt, at C (emotional consequences) once again depressed and self-downing. Use the ABC process as illustrated throughout much of our literature, reading material, and demonstrated live at online meetings to dispute (D) these IBs and form new effective beliefs (E).

Keep looking for, finding, and actively and vigorously disputing your irrational beliefs to which you have once again relapsed and that are now contributing to you feeling anxious or depressed. Keep doing them over and over, until you build intellectual and emotional muscle. Ellis says, “No matter how clearly you see that you upset yourself and make yourself needlessly miserable, you rarely will improve except through work and practice- yes, considerable work and practice- to actively change your disturbance-creating Beliefs and to vigorously (and often uncomfortably) act against them.”

Don’t fool yourself into believing that if you merely change your language you will always change your thinking. Again Ellis: If you mildly Dispute your irrational Beliefs (iBs) you may not change them and keep them changed. Therefore, you had better powerfully and persistently argue against them and persuade yourself that they are false. You may for a while find it easy to change your feelings. But you’re better keep working, working, working to maintain your gains?

Convince yourself. Here’s where the real work begins. It would be short sighted to believe that one or two exposures to a concept could totally make it yours. A long-time Smartie once told me the number one cause of relapse is lack of coping skills? If you have only a brief acquaintance with the skills presented here rather than a solid understanding built thorough study and repetition, how can you expect them to come to your aid when you need the most? Coping skills are learned like any other skills: first, learning them, then by practice and repetition until they become ingrained. Keep working on your disputes and coping skills until you are thoroughly convinced, not just mildly believing.

The hard work mentioned by Ellis can include:

a.. Written Work: The first exercise suggested by most here is the Cost Benefit Analysis (CBA). OK, you know that. But, do you really have one written down? Have you looked at it more than once or twice? This can be a powerful tool when it is utilized in the manner suggested. It should be an ongoing work that is revised, added to, and referred to in the face of temptation. Just having a general outline in your mind is not nearly as powerful as seeing your thoughts take form on paper. It can truly be illuminating.

We used to talk about homework around here but it is a topic that has fallen away in recent days. I would not propose to be anyone’s schoolmaster but you can, yourself, start your own written analysis of the IB’s that are particular to you. As you dispute those, continued emotional discomfort on your part might signal other IB’s that you still have to unearth. The written disputes of today might be forgotten 6 months from now and having a written record of these can help you from starting all over again.

b.. REI: Rational Emotive Imagery is another underutilized tool that is so powerful, if practiced for a regular period of time (Ellis suggests at least 30 days). Ellis provides a dramatic, live demonstration at his seminars. You can learn more about this technique in most any Ellis book. The key concept in REI is practicing cooler?thoughts. Sort of sounds like our PPP. (Practice, Patience, and Persistence).

c. Taped Disputes: One powerful way to do highly powerful, vigorous disputing is to use a tape recorder and to state one of your strong irrational beliefs into it. Figure out several disputes to this IB and present them strongly on this same tape. Listen to your disputing on tape. Do it over in a more forceful and vigorous manner and listen again, listening until you get better and better disputes. Keep listening to it until you see that you are able to convince yourself that you are becoming more powerful and more convincing.

Reading and Owning the material:

It is said numerous times in the meetings: to think rationally, rather than irrationally. Yes, you can look up the definitions of the two words, but does that really give you much more than a general help? If I weren’t already in the habit of thinking irrationally, I wouldn’t be here in the first place. How can I learn to think more rationally? Learning how to think? is a skill.

If you haven’t read any of the authorities recommended in the suggested reading material, who could blame you for not being too adept at spotting thinking disorders? An excellent book that points this out is “Feeling Good” by David D. Burns. He refers to 10 Cognitive Distortions and give lots of examples and exercises on how to recognize them. It is also the list that I have seen Betty recently utilize. You might have read the list at one time, but do you own the material? well enough to spot faulty thinking in your everyday thoughts?

If you still feel like you don’t really have a grasp on a lot of the basics, or these concepts just don’t come to your rescue when you need them, one should ask themselves, What resources have I invested in to help make this material mine? Do you have the Smart Manual in your library? Do you have a resources library? (Not demanding, just suggesting.)

Topics: Pat (Skywiz) has been a real mentor to myself and many others here too. His knowledge of REBT and related topics and his grasp of how it all fits together is sometimes astounding. How did that man get to be so Smart? I know that he has read and continues to read every book he can get his hands on to learn as much as he can about this subject and all related topics. As you start to explore and learn, you realize that getting sober is just the first step. The implications and applications of REBT and a balanced life-style can become an on-going search leading you from topic to topic. Other topics of interest that intertwine with REBT may be:

a. USA (Unconditional Self Acceptance). Surprisingly it is not the same as self-esteem.

b. Guilt- A topic brought up in most every meeting I have attended. An excellent book is Woulda, Coulda, Shoulda.. Overcoming regrets, mistakes, and missed opportunities by Dr. Arthur Freeman and Rose DeWolf.

c. Urges. Do you know the four common misconceptions (irrational beliefs) about urges? They are:

1. Urges are excruciating or unbearable.
2. They compel you to use.
3. They will not go away until you drink or use.
4. They will drive you crazy.

d. Anger- For many of us, when we don’t get our way, we get angry. Useful IB’s and disputes about this subject abound in the book “How to control your anger before it controls you? Ellis and Raymond Chip Tafrate.

e. Semantics- You will notice a distinct concentration (some say nit-picking) about ones choice of words around here. The subject of semantics delves into how our language says so much about what we think. Having trouble unearthing your IBs? What you say might help you zero in on them. That is why you might have seen the ATW (Automatic Thought Warning) that we have employed form time to time. A useful device to make us more aware of what we are saying.

I have only touched on a few topics and the field is open to wherever it leads you. It reminds me of websurfing. I start out researching one topic, see another interesting topic and surf over there, and hours later find myself 6 or 7 topics away! Anyone having trouble coming up with a Vital Creative Absorbing Interest (VACI)?

In conclusion, backsliding isn’t the end of the world. It is quite natural. Rather than the awful, terrible event that we so often portray it to be, it could be the impetus for us to get back to some much needed personal work. It can even help us to go back to some areas that we originally glossed over the first time around. With this attitude of healthy disappointment for our behavior, (rather than unhealthy attitudes that stifle growth) we can get back to the basics of the ABCs and REBT that helped us in the first place. We can keep looking for and vigorously disputing our irrational beliefs. We won’t fool ourselves that we have done the work by only mildly believing but we will continue working hard until we are thoroughly convinced of the truth of our disputes and the rational choices we have chosen to make. Learning and making our own the basic concepts of REBT will help us avoid the kind of thinking errors that caused the incident of backsliding for the future.

(Portions of this article is from the Ellis article “Maintain and Enhance Your Rational Emotive Behavior Gains”) From a post submitted by “Ali”.