Relapse prevention

Relapse Prevention Plan and Early Warning Signs10 Most Common Triggers of Substance Abuse RelapseWithdrawal symptoms (anxiety, nausea, physical weakness)Post-acute withdrawal symptoms (anxiety, irritability, mood swings, poor sleep)Poor self-care (stress management, eating, sleeping)People (old using friends)Places (where you used or where you used to buy drugs)Things (that were part of your using, or that remind you of using)Uncomfortable emotions (H.A.L.T.: hungry, angry, lonely, tired)Relationships and sex (can be stressful if anything goes wrong)Isolation (gives you too much time to be with your own thoughts)Pride and overconfidence (thinking you don’t have a drug or alcohol problem, or that it is behind you)The Stages of RelapseRelapse is a process, it's not an event. In order to understand relapse prevention, you have to understand the stages of relapse. Relapse starts weeks or even months before the event of physical relapse. In this page you will learn the early warning signs of relapse and specific relapse prevention techniques for each stage of relapse. There are three stages of relapse.(1)Emotional relapseMental relapsePhysical relapseEmotional RelapseIn emotional relapse, you're not thinking about using. But your emotions and behaviors are setting you up for a possible relapse in the future.The signs of emotional relapse are:AnxietyIntoleranceAngerDefensivenessMood swingsIsolationNot asking for helpNot going to meetingsPoor eating habitsPoor sleep habitsThe signs of emotional relapse are also the symptoms of post-acute withdrawal. If you understand post-acute withdrawal it's easier to avoid relapse, because the early stage of relapse is easiest to pull back from. In the later stages the pull of relapse gets stronger and the sequence of events moves faster.Early Relapse PreventionRelapse prevention at this stage means recognizing that you're in emotional relapse and changing your behavior. Recognize that you're isolating and remind yourself to ask for help. Recognize that you're anxious and practice relaxation techniques. Recognize that your sleep and eating habits are slipping and practice self-care.If you don't change your behavior at this stage and you live too long in the stage of emotional relapse you'll become exhausted, and when you're exhausted you will want to escape, which will move you into mental relapse.Practice self-care. The most important thing you can do to prevent relapse at this stage is take better care of yourself. Think about why you use. You use drugs or alcohol to escape, relax, or reward yourself. Therefore you relapse when you don't take care of yourself and create situations that are mentally and emotionally draining that make you want to escape.For example, if you don't take care of yourself and eat poorly or have poor sleep habits, you'll feel exhausted and want to escape. If you don't let go of your resentments and fears through some form of relaxation, they will build to the point where you'll feel uncomfortable in your own skin. If you don't ask for help, you'll feel isolated. If any of those situations continues for too long, you will begin to think about using. But if you practice self-care, you can avoid those feelings from growing and avoid relapse.Mental RelapseIn mental relapse there's a war going on in your mind. Part of you wants to use, but part of you doesn't. In the early phase of mental relapse you're just idly thinking about using. But in the later phase you're definitely thinking about using.The signs of mental relapse are:Thinking about people, places, and things you used withGlamorizing your past useLyingHanging out with old using friendsFantasizing about usingThinking about relapsingPlanning your relapse around other people's schedulesIt gets harder to make the right choices as the pull of addiction gets stronger.Techniques for Dealing with Mental UrgesPlay the tape through. When you think about using, the fantasy is that you'll be able to control your use this time. You'll just have one drink. But play the tape through. One drink usually leads to more drinks. You'll wake up the next day feeling disappointed in yourself. You may not be able to stop the next day, and you'll get caught in the same vicious cycle. When you play that tape through to its logical conclusion, using doesn't seem so appealing.A common mental urge is that you can get away with using, because no one will know if you relapse. Perhaps your spouse is away for the weekend, or you're away on a trip. That's when your addiction will try to convince you that you don't have a big problem, and that you're really doing your recovery to please your spouse or your work. Play the tape through. Remind yourself of the negative consequences you've already suffered, and the potential consequences that lie around the corner if you relapse again. If you could control your use, you would have done it by now.Tell someone that you're having urges to use. Call a friend, a support, or someone in recovery. Share with them what you're going through. The magic of sharing is that the minute you start to talk about what you're thinking and feeling, your urges begin to disappear. They don't seem quite as big and you don't feel as alone.Distract yourself. When you think about using, do something to occupy yourself. Call a friend. Go to a meeting. Get up and go for a walk. If you just sit there with your urge and don't do anything, you're giving your mental relapse room to grow.Wait for 30 minutes. Most urges usually last for less than 15 to 30 minutes. When you're in an urge, it feels like an eternity. But if you can keep yourself busy and do the things you're supposed to do, it'll quickly be gone.Do your recovery one day at a time. Don't think about whether you can stay abstinent forever. That's a paralyzing thought. It's overwhelming even for people who've been in recovery for a long time.One day at a time, means you should match your goals to your emotional strength. When you feel strong and you're motivated to not use, then tell yourself that you won't use for the next week or the next month. But when you're struggling and having lots of urges, and those times will happen often, tell yourself that you won't use for today or for the next 30 minutes. Do your recovery in bite-sized chunks and don't sabotage yourself by thinking too far ahead.Make relaxation part of your recovery. Relaxation is an important part of relapse prevention, because when you're tense you tend 

RELAPSE PREVENTION

Relapse Prevention Plan and Early Warning Signs10 Most Common Triggers of Substance Abuse RelapseWithdrawal symptoms (anxiety, nausea, physical weakness)Post-acute withdrawal symptoms (anxiety, irritability, mood swings, poor sleep)Poor self-care (stress management, eating, sleeping)People (old using friends)Places (where you used or where you used to buy drugs)Things (that were part of your using, or that remind you of using)Uncomfortable emotions (H.A.L.T.: hungry, angry, lonely, tired)Relationships and sex (can be stressful if anything goes wrong)Isolation (gives you too much time to be with your own thoughts)Pride and overconfidence (thinking you don’t have a drug or alcohol problem, or that it is behind you)The Stages of RelapseRelapse is a process, it's not an event. In order to understand relapse prevention, you have to understand the stages of relapse. Relapse starts weeks or even months before the event of physical relapse. In this page you will learn the early warning signs of relapse and specific relapse prevention techniques for each stage of relapse. There are three stages of relapse.(1)Emotional relapseMental relapsePhysical relapseEmotional RelapseIn emotional relapse, you're not thinking about using. But your emotions and behaviors are setting you up for a possible relapse in the future.The signs of emotional relapse are:AnxietyIntoleranceAngerDefensivenessMood swingsIsolationNot asking for helpNot going to meetingsPoor eating habitsPoor sleep habitsThe signs of emotional relapse are also the symptoms of post-acute withdrawal. If you understand post-acute withdrawal it's easier to avoid relapse, because the early stage of relapse is easiest to pull back from. In the later stages the pull of relapse gets stronger and the sequence of events moves faster.Early Relapse PreventionRelapse prevention at this stage means recognizing that you're in emotional relapse and changing your behavior. Recognize that you're isolating and remind yourself to ask for help. Recognize that you're anxious and practice relaxation techniques. Recognize that your sleep and eating habits are slipping and practice self-care.If you don't change your behavior at this stage and you live too long in the stage of emotional relapse you'll become exhausted, and when you're exhausted you will want to escape, which will move you into mental relapse.Practice self-care. The most important thing you can do to prevent relapse at this stage is take better care of yourself. Think about why you use. You use drugs or alcohol to escape, relax, or reward yourself. Therefore you relapse when you don't take care of yourself and create situations that are mentally and emotionally draining that make you want to escape.For example, if you don't take care of yourself and eat poorly or have poor sleep habits, you'll feel exhausted and want to escape. If you don't let go of your resentments and fears through some form of relaxation, they will build to the point where you'll feel uncomfortable in your own skin. If you don't ask for help, you'll feel isolated. If any of those situations continues for too long, you will begin to think about using. But if you practice self-care, you can avoid those feelings from growing and avoid relapse.Mental RelapseIn mental relapse there's a war going on in your mind. Part of you wants to use, but part of you doesn't. In the early phase of mental relapse you're just idly thinking about using. But in the later phase you're definitely thinking about using.The signs of mental relapse are:Thinking about people, places, and things you used withGlamorizing your past useLyingHanging out with old using friendsFantasizing about usingThinking about relapsingPlanning your relapse around other people's schedulesIt gets harder to make the right choices as the pull of addiction gets stronger.Techniques for Dealing with Mental UrgesPlay the tape through. When you think about using, the fantasy is that you'll be able to control your use this time. You'll just have one drink. But play the tape through. One drink usually leads to more drinks. You'll wake up the next day feeling disappointed in yourself. You may not be able to stop the next day, and you'll get caught in the same vicious cycle. When you play that tape through to its logical conclusion, using doesn't seem so appealing.A common mental urge is that you can get away with using, because no one will know if you relapse. Perhaps your spouse is away for the weekend, or you're away on a trip. That's when your addiction will try to convince you that you don't have a big problem, and that you're really doing your recovery to please your spouse or your work. Play the tape through. Remind yourself of the negative consequences you've already suffered, and the potential consequences that lie around the corner if you relapse again. If you could control your use, you would have done it by now.Tell someone that you're having urges to use. Call a friend, a support, or someone in recovery. Share with them what you're going through. The magic of sharing is that the minute you start to talk about what you're thinking and feeling, your urges begin to disappear. They don't seem quite as big and you don't feel as alone.Distract yourself. When you think about using, do something to occupy yourself. Call a friend. Go to a meeting. Get up and go for a walk. If you just sit there with your urge and don't do anything, you're giving your mental relapse room to grow.Wait for 30 minutes. Most urges usually last for less than 15 to 30 minutes. When you're in an urge, it feels like an eternity. But if you can keep yourself busy and do the things you're supposed to do, it'll quickly be gone.Do your recovery one day at a time. Don't think about whether you can stay abstinent forever. That's a paralyzing thought. It's overwhelming even for people who've been in recovery for a long time.One day at a time, means you should match your goals to your emotional strength. When you feel strong and you're motivated to not use, then tell yourself that you won't use for the next week or the next month. But when you're struggling and having lots of urges, and those times will happen often, tell yourself that you won't use for today or for the next 30 minutes. Do your recovery in bite-sized chunks and don't sabotage yourself by thinking too far ahead.Make relaxation part of your recovery. Relaxation is an important part of relapse prevention, because when you're tense you tend 

BANK OF IDEAS #support.don't punish

            THE TWELVE STEPS PROGRAM

The Twelve Step program has a largely successful track record for recovery from alcoholism. The principles of this program have also been incorporated for recovery from other forms of addiction, such as Narcotics Anonymous for drug addictions. This success is due in large part to the fact that all twelve steps reflect biblical principles. This article will document how A.A.'s 12 steps correlate with biblical principles.

 A person walking up stairs. Jake Hills/Unsplash

The primary secret to the longstanding record of success of the Twelve Step program lies in the fact that these steps, learned from the bitter road of experience, have been in the Bible long before they were realized and formulated in A.A.

Background of A.A.’s Twelve Steps

Alcoholics Anonymous (A.A.) was founded in 1935 by two men who determined to share keys to their recovery from the throes of alcoholism. Both men considered that God’s deliverance was the key to their sobriety. Their personal stories appear in Alcoholics Anonymous, known by A.A. members as “the big book.”

Three years later, the fledgling fellowship determined to put in writing the keys to the recovery experiences of some 100 A.A. members. This led to the publication of Alcoholics Anonymous in April 1939. The big book contains 30 case histories: testimonials about alcoholism from the alcoholic’s point of view. It also introduces the 12 steps to sobriety that were later expounded more thoroughly in Twelve Steps and Twelve Traditions, first published in 1953.

“Based on the experience of A.A.’s earliest members, the steps are a record of the principles and practices they developed to maintain sobriety (after many other approaches had failed)…The steps are a suggested program of recovery. Although experience shows that many A.A. members’ comfort in sobriety depends, to an extent, on their understanding and acceptance of the steps, no A.A. member is forced to accept or even read them. It is up to the individual to decide when and how the steps, will be used” (www.alcoholics-anonymous.org ).

Many people realize that the Bible is our Creator’s revelation to humanity. They acknowledge God’s Word as the supreme authority on what we should think and how we should live. They naturally are concerned to know: Is the Alcoholics Anonymous program in harmony with the Bible? Below you will see the evidence that the Twelve Step program is indeed in harmony with the Bible.

(This article is not meant as an endorsement of any organization or the Twelve Step Program. Other avenues of treatment and support for addiction have also been successful. Viable options should be carefully and prayerfully considered.) 

Step #1: We admitted that we were powerless over alcohol—that our lives had become unmanageable

Jeremiah states that we cannot manage our life on our own. “I know, O LORD, that the way of human beings is not in their control, that mortals as they walk cannot direct their steps” (Jeremiah 10:23, New Revised Standard Version).

David faced this dilemma many times in his life. In Psalms 38:4 David admits that he was overwhelmed by sin, unable to bail himself out on his own, writing, “For my iniquities have gone over my head; like a heavy burden they are too heavy for me.”

In Romans 7:14-23 the apostle Paul describes a Christian’s struggle with sin and need for God’s deliverance. He plaintively exclaims: ”Oh, what a miserable person I am! Who will free me from this life that is dominated by sin and death?” (Romans 7:24). Paul gives the solution in the next verse: ”Thank God! The answer is in Jesus Christ our Lord” (Romans 7:25, New Living Translation).

Commenting on Romans 7:24-25, The Expositor’s Bible Commentary observes: ”The agony of this unhappy condition comes out in the cry ‘What a wretched man I am!’ It is a powerful and moving cry, recalling the words of Isaiah when he became aware of his sin (Isaiah 6:5). Since Paul is unable to help himself he must look elsewhere…There is deliverance, provided by God through Jesus Christ.”

This expresses the same sentiment as step 2 of the Twelve Step program.

Step #2: We came to believe that a Power greater than ourselves could restore us to sanity

Hebrews 11:6 tells us, “He who comes to God must believe that He is and that He is a rewarder of those who diligently seek Him.” So step 2 urges the recovering alcoholic to acknowledge that recovery depends on “a power greater than ourselves.”

A.A. often uses the term “Higher Power” rather than “God” in order to allow for the differing beliefs of its members, some of whom are agnostics or even atheists. The two founders of A.A. were devout Christians. So they considered God and Jesus Christ as the source of this power, and this is the original intent behind the 12 steps.

Sobriety is defined in step 2 as restoration to sanity. Perfect sanity, of course, is to think as God thinks. We grow in sanity as we read the Bible with the Holy Spirit enabling us to have spiritual understanding. Referring to the Holy Spirit, Paul wrote, “For God has not given us a spirit of fear, but of power and of love and of a sound mind” (2 Timothy 1:7).

Step #3: We made a decision to turn our will and our lives over to the care of God as we understood Him

This step expresses a fundamental principle in our relationship with God that is expressed in numerous scriptural passages, including:

“Trust in the LORD with all your heart, and lean not on your own understanding; in all your ways acknowledge Him and He shall direct your paths” (Proverbs 3:5-6).

“Commit your way to the LORD, trust also in Him, and He shall bring it to pass” (Psalms 37:5).

“With eyes wide open to the mercies of God…as an act of intelligent worship…give him your bodies as a living sacrifice, consecrated to him and acceptable by him. Don’t let the world squeeze you into its mold, but let God re-mold your minds from within, so that you may prove in practice that the plan of God is good, meets all his demands and moves towards the goal of true maturity” (Romans 12:1-2, Phillips).

Step #4: We made a searching and fearless moral inventory of ourselves

Self-examination is another basic principle of Christian living. Important scriptural admonitions are found in 1 Corinthians 11:28 (“But let a man examine himself”), 2 Corinthians 13:5 (“Examine yourselves as to whether you are in the faith”), and Galatians 6:4 (“Let each one examine his own work”).

Step #5: We admitted to God, to ourselves and to another human being, the exact nature of our wrongs

In a word step 5 calls for confession of wrongs. Repentance involves admitting our sin to God as in David’s confession found in 2 Samuel 12:13: “I have sinned against the LORD.” Psalm 51 expresses David’s prayer of repentance after his sin with Bathsheba.

As step 5 indicates, one must also be honest with himself and face up to his sins and mistakes.

Step 5 calls for a candid and thorough admission of wrongdoing in response to the recovering alcoholic’s decision to turn his or her life over to God as called for by the third step. Here are some scriptures that express this kind of confession:

“You can throw the whole weight of your anxieties upon him, for you are his personal concern” (1 Peter 5:7, Phillips).

“I acknowledged my sin to You, and my iniquity I have not hidden. I said, ‘I will confess my transgressions to the LORD,’ and You forgave the iniquity of my sin” (Psalms 32:5).

“If we confess our sins, He is faithful and just to forgive us our sins and to cleanse us from all unrighteousness” (1 John 1:9).

AA also wisely recommends that the alcoholic relate to another person his history of alcohol abuse and the relevant mistakes and bad habits of his life.

“Therefore confess your sins to one another, and pray for one another, so that you may be healed. The prayer of the righteous is powerful and effective” (James 5:16, New Revised Standard Version).

The Bible does not require confession to a human being for the purpose of gaining forgiveness from God. In fact 1 Timothy 2:5 tells us that Jesus Christ is the only mediator between God and man. However, venting to a trained professional counselor or minister can be therapeutic. I have helped hundreds of recovering alcoholics through the fourth step as a chaplain at an alcoholism treatment center several years ago.

Step #6: We were entirely ready to have God remove all these defects of character

This step calls for a repentant attitude and willingness to change. This the Bible also teaches:

“You were taught, with regard to your former way of life, to put off your old self, which is being corrupted by its deceitful desires; to be made new in the attitude of your minds; and to put on the new self, created to be like God in true righteousness and holiness” (Ephesians 4:22-23, New International Version).

 

“Live life, then, with a due sense of responsibility, not as men who do not know the meaning and purpose of life but as those who do. Make the best use of your time, despite all the difficulties of these days. Don’t be vague, but firmly grasp what you know to be the will of the Lord” (Ephesians 5:15-17, Phillips).

Step #7: We humbly asked Him to remove our shortcomings

Being willing to have God remove our shortcomings must be followed by asking Him to do so. “Ask and you will receive” is a basic Bible principle in our relationship with God:

“And whatever things you ask in prayer, believing, you will receive” (Matthew 21:22).

“Therefore I say to you, whatever things you ask when you pray, believe that you receive them, and you will have them” (Mark 11:24).

“Ask, and you will receive, that your joy may be full” (John 16:24).

Asking God to remove our shortcomings is one of the most important requests that we can make.

God inspired Isaiah to write: “Seek the LORD while He may be found, call upon Him while He is near. Let the wicked forsake his way, and the unrighteous man his thoughts; let him return to the LORD, and He will have mercy on him; and to our God, for He will abundantly pardon” (Isaiah 55:6-7).

David prayed, “Search me, O God, and know my heart; try me, and know my anxieties; and see if there is any wicked way in me, and lead me in the way everlasting” (Psalms 139:23-24).

He also prayed, “Wash me thoroughly from my iniquity, and cleanse me from my sin” (Psalms 51:2).

Step #8: We made a list of all persons we had harmed and became willing to make amends to them all.

Step # 9: We made direct amends to such people wherever possible, except when to do so would injure them or others.

This is another aspect of confessing sins to another human being that the Bible requires. Jesus said in Matthew 5:23-24: “If you…remember that your brother has something against you…be reconciled to your brother.”

Regarding James 5:16, The Expositor’s Bible Commentary explains: ”If a person has sinned against a brother, he should confess the sin to him. This will no doubt result in mutual confession—”to each other.” Then the two believers should “pray for each other.” If the sin has caused sickness, healing will follow confession and prayer. James proceeds to add the assurance that prayer “is powerful and effective.” The “righteous man” here referred to is the man whose sins have been confessed and forgiven. His prayer is fully able to secure results, such as healing of the sick.

Matthew 18:15 reveals the positive results of confessing sins to each other: ”If another believer sins against you, go privately and point out the offense. If the other person listens and confesses it, you have won that person back” (NLT).

Step #10: We continued to take personal inventory and when we were wrong, promptly admitted it

Step 10 is basically making step 4 a continuous way of life, which should certainly be true of spiritual self-examination. This step requires growth in humility. In Colossians 3:12-13, Paul wrote, “Therefore, as the elect of God, holy and beloved, put on tender mercies, kindness, humility, meekness, longsuffering; bearing with one another, and forgiving one another, if anyone has a complaint against another; even as Christ forgave you, so you also must do.”

It also leads one in the direction of fulfilling the second great commandment, which is to “love your neighbor as yourself” (Matthew 22:39).

Step #11: We sought through prayer and meditation to improve our contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out

This step could be the subject of a whole sermon, Bible study or article. I will list only a few scriptures that relate to seeking “the knowledge of God’s will for us and the power to carry that out”:

“Seek the LORD and His strength; seek His face evermore!” (Psalms 105:4).

“Draw near to God and He will draw near to you” (James 4:8).

“Therefore, do not be unwise, but understand what the will of the Lord is” (Ephesians 5:17).

 

“I can do all things through Christ who strengthens me” (Philippians 4:13).

“For God is working in you, giving you the desire and the power to do what pleases him” (Philippians 2:13, NLT).

Step #12: Having had a spiritual awakening as a result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs

Participation in AA should be about giving help to others just as much as getting help from others. The scriptural principle for this is in Philippians 2:4: “Let each of you look out not only for his own interests, but also for the interests of others.”

Helping fellow alcoholics recover is also critical to maintaining sobriety. Of course, to be effective in helping others, one must have been successfully practicing the previous 11 steps. As Jesus says, ”We must get the beam out of our own eye before we can see clearly to get the speck out of our brother’s eye” (Matthew 7:3-5).

Paul writes in Galatians 6:1-2: “Brethren, if a man is overtaken in any trespass, you who are spiritual restore such a one in a spirit of gentleness, considering yourself lest you also be tempted. Bear one another’s burdens and so fulfill the law of Christ.” As we gain spiritual strength, we can better help to “restore” someone else to the right path. And bearing each other’s burdens is part of the kind of love that comprises the law of Christ.