People do not achieve lasting recovery just by abstaining from substances. Recovery involves creating a new life in which it’s easier to not drink or use. If individuals do not change their lives, then all the factors that contributed to their addiction will still be there.
A missing piece of the puzzle for many recovering individuals is understanding the difference between selfishness and self-care. Selfishness is taking more than a person needs. Self-care is taking as much as one needs. Clinical experience has shown that addicted individuals typically take less than they need, and, as a result, they become exhausted or resentful and turn to their addiction to relax or escape. Part of challenging addictive thinking is to encourage clients to see that they cannot be good to others if they are first not good to themselves.1
Individuals with substance use disorders who have achieved abstinence now work toward self-improvement and self-protection. Practicing a drug-free lifestyle – which began during detox and rehab – is so critical to the maintenance of a life that isn’t controlled by alcohol or drugs.
When abstinence has been attained, there is still a lot to do:
- You have to relearn how to live in the real world without drinking or using drugs.
- You have to work on the problems that drink and/or use caused with your family, your job, your friends and your money.
- You have to stay away from people you drank or used drugs with, as well as the places where that occurred.
- You have to learn what makes you want to drink or use again, so you can avoid or work on those things.
- You may also need treatment for health issues that led to drink and/or use abuse, such as depression, anxiety or other mental conditions.
A “trigger” is anything that makes a person feel the urge to go back to using drugs. It can be a place, person, thing, smell, feeling, or memory that reminds the person of taking a drug and getting high. A trigger can be something stressful that you want to escape from. It can even be something that makes you feel happy. People fighting addiction need to stay away from the triggers that can make them start using drugs again in the same way that people with allergies try to avoid those situations that escalate their bodies’ tendency toward a negative reaction.2
Recovering individuals tend to see setbacks as failures because they are unusually hard on themselves. Setbacks can set up a vicious cycle, in which individuals see setbacks as confirming their negative view of themselves. They feel that they cannot live life on life’s terms. This can lead to more using and a greater sense of failure. Eventually, they stop focusing on the progress they have made and begin to see the road ahead as overwhelming.1
Guarding Against that Persistent Foe: Relapse
The chronic nature of substance use disorders means that relapsing to drug abuse at some point is not only possible, but likely. Relapse rates (i.e., how often symptoms recur) for people with addiction and other substance use disorders are similar to relapse rates for other well-understood chronic medical illnesses such as diabetes, hypertension, and asthma, which also have both physiological and behavioral components. Treatment of chronic diseases involves changing deeply imbedded behaviors, and relapse does not mean treatment has failed. For a person recovering from addiction, lapsing back to drug use indicates that treatment needs to be reinstated or adjusted or that another treatment should be tried.
One of the key factors in preventing relapse to substance use is maintaining a recovery-oriented approach. That means keeping a humble attitude toward the power of the addiction and not taking one’s abstinence for granted. It is so critical for recovering addicts to have a realistic mindset with intentionality, self-discipline and personal vigilance against relapse – always being on guard. Vitally important are honesty with self and transparency to others. Continued participation in self-help groups – as well as keeping a careful watch on one’s own personal thinking and attitude – go a long way in staying the course.3
Relapse prevention is an extremely important component of recovery. After an individual has established some stability in abstinence, he should start to develop skills to prevent future relapse to substance use. He must learn how to manage negative or uncomfortable feelings without using any drugs.
Prevention of relapse calls for an addict to recognize in advance when she is headed toward a relapse and to respond by changing direction. Relapse is a process that actually begins before any substance use. With education, the addict can easily recognize the signs indicating an imminent return to alcohol or drugs. Indeed, the recovering addict must become aware of these red flags that indicate danger ahead.
These red flags can most simply be described as negative changes in attitudes, feelings and behaviors. Usually, an individual with a substance use disorder can recognize examples of these negative changes in his own life and, therefore, develop an understanding of the relapse process. With growing awareness of the nature of this process, his next task is to develop the ability to intervene and change any negative feelings or risky behaviors in order to continue in his recovery program. With practice (reconditioning), he will be able to quickly identify unhealthy situations and stay on his strategic course in recovery.4
Reevaluating Relationships to Support Recovery
Positive, healthy relationships are an extremely important source of support during an addict’s process of recovery. Hopefully the addict has a positive family and friend network that can be called upon to help when it’s needed. Damaging or unhealthy relationships must be avoided at all cost – that is, people who will tend to steer or push him back into addiction. A total relationship makeover is likely necessary, as difficult as that may sound.
Two types of unhealthy behavior can contribute to a person’s continued abuse of drugs:
- Codependency occurs when another individual, perhaps the addict’s spouse or family member, is controlled by the addict’s addictive behavior.
- Enabling behavior occurs when another person – often a codependent – helps or encourages the addict to continue using drugs, either directly or indirectly.
The addict needs to identify positive relationships with recovering or nondrug-using people who will be supportive of his recovery. The addict should feel free to call on these individuals for social support as needed. If the recovering addict has no supportive relationships she should get involved in the fellowship available through self-help or 12-Step programs. Other positive social involvement, such as religious or recreational organizations, can also be very beneficial.4
A stable, substance-free living environment is essential to sustained abstinence. Destructive relationships and living environments can derail recovery for even highly motivated individuals. A strong predictor of long-term outcome is the characteristics of the social network and living situation the addict develops during recovery, reaffirming the importance of social and environmental factors in recovery.5
Can Damaged Relationships Be Restored in Recovery?
The irony of addictive disease is that those closest to the person with the addiction suffer tremendously. It’s horrifying to watch someone you care about self-destruct. Crippled by fear, anger and overwhelming grief, families and friends either stay helplessly entangled in the addict’s illness – trying to control the uncontrollable – or they separate emotionally. Either way, the relationship may be damaged, sometimes beyond repair.
Mending Trust – Those who have been hurt as a result of addiction have no reason to trust the addicted person. Although early recovery restores hope, re-establishing trust is not so easy. It requires two things:
- First, the addict has to stop using drugs and alcohol and change his bad behavior.
- The second factor is time. How much time? As long as it takes.
Remember, trust is not the same as love or forgiveness. You can love and forgive someone without trusting him. For example, it is one thing to forgive an apologetic jewel thief and quite another thing to leave her alone in a jewelry store. Likewise, you can forgive a person recovering from alcoholism who asks for forgiveness. But it takes time, honesty, good choices and continued sobriety to regain trust.
Finding Forgiveness – Forgiveness is not a mental exercise. Rather, it is an intentional change of heart by those who have been hurt. It means not letting resentments steal your peace or rob your future. Forgiveness is not a natural thing to do. It’s hard, but it is the only thing that releases you from the bondage of bitterness, releases the addicts from his shame, and restores the possibility of trust and intimacy between people.
Restoring a wounded relationship is like trying to take down a large brick wall separating those with whom we were once close. No matter how hard you try, it won’t come down all at once. Be patient. Good recovery allows you to remove only a few bricks each day. Over time, there will be a hole in the wall large enough to talk through without shouting. After a while the opening will be large enough to reach a hand through and offer a loving touch. And hopefully one day, trust is fully restored and the wall disappears altogether.6
Advice for Friends and Family Members of a Recovering Addict
Caring for a person with a substance use disorder can be very stressful. It is important that as you try to help your loved one, you find a way to take care of yourself as well. It may help to seek support from others, including friends, family, community, and support groups. If you are developing your own symptoms of depression or anxiety, think about seeking professional help for yourself. Remember that your loved one is ultimately responsible for managing her illness. By the same token, it would serve you well to keep these recovery considerations in mind:
Your participation can make a big difference – Many health providers believe that support from friends and family members is important in the life of a recovering addict. However, if family/friends feel unsure about how best to provide the needed support, agencies and organizations are available to help direct them to one that would best fit their situation and needs.
Remember that changing deep habits is hard – It takes time to break strong, well-established habits. It requires repeated efforts. Failures along the way should be expected – not a surprise; learn from them and then keep going. Substance use disorders are no different than any other old habits. Try to be patient with your loved one. Overcoming this disorder won’t be easy or quick.
Pay attention to your loved one’s progress – It’s important to be very intentional about noting what specific progress is being made by your loved one as weeks and months pass – at times bringing healing, while at other times temptation may win the battle. What’s important is the war. Too often we are so angry or discouraged that we take effort and steps of improvement for granted. A word of appreciation or acknowledgement of a success can go a long way.7
It All Begins with Bringing Brain and Behavior Back Under Control?
Drug addiction manifests clinically as compulsive drug seeking, drug use, and cravings that can persist and recur even after extended periods of abstinence. From a psychological and neurological perspective, addiction is a disorder of altered cognition. The brain regions and processes that underlie addiction overlap extensively with those that are involved in essential cognitive functions, including learning, memory, attention, reasoning, and impulse control. Drugs alter normal brain structure and function in these regions, producing cognitive shifts that promote continued drug use through maladaptive learning and hinder the acquisition of adaptive behaviors that support abstinence.8
At Skywood, we have a depth of understanding and a solid track record of success when it comes to substance use disorders and mental illnesses – including the treatment of individuals experiencing both conditions, which so often is the case. We would be honored if you would entrust your or your loved one’s recovery to us. Please believe, we do not take that privilege and responsibility lightly. Each and every individual represents a “new beginning” to us at Skywood.
1 “Relapse Prevention and the Five Rules of Recovery”, Yale Journal of Biology and Medicine, National Center for Biotechnology Information, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/ , (September 3, 2015).
2 “Why Is It So Hard to Quit Drugs?”, Easy-To-Read Drug Facts, National Institute on Drug Abuse, https://easyread.drugabuse.gov/content/why-it-so-hard-quit-drugs .
3 “Drugs, Brains, and Behavior: The Science of Addiction”, National Institute on Drug Abuse, https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery , (July 2014).
4 “An Individual Drug Counseling Approach to Treat Addiction: Chapter 9 – Maintaining Abstinence”, National Institute on Drug Abuse, https://archives.drugabuse.gov/TXManuals/IDCA/IDCA11.html .
5 Bond, Jason, Ph.D., et. al., “What Did We Learn from Our Study on Sober Living Houses and Where Do We Go from Here?”, National Center on Biotechnology Information, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057870/ , (December 2010).
6 Edwards, Drew W., Ed.D., MS, “Rebuilding Relationships in Early Recovery”, PsychCentral, http://psychcentral.com/lib/rebuilding-relationships-in-early-recovery/ , (January 21, 2008).
7 “Treatment for Alcohol Problems: Finding and Getting Help”, National Institute on Alcohol Abuse and Alcoholism, http://pubs.niaaa.nih.gov/publications/Treatment/treatment.htm , (2014).
8 Gould, Thomas J., Ph.D., “Addiction and Cognition”, BioMed Central and National Center for Biotechnology Information, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3120118/ , (December 2010).