Relapse Prevention

You had a bad day today. You found out you didn’t get the promotion you had been worrying after for weeks. Worse, when you got out to your car at the end of your shift, you discovered that one of the tires had gone flat.

On your way home, you took the route that went past your old watering hole. You stopped there. You went in and placed an order in a rush, and you stared at the drink for a moment when it got to you. You told yourself that you didn’t plan to get drunk, that you were going to have one drink. You deserved one drink. And then you had a lapse in your recovery from substance abuse.

This does not mean that you have failed.

Relapse Prevention

But research does indicate that an initial lapse in recovery greatly increases the risk of a full relapse—uncontrolled substance abuse—or to abandonment of recovery goals altogether, so you must be careful. What this situation calls for is the Sherlock Holmes in you, a rational and objective lens through which to examine this lapse, to learn from it.

First, you should know what you’re looking for. The cognitive-behavioral relapse prevention model developed by Marlatt and Gordon describes two categories of factors that lead to an initial lapse: immediate determinants, like high-risk situations and coping skills; and covert antecedents, such as lifestyle imbalances and urges and cravings.

Relapse PreventionSo what were the immediate determinants of this lapse, and what could you have done to avoid them? You were disappointed and maybe angry when you found out that you didn’t get the job. Next time part of your plans fall through, you can create a chart to list all of the good things going on in your life to contrast the bad that has upset you. You can also speak to a hiring manager to find out what you can do to improve your chances for the next opening. To deal with the sudden rush of anger at finding a flat tire or some other inconvenience, something as simple as taking several deep breaths and counting works for many people. You chose to drive past the bar you used to frequent, when you had been avoiding that route since you started your recovery—this one is obvious: stick to the recovery road! And lastly, you talked yourself into that drink. For every reason why you should drink that comes to mind, remind yourself of two reasons why you should not. Enlist someone else, if you must. Tell the bartender that you’re recovering from substance abuse.

Those were the things that lead you to your lapse, but some covert antecedents made them more powerful. High anxiety in the weeks prior to today made the two bad things that happened carry more weight than all the good. Stress and anxiety can be mitigated by daily exercise, and perhaps medication if prescribed by your doctor. To combat the desire to drink, remember that your urges and cravings are not symptoms of a character flaw, but that you have been conditioned to feel that way. Advertising, social cues, and incorrect or incomplete outcome expectancies tell you that a nice cold brew is the only way to end a hard day properly. Remember that is not true, and adjust your outcome expectancies to include all of the negative long-term consequences of drinking, not just the good short-term effects. Carry reminders with you, on a notecard, if it helps.

Don’t allow yourself to wallow in this one lapse. Pick yourself up, identify what went wrong, correct what needs to be corrected, and avoid what should be avoided. It’s elementary.

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