TODAYS DISCUSSION Today we will touch briefly on the relapse process

highlighting the fact that relapse does not just happen.

We will discuss the warning signs that indicate that a relapse is approaching leading into a brief overlook at the warning signs document which the residents construct prior to leaving treatment.

We will look quite closely at the relapse prevention plan highlighting important elements to an effective relapse prevention plan.

THE RELAPSE PROCESS Relapsing on substance is never a spur of the moment,

“oh it just happened”, event.

It is a process that starts way before the individual relapses on substance which can be seen in changes in thoughts, attitudes, emotions, behaviour and obviously lifestyle and choices.

One is always able to, in hind-sight, see where things went wrong way before any relapse occurred.

An important factor of developing the graduation documents (Life-plan, Relapse prevention plan and warning signs) is to allow the individual and their supporters the ability to constantly monitor their progression in recovery.

An important principle of recovery is that if you are not moving forward you are moving backward. It means that if we are not paying attention to our recovery and not doing things to contribute to our recovery process we may be unconsciously moving toward relapse.

There are certain warning signs of relapse that appear that make relapse both predictable and preventable.

Please take note of the fact that relapse is predictable and therefor preventable.

WARNING SIGNS OF RELAPSE Irritation, frustration and anger are often good indicators

that there has been a shift in attitude and thought, that the recovering addict is moving away from personal responsibility and heading toward blame.

These “emotions” are often caused by craving cycles and therefor need to be monitored closely and if present addressed immediately. Should a craving cycle not be identified it can spiral out of control leading the addict to attempt to externally justify their emotions.

Self-Pity is another good indicator that the relapse process is underway. Self-pity is an indicator that the recovering addict is setting up justifiable reasons for relapse.

Denial and defensiveness are tell tale signs that relapse is imminent. Recovering addicts start to outright deny the truth about themselves, they do not accept the need to change their lifestyle and start to question the fact that they are actually addicts.

They begin to reject all possible help and start ignoring and avoiding crucial recovery activities. When questioned they become argumentative and all the indicators of denial start to appear – rationalizing, minimizing, blaming, justifying, deflecting, excuse making etc.

Action should be taken before it is too late.

Overconfidence reflects the belief that we have cured the incurable, that we have conquered our addiction and have nothing more to worry about. We begin to believe that “we have got this” and begin to neglect the small things. We become quick to advise others but are unable to receive criticism or acknowledge any faults in our own recovery process.

Change in routine and structure is highlighted by routines becoming haphazard, sleeping patterns irregular, missing appointments and having too much idle time. It reflects that the priority of our recovery has dropped and that we have slipped into a place of complacency.

THE WARNING SIGNS DOCUMENT Toward the end of the treatment process the resident

does step 4 – A searching and fearless moral inventory of themselves.

In step 4 they address resentments, relationships, self-obsession, shame and guilt, times they have felt victimized and their fears.

This work is then processed with their counsellor in a step 5 – We admitted to God, ourselves and another human being the exact nature of our wrongs.

This process allows the counsellor to highlight and draw attention to patterns of behaviours, flawed thinking and beliefs and other warning signs.

This feedback then gets translated into the warning signs document by the resident. A document that highlights, with explanation, the different warning signs that the individual is prone to display or use as a defence mechanism.

A good warning signs document will also explain under each warning sign what that possible causes are and what the action of rectification is.

There are usually between 50 and 100 warning signs highlighted and explained within the document. Don’t panic if your child has more or less.

This document helps with the evaluation of the recovery process and helps to highlight relapse behaviour before it is too late.

It is strongly advisable that you get to know this document well. You are most likely the one person that will be able to identify these signs when you do challenge them.

HEAL or your support group is good at identifying these signs and addressing them – be honest in your feedback.

THE RELAPSE PREVENTION PLAN The relapse prevention plan is a document which outlines

the lifestyle the recovering addict needs to develop.

It defines the boundaries in which the recovering addict needs to operate within and…

…recovery principles the recovering addict needs to remember/ adhere to.

It is a document which outlines the accountability measure put in place for the recovering addict (testing, finances etc) as well as outlining…..

…..consequences for certain transgressions and more importantly for relapse bearing in mind that the consequence is more often than not a precautionary measure to protect the addict from themselves.

BASIC PRINCIPLES OF RPP All points need to take into account the principle of

necessity verses accessory (careful decision needs to be made with regards to access to vehicles, cell phones and cash taking into account the risk and asking the question – Is it really necessary?).

All points to the best of your ability needs to be practical and measureable with levels of accountability and consequences applied to them.

The relapse prevention plan is a measuring tool and a form of accountability itself. It is designed by the residents as a blueprint to a successful long term recovery and should not be negated.

The resident and sponsors need to sign into the document, therefor the sponsor needs to have input in the document.

It is recommended should the resident be returning to stay with the sponsor/ family that they send house rules to be added to the relapse prevention plan.

The relapse prevention plan needs to be seen as a legally binding document that all parties are agreeing to and are stating, by signing, that they will enforce.

Should the Relapse prevention plan need to be altered it should be done in conjunction with your support group and/or the centre.

Regular family meeting should be held to go over these documents.

YOU KNOW THERE IS TROUBLE WHEN….

…..the resident upon returning disregards the relapse prevention plan stating that they only signed it to get out.

…..the resident already starts to negate the points prior to leaving over the phone….. “mom they going to tell you I can’t drink, that is what they have to say because most residents here have hectic drinking problems but you know me, alcohol was never my problem”…….

NA says it perfectly when they say “there is one thing above anything else that will defeat us in our recovery, that is an attitude of intolerance and indifference to recovery principles”.

DEVELOPING THE RPP Following are a few points which should be discussed

and included in the relapse prevention plan.

Remember that all plans are personalized to suite the individual needs in accordance to their environment and support structure.

The stricter you can be on yourself (as the resident) the better. The resident and the family know the persons addiction best of all and should attempt to pre-empt how the addiction will resurface and put measures in place to prevent that.

Routine and structure One needs to outline the potential routine and

structure to your day to day living – this should be defined by developing a “mock schedule” – weekly scheduling should also form part of the relapse prevention plan to take care of principles of proper prior planning and to enforce accountability.

Elements of physical, mental and spiritual components of recovery needs to be present and balanced and the weekly commitments (church, support group, quiet time etc) need be feasibly achievable.

Balance It is all about balance.

Balancing spiritual, psychological and physical components of recovery.

Balancing family time, quiet time, social time, work time, recovery time, relaxation time and on and on.

The minute your balance starts to topple so does your recovery – there are times that this is inevitable you need to monitor and rectify as quickly as possible.

If you feel your recovery is becoming flat – change the structure, change the routine and realign the balance – BASICS.

Boredom Please note that boredom is NOT a bad thing in fact we as

addicts need to learn to be bored.

Addiction is full of excitement – nothing is going to excite us quite like our addiction specifically not on the daily/ hourly basis like our addiction.

Boredom is combatted by effective weekly planning. When you are bored is not the time to start looking for things to do- it will only disappoint.

If you plan ahead you should be fine. Be aware that you should plan your social activities a week in advance to avoid seeking things that will combat your boredom.

Testing and medication Testing is none-negotiable. It is not a matter of trust but of

standard protocol. Testing should be done regularly irrespective of whether things are going good or bad.

Testing is only effective if done properly if the resident is able to cheat the test become invalid.

If the resident is on prescribed medication I would advise that the taking of such medication be monitored along with the daily taking of anta-buse.

There are certain medications that should not be taken as they will produce a false positive on test results and may also induce cravings.

Cars and cell phones This is a big area where the principle of accessory

verses necessity should be applied.

Does the resident need a cell phone, if so, does it need to have all the gadgets and internet access – the simpler the safer.

Unlimited access to the residents vehicle should be avoided and the resident should be slowly introduced to using his or her vehicle.

Vehicles should be fitted with a tracker however please do not use the tracker as an accountability tool.

Finances Residents should not have access to funds (Necessity verse

accessory).

Bank accounts should be avoided (Income should be paid into sponsors accounts where possible).

Creating of debt should be avoided for the first two years.

Cash books with receipts need to be managed on a weekly basis with budgets and cash requests given weekly (maximum amounts of request needs to be defined).

Principles of paying back debts needs to be addressed and principles of saving and budgeting.

Social networking On the basis that residents should give up their old friends

and social networks access to things like Facebook should be prohibited while the Resident develops new friends and social networks.

Making use of apps like BBM and Whatsapp are dangerous as we often find residents spend a large portion of their spare time chatting away to who knows who – this is clearly not healthy and often leads the resident to temptation. Boundaries become weaker and fraternisation and unhealthy alliances start to develop.

It takes anywhere from 6 months to 1 year to start to see new relationships and social networks developing.

Friends with recovering addicts A very dangerous affair and should be avoided or

managed effectively especially for the first two years.

Friends from SCRC who have been in treatment with you more so – the relationship has been developed in an unnatural environment.

If the chance of relapse is so high, then the more recovering addicts that band together the greater the chance of them all taking each other down.

They also end up “counselling” each other forming their own support group and not making use of groups like HEAL effectively.

Romantic relationships This is a big controversial subject here at South Coast

Recovery Centre.

The Resident should not get involved in a romantic relationship for at least 1 year after leaving treatment.

Should the Resident already be in a relationship then the dynamics and patterns of this relationship need to be changed which is done through careful structuring around the management of that relationship.

Getting involved in a romantic relationship prematurely is often a major contributing factor to relapse.

Accountability This is crucially important. As addicts we cannot trust

ourselves, or nicely put, our addiction. We cannot trust our motives or decision making ability as the subconscious current of addiction continues under the surface.

The set up to relapse comes unknowingly. Often we are not aware that we are manipulating or setting ourselves up (we will discuss this shortly under wise counsel).

We need to be held accountable to the commitments we make in the relapse prevention plan (that is what points need to be practical and measurable).

We need to be drug tested, we need to prove where we have spent money, that where we say we are and whom we are with is actually true

If we taking Anta-buse it needs to be witnessed otherwise it is pointless.

We need to be smart here for example it is no good to have a bank account with thousands of Rand’s in and say it is ok because I do not have the card – we can always walk into the bank.

Accountability should be carefully chosen and the right people need to hold us accountable for the right things.

Remember this is not about trust or mistrust, these measures should be in place when things are going well.

Aftercare and support This is another non-negotiable.

You cannot expect to continue growth in recovery, to maintain focus on your recovery as a priority in your life, if you are not attending a weekly support group.

AA and NA are wonderful formats however they very seldom hold accountable to your actions.

The beauty about support structures like HEAL and Might Wings is that the group format is interactional, confrontational and really push you toward self-betterment.

From a parent perspective you too need to be in a support group.

The support group helps you deal with your recovery process and empowers you and equips you with the tools and confidence to support your “addict”.

You too need a platform that can guide you and provide wise counsel and of course hold you accountable to your part in the recovery process.

HEAL and Might Wings provide this platform for you specifically providing education and support through the treatment process and empowering you thereafter.

I was “born” in SCRC and Bread in HEAL.

Finding a church and getting involved in a cell group affiliated to that church is another important aspect. Remember yesterday when we talked about forming new social networks.

While attending NA or AA daily may work for some it does not promote a life of balance.

Please note that in order for these structures to provide effective aftercare support they need to know exactly who you are, where you come from and better have a copy of your graduation documents.

Please note that you may need to shop for churches.

Wise counsel If I can never cure the incurable disease, if there is in

deed a subconscious current of addiction waiting for an opportunity to surface or better yet trying to set up an opportunity for relapse then surely I need a base that can monitor my decision making – I need a wise counsel.

This point here has saved my life, has saved my family and my marriage many many many times. I would not be working at SCRC if it were not for this.

A wise counsel comprises of at least three individual “units”, preferably with a good understanding of addiction, having 5 units is also good.

Your parents are one unit, your support group is 1 unit (1 vote), you sponsor/ facilitator, your pastor and sometime SCRC.

You should submit yourself to this counsel in any and all major life decisions. Propose your idea, your intention and then let them decide – a unanimous vote is what you are looking for, anything less and you should walk away.

Be sure to choose people that are going to tell you what you do not want to hear they are usually the ones that are right.

You can always manipulate one or two people, three to five not so much especially when there is a group on your counsel.

Parents if you are going to be advising your children or spouses your better halves the you too should have a wise counsel.

Please be sure that if SCRC is one that you maintain regular feedback and not just call 6 or 7 months later asking for advice.

Consequences First and foremost consequences are not a punitive

measure but a protective measure.

When things are not going well, start to limit access to cash, to vehicles, tighten up on the routine etc.

Some consequences are put in place to remind the addict of humility, gratitude, giving back etc.

It is important that you decide what is going to happen in the event of a relapse – remember that this is an emotionally charged situation and there needs to be a clear cut plan.