Here we will look at ways to prevent the process of a relapse and look at how to make a success of alcohol rehabilitation.
TRIGGERS & CRAVINGS
With alcohol rehabilitation, it is important for you to recognize that experiencing some craving is normal and quite common. Craving does not mean something is wrong or that you really want to resume alcohol use.
What is craving?
A state where you become focused on getting the substance/behaviour of choice
The desire to use given the opportunity
The psychological want for the positive effect of the alcohol
How do cravings work?
Triggers: happen before and after alcohol rehabilitation
A trigger is a situation or stressor that sparks off a feeling, thought or action to use drugs/alcohol/engage in addictive behaviour.
You get 2 types of triggers:
1. Internal triggers
2. External triggers
An internal trigger is something going on inside our minds or bodies that promotes the urge to relapse, these are broken down into feelings, thoughts, or a body sensation.
An external trigger is defined as things that remind you of using, things that have memories of using associated with them. These are things that are outside of ourselves, and can be broken down into categories of: people, places, things, times and events.
What are your biggest triggers?
What do we do when we need to face triggers?
If possible, we avoid triggers. For some of your triggers this may be easy, for some it may be hard and for some it may be impossible. If you can’t avoid triggers you need to learn to manage them. So, you have been faced with a trigger and now you are craving … What do you do next?
How do you manage cravings after alcohol rehabilitation?
BEFORE you can do anything with your craving you need to first acknowledge/recognize that you are craving! Once you have acknowledged and named the feeling as a craving you can decide to either use or to use coping strategies that you learnt during your alcohol rehabilitation treatment to manage your craving. Literally say to yourself “I am craving”
Coping strategies to manage cravings:
1. Share or talk about your craving (When, how and with who?)
First prize would be your sponsor. However, if you have supportive abstinent friends and family members, talking about craving when it occurs is a very effective strategy and can help reduce the feelings of anxiety and vulnerability that often accompany it. Close family members may become distressed when they hear you talk about craving because they expect it to lead to you using. Some friends may not understand cravings and may not be supportive and say things like “Well, one beer won’t hurt, will it?”.
If you cannot share about your craving immediately, write about it and express it – you need to get it out some way!
2. Get out of dangerous places
If you are in a triggering place or with triggering people get out of the high-risk/triggering place. It is important when you leave the high-risk situation and you go somewhere safe… (going home alone and having to pass a bottle store on your way home could also be high-risk!).
3. Avoid triggers/high-risk situations
If you are not in a high-risk/triggering situation, don’t go looking for one! You know what your triggers are, so especially when you are craving avoid them. For example: if you are craving alcohol, don’t go to the shop where you used to buy alcohol to do your grocery shopping at the moment you are craving. If you struggle with having money in your pocket when craving, don’t go and draw/pin money at that moment.
4. Delay your decision
Cravings are temporary – they don’t last forever. Delay your decision, by saying to yourself you won’t use now, but will reconsider at a later stage. The 12-step programme is a Just For Today programme. Commit to staying clean just for today. If this is too long in a moment of craving, make it shorter and commit for a few hours at a time!
5. Use distraction techniques
In many cases, an effective strategy for coping with conditioned craving is distraction, especially doing something physical. It is useful to prepare a list of reliable distracting activities. Such activities might include taking a walk, playing basketball and doing relaxation exercises. Other simpler distraction techniques can be to take a shower, clean your house, count backwards from 500 in 7’s… anything to try and get you mind off obsessing for a moment, until you can deal with the craving.
6. Play the movie through
When you start craving, you think of all the positive effects of using and don’t often stop to think of how your using will end and the commitment you made during your alcohol rehabilitation. Take yourself moment by moment to the ‘end of the movie’. What will happen etc. If you still think the ‘movie’ will end well think of your icons of loss of control. Ask yourself what will/could I lose if I use… is it worth the risk? If you received a letter from family members of loved ones about your addiction re-read the letter… why do you think the movie ends differently this time?
7. Use relaxation techniques
These can be using breathing techniques, guided imagery or meditation. Only use these techniques if you know you will not use your guided imagery or meditation to focus only on your D.O.C. or behaviour of choice.
8. Make sure you are not hungry or thirsty
Being hungry or thirsty can lead to cravings or can intensify cravings. Make sure you have eaten properly, and you have enough water to drink. Make yourself a cup of tea or have something healthy to eat.
9. Get involved in a healthy activity
When you first get clean or sober, you may not know what healthy activities you enjoy doing. Start making a list of healthy things you enjoy and use these activities when craving. Some examples could be: reading, listening to non-triggering music, going for a walk, playing sport/going to gym, doing yoga, volunteering your time to help others, draw/be creative, do a puzzle, spend time in nature, play a musical instrument, sing… the list is endless.
10. After your Alcohol rehabilitation treatment use your support network
The 12-step Fellowship is a wonderful thing. There is always someone available to help support you through a craving. Call or contact your sponsor, find a meeting (if you can’t find one in your area find an online meeting), read recovery literature, listen to a recovery share, contact someone else in the Fellowship, arrange to meet up with someone in the Fellowship.
Also use any other recovery support networks you have – speak to someone from your after-care group, message someone who is clean from treatment, meet up with other recovering addicts. Remember you are not alone.
11. Ride the wave during alcohol rehabilitation
The idea behind this technique is to let cravings occur, peak and pass; in other words, to experience the craving without either fighting or giving into it. Riding the wave means knowing that the craving will peak – get to its most intense stage and if you do not act on it, it will decrease, just like a wave does.
Are there any coping strategies that you have used or have been told about that you think could be helpful?
THE GRADUAL PROGRESSION OF RELAPSE
Many relapses happen gradually over time. In recovery, we need to remember that everything we do either takes us towards relapse or towards recovery. If we think this way, we are forced to look at what the warning signs are that mean we are heading to relapse. We need to look at our behaviour and our thoughts that build us up (down) to drinking and drugging.
Long before you pick up your first drink or drug you will be able to notice subtle (and sometimes not so subtle) changes. It is your responsibility to learn what these changes are and to then be able to identify them. We don’t do this alone. This is one of the reasons it is so important to surround yourself with other addicts in recovery so they can help you identify these warning signs.
When completing alcohol rehabilitation, relapse is a slippery slope.
PHASE 1 OF GOING DOWN THE SLIPPERY SLOPE
At this stage, you are not yet preoccupied with using. Occasional thoughts of using or having cravings is normal and part of being sober. There is a difference between an occasional thought/ craving and becoming preoccupied with using.
What are some of the first warning signs once completing alcohol rehabilitation?
• We begin changing our behaviour – we start decreasing the number of meetings we go to, we stop contacting our sponsor as regularly, we don’t really make time for step work. Alternatively, we still go to meetings, however, do not engage or participate and do not use the meetings or our sponsor effectively.
• We become irritable, often taking others inventory
• We become impatient and intolerant always wanting things to go our way
• We start bottling up our emotions, not thinking about expressing them healthily
• We stop asking for help and start thinking we can do this on our own
• We start isolating
• We start neglecting self-care, not paying attention to things such as healthy sleeping habits, healthy eating habits.
• We start slipping with our structure.
PHASE 2 OF GOING DOWN THE SLIPPERY SLOPE
We start to become preoccupied with using. We start to consider using as a possibility again and start to try and convince ourselves that we will be able to use successfully.
• We begin looking for opportunities to use – associating with people, places and things that are high-risk.
• We begin minimizing consequences of our using and comparing. We can do this by comparing our using to others, comparing type of drugs used, frequency of drug use, method of drug use etc.
• We start rejecting help from others
• We become overconfident (after alcohol rehabilitation) – thinking we have things under control
• We engage in euphoric recall (dry using) – glamorizing our using during and after alcohol rehabilitation.
• We discontinue after-care / meetings.
• We continue to isolate ourselves from healthy support structures.
• We find good enough reasons to use – we justify our decision to use
When we notice our warning signs, it is important we do something about them. If we leave them unattended to, we are sure to think that using is a ‘good’ idea and pick up again.
What do we do when we notice these warning signs after alcohol rehabilitation?
• It is important we acknowledge and recognize our warning signs and then talk about them.
• We need to ask for help and reach out to others
• We need to pay careful attention to structure
• We need to invest in self-care – pay attention to our sleeping and eating habits.
• We need to get to a meeting, and commit to going to meetings regularly
• We need to call our sponsor
• We need to reflect on the consequences of active addiction and remind ourselves of the reality of where our using took us.