In a previous meeting we talked about how easy it was to see the signs of a relapse when looking backward in time and how difficult it was to see them as they are occurring. Looking back on a relapse in your family, please leave a comment on some of the signs you saw before the relapse occurred. Also, you may want to check out the relapse information on the HBO site.
There is a lot of information on the HBO site. I plan on spending some time there.
The cartoon is from this months Readers Digest.
Relapse
"If the addict is going to relapse, there is not much anyone but the addict can do about it. But please read on, it is not quite that simple." -Ed A.
Everything that I have learned about relapse over the last 18 years of dealing with my addicted son and those that his addiction have led me to can be summed up in a single statement.
If the addict is going to relapse, there is not much anyone but the addict can do about it. But please read on, it is not quite that simple.
That is not to say that others close to the addict should not, or cannot, be aware of changes in attitudes and behaviors throughout the relapse process leading up to the beginning of a new cycle of use. Those close to the addict should attempt to be acutely aware of those tell-tale signs, and make every effort to encourage their addict to get back to the tools that they have found to effectively help them in their sobriety, such as avoiding “triggers” (people, places and things), attending and participating in meetings, working with a sponsor, 12-step programs, etc. This “encouragement”, be it positive or negative, should take every form, short of violence or the threat of violence, anything within practical reason, including any consequences that might help in blocking the relapse. However, it is the addict that must make the decision, and the addict that must do the work. Just as it was only the addict that could first choose to be clean and sober, it is now only the addict that can choose to remain clean and sober.
So, what if, after all efforts, they choose to go back to active use? Consequences, consequences, consequences—this is where those close to the addict must “turn up the heat”. Reasoning with them, bargaining, rewards—that is all wishful thinking. Addiction has never been known to respond to a soft approach. On the contrary, the soft approach will generally only lead to manipulation by the addict, conveying to them the message that they can get away with unacceptable behaviors. In other words, the soft approach is, in effect, just another form of enabling.
I have been privileged over the years to view a number of times a video on relapse by Dr. David Ohlmes, the noted psychiatrist from St. Louis specializing in addictions. It is from that excellent video that I have learned the most about the relapse process in addiction. I will attempt to summarize Dr. Ohlmes messages on relapse, as I understand them, and then add some observations of my own.
Importantly, in order to relapse one must first be in recovery, and abstinence does not equal recovery. Abstinence plus change equals recovery. In other words, just not using or just not drinking is not enough for an addict to be considered in recovery. In addition to abstinence, a person in recovery has made or is in the process of making important changes in their lives relative to people, places and things, and applying the tools of recovery mentioned above.
In his video, Dr. Ohlmes sites the three apparent most common causes of relapse, overconfidence, resentments and cross-dependency. Overconfidence leads the recovering addict to believe that they have beat their addiction, and no longer need to continue to use the tools mentioned above that they have used previously to remain clean and sober, thus leading to relapse. Resentments come in two varieties, reasonable and unreasonable, and the recovering addict must learn to properly differentiate between them and appropriately deal with or let go of them in order to maintain their sobriety. Cross-dependency encompasses the concept that once addicted to a mood or mind-altering substance, one is automatically addicted to all mood and mind-altering substances, and must learn to carefully guard against ingesting any of them in any form, whether it be medications, dental health products or whatever.
The highlight of the video is Dr. Ohlmes explanation of his view of the underlying cause of relapse that leads up to the addict falling into the traps provided by the three causes sited previously. He emphasizes that the addict who relapses is the addict who loses conscious touch with the memory of the pain of their addiction. That is to say that the relapse process begins when the addict can no longer remember how bad it felt when they were at their bottom. Of course, the best way to restore that memory is for the addict who is drifting away from their sobriety to get away from the triggers, to get back to their meetings, to get back in touch with their sponsor, to get back to their 12-setp program, etc. Or conversely, the addict in recovery with the highest likelihood of maintaining a clean and sober life style and accumulating significant clean time is the addict that most effectively remembers the pain of their addiction through the diligent use of their tools of recovery.
I will never forget the first time that I saw Dr. Ohlmes relapse video some years ago. Toward the end when he was explaining his underlying cause theory, a light went on. It occurred to me in an instant that this is the same reasoning that affects those of us who enable those addicts who are close to us. We also fight a disease-- the disease of co-dependency--a disease that causes enabling behaviors that we must accept, just as the drug addict or alcoholic must accept their disease of addiction, and take the proper steps to control each day. Knowing that I had a son that was definitely addicted, it was then and there that I decided to continue to educate myself relative to addiction and how to deal with it.
That decision has proved to be a Godsend for me. I have continued to regularly attend and participate in support groups and meetings, talking with many newcomers to and veterans of what are, in effect, our AA or NA meetings. We strive to stay in touch with the memory of the pain of our addiction—co-dependency. So, I suppose that our groups and meetings could be termed CDA.
Ed A.
When a relapse seems imminent.
There seems to be two basic categories for parents when they feel that a relapse for their teen is around the corner. Which category do you fit in?
One approach can be described as the "It's up to him now. He has to decide what he wants." In this approach, the parent does not deny that there are signs. Backing off of meetings, no calling sponsor, hanging out with old friends, having a chip on the shoulder day in and day out, feeling like you are starting to walk on egg shells around the teen again, seeing a lack of gratitude, noticing a strong sense of entitlement, overconfidence, the teen talking about how the treatment program they are in is "holding me back, " acting like a victim, talking about how the 12-step meetings don't help anymore, not taking suggestions and countless other signs are apparent. However, the parent has decided that the teen has to make their own decisions, that we can't work their program for them, and that they might even need to learn from a relapse. Often the belief is strong in the parents that "relapse is part of recovery."
The second approach is the category of "I'm not going to wait until you pick up to take action." In this second category, the parent believes that while they do not have the power to make their teen want recovery, they do have a responsibility to send action-based messages to their teenager that not working a strong recovery program is unacceptable. Just how the parent chooses to send this messages will vary depending on the circumstances. For example, does the teenager live at home or is he in an institution or half way house? If the teen lives at home, the powers of the parent are stronger. However, is the teen lives in an institution or half way house, then the parent can involve the staff of such places in the action-based message sending. In fact, involving the staff from whatever program is an action that can help send the message.
Let's examine more closely the action-based messages that you might send to your teen who still lives at home. Consider everything that your teenager does that requires a certain amount of trust. Driving a car. Getting to meetings on his own. Being on the phone with whomever and whenever. Managing his own money. Having his own mobile phone. Having a door or having a lock on his bedroom door. Having unsupervised access to an Internet connection. These are some ideas that can be used but there are no doubt many other good ones that you can think of because you know your child.
But how do you explain to your teen that you are restricting him from privileges because of a relapse that has not yet happened? Easy. It's about trust. If you don't trust him anymore then tell him that. Don't feel that you have to keep it a secret. You don't. Just tell him that you wish you had more trust; that you hope to have more trust soon, but that right now you are having a problem trusting him. This make it something that you as a parent "own." You aren't blaming him exactly although it is all related to what he is and to what he is not doing. The bottom is that you DO NOT FEEL COMFORTABLE letting him drive (for example.) No one can argue with you when you stake out your position based on something that you feel. It is your feeling- but the trick is to go with it.
You are powerless to create in your teen a willingness or a desire to recover. However, you are not powerless as far as sending action-based messages. The rule of thumb to follow is this one: doing something to send an action-based message is better than doing nothing. And generally, it will do one thing for you right away. You will feel better right away. You will feel better because you are not doing nothing. Doing nothing creates extreme anxiety. Doing something helps ease the pressure.
Read More......Interview with My Recovering Addict- By Mary
My 20-year-old son is a recovering heroin addict. He recently celebrated his one-year anniversary. I seem to learn something from him everyday. He is an inspiration.
Over a year ago, having 78 days clean, my son called me at work to tell me he relapsed. I told him he knew what to do. He needed to work “His Program” and get to a meeting. By the time I came home from work he had called his 12-step sponsor and was on the phone with his therapist. Later that evening he met with his therapist and went to an NA meeting.
This was the first time I looked at my son knowing he was high. Obviously, I had been around him high before. However, I was never aware of exactly what being high on heroin looked like. I was stunned to notice that his pupils were truly the size of pinpoints. I couldn’t stop thinking that just 2 hours ago he was shooting heroin into his veins. I had a really hard time looking at him knowing he was high on heroin. He was crying, sobbing actually and truly needed me. I didn’t know if this was the real him or the effects of heroin. I had my guard up against being manipulated while he was high. I just wanted the high to wear off to see if he was sincere that this was a mistake. When I spoke to his therapist shortly after I came home, she said the high would last about 3 hours. Three hours? That is all it lasts? No wonder heroin addicts turn to lying, stealing and cheating if the buzz only lasts a short time. Those were three of the longest hours I can remember. Knowing your child is high on heroin while you are in the same room as him is horrifying. I kept looking at him out of the corner of my eye so he wouldn’t notice me staring at him. Looking for who knows what but I wanted to see what this “High” was all about. What is so great about it? What is the big attraction? Why do so many young kids try this in the first place? It didn’t seem that great to me. He didn’t slur his words or walk funny. He wasn’t laughing or having a good time. He was sad and sullen. The funny thing is, if he didn’t tell me he had used or if I didn’t know to look at the size of his pupils, I would never have known he was high. It’s no wonder I never knew when he was high before. If you are not looking for it, it is easy to miss. Heroin is and can be a silent assassin.
Something changed with him that day. He explains it best: “I had too much NA information in my head to enjoy the high.” He describes this incident as “using” rather than relapsing. “I was clean for 78 days but I was not really in recovery. I felt like I had one foot in the door of recovery & one foot out. I had gone to a meeting everyday but I never asked for help or for anyone’s phone number. I always sat in the back of the meetings.”
I thought I would ask him some questions about his relapse, or as he says, “using.” I wanted to know more of what was going on in his mind before he used, the weeks leading up to it. What were the warning signs? What could I have done to help him, if anything?
Mom: What could your Dad & I have done to help you?
Son: Nothing, you could have been all over my back 24/7 but it was still a reservation and set in stone that I was gonna use. No one was stopping me.
Mom: When you have seen your friends relapse could you tell it was going to happen?
Son: Yes. Just the pattern of behaviors and the way they slack on their program. And they put all of their focus on other things. One friend has a girlfriend; he is coming up on one year- he relapsed once before because he had a girlfriend. He doesn’t want to hear it from me or anyone. Another friend has relapsed and I have never seen it coming. I have seen him at a meeting and the next morning I hear he overdosed & almost died. He can fool everyone- but not himself.
Mom: Did you ever do anything proactive to help a friend who you thought was going to relapse?
Son: I can say all I want or offer help but us addicts are stubborn people. We don’t like asking for help and admitting we don’t know something.
Mom: Would you ever consider 301'ing yourself to keep from relapsing?
Son: No
Mom: Are there really things that parents do that make you want to use?
Son: There are things that my parents do that make me feel like I want to get high but it’s ultimately my choice. No one makes me use. If I want to get high then it’s my choice.
Mom: How would you feel if I had called your sponsor because I was worried about you?
Son: Probably embarrassed because my relationship with my sponsor is personal and I wouldn’t like you going to my sponsor even though I knew it would be for my well being.
Mom: What would you think if your sponsor had called me?
Son: That would mean I was not talking to him or lying to him.
Mom: Knowing that when you relapse your thinking goes out the window, what kind of plans can you put in place now to stop the relapse as soon as possible after it starts?
Son: I have to get the thoughts out. I have to talk about it.
Mom: If you think you are going to relapse how do you abort the urge?
Son: Call someone in the program immediately. It would have to be someone in the program. They would get it; know what I’m going through.
Mom: We all know there are places that are risky for you. What places are safe for you to go where relapse would be very unlikely?
Son: Meetings would be the number one place to be or wherever you go as long as you are with recovering addicts with significant clean time. Probably they would have to have more clean time than me but also knowledge of how to work a good program.
Mom: We always hear that the relapse starts in your mind before the actual event; can you stop it after it starts in your mind?
Son: Yeah. You can as long as you express it to someone. For me, opening up to another recovering addict is the best thing to do.
Mom: For those 78 days you had clean and you were in outpatient, was it all just a farce?
Son: No, it wasn’t a farce. I was only abstaining, but I acted like I was in recovery. For me, it was about choices. I chose what to do and how much to do. I went to the required amount of meetings and no more. I chose to be disconnected when I was at meetings.
Mom: Tell me some of the things that you did before you used?
Son: I was throwing my Revia away for about two weeks before. I would throw them down the disposal or in the garbage.
I was using the computer and contacting “user friends”. I planned the day and date I was gonna use. I remember sitting in outpatient on Monday night and all my thoughts were on getting high the next day.
Mom: Is there anything that I could have done to help you or prevent your use?
Son: After outpatient & before I contacted my “user friend,” nothing could have stopped me.
Mom: That is a very scary thought as a parent.
Son: It’s a scary thought as an addict too.
Mom: What made you call me right after you used?
Son: I knew what I was doing was wrong and I needed to change. I didn’t even enjoy it. Something clicked with me. It’s hard to explain. Someone in the program told me after being in NA [Narcotics Anonymous] the high would never be the same again.
Mom: Why did you reach out for help then?
Son: I did not know how to do it on my own.
Mom: After you used, when did your recovery begin?
Son: My clean date? The next day. I knew what to do and I made a choice to do it.
Mom: What did you do?
Son: I asked for help. I called a friend that day; he became my sponsor. I went to a meeting with him that night and I sat in the front of the room with him. I listened that night with “open ears.” The next day I asked for phone numbers. Me using was a wake up call. I turned it [recovery] up a notch and did all the things that were suggested to me.
Mom: Do you worry about relapsing or have constant thoughts about it?
Son: Not constant thoughts- No. I know it’s always a possibility though. That’s why I keep going to meetings and learning from others everyday.
Mom: What advice would you give someone on relapse?
Son: There is nothing good out there. Using drugs is life or death; it’s like rolling dice…
I enjoyed talking to my son about his “using”. Since he has been in Recovery, I have talked to so many different people; friends, family, parents at the PSST meetings, about my son’s drug use. It was nice to actually talk to him about it!
If you have been in a similar situation please leave a comment so others may learn from your experience.
Parenting Younger Siblings of Addicted Teens
When our child is a drug addict, it affects the entire family. This makes parenting even more difficult. If our teen is actively using drugs our primary focus needs to be saving their life. What about the siblings of the addict? Where do they fall into this? I found the following information very helpful.
As with any family-related trauma, the person at the heart of the concern gets the most attention. When adolescent mental health or substance abuse issues arise, the siblings of the substance abuser may be overlooked or neglected.
Parents focus on the child with the drug addiction. Grandparents provide support for the parents. Extended family members become educated about substance abuse. Faith communities are asked to pray for the child involved with illegal substances.
It’s expected, or at least hoped, that the siblings of the substance abuser will maintain their “good” status and allow everyone to focus on the child with the issues.
This single-focused attention may put the siblings in stressful situations. They get less one on one time with mom or dad. They might take on additional household responsibilities. They may be required to provide extra caretaking for younger siblings. And, siblings themselves may become at risk for various behavioral, mental health, or substance abuse issues.
As parents begin to create a plan to address the issues of the adolescent with substance abuse problems, they must also create a plan for the other children in the family.
Siblings still need one on one time with mom and dad. And, if the usual amount of time needs to be reduced, parents need to address it directly rather than assuming that the child “will understand.”
Parents should not neglect attending sports events, plays, concerts, and other recognition events for siblings.
Opportunities should be provided for expending physical energy. Whether the activities help to minimize issues of possible depression, or provide an outlet for negative emotions, the chance to run, play a sport, walk, or swim need to be easily available.
Provide positive feedback for the kids who are not substance abusers. It’s easy to emphasize the negative when under stress. Compliment the children when they are required to go above and beyond their usual responsibilities.
Create a schedule that allows siblings to continue extra curricular, community, or church and synagogue participation, whenever possible. This involvement provides stability, as well as a diversion from the emotionally charged home life.
Even if all members of the family are attending family therapy sessions, it may be beneficial for siblings to have additional one on one therapy. This might be with the family therapist, or a completely different counselor.
Parents and therapists mustn’t forget that when one child becomes a substance abuser, the other children in the family are also at risk. A study published by the University of Queensland and the University of Washington, in January 2006 (www.researchaustralia.com.au), showed that younger siblings’ use of alcohol and tobacco increases by three to five times when older siblings are already involved. They suggest that prevention programs, which usually focus on parent-child interactions, need to shift the focus to sibling influences.
How It Doesn't Work
A counselor in a treatment program handed me this yesterday. It has no author listed and according to the counselor this information can be used freely. There may be a way to motivate oppositionally defiant with these "opposite 12 steps."
"Rarely have we seen a person recover who has thoroughly tried to fake their way though this program...
"Those who do not make it are people who cannot or will not completely give up their jailhouse ways; usually men who are constitutionally incapable of not acting like criminals. They are unfortunates. They deserve to be incarcerated; they don't think they need to change. They are naturally capable of avoiding any manner of living that requires even one iota of honesty. There chances are not even below average. There are those, too, who don't realize that they have been diagnosed with grave emotional and mental disorders, but many of them do recover if they have the capacity to let go of their criminal thinking.
"Our stories of failures disclose in a confusing way, what we thought they were like, what we said the cops did and what we think the parole board should do. If you have decided to fail and are not willing to make an honest effort- then you are ready to take certain steps.
"Most of these we tried to avoid. we knew we could find an easier softer way. and we kept tring even though we were told we couldn't. With no sincerity in our minds, we urge you to be cowardly and sloppy from the very start. Most of us are holding on to our old ideas and won't let go no matter how negative the results.
"Remember that we deal with the man- cunning, baffling and powerful! With all the help it is too much for us. But there is one who should control all- that one is Self. May you depend on him forever.
"Half measures availed nothing. We avoided the turning point. We refused to ask for protection and care.
"Here are the steps we took, which are suggested as a program of failure:
1. We refused to believe we were powerless and pretended that our lives were very manageable.
2. Refused to believe that a power greater than ourselves existed and felt we had no insanity.
3. Avoided any decision to turn our will and our lives over to anybody.
4. Avoided any searching or realistic inventory of ourselves.
5. Refused to admit to anyone that we had any problems.
6. Never became ready to make any changes.
7. Told others to mind their own business.
8. Forgot anyone we had harmed and realized that we were the real victims.
9. Continued to use such people whenever possible, except when to do so would not yield any profits to us.
10. Continued to avoid any responsibility and promptly blamed others.
11. Sought though pleasure and medication to do whatever we damn well pleased.
12. Having avoided any change as a result of these steps we continued to exploit others and practice these principals in all our criminal affairs."
Dual Diagnosis and Relapse
Many of our adolescents struggle with Mental Disorders in addition to being addicts. This can make recognizing Warning Signs even more difficult.
Read More......
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