Sunday, December 13, 2009
Stimulus avoidance (the “people, places, and things” strategy) can get you only so far. Complete relapse prevention training involves the kind of preparation that takes the “improv” element out of your problem-solving. Sponsors are nice, but they are not always available and... they arenot always sober/abstinent themselves. The following is a list of several hypothetical challenges to your substance use recovery that I have previously used as part of psychodrama Theatre of Relapse while running a drug and alcohol treatment program in a county jail (Somov, P. G. , 2008, A Psychodrama Group for Substance Use Relapse Prevention Training, The Arts in Psychotherapy, 38 , 151-161).
Here’s what I suggest: read each vignette, think about how you would deal with it; as you try to problem-solve your way through the situation, try to rely as much as you can on yourself; try to go it alone (at least in your mind), without a sponsor (if the sponsor is available, great, but that’s not always the case, as you will see from the vignettes below). In my experience, a fool-proof lapse/relapse prevention plan is entirely self-sufficient and it involves a well thought-through method, rather than “flying by the seat of your pants” creativity. If you find yourself stumped and unsure by some of these vignettes, consult a professional therapist (about craving control and lapse/relapse prevention training).
Now, as you read this, you might feel that just reading these vignettes triggers you. You might decide that relapse prevention is the same as planning for what to do should you relapse and that if you have a plan, you are giving yourself a permission to drink and/or use. Let me quickly disabuse you of this notion. If you bought a car with airbags it doesn’t mean that you should drive carelessly and speed. Having a relapse prevention plan is not a permission to use. A plan is just that: a plan, a responsible step of addressing various possible contingencies. If, however, merely reading these vignettes sends you into a craving tailspin, there’ s some important feedback in that for you as to the frailty of your recovery status. Much more the reason to seek professional support.
“Sponsor Gone Bad.” You discover that your sponsor has lapsed/relapsed. Alternatively, while feeling triggered and needing help, you invite your sponsor on the scene and your sponsor develops a craving of his/her own.
“Found a Stash.” Imagine that you have found a stash of cash and/or drugs from the previous run. How are you going to deal with it? You have called the sponsor and he/she is not available.
“To Sell or Not to Sell.” Recession time. You’ve been unsuccessful in trying to get a job and have been approached with an offer of selling drugs. Alternatively, you have been doing well for some time but something unexpected came up. So you are thinking about “flipping a couple of Gs” from your savings account to fill up the deficit in his budget. How are you going to deal with this?
“Street Come-on.” This is a bread-and-butter scenario: you have been offered drugs on the street. Maybe you’ve been waiting for a bus, or coming back from work, or just sitting in a park, or at a meeting. What’s your plan for handling this? You have a whopper of a craving, your sponsor’s out of town...
“Meeting Got to Me.” After a self-help meeting, you’ve heard too much about other people’s bottoms and now you are pondering a peek into your own abyss. It’s just you. You don’t have a sponsor yet. Or you do, but he/she is in rehab. What’s your plan?
“Pay Day.” You came into some cash and/or have been asked to go to a bar or to celebrate the end of the work week with his or her work buddies. You are craving like there’s no tomorrow. Your cell phone’s dead. Your spouse/partner is out of town. It’s weekend. No one will know. Your sponsor isn’t answering your calls. What’s your plan?
“Let go.” You’ve been let go (fired, terminated, downsized) with severance pay. You got some money to blow and all the time in the world. You are frustrated and you just wan to let loose. What’s next? You called your sponsor but he/she sounds a little off. You hit the meeting or two, no effect. What’s next?
“Disabled Enabler.” Your support person (spouse, partner) turns on you. They say “it’s okay, one is not gonna kill you...” You got nowhere to go. Too late for a meeting. Sponsor is in the hospital. Prayer didn’t help. Big book didn’t help. What are you going to do about this craving?
“Back on the Set.” You are back on the “set.” Involuntarily. Perhaps, your work route now runs through your old playground... Or, perhaps, after years of keeping clear of certain places, you are back there – perhaps, you have finally made a visit to your A-frame where you used to get wild or to your hunting camp... And you got a killer craving... What to do?
“Using Peer.” A person you work with keeps talking about drinking/using. It’s just the two of you. In a car, on a sales route, exchanging war stories, you got a craving. Or maybe you are on a sales trip and he/she hits the happy hour...
“Drugs and Sex.” You are having sex and you feel triggered to use because of the past combination of using and intimacy. What’s your plan?
“Righteous Child.” You have an altercation with your adolescent child who is either caught using or selling and righteously excuses his or her behavior by blaming you for modeling the very behavior in question. You feel terrible. You want to use/a drink. Sponsor’s unavailable.
“Family Function.” You are at a family reunion, pool party, backyard barbecue, wedding. Rivers of booze. And there are some pills going around. You can’t quite leave (maybe you didn’t drive, your leg’s broken or you just don’t want to be a party-pooper). But you are craving as hell. What’s the plan?
“Relationship Trouble.” You lost a relationship (break-up, quarrel, separation, divorce) or having relationship trouble. Feeling misunderstood, alone, wanting a drink or to numb out. In between sponsor. Too late for the meeting. You got the picture...
Recovery is like an “improv” theatre. The best prepared have the last laugh. Test-drive this abstinence of yours through a couple of these hypothetical topsy-turvy recovery challenges, check your craving control breaks. Inspection time. How's your craving control? I know you got your higher power all right, but how about craving control skillpower? Do you have your lapse/relapse prevention plan down pat? I hope so because winging won't do.
I wish you well.