How to Prevent a Relapse
Photo by Helena Lopes
Our last blog addressed what to do if you relapse in your recovery, and referenced that relapse is often part of the recovery process. But it does not have to be. Today, let’s focus now on how to prevent a relapse.
Stress, anxiety, hunger, loneliness, anger, exhaustion, family issues, job loss, death of a loved one, a breakup, divorce…oh…let’s not forget a global pandemic. These are just a few of the feelings and most stressful events one encounters along the way in this crazy, challenging journey we call life. They are also major triggers for relapse for those in recovery.
Life is not easy for anyone, but hopefully, it is the proper balance of challenges and blessings. For those in recovery, the pitfalls may feel scarier. We talked to the experts at Freedom Institute to hear about our Advanced Relapse Prevention group and the skills we teach to help prevent relapse.
Connection is the Best Prevention
Freedom Institute’s Advanced Relapse Prevention (ARP) group is a process group for individuals with 90 days plus of sobriety. The group helps members connect with one another in an open, supportive, and validating context. Members start every group with a brief check-in about their week and make a request of the group. Members are encouraged to share their own experiences and to connect on a deeper level with their emotions and experiences in the moment. Group members benefit from asking (and learning to ask) for what they need from other group members and there is a strong sense of community and collaboration in these groups.
As one of the group facilitators, Freedom Institute’s Salah Bustami, LMHC states, “facilitating this group brings me great joy. I am always so grateful to bear witness to the process of connection that takes place. Members talk about ‘keeping each other in mind’ throughout the week when they are feeling triggered to use, when they are excited to share with the group ways that they've navigated different challenges, or simply when they've thought about another group member. I am struck by how much the idea of "service" or giving back to the community plays a role in the group, and in recovery in general. Group members talk about ways that they have advocated for others (for example, membership/participation in AA, a post on Facebook) and how that can enrich one's own recovery.” Connection is a key component in recovery and a critical tool in preventing relapse.
Practice Makes Perfect
Advanced Relapse Prevention builds on skills learned in early recovery. Tessa Kleeman, LMHC, director of Freedom Institute’s, Dialectical Behavior Therapy (DBT) Program, states, “Whether in-patient or out-patient at Freedom Institute, clients acquire a repertoire of skills in their first 90 days of recovery and simply need more time to generalize those skills to any situation they find themselves in as they return to their lives - job, home, and family - in their first year of recovery. Our ARP group gives clients a place to practice these new skills, identify obstacles to using their skills, and to problem-solve with fellow travelers in recovery and a trained, experienced clinician to overcome them.” The group is also a place where individuals can practice asking for help, build a sober network to call upon during vulnerable times, receive validation and encouragement, and give to others. “Clients have said the opportunity to share their experiences and hear about others is comforting, normalizing, and makes them feel less alone,” continued Tessa. “Often those in recovery feel they don’t have a lot, if any, people in their close circle to talk to about what it is like to stay sober.”
Know Your Triggers
What triggers an urge to drink or use is highly individual. HALT, an acronym used in AA, stands for hungry, angry, lonely, tired. These are common feelings most humans feel at any given time, on any day, during normal life. We often cannot avoid these triggers, but we can be mindful of them, minimize encounters with these states of mind and body, and manage them using skills learned in early recovery. Take care of yourself and eat regular meals. Work on your sleep hygiene, going to bed at the same time each night preferably before 12:00 midnight, getting 8 hours of sleep, and waking up at the same time. Make exercise or movement part of your daily routine. Start a mindfulness or meditation practice. There are several apps available to teach this. At Freedom Institute, we offer Transcendental Meditation (TM) training, an effective tool to prevent relapse, through the David Lynch Foundation.
Change your routine, (and maybe even your friend group). Avoiding certain situations and behaviors, such as not going to the bar or houses of friends with whom you used to drink or use, minimizes encounters with triggers. Embracing your triggers may also work. Practice healthy coping skills like going to meetings, calling a sponsor, doing yoga, meditating, or other healthy activities and skills you have learned to help you become more resilient. And try the pause and pivot, knowing that the urge will pass. Early in recovery, it may be important to join a support group such as AA. If AA isn’t for you, there are several othersupport groups, such as SMART recovery, Women for Sobriety, or Tempest among others.
So, What Are These Early Recovery Skills?
The foundation of Freedom Institute’s clinical programming is our unique integration of Dialectical Behavior Therapy (DBT) and Relational Family Therapy. DBT, a therapeutic model heavily backed by scientific research, is central to FI’s renowned Intensive Outpatient Program. DBT focuses on four skill modules - Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness.
Mindfulness teaches a set of skills to help accept and be present, nonjudgmentally, in the moment, experiencing emotions and senses fully, yet with perspective. The goal is to help maintain a sense of calm, balance, and well-being amid periods of high stress and anxiety.
Distress tolerance focuses oncoping with, and moving through, unpleasant emotions. The goal is to become capable of calmly recognizing negative situations and their impact, rather than becoming overwhelmed or hiding from them. Distress Tolerance Skills are designed to get you through suffering when the situation causing it cannot be changed and without making it worse, especially by relapsing. One of the most widely used, fastest, and most popular distress tolerance skills is TIPP as it alleviates distress very quickly. (Check out our videos on FI’s YouTube Channel teaching TIPP.)
Emotion regulation is categorized into four modules: understanding and naming emotions, changing unwanted emotions, reducing vulnerability, and managing extreme conditions. The goal is to help people manage intense, negative emotions, and alter past, unhealthy conditioned responses, changing them to healthier ones.
Interpersonal effectiveness is essentiallyassertiveness and interpersonal problem-solving skills. It teaches how to communicate with others more effectively and includes strategies for asking for what one needs, saying no, and coping with interpersonal conflict.
Recovery is a lifelong process. While relapses may occur, the best-case scenario in recovery is to avoid them by immediately turning to the skills acquired, asking for help, or joining a support group. If you or a loved one needs help or extra support in your recovery journey, please contact us at Freedom Institute at 212-838-0044 or info@freedominstitute.org to learn more about our programs and our Advanced Relapse Prevention group.
Subscribe to Freedom Institute’s YouTube Channel for more videos on DBT skills.
On our radar at Freedom Institute: Listen to or read this interview on The Ezra Klein Show. He interviews Jud Brewer, an associate professor of psychiatry at Brown University, and the director of research and innovation at its Mindfulness Center. That Anxiety Your Feeling? It’s a Habit….https://nyti.ms/3gIk6xO. Jud Brewer is the author of The Craving Mind on addiction. This interview gives insights about using your feeling brain versus thinking brain and other skills for managing unhealthy anxiety and behaviors.