IX. Continuing Recovery: Helpful Guidelines
CONTINUING RECOVERY: HELPFUL GUIDELINES
Substance abuse disrupts individual, couple, and family functioning. It is not uncommon for there to be periods of complete abstinence sprinkled with stress, disagreements, and urges to use, followed by a slip or return to old substance-using behaviors.
The beginning of this section will talk about those struggles and urges, helping to define the reality that alcohol and drug free lifestyles and relationship enhancement are ongoing processes that require attention and care. The later part of this section outlines plans and strategies to help work through those tough times.
1. Lapse vs. Relapse
It is important to define the terms lapse and relapse because many substance abusers and their partners mistakenly think that a lapse is permission to use substances every so often and/or that a relapse means that all is lost and there is no hope for complete abstinence from substances.
a. Lapse: A “lapse” refers to the single occurrence or act of substance use following a period of abstinence1. The term “lapse” was introduced (which can also be thought of as a “slip”) to help individuals in recovery realize that if they have one drink, or one substance-using episode, it does not mean that they “blew it;” thus they don't have to return to heavy, regular substance use [1].
Rather, they can view this lapse as a mistake or an ineffective coping response, and can get back on track and become abstinent again immediately.
b. Relapse: A “relapse” is the “full return to the former behavior” (p.32) [1], particularly after an apparent period of improvement. For many substance abusers, the term “relapse” suggests that the person has returned to substance abuse, has “blown it,” and is doomed to continue substance abuse. With this thinking, the substance abuser will often decide that he or she already “blew it,” and might as well “keep using,” thus reverting back to the former state of substance use.
[1] Marlatt, G.A. & Gordon, J.R. (Eds.). (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York: Guilford Press.
2. Abstinence Violation Effect
The Abstinence Violation Effect is a set of ideas that lead the substance abuser to believe that he or she is doomed once the rule of abstinence is violated. If a lapse occurs, feelings of guilt and failure compound the perception of doom, increasing the likelihood of a full relapse.
Indeed, substance abusers will often set themselves up for a long and difficult journey back to abstinence once they start using substances again. The purpose and importance of understanding the differences between a lapse and a relapse is to highlight that there is hope for returning to abstinence with the use of recovery tools and supportive resources.
3. Continuing Recovery Model
The Continuing Recovery Model1, presented in Figure 1, provides a visual aid to help you and your partner recognize gains and improvements that you have made, individually and as a couple, to help work through future problems and challenges as they come up.
The Continuing Recovery Model illustrates the process of continuing recovery by focusing on each partners’ strengths. This model assumes that strengths, problems, and stress will continue even when there is a lifestyle that is drug and alcohol free. Throughout this workbook, you have learned and practiced a number of skills that will help you face challenges while continuing to build on your relationship and continued recovery.
Figure 1: Continuing Recovery Model
(Adapted from Marlatt & Gordon 1)
The Model shows us quite a bit about the continuing recovery process. The blue circles with the vertical lines indicate areas that you have learned about. The titles inside of the circles describe the skill areas that, when used regularly, will help you work through ongoing and future life stressors. For use with this workbook, the areas and skills are:
Key areas: Skills:
(1) Support for Recovery: Abstinence Trust Discussion, Self-Help, Treatment, Medication
(2) Relationship Skills: Catch Your Partner/Child Doing Something Nice, Shared Rewarding Activities, Caring Days
(3) Communication Skills: “I” Messages, Mirroring, Positive Specific Requests
(4) Continuing Recovery: Action Plan, Continuing Recovery Plans
The red dotted circle with the label ‘High-risk Situations,’ indicates that stress, problems, or cravings have come up in your life. Two options are available once these high risk situations are present.
Taking the high road, we see the green circle with the dashed lines that says ‘Take Inventory of Skills;’ here is where you realize that there are some struggles and you look at your plan to see what needs to be done to help you through. For example, perhaps talking with your partner, sponsor, or friend, or attending an extra AA meeting will help. These actions reduce the likelihood of a relapse occurring.
If there is no plan of action or there is refusal or resistance to using the plan, we find ourselves at the yellow checked circle. Refusing to do something to change or deal with the problem increases the chance of a lapse or a slip. Once a lapse occurs, there are two options. The first is to use your plan immediately. Don’t wait another second to do something that can help you get out of this cycle.
It is important to realize that recovery is a process and there will be times when there will be pressure and difficulty staying alcohol and drug free. This is common and very understandable. Keep moving up, use your plan and get back to doing what keeps you healthy and happy. If no plan is used or there is no desire to change, this will increase the likelihood of experiencing a relapse.
High-risk situations and stressful life events do NOT have to lead to relapse. The Model shows that at any point you can draw upon your strengths and apply the skills you have learned to conquer the urge to use. Remember, if there is use of alcohol or drugs, it is always possible to stop the cycle and get back to using skills and getting help.
EXERCISE 1 is designed for the substance user. The goal is to take inventory of skill areas and strengths that have been helpful in recovery and those that have increased relationship satisfaction.
EXERCISE 1
Taking Inventory of Your Recovery and Relationship Improvement Toolbox:
Substance-Using Partner
- Take some time to look over the model, following the written description that follows.
- Check the areas below that you would like to keep using to help maintain an alcohol and drug free lifestyle and continue improving your relationship.
1. Support for Recovery:
____ Abstinence Trust Discussion (____x/week)
____ Regular Support Meetings (list location, days and times)
_______________________________________
_______________________________________
_______________________________________
_____Medication Compliance
2. Relationship Enhancement Activities:
_____ Catch Your Partner Doing Something Nice
_____ Catch Your Child Doing Something Positive
_____ Shared Rewarding Activities (___x/week)
_____ Caring Day (___ x/week)
3. Communication Skills:
_____ “I” Messages
_____ Mirroring
_____ Positive Specific Requests
4. Continuing Recovery Tools:
_____ Continuing Recovery Inventory
_____ Action Plan
_____ Continuing Recovery Plan
5. Other: _____________________________________
_____________________________________________
We believe that it is necessary for both partners to be working towards the same goals. However, what each of you needs to do for the relationship may not be the same. That is why there are two exercises, one for the substance user and one for the non-substance-using partner.
It is vital that the non-substance-using partner stay active in the recovery process. When both partners are actively involved in improving the relationship and continuing recovery, relationship satisfaction increases and alcohol and drug free lifestyles are better maintained.
EXERCISE 2 is designed for the non-substance-using partner. The goal is to choose activities that he or she would like to continue participating in that support the substance-using partner in his or her recovery. In addition, he or she will identify relationship skills that he or she would like to continue doing.
EXERCISE 2
Taking Inventory: Supporting Recovery and Increasing Relationship Satisfaction
Partner’s Role (completed by non-substance-using partner)
1. Support for Recovery:
____ Abstinence Trust Discussion (____x/week)
____ Regular Support Meetings (list location, days and times)
_______________________________________
2. Relationship Enhancement Activities:
_____ Catch Your Partner Doing Something Nice
_____ Catch Your Child Doing Something Positive
_____ Shared Rewarding Activities (___x/week)
_____ Caring Day (___ x/week)
3. Communication Skills:
_____ “I” Messages
_____ Mirroring
_____ Positive Specific Requests
4. Other:
________________________________________
4. Action Plan
Having a detailed plan of action to work towards maintaining abstinence and agreeing to work on persistent problem areas are essential to creating change. Being able to handle emergencies, high-risk situations, and unplanned life events are critical skills for promoting and maintaining abstinence.
An Action Plan is an important tool used to help a couple specify activities and skills learned to start and maintain abstinence and relationship improvement. Developing an Action Plan provides an opportunity for a couple to identify what they have learned throughout this workbook, identify skills and activities they would like to begin practicing at home, as well as the chance to work together to brainstorm ideas that will benefit their relationship.
The Action Plan lists specific activities and skills that you will continue to use in your relationship and family life. Examples include:
• Continued self-help attendance and participation.
• Daily practice of the Abstinence Trust Discussion.
• Weekly Family Meetings.
• Engaging in Shared Rewarding Activities.
Table 1 provides some tips on creating an Action Plan. Review the tips and then create your own Action Plan in EXERCISE 3.
Table 1: Tips for Creating an Action Plan
It is a good idea to review some of the skills that have been learned up to this point to highlight that a number of these skills can be applied in everyday life. Some helpful ideas are to:
1. Identify areas (related to substance use & relationship/family life) that you would like to see change or improve.
2. Choose the skills and activities that you have learned in this workbook that you would like to keep using as a couple and/or family.
3. Be specific concerning how often you will use these skills or participate in these activities (i.e., daily, weekly, or monthly).
4. Be honest and realistic in your assessment of how often you will be willing and able to practice these skills and participate in these activities.
5. Choose activities and skills that have not been presented in this workbook, but that have worked for you and your family in the past.
EXERCISE 3 Developing an Action Plan
1. Change Areas
2. Skills & Activities
3. How Often?
4. Honesty & Realism
5. What has worked for you in the past?
A detailed plan can help to prepare you for high-risk situations, emergencies, unplanned life events, as well as continuing to promote abstinence and relationship improvement. In order to develop any Action Plan, there are a number of key questions that need to be answered:
-What do you want to change? -How are you going to do it?
-How often (daily, weekly)? -Is your plan honest and realistic?
-What are some skills that you have used in the past to help you get through challenging times?
-What are activities that you, your partner and family enjoy?
Working together, review the following areas and develop your own Action Plan:
1. List the areas, as related to substance use & your relationship/family life, that need change:
__________________________________________________________________________
__________________________________________________________________________
2. Skills and Activities: 3. How often?
Check skills/activities that you would like to use. Circle how often you will engage in that activity where appropriate:
____Abstinence Trust Discussion daily weekly
____Shared Rewarding Activities weekly biweekly
____Self-Help: AA NA Al-Anon weekly 2-3x weekly
____Catch Your Partner daily
____Catch Your Child daily
____”I” Messages ____Positive Specific Requests
____Expressing Feelings Directly ____Continuing Recovery Plan
4. Evaluate if you have been realistic in your expectations of yourself and of each other. Discuss any concerns that either of you may have and modify your plan to work for you and your family.
______________________________________________________________________
5. List some skills and activities that you have engaged in individually, as a couple or as a family that have been helpful and enjoyable:
________________________________________________________________________
It is important to review your Action Plan regularly in order to be reminded of the skills that you possess to cope with difficult situations and to reinforce the positive changes made in your life and your relationship. Take a moment to revisit two items that, when practiced, can have a strong influence on abstinence support and relationship balance: Couple Promises and the Abstinence Trust Discussion.
* Clarification on these items can be found in the section titled: Building Support for Abstinence.
5. Continuing Recovery Plans
The goals in developing a Continuing Recovery Plan are to:
• Prevent lapses and relapses.
• Identify and cope with high-risk situations.
• Identify early warning signs.
• Minimize duration and impact should substance use occur.
• Identify and link with supportive resources.
The ability to handle high-risk, emergency, and unplanned life events will support an alcohol and drug free lifestyle. The Continuing Recovery Model shown earlier highlights these variables and provides direction on what to do.
a. High-Risk Situations: A change in mood, a family or social event, certain people and places, and life stage changes may be specific high-risk situations related to the potential to use substances.
• One strategy that is helpful in preventing relapse is to identify known and anticipated high-risk situations or events (e.g., daughter's wedding, business trip, change of income, anniversary of abstinence) as well as plans to cope with each situation (e.g., remind family/friends of abstinence, talk with sponsor).
b. Early Warning Signs: These are the red flags that indicate risk of substance use is high. These may be the same or similar to the reasons why a person previously used substances and continued to use them.
Some warning signs may include:
• Feeling depressed or agitated.
• Repeated thoughts or cravings to use.
• Feeling stressed out and overwhelmed.
• A change in relationship status, grief and loss, etc.
c. Coping Strategies: What can you do to prevent substance use and to reduce damage caused by a lapse or relapse? Are there certain activities that help to reduce tension and stress? Are there areas in your life that can be addressed to help minimize the stress in your life? How can you and your partner work together to deal with high-risk situations?
d. Asking for Support: Couples dealing with substance abuse issues are often afraid and embarrassed to ask for support from others, even those they feel closest to. Substance-abusing partners are often isolated and secretive, and as a result, they distance themselves from social support networks available to help with relationship and substance abuse issues.
It is important to ask for support from others AND from each other. Some important things to think about when considering reaching out for support are:
• What kind of support are you looking for? Is it financial, emotional, and/or spiritual?
• How do you and your partner perceive or define support? Is it someone who will listen, provide advice, or be confrontational and challenge your thinking and behaviors?
Having answers to these questions will help make it easier to determine who will be best able to provide support for the specific needs of the substance user and/or the couple/partner/family.
5-1. Continuing Recovery Plan: Substance User
Achieving and maintaining abstinence can be one of the toughest life challenges for an individual who has a substance abuse problem. These individuals may have had severe negative consequences or may be trying to repair damage caused to their relationship and family life over the course of their substance-using history.
Thus, it is important to identify coping skills and supportive resources for when times get tough and for ongoing support. Planning will allow for quicker access to help and a greater chance at preventing negative outcomes.
5-1-a. High-Risk Situations: Identify any upcoming events or situations that you consider have potential the potential to trigger the urge to use. Remember to also list places, people, and holidays that could be high-risk.
5-1-b. Warning Signs: Are some of the high-risk situations that you identified also connected to mood changes (e.g., holiday [situation] and sadness [mood])? Is there an upcoming deadline at work that you are working really hard to meet? Have you been feeling stressed out or overloaded lately? Did you tend to use when you felt angry, sad, or depressed? Have you been experiencing cravings to use more often?
5-1-c. Coping Strategies: What can a substance abuser do to cope with high-risk situations? Identifying high-risk situations and having a plan in place can help to minimize the impact of these high-risk situations.
Some useful coping strategies include:
• Remind family and friends of abstinence lifestyle.
• Attend self-help meetings and increase attendance as needed.
• Participate in hobbies and exercise programs.
• Talk with friends who are supportive of abstinence.
• Take a vacation.
5-1-d. Support Resources: What are some available resources that can be used to provide support during the tough times? Which friends and family members are supportive and can be reached to provide support? Is church, temple or synagogue a helpful and peaceful resource?
• Self-help resources include AA and NA.
• At times, it may be helpful to talk with a counselor or attend a treatment program that specifically addresses substance abuse issues (individual and/or couples focused).
EXERCISE 4 requires the substance user to develop a Continuing Recovery Plan. The goals of the plan are to identify high-risk, upcoming situations and to identify strategies and supportive resources that support recovery.
EXERCISE 4 Developing a Continuing Recovery Plan for a Substance User
- Look ahead to the next 6 months, think about some upcoming events that may be high-risk for you and list them.
- Then, thinking back to when you began using and why you might have continued to use, list some early warning signs that may indicate a risk.
- List some strategies that you could implement to reduce that risk.
- Finally, list supportive resources that are available to you, as well as ways that you think your partner can support you.
High-Risk Situations: Warning Signs: Coping Strategies:
_______________________ ______________________ _________________
_______________________ ______________________ __________________
Support Resources: Be Specific: List locations, dates, phone numbers
______________________________________________________________________
______________________________________________________________________
How can my partner support me?: It is important for you to talk honestly, clearly, and directly with your partner. There are no mind readers in relationships, therefore, you should write down the things that your partner can do that are helpful to you. This, in turn, helps your partner have a greater understanding of what he or she can do to help.
_______________________________________________________________________
_______________________________________________________________________
5-2. Continuing Recovery Plan: Partner
The non-substance-abusing partner plays an important part in the substance-abusing partner’s recovery, and both partners must be active in using the skills they have learned to help their relationship. The skills presented and discussed can help the non-substance-abusing partner become active in his or her partner’s recovery, when previously he or she may have felt helpless and powerless.
Being active in the substance-abusing partner’s recovery means that, even when the relationship may have problems, it is important that the non-substance-abusing partner stay positive and future-focused on the recovery (i.e., during the Abstinence Trust Discussion).
The couple has a partnership in the substance-abusing partner’s recovery, as well as relationship improvement. As the substance abuser may have struggles and challenges, it also is important to recognize that the non-substance-abusing partner also needs to identify coping skills and supportive resources.
5-2-a. High-Risk Situations: Can you think of any situations, events, people, or places that could be high-risk for your partner? It is important that you and your partner share your lists as there may be something that the other has not thought of. Also, you have a unique understanding of your partner and his or her substance-using history. For example, there may be a certain place or upcoming event that, in the past, was a time when your partner generally drank or used drugs.
5-2-b. Warning Signs: What changes might you see in your partner that may indicate he or she is struggling not to use or that you have seen in the past right before a substance-using episode? Has your partner mentioned that he or she has been thinking about drinking lately? Did your partner tend to use when he or she was angry, depressed, or overwhelmed with work? A mood change or a change in typical behavior can be warning signs that your partner might need extra support.
5-2-c. Coping Strategies: What are some of the things that the non-substance-abusing partner can do to assist the substance user in abstinence achievement and maintenance, as well as help themselves to cope with stress?
• The partner can be verbally supportive of abstinence with daily use of the Abstinence Trust Discussion.
• The partner can refrain from care-taking behaviors that are not supportive of abstinence.
• The partner can also refrain from starting an argument with the substance abuser if he or she does relapse.
• To minimize his or her own stressors, the partner may stay at a friend’s house if relapse occurs, participate in exercise and stress management programs, and talk with supportive friends and family.
5-2-d. Support Resources: There are a number of supportive resources available to family members who are dealing with substance abuse including:
• Al-Anon
• Spiritual council
• Family
• Friends
• Supportive counseling (can be individual and/or couples focused)
EXERCISE 5 is designed for the non-substance-using partner. He or she develops a Continuing Recovery Plan that is supportive of the substance-using partner’s recovery and identifies supportive resources for oneself.
EXERCISE 5 Developing a Continuing Recovery Plan for a PARTNER of a Substance User
Supporting your partner through abstinence achievement and maintenance, and enhancing relationship satisfaction can greatly reduce the chance of a lapse or relapse. You are in a unique position to recognize early warning signs and situations that may present challenges to abstinence and relationship balance.
- List situations that you perceive to be high-risk and warning signs that you may have noticed in the past when your partner began and/or continued to use substances.
- We also recognize the importance of non-substance-abusing partners having access to their own support systems. Please list some of the supportive resources that you perceive to be available to you.
- Finally, list strategies that you can implement that will be supportive of partner abstinence and relationship improvement.
You and your partner can work together in abstinence and relationship improvement.
High-risk Situations: Early Warning Signs: Coping Strategies:
_______________________ __________________________ ___________________
_______________________ __________________________ ___________________
_______________________ __________________________ ___________________
Support Resources: Be Specific: List locations, dates, and phone numbers
________________________________________________________________________
________________________________________________________________________
How can you support your partner?: It is important for you to talk honestly, clearly, and directly with your partner. There are no mind readers in relationships, therefore, you should write down the things that you can do that can be helpful to your partner and in your relationship.
________________________________________________________________________
**Finally, both partners should come to some agreement together as to how to deal with a lapse or relapse to substance use.**
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See more of this publication at Sobriety: A Couple’s Workbook
Learning Sobriety Together: A Couple’s Workbook is also available as a pdf download – see list of manuals on the Addiction and Family Research Group site
http://addictionandfamily.org/