Relapse prevention and recovery

1. Thomas P. Britton MA, LPC, LCAS, CCS, ACS tbritton@arpnc.org Relapse prevention and recovery Drug Treatment Court Conference 8/31/2010

3. Anyone can be an Addict

4. Who is an Addict An addict is a man or woman whose life is controlled by drugs An addict is a person who has lost the ability to control their use of drugs including alcohol An addict is a person who knowingly sacrifices their values and morals to get high An addict is a mother, father, brother, son, employee, friend – an addict is anyone

5. 23 Million People

6. 3 Million People

7. What is Addiction Experiment gone wrong Disease of the mind, body and spirit Lifestyle disease like diabetes, obesity and cancer Compulsive drug seeking and use despite consequences Powerlessness to regulate once begun

8. The Impact of Addiction • $276 billion dollars or $1000/person in the United States. Cost impacts include medical care, incarceration, lost work productivity, law enforcement, the judicial system, and crime. • The potentially larger and immeasurable cost is to the addicted persons themselves and the neglect of social, family, and parenting responsibilities.

9. Adjudication and Addiction • Law has consistently been modified over the past 40 years to require harsh punishment and has restricted or removed the ability of judges to apply their judgment to the level or type of sentencing for criminal behavior stemming from addiction or mental illness. Minimum sentencing requirements went back into law with among others the “three strikes you’re out” ruling in 1994 with three time offenders facing 25 years imprisonment creating the most expensive and comprehensive judicial, law enforcement, and penal system in the world. • As of 2006, a record 7 million people were either incarcerated, on probation, or on parole. Of the seven million, 2.2 million are incarcerated . • Assuming that the national data is accurate on rates of addiction in the adjudicated population, 5 million people involved in the legal system need treatment for drug and/or alcohol problems. • There is a direct correlation between recidivism and substance abuse with 41% of 1st offenders, 61% of 2nd time offenders, and 81% of those with 5 or more convictions being substance abusers and mandating treatment significantly reduces recidivism in offenders with problems of substance use and abuse.

10. Success & Failure in the Criminal Justice System Offender Sentenced to Punishment Offender Enters Judicial System Revoked and experiences sentence Recovery Offender Leaves Judicial System

11. The Cycle Reduced Recidivism Abstinence Support Group Retention Treatment Retention Relapse

12. What if nobody does anything?

13. What is Recovery • Sustained abstinence from mood altering chemicals • Removal of physical and psychological desire to use • A removal of denial, rationalization and justification • Build-up of coping and living skills • Improved functioning in primary life domains • Development of healthy social networks

15. How Does Recovery Occur • Work • Willingness • Work • Change • Work • Support • Work • Maintenance

16. Is There Hope

17. Addiction need not be a life sentence.

18. What is Relapse • A relapse is not an event – it is a process • A change in perception • Normal but not necessary • The return of self destructive and harmful behavior • The sacrifice of successful coping strategies • The physical use of substances is the end result not beginning

19. What is Relapse Prevention • An exploration of changes in attitudes, beliefs, and thinking patterns that an individual would exhibit prior to returning to chemical use. • Knowing relapse warning signs helps cut the process short without having the end result of actually returning to chemical use. • Creating and implementing an action plan to reverse relapse process and return to recovery process

20. Avoidance and Defensive Behavior • Denial and believing “I’ll never use again”  • 40-60% relapse in first year • Worrying about Others Instead of Self • Justification, Rationalization and Defensiveness • Compulsive and Impulsive Behavior • Tendencies towards Loneliness and Isolation

21. Changes in Mood and Attitude • Anger, Stress and Impatience • Depression and Complacency • Paranoia and Blaming Others • Emptiness • Hopelessness • Resentment • Amotivation • Dissatisfaction with life • Self Pity and Shame

22. Behavioral Changes • Playgrounds and Playmates • “Old” Behaviors • Relationships • Work • Acting Out • Irregular Attendance at Support Groups  and Treatment meetings • Development of an “I don’t care” attitude • Open Rejection of Help • Dishonesty “secrets keep you sick”

24. Physical Changes • Irregular Eating Habits • Lack of desire to take action • Irregular sleeping habits • Loss of daily structure • Periods of deep depression • HALT

25. CRAVING CITY

26. Acute Relapse Episode • Degeneration of all life areas • Alcohol or drug Use • Emotional Collapse • Physical Exhaustion • Stress Related Illnesses • Psychiatric Illness • Suicide • Disruption of Social Structure

27. What to Do • Prevention • Back to the basics • Continue with attendance and involvement in social support meetings • Service work / Home group • Work the 12 Steps with sponsor • Frequent contact with sponsor • Accountability with others • Continued therapy support / self-awareness • Interrupting the Relapse Process • Stabilization • Self-assessment • Relapse Education • Warning Sign Identification & Management • Involvement of Significant others • Prevention • Planning • What to do in Relapse • Ask for help – medical or social detoxification – honest evaluation of needed change

28. What Is the Narcotics Anonymous Program NA is a nonprofit fellowship or society of men and women for whom drugs had become a major problem. We are recovering addicts who meet regularly to help each other stay clean. This is a program of complete abstinence from all drugs. There is only one requirement for membership, the desire to stop using. We suggest that you keep an open mind and give yourself a break. Our program is a set of principles written so simply that we can follow them in our daily lives. The most important thing about them is that they work. In 2008, there were over 25,000 groups holding over 53,000 weekly meetings in 127 countries with 5,000,000 attendees 41-70% of participants in 12-step groups are court mandated Mandated referrals to 12-step fellowships experience a 40% dropout within the first 30 days and 80-90% overall dropout

29. First Amendment and the 12 Steps • Establishment Clause – Can not force religious participation • Free Exercise Clause – Right to practice own religion • Kerr v. Ferry, 95 F.3d 472 (7th Cir. 1996) Prison punishment • Warner v. Orange County Department of Probation, 115 F.3d 1068 (2d Cir. 1997) Atheist • Inouye v. Kemna, 504 F.3d 705 (9th Cir. 2007). Buddhist • As long as secular option is available – ok to require participation in support groups as long as participant is informed • O’Conner v. California, 855 F. Supp. 303, 308 (C. D. Calif.) (no Establishment Clause violation where DUI probationer had choice over program, including self-help programs that are not premised on monotheistic deity); In Re Restraint of Garcia, supra, 24 P.3d at 1093. • Bausch v. Sumiec, supra, 139 F. Supp. 2d at 1036 (the choices need to be made known to the participant); see also De Stephano v. Emergency Housing Group, 247 F.3d 397 (2nd Cir. 2001).

30. The Effectiveness of 12-Step Fellowships • Opiate users are 3-4 times more likely to be clean when attending Narcotics Anonymous meetings and alcohol users 4-5 times more likely to be sober when attending Alcoholics Anonymous. • Those with sober peer networks demonstrate significant increases in abstinences. • Participants experienced significant increases in social functioning, employment, interpersonal functioning, and reduced criminal behavior. • Meeting makers make it. • Service • Sponsorship • Powerless over addiction

32. What is a Sponsor • Individual in recovery with a working knowledge of the 12-steps • Individual with continued abstinence from all drugs • Individual who share their experience, strength and hope with sponsees to help guide them in working the 12-steps • Someone to totally trust and be open to • An individual who is living in a way that you want to model

33. What is a Home Group • A recognized 12-step meeting • A place to commit to go to weekly • A place to do service • Home groups may have multiple formats • A place to feel safe to share your secrets and challenges • A place to build a recovering social support system

34. What is Service • Home groups • H+I • PR • Area • Sponsorship • Meeting attendance • Working the 12-steps

35. What About God • NA is a spiritual not religious program • NA gives no mandate or explanation of what or who God is • NA only gives the suggestion that a higher power be loving, caring and greater than yourself however you define it • Atheist, agnostics and the uncertain are welcome and thrive in the 12-step fellowships

36. Surrender and Preparation • We admitted we were powerless over our addiction, that our lives had become unmanageable. • We came to believe that a Power greater than ourselves could restore us to sanity. • We made a decision to turn our will and our lives over to the care of God as we understood Him.

37. Housecleaning 4. We made a searching and fearless moral inventory of ourselves. 5. We admitted to God, to ourselves, and to another human being the exact nature of our wrongs. 6. We were entirely ready to have God remove all these defects of character. 7. We humbly asked Him to remove our shortcomings.

38. Making it Right 8. We made a list of all persons we had harmed, and became willing to make amends to them all. 9. We made direct amends to such people wherever possible, except when to do so would injure them or others. 10. We continued to take personal inventory and when we were wrong promptly admitted it.

39. Deepening and Giving Back 11. We sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out. 12. Having had a spiritual awakening as a result of these steps, we tried to carry this message to addicts, and to practice these principles in all our affairs.

40. Summary • Relapse is a process that can be identified and halted before drug use begins • Drug Court leaders and participants can be instrumental in reducing and stopping relapse • Relapse is not a failure • Recovery can happen at any time • It works if you work it

41. 12 Step Support and NC • WWW.NA.ORG • Information for both the professional and the addict Phonelines NC: http://www.na.org/?ID=phoneline WWW.AA.ORGInformation for both the professional and the alcoholic Homer M.Coordinator, Cooperation with ProfessionalsNC-Alcoholics AnonymousContact Information:Email: serenity.awyout@yahoo.com or cpipi@aanorhtcarolina.orgPhone: 336-671-9435

42. References Narcotics Anonymous Free Literature http://www.na.org/?ID=ips-eng-index CONSTITUTIONAL AND OTHER LEGAL ISSUES IN DRUG COURT http://legisweb.state.wy.us/2007/interim/DrugCourt/LegalIssues.pdf Free Exercise Clause http://en.wikipedia.org/wiki/Free_Exercise_Clause_of_the_First_Amendment Establishment Clause http://en.wikipedia.org/wiki/Establishment_Clause_of_the_First_Amendment REFERENCES Gorski, Terence T. Understanding Relapse. Derived from GORSKI-CENAPS Web Publications www.tgorski.com/gorski_articles/understanding_relapse. Gorski, Terence T. How to Develop a RP Plan. GORSKICENAPS Web Publications Derived from www.tgorski.com/gorski_articles/developing_a_relapse_prevention_plan.htm Gorski, T.T. & Miller, M. Staying Sober: A Guide For Relapse Prevention. Gorski & Miller 1986. Our Devilish Alcoholic Personality. By The Author of The Little Red Book. Hamar Publishers 1970 Edina, MN Video: Relapse by Father Joseph C. Martin. Kelly Productions, Inc.