Recovery Relapse

1. Recovery & Relapse

2. Defining Relapse An absence of recovery characterized by a process of returning to old attitudes and behaviors

3. The relapse process There are progressive and predictable symptoms of relapse Often initially characterized by changes in thought patterns, emotional process and behavior The symptoms will increase in frequency and severity Return to use is the end, not the beginning of the relapse process Ability to see options shrinks until they suffer from physical/emotional collapse, thoughts/attempts of suicide or use

4. The relapse process We want to teach patients to recognize these symptoms in themselves before they get to this state Gorski identified 37 signs of relapse (p. 57-65)

5. Elements of Relapse Absence of recovery Means that recovery has to be present A process, not a destination Returning to use is the end of relapse, not the beginning Denial is often one of the first symptoms to return

6. Relapse Dynamic Most relapse prone clients drop out of treatment before they use Therefore, treatment retention is crucial Once denial has returned, judgment is impaired One strategy is to have clients check for relapse signs daily The earlier the signs are recognized the easier it is to intervene in the relapse process

7. Relapse in chronic disease Chronic diseases progress over long time Symptoms become increasingly severe over time People adapt over time to the changes in lifestyle and interactions on the physical, social, psychological and behavioral levels changes are so subtle that they are often not recognized

8. Relapse in chronic disease Since all aspects of life are affected by addiction, all aspects need addressed in recovery Develop a relationship with their illness A sense of loss can occur when accept they cannot use again psychological, behavioral and social habits have developed as a result of this relationship

9. The recovery process Abstinence is the beginning, not the end of recovery An active, ongoing process, not a destination See a progression of recovery, similar to progression of relapse

10. Developmental Model of Recovery Pretreatment Often the phase where �hitting bottom� happens See a �motivational crisis� that allows the addicted person to see that something is seriously wrong Stabilization Detoxification and withdrawal Goal is to stabilize physically and psychologically so they can be helped and initialize abstinence

11. Developmental Model of recovery (cont�d) Early recovery Where the addiction is addressed as well as a thorough look at the life problems resulting from the addiction Patient needs to believe that they are addicted and develop strong, meaningful motivation for recovery 0-2 years Middle recovery Person has made a commitment to long term recovery Often see a demoralization here when they begin to understand the devastation that their use has made

12. Developmental Model of recovery (cont�d) Middle recovery (cont�d) Struggle with emotional acceptance of this disease Develop a structured, self-regulated plan for sobriety Late recovery Stabilization of addiction related life problems Learn to distinguish addiction-centered values from recovery-centered values Identify those self defeating characteristics that can lead to relapse

13. Developmental Model of recovery (cont�d) Late recovery (cont�d) Establishing or re-establishing spirituality Focus is more toward living not cleaning up the past Maintenance Recognizing the ongoing need for a recovery plan Recovery is such a part of life now, it is nearly automatic However, attention is still needed so that when times of stress or concern happen recovery is attended to

14. Prevention Planning Relapse can be prevented Most relapse is a result of ignorance of signs of relapse Good relapse planning provides a sense of security Prevention plans are designed to the risk of relapse through education, self-exploration and action plans

15. Prevention Planning Stabilization Assess the impact of the relapse on individual and family Determine if relapse is therapeutic or non-therapeutic Assessment Review presenting problems, current relapse dynamic, relapse history, complications, level of treatment completion, individual�s coping strategies. Patient education Review recovery process, symptoms, complications, relapse planning

16. Prevention Planning Warning sign identification Update personalized warning signs with detailed individual descriptions Review of the recovery program Identify what they were doing before relapse that was working, what needs changed Inventory training Daily check for signs of relapse Evaluations like, �do I believe I�m an alcoholic/addict, am I resentful about my daily recovery program, do I believe I still need my daily recovery program�, etc.

17. Prevention Planning Interruption of the relapse dynamic Identify/clarify relapse signs, think through consequences and alternatives Involvement of significant others Recovery doesn�t happen in isolation Follow-up and reinforcement Treatment and support groups, sponsors, etc., are critical to ongoing recovery