Integrated Treatment: Part 2 – The Approach
The integrated treatment approach to psychiatric and substance use disorders makes sense from the standpoint of viewing recovery from a holistic approach.
Relapse prevention skills are essential to learning to live a happy life in recovery. One day at a time, one can learn to implement these coping skills to prevent relapse and live a life beyond their wildest dreams.
Recovery from alcohol or other drugs is a process of personal growth with developmental milestones. At any stage of recovery, there is risk of relapsing, making relapse prevention skills highly important to know and understand. Some of the most common triggers of relapse include:
Most alcohol and drug treatment centers educate clients on relapse prevention techniques and help clients learn them in order to maintain recovery and achieve short- and long-term goals. There are a vast array of relapse prevention tools one can implement into their daily routine to help prevent relapse. There is a common misconception that relapse prevention skills should only be used when someone is having a desire to use. However, relapse prevention skills should be implemented into each recovering person’s daily schedule and routine to prevent or reduce the risk of cravings.
The top 10 relapse prevention skills include:
Common post-acute withdrawal symptoms when recovering from addiction include insomnia and fatigue. The New York Office of Alcoholism and Substance Abuse Services (OASAS) reports that these are common potential triggers for relapse. By implementing physical exercise and a balanced diet, one can improve their quality of sleep. This can be done by setting up and following a structured sleep, exercise, and eating schedule. By doing this, one can retrain the body to sleep better and will also help reduce the risk of relapse.
HALT is an acronym for Hungry, Angry, Lonely, and Tired. Whenever feeling a craving to use, or in general feeling anxious or “off,” ask yourself if you are feeling any of these symptoms. The most common triggers for many recovering alcoholics and addicts are hunger, anger, loneliness, and feeling tired. By doing a regular inventory of HALT, one can help prevent the risk of relapse.
When, therefore, we were approached by those in whom the problem had been solved, there was nothing left for us but to pick up the simple kit of spiritual tools laid at our feet. p. 25 Big Book
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Mindfulness meditation is a concept that teaches individuals to become more self-aware. When we are more self-aware, we are better able to cope with potential triggers to relapse. A study by NCBI found outcomes that suggest significant improvement in individuals in recovery who follow a mindfulness meditation relapse prevention program versus those who do not use mindfulness meditation. The individuals using mindfulness meditation remained clean and sober longer and reported less cravings and increased awareness and acceptance. With Mindfulness meditation, participants are encouraged to learn to “roll with” their cravings, rather than fight them. Acceptance that cravings will come is a learned skill through this practice, while implementing relapse prevention skills. Concepts such as acceptance, letting go of personal control, and the use of prayer and meditation are hallmarks of mindfulness meditation. A simple practice of mindfulness meditation, developed by Spirit Rock co-founder, Jack Kornfield, is a mantra to repeat 3 times while gently and mindfully focusing on your breath:
May I be filled with loving kindness
May I be well
May I be peaceful and at ease
May I be happy.
The core concept of mindfulness is paying attention, awareness, or focus on what you’re doing, where you are, who you’re with, and more. To start the process of becoming more mindful, simply notice what you are doing with no judgement. It can be helpful to write down one’s daily activities by tracking them with a smartphone to bring more awareness to what you are doing, thinking, and feeling. This can lead to tremendous insight and empowerment over cravings.
Triggers can be internal (anxiety, irritability, stress, anger, low self-esteem) or external (people, places, or things that remind one of their past use). Making a list of internal and external triggers is an efficient way to gain awareness of one’s triggers and reduce the risk of relapse.
Participating regularly in a support group, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) provides support, accountability, education, and the ability to meet peers who understand what you are going through. It further prevents relapse as it decreases feelings of loneliness and the risk of isolation, both of which can be common triggers for relapse.
Stress and anxiety are often the biggest obstacles when it comes to recovery. A helpful relapse prevention technique is a grounding technique called the 5-4-3-2-1 coping technique. It takes you through the five senses to focus on the moment and avoid thoughts of using alcohol or other drugs, anxiety, negative self-talk, and any other unhealthy thought or feeling that may lead someone to want to use to escape.
The 5 steps begin by taking a few deep breaths, followed by the following:
5: Acknowledge five things you see around you
4: Acknowledge four things you can touch around you
3: Acknowledge three things you can hear around you
2: Acknowledge two things you can smell around you
1: Acknowledge one thing you can taste around you
End this exercise with a long, deep breath. Focusing on your senses will help you gain self-awareness and increase mindfulness, which will help you accomplish daily tasks, overcome unhealthy thoughts or feelings, feel more in-control and less overwhelmed, and reduce the risk of relapse.
Breathing is central to life, as you know. What many do not know, however, is how much control you have over your life by simply changing your breathing patterns. Breathing is not only connected to various essential functions throughout your body, but it also has a large effect on your brain chemistry. Breathing greatly impacts your emotions and helps regulate your overall mood. This is why deep breathing is so essential with one’s mental health.
Deep breathing releases neurotransmitters in your brain, many of which trigger feel-good chemicals resulting in relaxation, happiness, and pain reduction. Deep breathing, and the resulting increased oxygen flow, also encourages your body to exhale toxins. A useful deep breathing technique is the 4 x 4. Take four deep breaths in through your nose and hold, then release for four seconds. You should feel your diaphragm moving in and out while you breathe. Deep breathing is an excellent relapse prevention technique because it can be utilized virtually anywhere without anyone knowing you’re doing it.
When an urge comes, it can be difficult to manage it, especially in the beginning of recovery. A very helpful relapse prevention skill is making a list of healthy family members or friends who are also in recovery that you can call for support. Having a safe person to talk to can help you get past the craving and remember why you do not want to return to previous behaviors. Keeping that list on you at all times is important because it is a readily available resource you can use by quickly calling someone safe.
If you find yourself having a desire to drink or get high and you are debating what to do, a great tool is playing the tape through first. To play the tape through, you must play out what will happen in your mind until the very end. Imagine what will happen in the short and long-term future if you decide to drink or use. Think of the consequences that would occur if you used vs. if you did not use. This can help with your decision making and reduce the risk of relapse.
The fear of relapse can be debilitating. However, it does not have to be when you are fully prepared with a toolbox of healthy coping strategies. Implementing these relapse prevention techniques into your daily schedule can greatly help reduce the risk of relapse. Contact a dedicated treatment provider to learn more about inpatient or outpatient treatment programs to learn more relapse prevention skills and get help today.
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