# Presentation: 169150

## Session 5:Roadmap for Recovery

## Recovery Stages

- Stage 1: Withdrawal
- Stage 2: Early Abstinence (“Honeymoon”)
- Stage 3: Protracted Abstinence (“the Wall”)
- Stage 4: Adjustment/Resolution

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## Stage 1: Withdrawal

- Physical detoxification
- Cravings
- Depression/anxiety
- Low energy
- Irritability

- WITHDRAWAL

- Exhaustion
- Insomnia
- Paranoia
- Memory problems
- Intense hunger

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## WithdrawalRelapse Risk Factors

- Powerful cravings
- Paranoia
- Depression
- Disordered sleep patterns
- Unstructured time
- Proximity of triggers
- Fear of withdrawal symptoms

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## WithdrawalStructure

- Self-designed structure
- Helps eliminate avoidable triggers
- Makes the concept of “one day at a time” concrete
- Reduces anxiety
- Counters the drug-using lifestyle
- Provides a basic foundation for ongoing recovery

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## Building Blocks of Structure

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## Scheduling Pitfalls

- Unrealistic schedules
- Unbalanced schedules
- Imposed schedules
- No support from significant others
- Holidays, illness, and other changes

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## Stage 2: Early Abstinence

- Intense feelings
- Mood swings
- Other substance use
- Inability to prioritize
- Mild paranoia

**Stage 2: Early Abstinence**

- Increased energy and optimism
- Overconfidence
- Difficulty concentrating
- Continued memory problems

- HONEYMOON

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## Early AbstinenceRelapse Risk Factors

- “Workaholism”
- Discontinuation of structure (including treatment)
- Overconfidence
- Secondary drug or alcohol use
- Inability to prioritize
- Resistance to behavior change
- Occasional paranoia

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## Early AbstinenceTriggers and Thought Stopping

- Trigger

- Thought

- Thought stopping

- Continued thoughts

- Use

- Cravings

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## Interruption

**Interruption**

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## Types of Triggers

- Triggers can relate to
- People
- Places
- Things
- Times
- Emotional states

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## Triggers People

- Friends who use drugs/dealers
- Absence of significant other
- Voices of friends who use drugs/dealers
- Intimate partners
- People discussing drug use

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## Triggers Places

- Drug dealer’s home
- Bars and clubs
- Drug use neighborhoods
- Work
- Some street corners
*Anyplace* associated with use

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## Triggers Things

- Drug paraphernalia
- Money/ATMs
- Movies/TV shows about drugs and alcohol
- Sexually explicit magazines/movies
- Certain music
- Secondary drug or alcohol use

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## Triggers Times

- Idle time
- After work
- Holidays
- Birthdays/anniversaries
- Stressful times
- Paydays
- Friday/Saturday nights

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## Triggers Emotional States

- Anxiety
- Depression
- Boredom
- Fear
- Sexual arousal *or* deprivation
- Fatigue
- Anger
- Frustration
- Concern about weight gain

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## Thought Stopping

- Learn to recognize “using thoughts”
- Use visual imagery
- Snap a rubberband
- Relax
- Call someone

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## Nontrigger Activities

- Exercise
- 12-Step/mutual-help group meetings
- New recreation/hobby
- Faith-based or spiritual activities
- Eating/sleeping
- Non–drug-oriented movies
- Structured/monitored periods

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## Stage 3: Protracted Abstinence

- Continued lifestyle changes
- Anger and depression
- Isolation
- Family adjustment

**Return** **of** **cravings**
**Return to old behaviors**

- THE WALL

- Positive benefits from abstinence
- Emotional swings
- Unclear thinking

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## Protracted AbstinenceRelapse Risk Factors

- Increased emotionality
- Behavioral “drift”
- Decreased ability to feel pleasure
- Low energy/fatigue
- Secondary drug use

- Breakdown of structure
- Interpersonal conflict
- Loss of motivation
- Insomnia
- Paranoia
- Relapse justification

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## Secondary Drugs and Alcohol

- Use of a secondary drug or alcohol may lead to relapse to stimulants through
- 	Cortical disinhibition
- 	Stimulant craving induction
- 	12-Step philosophy conflict
- 	Abstinence violation effect
- 	Interference with new behaviors

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## Protracted AbstinenceRelapse Justification

**The addicted brain attempts to provide a *****seemingly***** rational reason (justification) for behavior that moves a person in recovery closer to a slip.**

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## Relapse JustificationOther People Made Me Do It

- My wife used so ...
- I was doing fine until he brought home ...
- I went to the beach with my sister and ...
- My brother came over for dinner and brought some ...
- I wanted to see my friend just once more, and he offered me some ...

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## Relapse Justification I Needed It for a Specific Purpose

- I was getting fat again and needed to control my weight, so I ...
- I couldn’t get the energy I needed without ...
- I can’t have fun without ...
- Life is too boring without ...
- I can’t be comfortable in social situations or meet people without ...

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## Relapse Justification I Was Testing Myself

- 	I wanted to see whether it would “work better” 	now that I’ve been clean awhile.
- 	I wanted to see my friends again, and I’m 	stronger now.
- 	I needed a little money and thought I could sell a 	little without using.
- 	I wanted to see whether I could use just a little 	and no more.
- 	I wanted to see whether I could be around it and 	say no.
- 	I thought I could drink without using.

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## Relapse Justification It Wasn’t My Fault

- It was right before my period, and I was depressed.
- I had an argument with my spouse.
- My parents were bugging me.
- My partner was intimate with another person.
- The weather was gloomy.
- I was only going to take a hit and ...

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## Relapse Justification It Was an Accident

- I was in a bar, and someone offered me some meth.
- I was at work, and someone offered ...
- I found some in my car.
- I went to a movie about ...
- A friend called to see how I was doing. We were talking and decided to get together.

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## Relapse Justification I Felt Bad

- Life is so boring I may as well use.
- I was feeling depressed, so ...
- My job wasn’t going well and I was frustrated, so ...
- I was feeling sorry for myself, so I ...
- Recovery is just too hard.

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## Stage 4: Adjustment and Resolution

- Feelings of accomplishment

- ADJUSTMENT/RESOLUTION

**Maintaining a balanced lifestyle**
**Accepting that recovery is a life-long process**

**Monitoring for **
**relapse** **signs**
**Addressing underlying issues that may surface ****or resurface**

- Continued lifestyle/ relationship change

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## Adjustment and ResolutionRelapse Risk Factors 

- Secondary drug or alcohol use
- Feeling “cured” and relaxing vigilance for relapse signs
- Relaxation of structure
- Losing recovery momentum/commitment
- Struggle with accepting addiction and recovery as a life-long process
- Reemergence of underlying emotional issues

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## Adjustment and ResolutionBalance

**Work**

**Recovery ****Activities**

**Sleep**

**Leisure**

**Relationships**

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