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Integrated Relapse Prevention

Is avoiding relapse twice as difficult in Dual Recovery?

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Understanding Relapse as . . .

. . . the PROCESS of returning to substance use and/or active symptoms after a period of abstinence / stability

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Understanding Relapse as . . .

. . . ALWAYS a risk when dealing with two, co-occurring “chronic, relapsing conditions”

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Relapse “Clues”

Behavior changesDecreasing what

helps; Increasing risk-

taking, or what doesn’t help

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Relapse “Clues”

Attitude changesNegativity “Not caring”Disowning

personal responsibility

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Relapse “Clues”

Mood changesMoodinessAngerBoredomManiaDepression

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Relapse “Clues”

Changes in thinkingRationalizationJustificationDenial “Stinkin’ thinkin’”Deprivation /

entitlement Irrational thoughtsDelusional thoughts

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Identifying High-Risk Situations Individualized (different for

everyone) Negative feelings, attitudes,

thoughts, behaviors Social pressures Treatment-related problems Relationship problems Urges / Cravings / Temptations /

“Teasing the addict” Others (boredom, weekends, $

$, physical pain, holidays, etc.)

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Managing High-Risk Situations

Individualized (different for everyone)Analyze the risk factors Identify “precursors,”

the steps leading up to the high-risk situation

Strategize for recovery

success

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Managing High-Risk Situations

Individualized (different for everyone)Write down a planShare the plan with

others Identify gaps in skills

/opportunitiesProblem-solve and fill

gaps

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Building a LONG-TERM Dual Recovery Plan

Can be looked at as “aftercare” following a treatment episode, or as “maintenance” of existing gains

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Building a LONG-TERM Dual Recovery Plan

May include many things: Counseling Medication / seeing a psychiatrist AA / NA / DRA meetings, other

groups Working with a sponsor / mentor Daily reading of recovery literature Halfway / ¾-house, long-term

housing Antabuse Educational / vocational efforts ?

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Emergency Recovery Card

Designed to be carried in wallet or purse

Contains a list of names and phone numbers of people supportive of your dual recovery

May include professional treatment providers, natural supports, AA / NA / DRA contacts

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Relapse Response Planning

“Progress, not perfection” (although, “Progress not permission” as well!)

Dialectical approach, need to not let guilt / shame be an obstacle to getting back on track

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Relapse Response Planning

Some important pieces . . .STOP IMMEDIATELYReach out to “safe” peopleGet crisis care if necessary

(Detox, PES, CRS, Hospital ER)

Get back to doing what worksConduct a Relapse Autopsy,

and adjust recovery plan

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Daily Relapse Prevention Inventory

At the end of each day, take the time to review these questions: Were there any clues

today that indicate movement toward relapse of substance use or re-activated symptoms?

Were there any high-risk situations today that could trigger a relapse of substance use or symptoms?

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Daily Relapse Prevention Inventory

If “yes” is the answer to either of these questions, make a plan to do the necessary adjusting to support dual recovery moving forward . . .

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Back to our initial question . . .

Q. Is avoiding relapse twice as difficult in Dual Recovery?

A. _______________________________

_______________________________

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THE END

Until next time . . .