Relapse PreventionDr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, NCC

Executive Director AllCEUs

Objectives Define relapse in terms of addiction as well as

mental health Examine relapse prevention techniques Explore needs of the person: Psychosocial and

Maslovian

What is Relapse Relapse is the return to addictive behaviors or the

recurrence of mood disorders Relapse often starts long before the person uses

again Get caught up in day-in-day-out Start acting “mindlessly” Stop going to meetings/counseling/church/lifeline Begins running out of energy to do new behaviors Frustration, irritability and exhaustion set in

Caveat…an extreme stressor can prompt “immediate relapse”

Extreme Stressors Those things that overwhelm an individuals ability to

cope Thrust them into the fight or flight New coping skills and support resources may not even

be considered, or only half-heartedly Have clients identify or practice dealing with these types

of situations in group Divorce Death Job Loss Diagnosis of a terminal or chronic illness (Cancer, ALS, HIV)

Beginner Tools for Extreme Stress Get support… You are outnumbered! Self-soothing/De-Escalation Systematic Desensitization Cognitive Behavioral Therapy

CPT Note Card I feel… because …… What am I upset about What are the FACTS for and against this belief Am I using all or nothing thinking or jumping to conclusions I need to call _______ to get an objective perspective or what

would _____ do

Psychosocial Needs Represent tasks that must be accomplished or needs that

must be met as the people grow up These tasks help people learn self-control, confidence and

esteem Problems in achieving these tasks/needs can lead to

problems in development Problems later in life may cause people to question their

earlier conclusions These tasks are not linear and final Part of the treatment process is helping people learn how to

“parent” themselves. Clinicians initially take the part of the parental figure

modeling how to resolve issues

Psychosocial Needs Trust vs. Mistrust

If people receive consistent, predictable and reliable care, they will develop a sense of trust/faith in themselves and others

They will be able to feel secure even when threatened. This leads to developing hope that as new crises arise,

there is a real possibility that other people will be there are a source of support, they have the strength to endure and their intuition is correct.

I can trust myself (thoughts, intuition) I can trust those around me Example: Child abuse survivor

Psychosocial Needs Autonomy vs. Shame and Doubt

Explore the limits of their abilities within an encouraging environment which is tolerant of failure

The aim has to be “self control without a loss of self-esteem” (Gross, 1992). Success in this stage will lead to the virtue of will/discipline/courage.

If people are criticized, overly controlled, or not given the opportunity to assert themselves, they begin to feel inadequate in their ability to survive, and may then become

Overly dependent upon others Lack self-esteem Feel a sense of shame or doubt in their own abilities.

Psychosocial Needs Initiative vs. Guilt. ...

People learn to initiate activities with others, and feel secure in their ability to lead others and make decisions.

If this tendency is squelched, either through criticism or control, people develop a sense of guilt, feel like a nuisance to others and will therefore remain followers, lacking in self-initiative and self-confidence.

A healthy balance between initiative and guilt is important. Success in this stage will lead to the virtue of purpose.

Psychosocial Needs Industry (competence) vs. Inferiority. ...

People’s peer groups are a major source of self esteem. They feel the need to win approval by demonstrating

specific competencies that are valued by society, and begin to develop a sense of pride in their accomplishments.

If this initiative is not encouraged, people begin to feel inferior, doubting their own abilities and therefore may not try or may give up at the first sign of failure.

Some failure may be necessary so that the person can develop some awareness of personal limits.

Psychosocial Needs Identity vs. Role Confusion

In response to an identity crisis a person may begin to experiment with different lifestyles (e.g. work, education or political activities).

People experience identity crises in adolescence, adulthood and in response to major stressors

Pressuring someone into an identity can result in rebellion.

People must define what recovery looks like for them and be motivated to do it for themselves.

Psychosocial Needs Intimacy vs. Isolation

Sharing of ourselves and being accepted and loved for who we are

Successful in this stage can lead to a sense of commitment, safety, and care within a relationship.

Avoiding intimacy, fearing commitment and relationships can lead to isolation, loneliness, and sometimes depression.

Exploring past relationships is often a task for therapy Relapse prevention involves

Increasing awareness of what healthy relationships look like Reminding themselves that what happened in the past with a

different person is not necessarily going to happen again.

Maslow Biological

Housing (create safety and remove/address triggers) How can they make the best of what they have

Safe routes to and from work Make their home or room a safe haven

What are the negative and positive triggers and solutions in their current environment

People Times of day/week Things

Maslow Biological

Medical Care (Eliminate vulnerabilities) Chronic pain Mental Health Substance Abuse (Buprenorphine, Antabuse,

Methadone, SSRIs) Food and water, sleep (Create a recovery

environment) Self care is a new skill for many clients, go slow Routine…routine…routine

Maslow Safety

From physical or psychological injury by self or others From peer pressure

Relationships Nurturing Encouraging of sober behaviors

(honesty, hope, faith, courage, discipline, integrity)

Self-Esteem A sense of pride in who they are Acceptance of strengths and weaknesses Lack of self-esteem can lead to a need for external

validation Self-Esteem workbooks abound to develop positive

self esteem Eradicating harsh, self-critical self-talk is the second

part Be aware of the imposter phenomenon.

Mindfulness Relapse often begins when mindfulness ends Mindfulness is being aware of

Who you are How you feel (emotionally, mentally, physically) What you want (and what you actually need)

Are you eating because you are hungry or stressed What not getting wants met mean to you

Activities Morning and evening journals Behavior Interruption esp. regarding substitute addictions

Mindfulness ACT Matrix

Summary Relapse prevention begins with remaining aware of your

wants, and needs Relapse begins when the old behaviors start to surface

Avoidance Minimization Rationalization Denial Numbing

People need to learn how to self-govern as a part of recovery People need to learn how to meet their basic needs and how

these needs impact their recovery.