Many people who successfully complete a detox program are surprised when they continue to crave their addictive substance. Effective relapse prevention requires an understanding of the different types of cravings and why they happen. Taking the first step towards treating your substance use disorder can be scary and overwhelming. The more prepared you are for the obstacles that often lead to relapse; the more likely you’ll be to have a successful long-term recovery.
Two Phases of Withdrawal
Withdrawal, as it is related to drug or substance abuse, refers to the painful physical and psychological symptoms experienced after purging the substance from the body. The first phase of withdrawal is detox, or acute withdrawal. Once detox ends, the second phase kicks in. This phase is called post-acute withdrawal, or PAW.
The duration and intensity of PAW symptoms depend on the addictive substance, how frequently, and how long it was used. The severe symptoms of withdrawal occur during this phase. Even after the last traces of the substance are gone from the body, symptoms persist. These symptoms are especially prevalent in those who have a long-term history of opioid use.
Post-acute withdrawal symptoms usually come and go, interfering with the person’s ability to concentrate. They may have difficulty focusing on tasks, poor appetite, memory, and sleep problems. Their moods vary from feeling anxious and irritable to being unreasonably angry or depressed.
PAW isn’t something that some people in recovery go through; it is a necessary process that everyone who goes through recovery will experience. Addiction results from chemical changes to the brain. These changes make it more difficult for users to enjoy the same level of pleasure from other things without the chemical in their body. It takes more than getting the chemicals out of the brain and body to get back to life substance-free. The body and brain have to adjust to the changes detox puts them through.
Detox isn’t easy, and there are genuine risks associated with the process. That’s why no one should try to go through the process alone at home. Sometimes people fail to successfully get through detox and go back to using the addictive substance. There’s also the possibility that an emergency situation will arise. When it does, they are much better off to be in a facility that specializes in detox. A staff that understands the challenges and the dangers will help them have a safer, more successful recovery.
Every person and every addiction is different starting with the abusive substance. Every person has a unique story about their path to addiction. It isn’t surprising then that they also have different triggers and temptations. For some, engaging in their previous behaviors is a way to experience certain feelings. They are drawn to the effects they know the substance causes. For others, it’s a way to escape situations and emotions that cause them pain.
The Most Common Triggers That Cause Relapse
There are many triggers that result in relapse, but some are much more common than others. These include the settings and situations that led to addiction in the first place. They may have a positive or negative connotation, including:
1. Physical and Emotional Symptoms of Withdrawal Detox is the first step towards recovery. It causes many uncomfortable symptoms as the abusive substance is flushed from their body. Some people struggle with nausea, anxiety, or loss of energy they experience during this necessary phase of recovery. Some simply give in to the symptoms and return to the substance of choice to get relief from these painful or unpleasant symptoms. These include the symptoms of post-acute withdrawal as described above.
2. Inability to Cope With Self-Care Recovery is a time to change bad behaviors into good ones. That includes eating a healthy diet, getting plenty of rest, and dealing with stressful situations in different ways than through substance abuse. Failing to provide a high level of self-care can cause them to relapse.
3. Re-Entering the Abusive Environment Once they complete the recovery program, most return to the same environment where they used before. They are surrounded by the same people and the same triggers that caused them to use before. Sometimes the appeal to use is more than they can ignore.
4. Relationships & Sex These issues are emotional. When things don’t go wrong, the negative feelings and stress can lead them to abuse the substance again.
5. Isolation & Loneliness Leaving situations where they are in contact with the friends they used to use with can have a different impact. They have too much time to think about their situation and may medicate their loneliness with their substance of choice.
6. Overconfidence Some people refuse to acknowledge that they are an addict or think that their recovery puts their problem in the past. Failing to acknowledge the addiction is a sure way to trigger a relapse.
7. Experiencing Uncomfortable Emotions H.A.L.T. is a tool that some people use for relapse prevention. The acronym stands for Hungry, Angry, Lonely, and Tired. When these basic needs aren’t met, relapse becomes more likely. HALT serves as a reminder to take a moment to consider whether they are taking care of themselves and are aware of any emotions that they should treat as a warning.
Hunger refers to a physical or emotional need. It isn’t enough to just eat out of convenience. It’s crucial that a recovering addict maintains a nutritious diet that keeps their body functioning and feeling well.
When the hunger is emotional, it can be for affection, compassion, or accomplishment. The person uses the HALT system to recognize these needs and find positive ways to meet them.
Anger is an emotion that we all feel sometimes. For the recovering addict, it’s important not only to recognize the emotion, but also to get to the cause. They need to analyze their reasons for feeling angry and identify the target. Then, they can figure out what to do to resolve the situation in a good way.
They don’t have to be alone to experience Loneliness. Even in a crowd, it’s possible for them to feel different, misunderstood, and alone. Using the HALT system reminds them to ask whether they have made an effort to reach out to other people. They can make an effort to reach out to a loved one or friend to get rid of feelings of loneliness. A little effort can change the feelings of loneliness into much happier emotions.
Anyone can experience Tiredness when they put an extra burden on their body or mind. It’s important for the recovering addict to take the time they need to get enough sleep and rejuvenate. Depending on their specific needs, they may need a short nap, a relaxing yoga class, or a relaxing massage.
Relapse: How It Happens
Relapse doesn’t happen all at once. It’s not a single event where the person slips back into their old behaviors. It occurs in stages that begin weeks or months earlier. That’s why understanding the triggers is such an essential part of relapse prevention. Knowing what to do during each stage of relapse also makes it easier to prevent relapse from occurring. The three stages include emotional, mental, and physical relapse and each has unique techniques for preventing relapse.
1. Emotional Relapse During emotional relapse, the person still remembers the last time they relapsed and they don’t want to repeat it. They don’t have the desire to use again but their emotions and behaviors are preparing them for a future relapse. They are in denial that they haven’t gotten past their addiction and that relapse is a possibility.
They experience a broad range of emotions including anxiety, anger, defensiveness, and intolerance. These emotions extend to their behaviors, causing them to isolate, failing to go to meetings, and having poor eating and sleeping habits.
This early stage of relapse is the easiest to pull back from. The first step is for the person to recognize the symptoms of emotional relapse and to acknowledge their changes in behavior. Practicing better self-care will provide the changes they need. It will also help them get the rest they need to prevent them from moving to the next stage of relapse.
2. Mental Relapse The next stage in the process is mental relapse. Now, the person is divided between wanting to use and not. If the battle in their mind continues, their resistance will wear down. The need to escape will grow stronger, and they will give in.
Mental relapse is marked by cravings for their abusive substance, thinking about the places and people associated with past use, and looking for opportunities to use. During this stage of relapse, the person begins to minimize the consequences, preferring to glamorize their past use. The plan for relapse begins to take shape.
The person has been down this road before. When they think the previous scenarios through, they know that the fantasies in their mind aren’t realistic. Every person who has undergone substance abuse recovery knows that the consequences are real. The best method of mental relapse prevention is to talk with someone about the urges. This is the best way to make those urges disappear.
Another technique is to start planning something else to distract them. When they get their mind focused on something else, it’s easier to keep the urges at bay.
Finally, they should wait thirty minutes before acting on the urges. Most urges last between fifteen and thirty minutes. Once they pass, it’s easier to move onto something else.
3. Physical Relapse Physical relapse refers to the actual physical use of the substance. What may begin as “just one drink” or “just one use” can easily turn into a loss of control. Often, the physical relapse comes about as a result of opportunity. The person takes advantage of a time when they think they won’t get caught.
At this point, relapse prevention is nearly impossible. Once the process of acquiring the substance and using it once, it isn’t likely to stop at that point. It’s important for the person to recognize the early signs of relapse so they can stop it before it ever reaches the physical stage.
Dealing with Cravings
The cravings that occur immediately after detox are normal. That doesn’t make it any easier for the person to deal with them. Ideally, they will focus on self-care and face the cravings for what they are: temptations that only they have the power to overcome.
The cravings are their strongest during detox, making it a prime time for relapse. Prevention takes effort and learned skills to deal with the temptations during each phase. The fact is that failing to take care of themselves physically and mentally during the post-acute period drives the risk of relapse to its highest level. The good news is that cravings usually last no more than 30 minutes and they aren’t always present. If they know the feeling will pass, they can often fend off the urge to act.
It takes time, but the good days become more common as the cravings diminish. It takes work, effort, and above all, self-awareness to get there. The more they understand about addiction and withdrawal, the easier it is to develop effective skills for effective relapse prevention at every stage.
Relapse can occur at any stage of the recovery process. Nothing is more important than having the support needed to deal with emotions, cravings, and worries every step of the way. No one ever has to go it alone, and they shouldn’t! Don’t wait to get into detox and get the support of people who understand exactly what you’re going through.
Contact Pemarro today and schedule a free and confidential consultation. Get the expert care you need from a team of highly educated, experienced, and caring individuals in the field of addiction. A number of our staff members have been in your shoes. We know what you’re going through and we will treat you with the kindness, compassion, and respect that you deserve.
You might have seen articles about mindfulness, and using it to help with everything from weight loss and work pressure to chronic pain management and addiction recovery. But even after reading those articles, you probably find yourself asking “what is mindfulness” exactly? Because it is more about a way of doing things than something you actually do, it is difficult to define.
In fact, a quick search of the internet brings up dozens of different definitions. The Google definition, which is based on the Oxford English Dictionary says it is:
“a mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations, used as a therapeutic technique.”
Scott Bishop, a psychologist who studies the effects of mindfulness meditation on stress describes mindfulness as a:
“Non-elaborative, non-judgmental, present-centered awareness in which each thought, feeling, sensation that arises ... is acknowledged and accepted as it is.”
And if you read this article from the Positive Psychology Program site, you will find another 20 definitions collected from a variety of different sources. So as you can see, not even the experts can agree on a single answer to the “what is mindfulness?” question. However, there are three things that all of these definitions have in common.
Mindfulness means being consciously aware
Showering, driving, making coffee, breathing. These are all things we do every day. But we do them subconsciously, without really thinking about what we are doing. Instead we are thinking about a hundred other things. Like the argument you had with your partner last night. The meeting you’re headed to. The post you just saw on Facebook. The holiday you’re planning for Christmas.
If you’ve ever driven a car that isn’t yours and turned on the wipers instead of your flashers, you’ll know what we’re talking about. You’re on autopilot, and the autopilot says flashers are on the right. When you’re being mindful, you are consciously and deliberately focusing your attention on yourself, your surroundings and what you’re doing.
Mindfulness is about this moment right now
Whenever we aren’t fully focused on the task at hand, our mind wanders off on a little mission of its own. We might get caught up in replaying memories from the past, whether that past memory is from an hour ago or a decade ago. Or we’ll head into the future; daydreaming, planning, wondering, worrying, hoping about a multitude of things.
Although we are often told to live in the moment, we very rarely do. Being mindful means being completely engaged in the experience of the current moment. You don’t think about the past, you stop worrying about the future. You are here, in this moment – and all your thoughts are about what you are experiencing right now.
Mindfulness is non-judgmental
If you are angry right now, then say “I am angry”. It doesn’t matter if your anger is deserved or righteous or foolish. You are angry and that is okay. Being mindful does not mean that you should be controlling, suppressing or stopping your thoughts or feelings. It just means that you trying to pay attention to them as they occur – without attaching a label or judging them in any way.
Think of being mindful as standing to one side and watching yourself feeling, hearing, seeing, tasting, smelling or touching those things. Distancing yourself like this allows you to be consciously aware of those thoughts, emotions and sense perceptions without getting swept away by them. And that means you’re less likely to allow your autopilot to do whatever it usually does in a moment like this.
This might mean eating a little slower because you savor each bite a little more. It might mean not punching a wall, even though you’re spitting mad. It might mean calling a recovery center instead of satisfying that craving because you’re struggling to cope. Because you are consciously aware of what you are feeling right now, and you accept that those feelings exist. And this allows you to make a conscious decision about what you’re going to do next.
So where does mindfulness come from?
Although it is only in the last decade or so that mindfulness has become a popular practice, it has actually been around for thousands of years. Or let’s rather say that the original form of mindfulness has been practiced by Buddhists for thousands of years. Back in 1979 Jon Kabat-Zinn stripped away all religious overtones and developed his Mindfulness-Based Stress Reduction (MBSR) programs at the University of Massachusetts Medical School.
The initial aim of this eight week program was to help patients deal with chronic pain while avoiding addiction to painkillers. He realized that patients were trying to mentally escape or avoid the pain, which ultimately caused more mental distress and exhaustion. In other words, they were making their situation worse by trying to avoid the problem.
Because mindfulness as we know it today is not dependant on any belief system or ideology, anyone can try it. Whether you are Christian or Pagan, Muslim or Atheist, or follow any of the many religions out there – you can practice mindfulness. And although it was originally designed for pain management, mindfulness is beneficial in a wide variety of situations. Some prime examples include:
Does mindfulness really work?
Although mindfulness is not like full blown meditation, it is meditative. Combine that with the fact that it is derived from Buddhist traditions, and you might start thinking that it is far too “New Agey” or “woowoo spiritual” to really work as advertised. You would be wrong though, because there are literally dozens of studies and research papers about the effectiveness and benefits of mindfulness. These studies include the following:
What are the benefits of mindfulness?
Now that you know what mindfulness is, and that it is effective – you might be wondering what the benefits are. Well here are just a few of them, along with links to studies showing those benefits.
How to get started with practicing mindfulness
Take 3 mindful breaths
The first and easiest way to start being mindful is to take three mindful breaths, no matter where you are, what you’re doing or the time of day. You breathe all the time, without ever thinking about it. By focusing your attention on your breath you are able to still your mind, step into the present moment and give your system a “soft reboot”.
Perform a body scan
A body scan is a meditative process where you consciously think about and notice everything your body is feeling. From how your toes feel in your shoes, to the air moving against your face. It can be done sitting up or lying down, and a single body scan can last anywhere from 3 minutes to 45 minutes or more.
While evidence shows that people who practice body scans for longer reap more benefits, it doesn’t really matter how long you do it for. And if you’re not sure how to actually do a body scan, then just search for a guided body scan or script and choose the one that suits you best.
Do one routine activity mindfully
Whether it is washing your hands, drinking coffee or eating lunch – choose one thing that you are going to give your full attention to. In the beginning it may be best to do this somewhere that people won’t interrupt you, but in time you could do it during a meeting, at your desk or while friends and family are with you. Just remember that “single tasking” is not a good idea if you need to be focused on several things at once – such as while you’re driving!
Your mind will probably wander, but don’t beat yourself up because you lost focus. Just return to your breath, then carry on from the last point you remember.
A final note
By now, you should have a good idea of what mindfulness is and where it originated. You know that there is clinical research and numerous studies about how effective it is. You are aware of the benefits and you may have even read some of the articles and studies about those benefits. And although you might not be searching for a mindfulness course near you right now – you have some simple mindfulness exercises that you can start practicing on your own.
Just remember that while there are dozens of benefits to practicing mindfulness, sometimes it is better to set your mind free and let it wander. In fact, it has been reported that creativity and insight might depend on a little bit of unrestricted daydreaming. So take into consideration that Buddhism is about finding a middle way between spiritual and worldly concerns.
So learn to find the balance between letting your mind take a break and being aware of everything about yourself and your immediate environment. If you are interested in the use of mindfulness as part of a treatment program for substance misuse disorder or relapse prevention then contact the caring experts at Pemarro for more information and guidance.