Peggy L.Ferguson, Ph.D., LADC, LMFT
116 W. 7th, Suite 211
Stillwater,OK 74074
Phone 405-707-9600; Fax 405-707-9601
peggyferguson@peggyferguson.com
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Please register for my newsletter on the home page at http://www.peggyferguson.com to receive updates on upcoming information and educational opportunities such as webinars, teleseminars, podcasts, ebooks, and other informational packets.
My ebooks and other educational products (i.e., the Honey Jar) are located on the "ServicesProvided" page.
You can also give me feedback on subjects you would like to learn more about by filling out my survey on the ServicesProvided page.
Please feel free to ask a question that might be printed in my "Ask Peggy" Column.
Thanks for visiting my site.
New: Don't Let Grief Derail Your Transition Into Recovery
New: Denial Enables Addiction to Persist Despite Obvious
Negative Consequences of Drinking/Using
New: Addiction and Recovery- Preventing Relapse
By Making Good Choices
New:
16. Addiction Recovery - Maintain Your
Recovery Motivation or You Will Relapse
17. Dealing with Alcohol and Drug Cravings:
Manage Those Cravings and Prevent Addiction
Relapse
18. Addiction and Recovery: Take Action
Now To Stop Drug Cravings
19. Addiction and Recovery: 5 Tips to
Prevent Cross Addiction Relapse
20. Addiction and Recovery: Plan
Your Vacation, Not Your Relapse
21. Addiction and Recovery: Do You Need Detox
After Relapse?
22. Addiction and Recovery: The Emotional Highs
and Lows of Early Recovery
23. One More Tool for Early Recovery -- Structure
24. Addiction and Recovery- Defenses Distort Reality
To Enable Continuing Alcohol & Drug Use
Recovery Worksheets
1. Preventing Relapse Using the Social and Environmental
Triggers For Relapse Worksheet
2. Addiction and Recovery - Learn From Your Recent
Relapse By Using The Relapse Assessment Worksheet
3. A Relapse Prevention Tool - The Emotional Cues For
Cravings in Relapse Worksheet
4. Continuing Recovery Lifestyle Worksheet
5. Using The Problems Checklist To Assist In Your
Ongoing Recovery Efforts
6. The Cross Addiction Worksheet
3. Family Members Know That You
Are Going To Relapse In Your Addiction
Before You Do. Listen Up
Essential Things You Need to Know For
Your Marriage To Survive Recovery
Mental Health Articles
7. What is Depression?
8. Grief - Dealing with the Loss of a Loved One
By Peggy L. Ferguson, Ph.D.
One of the common experiences of the earliest efforts toward quitting drinking and becoming sober, is grief over the loss of the chemical. For many people with an alcohol or other drug problem, the chemical, (whether it is alcohol or oxycodone) has become the addict’s best friend and constant companion. When this best friend is given up, the alcoholic/addict experiences grief.
The chemical plays all kinds of roles in the alcoholic’s life and these roles are necessary and meaningful. The chemical that comes to occupy those roles almost exclusively, eventually turns on you, and brings about its own escalating set of natural negative consequences. Because the chemical has played such vital functions in the life of an alcoholic/addict over time, the alcoholic/addict is heavily invested in maintaining the relationship with the chemical. The alcoholic does not want to give up his/her best friend. As the negative consequences of drinking or using other drugs keep piling up, emotional comfort with continuing to drink requires a certain amount of psychological fancy footwork, otherwise known as defense mechanisms.
There are a number of defense mechanisms that alcoholics and addicts deploy in early recovery. “Denial” is the one that most people are aware of. “Denial” seems to have become generalized to describe all defense mechanisms in addiction. Examples of denial would be “I am not an alcoholic,” “I only take prescription drugs so I am not an addict,” “I am not an alcoholic because I only drink beer/wine.” Rationalization is about coming up with reasonable, rational explanations for why you drink, such as “I drink because I have social anxiety and it helps me be more outgoing,” “I drink because I am lonely and I don’t mind so much when I’m drinking.” Minimization is about playing down the amount, frequency, or consequences of the drinking/using, such as “I only drink on weekends,” “I don’t drink like Larry. If I ever do, I’ll quit,” “I have never had a DUI.” These are just a few of the defense mechanisms. In essence, defense mechanisms allow you to continue to drink/use in the face of the negative consequences by psychologically making it ok to do so. Defenses also assist with chasing an illusion of control. The person who is at the beginning of recovery, may still be spending a lot of energy with deciding whether to drink or not drink, and in evaluating the choice, bolsters the argument for drinking with continuing to rationalize and chase the illusion of control.
Most people at the very beginning of recovery, have a lot of ambivalence about quitting. On the one hand, they are beginning to see problems caused by the drinking and on the other hand, they continue to perceive benefits from continuing to drink—just without the problems. They are hoping that they are blowing things out of proportion and that they still really have control over their drinking, if they just make better rules, strategies, or drinking companions.
Loss of control defines addiction. People often think that you must have loss of control each and every time that you drink to experience “loss of control”. By that standard, successfully having two drinks at happy hour after deciding to do so, would confirm that one is not alcoholic. Such is not the case. Alcoholics can have such drinking episodes that do not appear to be out of control to themselves or to others. If you cannot predict with any reliability—after the first drink, how many more drinks there will be or what will happen, your drinking is out of control.
To gain control over your drinking/using, you must stopping drinking and/or using other drugs. Facing this reality can feel like punishment and it usually feels like a terrible loss. Grief over the loss is very common in early recovery. Many people also feel depressed at this time. While many of the drugs of abuse, (alcohol included), actually cause depression, common symptom of detox, (a neurochemical process), involve symptoms of depression. For many people, the depression will subside by itself within a relatively brief period of time. For others, an antidepressant may be appropriate. Similarly, anxiety, another common early recovery symptom, may also go away by itself or be improved by an antidepressant, especially one of the SSRIs.
Depression and anxiety are two of the most common conditions that alcohol and other drugs are used to medicate. Depression and anxiety, are typically therapeutic targets, where new living skills are learned as healthy replacements for the old chemical solution. New skills and healthy alternatives serve as recovery replacements for the chemical and provide relief from the symptoms. Some of those healthy replacements might include: socializing, exercise, diet/nutrition, 12 step meetings, improving self-esteem and self-efficacy, replacing worry with effective problem solving, etc. All these new living skills are acquired through working a program of recovery, identifying problem areas that need remediation and setting about to deliberately acquire new skills.
Many people are motivated to seek recovery when the pain of continuing to drink (and its consequences) is somewhat greater than the fear of quitting. There really is life after addiction and the grief goes away. While many alcoholics approach quitting drinking with fear, grief, and resentment, it isn’t too long before these feelings are replaced with gratitude for recovery, restoration of relationships, and a return to physical, emotional/psychological, financial, and spiritual health.
Negative Consequences of Drinking/Using
By Peggy L. Ferguson, Ph.D.
"I am not alcoholic!" "I do not have a drinking problem!" "I can quit any time I want". This is not the only form of denial that alcoholics and addicts have. If it were only that easy! Despite the alcoholic's best attempts to regain control, they cannot effectively control the compulsion to drink and cannot guarantee that they will not experience negative consequences of the drinking. Family members and others feel compelled to intervene in their behalf.
Many alcoholics and addicts come to the helping profession as a result of some level of coercion. The judge says, "Go to treatment or go to jail". The spouse says, "Go to counseling or I'm getting a divorce". The adult kids say, "Go to treatment or I'm not going to let you be around my kids any more". The boss says, "Go to treatment or you are fired". These are all examples of coercion as intervention.
To most addicts at this point, these threats or "bottom lines" seem completely unjustified. The addict usually feels that others are trying to take control over him or her-which, of course, they are. What the addict doesn't realize is that they are out of control.
Family members often ask me, "How can the addict not know that they are out of control?" The simple answer is "denial". The addict does not realize that they are out of control because of denial. This denunciation of reality is one of the main symptoms of addiction, and much maligned by non-addiction professionals and addicts in denial of their own addiction.
"Denial" is a term that is used to generally conceptualize defense mechanisms used by alcoholics and addicts that allow them to continue to drink or use other drugs. "Denial" is also specifically used to denote the defense that tells the alcoholic/addict that there is no problem or that the drinking is not the problem. Rejection of the truth about their condition allows them to continue the drinking in the face of negative consequences from the drinking, and allows for re-establishment of some level of emotional comfort in the process. This rejection of personal insight defends the alcoholic against emotional distress by allowing him or her to distort reality to themselves in such a way, that they cannot see that it is the chemical use that is causing problems in their lives.
They may use outright denial such as "I don't have a drinking problem", or they may use a variety of others, including rationalization, intellectualization, justification, or blaming. Denial must operate outside of awareness or it will not work. These defenses allow the addicted person to identify other people or issues as the source of problems in their lives and to continue to pursue the solution of choice - drugs or alcohol.
It is often said that alcoholics operate in delusion. They often harbor the hope that the treatment professional or team will tell them that they were right all along, that it is their family that is in error, that the family is being unreasonable with trying to get them to quit drinking or using drugs and that they can learn to drink or use drugs without the negative consequences. People often come to treatment with the agenda of learning how to drink or use drugs socially. They often initially resist the notion that abstinence is the only way to recover. Or they may harbor the idea that they cannot quit drinking--that it is not possible, or that their life would be totally miserable without alcohol (or other drugs).
When enough of the "delusion" has lifted they are able to admit that their consumption of alcohol or other drugs is causing enough of a problem for them to need to get some level of help. These cognitive distortions do not disappear. At the beginning of recovery, people may think that they can just "put the plug in the jug" and be perfectly fine. They may believe that it is the job, the family, the stress, the time of year (or any manner of other things) that is "causing" them to drink. They would, of course, believe that when that "thing" is taken care of, they will not drink any more and that everything will be just fine.
They may believe that if you want to quit drinking and have made a decision to do so, that is all that is needed. The whole idea of learning about addiction, learning abstinence skills, joining a support group, talking about feelings, issues, and changing other behaviors that supports their drinking may seem ridiculous to them.
Alcoholics and addicts often operate under the delusion that they can regain control over the alcoholism with some bare minimum of effort. A common example is when newly recovering alcoholics or addicts attempt to stop using by avoiding the people they used to drink or use with, and the places that they frequented. This is a useful tool, but insufficient for continuing abstinence.
Early recovery skills must be learned that empowers the alcoholic or addict to fight cravings and to maintain abstinence each day. These are the most rudimentary skills for recovery and without them, there is no recovery. However, these skills, in and of themselves, are insufficient for sustained abstinence over time. It is also important to know that "recovery" is so much more than abstinence. Recovery is active and brings with it lifestyle, relationship, attitude, behavioral, emotional, and spiritual changes. Alcoholics and addicts cannot recover passively. Most people need help with building recovery skills.
Addiction and Recovery - Preventing Relapse By Making Good Choices
By Peggy L. Ferguson, Ph.D.
Relapse is a process that occurs over time, in the context of significant decisions. Many people who relapse say that drinking or using was the furthest thing from their mind just before they consumed the chemical. In reality, most of the time, relapse was in process some time before the chemical was ingested. The relapse process involves a return to old thinking, old feelings, and old behavior.
When someone is addicted, consumption of their mood altering drug of choice is almost automatic. It is a deeply ingrained and somewhat unconscious action. It has become "first nature".
The behavior of addiction is like driving your car on a familiar superhighway. You have driven the route many, many times before. The road is smooth, flat, and straight. Your mind wanders. You think about what happened at work, what you're going to fix for dinner, and a conversation that you had earlier in the day. You are not focusing on maneuvering your car down the highway. It seems to just take you.
You don't get up in the morning and remind yourself to smoke pot before you go to work. You just do it. You don't have to remind yourself to stop at the convenience store on the way home to pick up the six pack. Your car seems to know the way. Many of the things you do are part of your routine and not conscious decisions about how to behave.
When you make a decision to get clean and sober, it is like taking a small unpaved utility road off that superhighway. You have to pay close attention to not fall in the potholes, to avoid the big tree roots, and to watch out for deer in the path. In short, you have to pay close attention to what you are doing to keep going down the road. You make conscious decisions about how fast or slowly you are going or about the slight turns in maneuvering your vehicle. You are self-conscious.
You have to be pretty self-conscious to make good recovery decisions each day. You have to consciously identify and deal with your feelings and your thoughts so that your behavior is recovery-appropriate. As you deal with what life serves up everyday, one day at a time, and remain abstinent, it gets easier and easier. The utility road gets smoother and smoother as you travel it, and recovery becomes second nature. After awhile the need for hyper-vigilance decreases.
In early recovery however, the need for hyper-vigilance about your every decision is appropriate. Seemingly unimportant decisions can have major influence over whether you relapse. To prevent relapse it is crucial to scrutinize your patterns of use and identify your vulnerabilities. To identify your specific vulnerabilities, ask yourself these questions, then make a plan to reduce or manage your vulnerabilities, This will help reduce your risk: 1. What drugs did you use?
2. Where did you get it/them?
3. When did you purchase it/them?
4. When did you use?
5. Who did you use with?
6. What activities are associated with use?
Answering these questions gives you a great deal of information to assist you in maintaining abstinence in early recovery.
Let's say that you drank beer alone, purchasing it at a convenience store on the way home from work, and began to drink after dinner while watching tv. Reducing your vulnerability to relapse from this pattern could include these simple cue avoidance techniques:
a. getting the alcohol out of the house,
b. taking a different route home so that you don't see the convenience store where you used to buy it,
c. something else to do after dinner that does not involve television.
Cues are those visual, environmental, and emotional reminders of your chemical use. In this example, you are replacing relapse cues with different cues. You are making conscious choices that can have direct bearing on whether you will relapse. As you do that more and more frequently, your pro-recovery choices become less and less self-conscious and more "natural" to you. At the beginning of recovery, each one of these conscious choices feel weird, "unnatural", or forced. In early recovery, there is an axiom that say "if it feels right, don't do it". You are learning a whole new way of life - with new thinking, new feelings, and new behavior.
1. Addiction and Recovery –
Top 10 Craving Management Tools That
Alcoholic Addicts Should Use to
Not Take the First Drink
By Peggy L. Ferguson, Ph.D.
- When dealing with cravings or urges to use alcohol or other drugs, it is helpful to remind yourself that your cravings are a normal response to withdrawal and the detox process. Remind yourself that withdrawal and detox are a temporary condition. The longer that you are abstinent, the fewer the cravings and the intensity. Cravings are also short in immediate duration. If you postpone using for a few minutes, the craving will usually subside.
- Identify the cues or triggers that have set up the cravings. Have you recently experienced environmental cues or emotional/psychological cues? Resist the cravings and spend your mental energy thinking about how you can avoid these same triggers in the immediate future or how you deal with them without using.
- Identify the positive things you are expecting the drug to do for you. If appropriate, challenge the belief that the drug will actually accomplish that expectation. Ask yourself if the drug was still doing for you what you wanted it to do, then identify the consequendes that occurred because you used the drug. Your belief in the drug's ability to perform a positive service for you probably does not fit your experience right before you decided to quit using. The drug had turned on you by then. Tell yourself the truth about the drug.
- When dealing with emotional triggers, ask yourself what emotions or stressors you are experiencing? What other methods do you know to deal with these stressors? Practice new living skills.
- Make notes and put them all over your house and your car to remind yourself of why you quit drinking/using in the first place.
- Practice distraction until the craving has gone. Do something to engage your thinking, your attention, your body, so that you give the craving a chance to pass.
- Challenge cognitive distortions that feed the craving. Identify the thoughts that you are having that make it ok to relapse. Challenge each thought as it comes up. These cognitive distortions are lies and defenses that make it ok to relapse.
- Call on others for help. Call someone in AA/NA, someone in your family that supports your recovery, or your sponsor and talk to them about cravings and why you wanted to get sober in the first place.
- Use your spirituality to resist cravings. Use prayer, meditation, or reciting the Serenity Prayer, or making a gratitude list for what you have already received in recovery.
- Use thought stopping techniques, like visualizing a stop sign, and saying "stop!", replacing positive memories about using with realistic appraisals of your current situation, or using grounding exercises, such as observing the objects around you (i.e., 3 things I see, hear, touch).
Sometimes recovering people believe that they can drink "near beer" because it is "non-alcoholic". Regardless of whether it has alcohol in it (which it usually does), you would be practicing to drink beer. Cues for relapse include familiar drinking places, people, feelings, smells, and tastes. Really anything could be a cue for cravings and relapse since they are based on your own unique experiences.
To maintain sobriety you must monitor, identify, and deal with each cue and trigger as they come up. The cues and triggers can lose their impact after a period of time. Early recovery is the most vulnerable to relapse. Minimizing your risk of relapse by minimizing your exposure to triggers is an appropriate thing to do.
You can avoid a lot of pain by not setting yourself up for relapse. Don't return to a lifestyle that you have outgrown in recovery. Sometimes there is a gap between letting go of an old life, and fully developing a new one. AA/NA and a recovery support system can carry you through to the next phase of your recovery and your new life.
Think of recovery as a life long process that occurs by managing the events in your life, including cues/triggers, cravings, feelings, and problems one day at a time. Don't go to the beer joints and don't drink "near beer".
When you have a drinking or using dream, you may wake up not really knowing if it actually happened. Many people in early recovery find it disturbing and frightening when they experience a "using" dream. Drinking and using dreams are those dreams where the central theme or experience is about drinking or using. Common examples include being in a position to be tempted to drink or use other drugs, having the feeling or the sense that you did use, or experiencing yourself in the act of drinking and/or using, or successfully avoiding drinking or using.
These dreams can feel so real that, upon awakening, they can leave you confused about whether you had actually used. They can also set the a disturbing tone for your day. It can involve an unsettling feeling that creates or exacerbates anxiety, tension, or stress. You may even be embarrassed to tell others that you had a drinking or using dream.
Care should be taken after having a drinking or using dream to avoid any other cues or triggers, and to treat the dream as a cue or trigger in its own right. Drinking and/or using dreams that occur in later recovery after extended abstinence could possibly signal heightened vulnerability to relapse. One should maintain conscious awareness of any possible triggers and employ the necessary recovery skills.
It is, however, fairly common for recovering people to have drinking/using dreams around their recovery anniversaries, especially in the first few years. It is important to avoid shaming or blaming yourself if you experience drinking or using dreams. Although conscious awareness is called for, drinking/using dreams do not signal failure in recovery efforts.
As with any increase in triggers or cues, people in recovery should utilize good trigger management activities such as the ones listed below:
- step up meeting attendance
- maintain an appropriate scheduled routine
- increase use of appropriate living skills
- maintain close connections to recovery support people
- get physical exercise
- use good nutrition
- manage stress appropriately
- deal with feelings appropriately as they come up
- deliberately make good choices about the people, places, and things, that you spend time with
I) For Fear try these things:
use thought stopping to eliminate worry, rumination, and obsessing about it,
II) For Anger, try these:
B. Identify any other feelings that may have occurred before the anger.
III) For Shame, try these:
good enough. (e.g. mom, dad, school).
of your own free will. Change old negative statements to positive ones like these: "I am good enough", "Everyone makes mistakes", "I am human and I am worthwhile".
IV) For Guilt, try these:
V) For Hurt, try these:
VI) For Sadness, try these:
VII) For Loneliness, try these:
VIII) For Helplessness, try these:
IX) For Joy, try this:
One of the most needed skills for recovery from alcoholism and other drug (AOD) addiction is the ability to appropriately process and manage emotions. The very absence of this skill is a common characteristic of addiction.
Alcoholics/addicts in active addiction, use the chemical as an affect regulation tool, sometimes almost exclusively. So, one of the first tasks of early recovery is to learn to appropriately navigate and manage the territory of negative sentiment without the use of "mood altering chemicals".
1) Stuff them;
2) Act them out;
3) Work through them.
1) How to stuff them: You can pour alcohol and other chemicals on them to numb them out. Use of other obsessive compulsive behaviors also permits escape from uncomfortable affective states. Some of these behaviors include gambling addiction, sexual addiction, compulsive spending, compulsive eating, compulsive cleaning, or work addiction. Defense mechanisms that minimize, rationalize, intellectualize, ignore, justify, blame, and project responsibility also offer some relief by distorting reality. You can even hide them from yourself by quickly pairing them up. Stuffing feelings doesn't make them go away. They leak out around the edges in very unhealthy ways over time. They can sneak out in passive aggressive expressions of anger. Or they can get your attention by manifesting themselves in symptoms of depression or physical illnesses.
2) How to act out them out:. Everyone is familiar with acting-out negative sentiments with temper tantrums, name-calling and other dirty fight techniques. Acting them out is not the same as releasing them. Acting out can only release some of the pressure driving the feeling. It does not release the actual feeling. So when you break a piece of pottery and feel momentary relief, it is because you have released some pressure or energy.
3) How to work through them: There are four steps in working through an uncomfortable emotion:
a) identify it;
b) own it;
c) express it;
d) practice pro-active problem solving on it.
"Working through" begins with identifying the feelings. If you think of them as problems to be solved, the first thing you do in problem solving is identify the problem. It is crucial to be able to accurately label your feelings. Otherwise the "working through" process will be hindered. For example, imagine experiencing sadness and only having two labels for that experience -- (happy and mad) then trying to communicate sadness to your spouse or best friend. Your attempt would be unsuccessful because neither of those words (happy and mad) appropriately expresses the experience of sadness. It is important to be able to distinguish between and among emotions. Fear and anger seem very much alike in what our bodies experience when we have those emotions. Yet they are not the same. The confusion is further complicated by the fact that a number of emotions get paired up in our experience of them. Sometimes we move so quickly from one feeling into another less distressing one that we don't even recognize or remember the original one. A common pairing is hurt and anger. We often experience anger along with other emotions. It is often just as important to communicate the other emotions (if not more important), than the anger itself. So the first step in "working through" is to correctly identify and appropriately label them.
The second step is to own our own feelings, with "I feel". The distinction is important. With "I feel" you are taking ownership. When we say "you make me feel", you perceive yourself to be a victim and at the mercy of others who are responsible for altering your affective experience. Since it is impossible for others to actually change our experience, we will be waiting a long time to be "fixed". In order to solve a problem, it must be ours to solve.
The most appropriate thing to do with feelings is to directly express them to the person that they are associated with. Sometimes, however, it is not safe to do that or it does not seem safe to do that. When that is the case, you have some options. It is important to have a confidante that you can talk with about your emotions. When unsure what you are experiencing, talking helps you sort it out. You may then be able to appropriately label your experience. You may then feel competent enough to discuss them with the party the emotions are connected to. That is the most effective course of action. If experience has taught you that talking directly with them will not achieve the desired results, try writing them a letter. If they read your letter, they will have "heard you".
Sometimes negative sentiments persist after you have expressed them. If they continue to plague you, then it is appropriate to make a conscious decision about what to do with them. They belong to you. They are your responsibility. You can take responsibility for them in a number of ways including these:
1) taking direct steps to protect yourself, including deciding whether or not to stay in the relationship,
2) setting and maintaining other appropriate boundaries,
3) forgiving someone for something that happened in the past and letting go of it,
4) checking for whose problem it actually is, yours or "theirs",
5) examining your beliefs or "filters" about the event and challenging any cognitive distortions,
6) changing your expectations of self and others,
7) examining your own part in setting yourself up to be hurt in the same ways repeatedly and changing your own behavior,
8) looking for the behavior characteristics of others that you dislike in yourself,
9) using the AA technique of praying for their health, wealth, and happiness, to eliminate resentments.
These are but a few examples. The most important part of deciding what to do with your feelings is to accept full responsibility for them. When you accept responsibility for them, you never have to try to convince others that they are legitimate. You are the expert on your feelings.
A lesson in feelings management may be remedial for some people, but it is a timely lesson for essential skill development for recovering alcoholics and addicts. One of the most frequent contributing factors of relapse in early recovery is the lack of these essential skills.
"Detox" is the beginning of the process of recovery. Most people need some kind of help getting through detox. Some people need medical help or additional structure and support. The kinds of difficulties that an alcoholic or addict will have with detox depend on a number of variables, including, personal characteristics, the specific types of drug(s), combination of drugs, length of use, amount of use, and last use.
Detox is the process where your body rids itself of the mood altering chemicals that you have been ingesting. When you use drugs over time, they build up in your system. Many drugs have a half-life. That means that if you take a drug one day, the next day you still have half of the drug you took the day before. That, along with neurochemical changes to the brain when you use, then when quit using, leads to withdrawal symptoms. The withdrawal symptoms that you will experience depend again on the types of drugs you took, the amounts, length of use, last use, etc. Different drugs have different withdrawal symptoms associated with them.
Detox services aim to help with the physical and psychological withdrawal symptoms. It involves providing support and possible medication to aid in breaking the compulsion of drug (including alcohol) use. Because the compulsion to drink or use other drugs is so strong when you are addicted, the very beginning of recovery requires intense effort and support to stay abstinent in the face of cravings that are clamoring for the drug. Detox help is often required to break this "momentum" of continuing use. People often try many times to quit drinking or using. The momentum of continuing use is so strong that much of the time, despite a desire for sobriety, "recovery" never gets off the ground. That initial break in the cycle of use never gets interrupted.
In the detox phase of recovery, the alcoholic/addict receives education and assistance in breaking through the denial that helps perpetuate the continuing momentum. They learn about the need for recovery activities and environments. This is the time when it is crucial that the patient understand that simply getting through withdrawal and breaking the momentum of use is generally insufficient in and of itself for sustained abstinence. It is a time of educating the patient and his or her family that this is but a sliver of a beginning of the process. This is the point at which the patient begins to gain information that helps to break through the denial that they are in control of the drinking, rather than the disease being in control of them.
Detox is a pretty crucial time for recovery outcomes. If the alcoholic/addict does not understand just what it is that they are up against, they can believe that this initial detox is the solution and that they have conquered this problem. This, of course, sets them up to fail, since this is just Round One.
There is a generally misguided notion that you have to "hit bottom" to be able to get sober and stay sober. "Hitting bottom" is usually seen as the loss of the things that you value in your life. It is an individually defined event and the concept has probably hindered the recovery efforts of a lot of people or at least served as a rationalization for continued drinking.
For some people hitting bottom is embarrassing themselves in public-once. For another, it may be spending so much money on their drug of choice that they can't pay the bills. For some people getting a divorce is their bottom. For others, a DUI is the bottom. For others still it might be running over a grandchild's bicycle with the car. It could be the culminating event that gets your attention.
Denial keeps the disease active. The reality of the alcoholic's circumstances, the destructiveness of the drinking, the level of the negative consequences are distorted in such a way that the drinking can comfortably continue. It is difficult for the alcoholic to connect negative life events with their drinking. Problems in one's life are chalked up to anything BUT the drinking.
Conceptually, hitting bottom is the place where the alcoholic begins to see the extent of the destructiveness of the addiction on his/her life and becomes motivated to stop drinking. For many alcoholics, hitting bottom is that emotional space where you are able to admit that the problem is actually the drinking and that help is needed to stop the drinking. Hitting bottom also involves humility and willingness to accept help.
The notion that you have to lose everything in your life that matters to you, in order to get and stay sober, is inaccurate and damaging. In actuality, the more infrastructure that you still have left in your life, the more likely that you are to be successful with your sobriety efforts. If you still have your family, your job, an income, a home and people who love you and are still talking to you, you still have your infrastructure.
If you have lost the infrastructure of your life, there are more obstacles between you and your ultimate recovery. It's like trying to work your way up to ground level. It is hard enough to get clean and sober without having to figure out where you are going to sleep, find work, and grieve the losses of your relationships. Imagine trying to deal with the stress of having lost everything while trying to get and stay clean and sober. It would be more difficult. Fortunately hitting bottom can be a "moment of clarity" when you realize the extent of the problems caused by the drinking, and become willing to get the help you need to learn how to get and stay sober.
I keep hearing the same old myths over and over again. And I can't help but think that others hearing these myths either believe them and give up or use them for excuses to avoid taking action on getting clean and sober. One of the myths that I hear daily is that you can't get sober for someone else, that you have to want it for yourself, or your recovery efforts won't work. This statement is both true and false.
The idea that you can't get sober for someone else is completely wrong. People do it every day. Many people find their way into treatment centers, counselors' offices, and AA/NA rooms at the urging of someone else. Alcoholics and addicts are commonly coerced into abstinence and early recovery. Wives and husbands lay down bottom lines that they will leave the alcoholic and get a divorce if they don't quit drinking. Spouses are not the only ones doing the coercing. Employers, parents, judges/court system, and children have all influenced alcoholics/addicts into treatment and abstinence.
Initially, these stark raving sober people get that way doing it for someone else. They essentially do whatever is necessary at that moment to keep from losing whatever it is that they fear losing. Their early recovery efforts are "externally motivated".
A number of the events and characteristics of early abstinence can create the desire for sobriety. With abstinence from alcohol and other drugs, brains and bodies begin to detox. Taking it one day at a time, to do what is necessary to not drink/use that day, the sober alcoholic/addict's thinking begins to clear up. They begin to feel better. As they deal with situations that they used to use drugs over, a self-efficacy about being able to get and stay sober begins to develop. The negative impacts of the disease and the positive benefits of sobriety become obvious. It is now conceivable to the addict, that one's life course can be changed and that they can recover and be happy. Now they can start to see the benefits of sobriety.
They begin to actually begin to believe that it is possible to have a life without alcohol/drugs, something not conceivable before. If you can separate from the drug long enough, you can begin to believe that you can get sober. Addicts begin to experience some of the benefits of abstinence early on. Hope happens.
People who don't know much about alcohol and other drug addiction, often buy into common myths and stereotypes about addiction and addicts. It is important to replace mistaken assumptions and judgments about addiction, so that you can approach those afflicted with the illness, with compassion and understanding. Many people mistakenly believe that if you call addiction a "disease" that somehow it exempts the alcoholic or addict from responsibility of their behavior. Below are some myths in italics. The truth is in regular print.
1. Addicts are losers and skid-row bums. Addiction is no respecter of persons. People from all walks of life can become alcoholics/addicts. Most alcoholics/addicts are employed.
Early addiction recovery is a fragile thing. One of the most frequent contributing factors in relapse is something we call "cross-addiction". Essentially what cross-addiction means, is that if you are alcoholic or addicted to other mood altering drugs, you a potentially addicted to all mood altering drugs.
To truly understand cross-addiction, you must appreciate the character of addiction and the nature of mood/mind altering drugs.
Addiction is a disease. It is frequently described as a primary, chronic, progressive, and relapsing disease. Research in the last decade tells us that addiction is a brain disease.
People are often reluctant to acknowledge addiction as a disease because of voluntary first use of the chemical. Although someone chooses to use alcohol or other drugs initially, the changes that occur in the brain over time do not reflect a deliberate choice. Addiction changes the neuropathways of the mind. These changes are suspected of creating the thinking and feeling distortions that lead to the compulsion to consume drugs despite the obvious negative consequences. Thus, the nature of addiction is that of compulsive drug use despite negative consequences. This "compulsive use despite negative consequences" observation has become an part of an accepted definition of
addiction.
Addiction induced brain changes are common to all drug addictions and some process addictions (e.g. compulsive behavioral addictions such as gambling addiction, compulsive overeating, sexual addiction). Addiction also involves a bio psychosocial combination of factors in the genesis, maintenance, and recovery. It has been said in the addictions field for a long time that certain people are "hardwired" for addiction, due to biology (i.e., genetics), and become addicted with first use of any mood altering drug.
Mood altering drugs operating in the altered brain neuropathways are self reinforcing in a number of ways. They meet specific individual needs (relaxation, feelings numbing, reducing behavioral inhibitions, etc.), which is self-reinforcing. The altered neuropathways help maintain the compulsion. The specific drug(s) selected meets individual needs over time so that living skills to meet those same needs do not develop. A common example is where a drug is chosen for its anxiety reduction properties because the addicted individual has few if any anxiety reduction skills. When stress and anxiety levels exceed some threshold, relief will be sought. Without skills to reduce the anxiety, a pharmaceutical solution will be sought, regardless of whether the drug is last drug of choice or a substitute. This is one reason why it is so crucial to identify the roles that the chemicals have played in a recovering person's life, and to develop the living skills with which to replace those roles.
When a person in recovery acknowledges the problems caused by the drug of choice and believes that s/he can safely use a different drug of choice, they are not taking into account the fact the "new drug". like the "old drug" will still operate in the brain in the same way(s). When an addict substitutes one drug for another they are not abstinent. His/her brain is still in an active state of addiction. Thus, someone who is addicted to one mood altering drug is addicted to all mood altering drugs.
An addicted brain is qualitatively changed. Changing drugs of choice does not return an addict to a non-addicted state. An addicted person will continue to experience the same negative consequences of drug use. You cannot regain persistent control over drug use by changing drugs.
Peggy's note: If you found this article helpful you might find my ebooks, Preventing Addiction Relapse: Protecting Your Recovery in Post-Surgery Pain Days", and "Understanding Cross Addiction To Prevent Relapse" helpful. They can be purchased here at www.peggyferguson.com/ServicesProvided.en.html
Ok, so you have decided that your life needs a little help and to accomplish this, you have decided to quit smoking pot. You have flushed or given away your stash. You have gotten rid of the paraphernalia. It has been a couple of days since you smoked pot and you're feeling cranky. You are not sleeping well. You feel anxious and jittery. You're sweaty; you're experiencing shakiness and you're sick at your stomach. You just don't feel good and you keep thinking that just a couple of hits from a joint will take the edge off.
Those detox symptoms will go away if you don't use. Detox symptoms and cravings go together like a hand in a glove. Cravings will go away if you don't use. Don't drink alcohol or do other drugs. Cravings can be a little more subtle. You might be thinking about drinking or using some other chemical or compulsive behavior in its place. Or you might be thinking about going to a bar and not using or drinking, or thinking about going to your friend's house where you used to use or buy drugs. These kinds of thoughts could be about subconsciously setting yourself to return to using.
Quitting cannabis or other drugs is easy. Staying quit is the hard part. Most people with addictions have been able to quit for brief periods of time. There are many things you can to do to keep from returning to using. Here is a list of tips to prevent relapse:
1. Stay away from old smoking or drinking buddies. Delete their numbers from your cell phone.
2. Avoid places that set up visual, auditory, or olfactory cues that lead to cravings.
3. Stay busy. Find something to do. Engage in a highly distracting activity, (like puzzles, reading, solitaire, gardening, tinkering).
4. Don't think about quitting forever. Put it in a "one day at a time" context. Do what you have to do today to not use. Tomorrow, do the same thing.
5. Use hand to mouth substitutes, but don't take up cigarette smoking or overeating. Chew gum; gnaw on straws, keep a tooth pick in your mouth. Carry objects to fiddle with. Carry an NA keychain or an AA 24 hour chip and rub it.
6. Go to places where you would not have gone while getting high, or to places that you just never got around to going.
7. Practice new relaxation skills. Learn yoga or martial arts. Learn relaxation breathing.
8. Practice thought stopping. When you think about smoking pot, tell yourself to stop. Visualize a stop sign. Visualize a skull and cross-bones superimposed over the image of the pot.
9. Write out a list of all the pot you have ever used, from the beginning. Add in a history of your other drug use. Add in the financial consequences of your use. Then come up with a grand total of the cost of your drug abuse/addiction.
10. Practice cognitive therapy to challenge the cognitive distortions that have made it acceptable to return to using pot in the past. Identify your defense mechanisms. Challenge them one by one.
11. Reconnect with old friends that don't smoke pot or drink alcohol.
12. When you feel grief over the loss of the chemical, remind yourself of the negative aspects of using.
13. Tell the significant people in your life that you are quitting. Seek their support. Ask for help.
14. Talk about your feelings as they come up. Don't stuff them or act them out.
15. Explore new ways to have fun. Pick activities that are not usually associated with getting high.
16. Go to AA or NA. Get the phone number list. Call the people on the list when you want to use. Ask someone to be your sponsor. Read the literature. Pray and meditate.
You really can be addicted to marijuana. And to quit using and stay quit, most people require some level of treatment or help. To recover from marijuana addiction, abstinence must be established. Denial and other defense mechanisms that keep cognitive distortions in place that allow the addict to return to using must be eliminated. Cutting through denial is a process that occurs over time.
The earliest part of recovery is engaged in establishing and maintaining abstinence by preventing relapse. While most people need help in this process, most addicts have difficulty with admitting that they need help and in asking for that help. If you are trying to quit smoking pot, bite the bullet and ask for help.
You are ultimately responsible for your own addiction recovery. When you know that you have to have surgery, it is important to keep everyone treating you informed about your recovery and addiction history, including the names of the drugs, the amounts, the lengths of time that you took them, and your last use. You are responsible for asking a lot of questions of the treatment team. Questions like the following are appropriate: "How long will surgery take?" "What is the procedure and what will it entail?" What kinds of anesthesia will be administered?" "How long will I need pain medications after surgery?" "What kinds of pain medications do you usually prescribe for post-op?" "What kinds of different choices for pain medications are available to recovering addicts who are concerned about having their addiction triggered?" "What doctors will I be working with for post-op procedures and checkups?" Make sure that all the medical professionals that you are working with understand that you are an alcoholic/addict in recovery.
Maintain complete honesty all the way through the process. If you are scared, say it. If you are given a medication that has a mood/mind altering effect, or has triggered some euphoric recall or craving, tell them. Your feedback on how you are reacting each step of the way, can help inform your treatment in the most beneficial ways and additionally be most protective of your continuing recovery.
It is also crucial to be completely honest and communicative to those in your support network. When planning surgery, consult with your AA/NA friends of buddies who have already experienced what you are going through. Talk to the old guys/gals in the group, even if you don't normally hang out with them. Ask them whether they have been through it or been witness to others going through it. Ask for any recommendations that they may have.
Recovery wisdom encourages any recovering persons going through surgery to have as many "program" folks around him/her as possible for support. This means having people in recovery doing a kind of "babysitting" with you, not around the clock, but "checking in and checking on". Be honest with them about what you are thinking, feeling, and doing. When you feel lousy, you probably won't want a lot of company. Do it anyway. This is when you need it most.
After you go home, you may still be on pain medications. It is crucial that you give your pain medications to someone else to dispense to you. This may be a spouse, a sponsor, a nursing service, but someone other than you should be in charge of the medications. You may think that you are not vulnerable for relapse, since you feel confident. Not wanting to relapse is insufficient to prevent relapse. Giving control of the pain medications to someone else may bee feel completely unjustified and it may seem like an unnecessary step, especially in light of surrendering control to the medical professionals with surgery.
Making it through surgery and post-op pain management is a major challenge to your continued recovery. It takes a lot of awareness and utilization of recovery skills that yoiu may just be beginning to develop. To maintain recovery, give the meds to someone who will not give in to your anger and frustration. They should make sure that they know exactly what the prescription directions say and whether there is any leeway in dosing. Addicts often hear something other than what the doctor or pharmacist says about doses. Or the fear of the pain may drive dishonest behavior.
More than the physical response to surgery drives the perception of pain. It is very easy to get into a circular pattern when the pain creates anxiety or fear, which leads to more pain and tension and the need for more medication. The body craving medication can create emotional or psychological symptoms as well as an increased perception of pain, which drives the need for more pain medications.
Remember too, that mind/mood altering medications drug your thinking and feeling as well as your physical body. An example would be distorted beliefs about the motives of others. If you think that you are in pain because the treatment team is ignoring your needs, you will probably feel angry and frustrated. Your communication of that anger and frustration may be acted out if you are not proficient at appropriate expression and management of emotions. You might argue with the spouse who is administering your pain medications. If you distrust the motives or knowledge of the doctor or nursing staff, you may feel justified in manipulating them for more (or different) drugs.
The more the psychological or emotional turmoil associated with the pain, the more the tendency to act it out, producing more turmoil, which can be experienced as more pain, and increased need for drugs. This turns into a self-reinforcing circular pattern.
This sounds complicated. In fact, when you stay honest and talk about your experiences, physical and emotional, from the beginning, you are better able to identify the thoughts you are having about pain, the emotions attached to it, and to move from acting out feelings, to working through them, asking for help, and practicing effective relapse prevention. This whole description applied to the short term recovery period after surgery. For chronic pain issues or long term recovery necessitating mind altering drugs over an extended period of time, it is even more complicated.
Peggy's note: If you found this article helpful you might find my ebooks, Preventing Addiction Relapse: Protecting Your Recovery in Post-Surgery Pain Days", and "Understanding Cross Addiction To Prevent Relapse" helpful. They can be purchased here at www.peggyferguson.com/ServicesProvided.en.html
When teaching about chemical dependency it is imperative to begin with a brief discussion of the differences between substance "use", "abuse", and "addiction". "Use" consists of the "appropriate" consumption of alcohol or some other mood altering drug. Appropriate usage of a chemical means that the consumer is using the chemical at the appropriate time, in an appropriate place, and in the proper quantity. It involves the application of a drug in a way that it was meant to be utilized, and by persons defined as appropriate consumers.
When minors use alcohol (or any other non-prescribed mood/mind altering drug) it is considered abuse. The consumption of alcohol (or any other non-prescribed mood/mind altering drug) by minors is considered abuse. Any consumption of an illegal drug is considered abuse. When someone consumes a prescription medication that was prescribed for someone else, it is considered abuse. It constitutes using the chemical in a manner that is inconsistent with its intended purposes). That could include taking a prescription drug in a manner not prescribed -- in terms of quantity, form, or frequency. It could mean consuming the chemical at an improper time or place. It could involve drinking alcohol to get drunk. Consumption is also considered abusive when the chemical takes on elevated importance in the lives of the consumer.
"Abuse" also involves continued consumption of alcohol despite adverse consequences. A person who drinks too much or too often could still be abusing alcohol, rather than being considered alcohol dependent or alcoholic. Diagnostic criteria for abuse include a set of symptoms that do not satisfy criteria for dependence, but does include symptoms such as these: continued drinking despite problems in varying areas of a drinker's life, impaired ability to take care of one's roles and responsibilities, and recurrent drinking in situations that are dangerous (e.g., drunk driving).
Alcohol or other drug consumption is considered addiction or dependence if the aforementioned criteria are present, along with the following symptoms:
Tolerance is a need for more of the chemical to get the same result or the effects of the same amount of the chemical have a reduced effect. Withdrawal involves physical and psychological symptoms that arise when the chemical is stopped or significantly reduced.
Although the previous descriptions serve as usual criteria for clinical diagnostic purposes, thinking of use, abuse, and dependency as finite, discrete categories is problematic when you think about addiction as a chronic, progressive illness. The progression of addiction from first consumption to end stage may involve some or all the previous descriptors at one point, beginning with "use", progressing to "abuse", then to "dependence" or "addiction". For some people, "use" won't progress into the subsequent stages. For others, consumption may get to the next level and stop. Alcoholics or addicts progress from use to dependence. The progression can be quick or slow. With denial, an alcoholic can exhibit symptoms of alcoholism (as identifiable by a professional) for a decade, before having an awareness of their own addiction.
Once the consumption becomes an addiction, it cannot go back to "abuse". For some the progression to addiction begins at the first use of alcohol and other drugs (AOD). For others, there might be a period of responsible consumption of alcohol (or prescription drugs) that persists over time, before that pattern progresses to subsequent stages, and ultimately into addiction. Some people experience a genetic predisposition to addiction. Others do not, but become addicted over time and behavior. Some people who experience alcohol and other drug dependence (AOD) in their families of origin, and in their genetic predispositions, do not get addicted.
While it seems appropriate to distinguish between and among use, abuse, and addiction, a warning is also appropriate. "Use" may not be simply "use", if you have genetic and other environmental, emotional, and behavioral risk factors. "Use" could be the beginning stage of the progression of addiction.
Family members are often astounded that alcoholics continue to drink when it is obvious to them that the drinking is causing major problems not only to the alcoholic but to the family and other significant people in the alcoholic's life. Family members ask the question, "why does an alcoholic drink", with the implication that if you can discover the "reason" that an alcoholic persists in drinking in the midst of the devastation caused by that drinking, then you can somehow fix whatever the reason is, and the addiction will be cured. Family members quickly point out that the alcoholic has low self-esteem, ADD, depression, is underemployed, married too young, etc. Family members think that the drinking is part of some other "disorder" and that if you fix the problem, the drinking will stop. It doesn't work that way. The drinking has to stop. Then you identify the roles the drink played and how to replace those roles with healthy living alternatives.
The "reason" alcoholics drink, changes over time. In the beginning the alcoholic usually drinks for the same reason any drinker does - to be a part of a group, to have fun, to feel good, to experience euphoria. Alcohol lowers inhibitions, so that the drinker feels more comfortable socially and more self-confident. As the drinker discovers that alcohol helps to temporarily relieve some discomfort or temporarily solve some problem, alcohol (or any other mood altering drug) is applied to a wider ranger of circumstances or situations. A common example would be the reduction of the anxiety associated with social situations. The chemical would take on the function of "problem solver". Because it works it is applied across a broader spectrum of situations and is used more and more often.
Tolerance can develop as the frequency and amount increases over time. Likewise, amount increases as tolerance increases. Tolerance means that increasing amounts of alcohol are necessary to achieve the same results. Tolerance is a symptom of addiction. Loss of control occurs with addiction. Loss of control means that once a person takes a drink, they cannot predict with any certainty, how much they will drink, or what will happen when they do. It is now generally accepted that chemical dependency is a brain disease, with research pointing out that the brain changes as a result of prolonged use, that the brain becomes qualitatively different in addiction. The changes in the brain are responsible for the cognitive, emotional distortions of the addict, including the compulsion to use despite the negative consequences. Alcohol and other drug (AOD) use is self-reinforcing neurochemically. Use becomes a conditioned response from the positive reinforcements of the desired effects, including avoiding the unpleasant effects of withdrawal. Environmental and genetic factors are involved in the risk for AOD dependence. High tolerance for AOD from the beginning of use is one indicator of increased vulnerability to addiction]
Loss of control and negative consequences coincide. Examples of negative consequences could be anything from arguments with spouse, DUIs, compulsive spending, financial problems, calling in sick, irresponsible behavior, loss of job, to death. Now, when the alcoholic drinks s/he is drinking to escape the pain of those consequences. Once the alcoholic becomes addicted, the progression of the illness seems to take on a life of its own. The course of addiction seems to be a series of crises, with the crises getting closer together and more extreme as the addiction progresses. There is an old proverb that describes the progression of the illness this way, "A man takes a drink, the drink takes the drink, then the drink takes the man". It is a self-reinforcing circular pattern of powerless attempts to regain control over the continuing drinking and a life that keeps getting more and more unmanageable.
So why would the alcoholic just keep drinking in the midst of all that powerlessness and unmanageability? Compulsivity and denial. Alcoholism involves compulsive drinking. Compulsive means that you feel compelled to engage in a behavior, regardless of whether it is reasonable or rational. Denial makes it more emotionally comfortable to engage in compulsive behavior while telling yourself that it is not compulsive, that you are not out of control, and that other issues are "the problem". Denial is a symptom of alcoholism. The alcoholic sees the alcohol as the solution instead of the problem. Although family members often believe that the alcoholic's denial is lying, it is not the same thing. Denial is a form of self-delusion that allows the alcoholic to continue the drinking without having to experience the pain of the reality of the damage that it is creating in his/her life.
Some of the most common forms of denial used by alcoholics are blaming, minimizing, justifying, projection, anger, diversion, rationalizing. Denial does not end with early recovery. Some denial persists for a long time into recovery. It is not possible to eliminate all denial in one swift action. Layers of denial are peeled away over time as the alcoholic examines his/her life, and gains insight into the addiction, his/her behavior and the damage caused.
The short answer of to "Why does an alcoholic drink" is, "An alcoholic drinks in the beginning because it is fun, then because the drinking is self-perpetuated by compulsiveness and denial. Ultimately, the alcoholic continues to drink because they are alcoholic."
medication that can grant you living skills or emotional maturity/intelligence.
Or You Will Relapse
By Peggy L. Ferguson, Ph.D.
People often find their way to recovery in the midst of a crisis. Someone standing at the crossroads of recovery, may have been arrested for DUI, may have been fired, or may have received a scary report from the doctor. He may have heard the bottom line demand from his spouse-- "Get help or we are getting a divorce." Or, the alcoholic/addict may in fact, have a moment of clarity and really be able to see that he does have a problem and that help and abstinence are called for. The alcoholic/addict feels afraid. He feels ashamed. He feels angry at others or at himself for being in this position in the first place.
Fear, coercion or crisis helps him find his way into recovery. Fear is a fairly good short term motivator, but not so good in the long run. Once the fear subsides and the crisis is over, it is very easy to lose your motivation and momentum. At the point where the cycle of addiction is interrupted by failing to take the next drink, dose, or joint, there is a lot of tension, anxiety, and mindfulness of where you are in the process. Detox or withdrawal may occur, with physical and/or emotional symptoms being very consciously experienced.
When you get to feeling better physically and emotionally after detoxing, it is easy to lose your momentum. Your focus on recovery can dissolve. Some of the problems that once motivated your recovery might be resolved now. Because you have quit drinking or using, your spouse and kids are once again speaking to you and are in the process of forgiving you. You may have even won back some trust. Everything seems to be going well.
Under these circumstances it is quite easy for you to take your eyes off the target and lose your focus on recovery. Erroneously, you may believe that your abstinence is not so fragile now. Feeling better, you may think you have it "whipped".
Without actively focusing on your continuing abstinence and recovery, your behavior can begin to drift away from the newly instituted behavioral changes that you have made. You run the risk of returning to old thinking, old feelings, and then ultimately old behavior. The reason why this would happen is that you are not consciously taking steps to continue on a path of recovery. This path involves many changes in your behavior and in your life style. Without making conscious choices in regard to how each decision affects your new recovery life or your old addiction life, you are unconsciously choosing your old life. Choosing recovery is not like jump starting your damaged car battery where once you get it started, it recharges itself as run it. You have to continuously work a program of recovery. Without doing so, your efforts will be short-lived.
You will quit going to counseling. You will quit going to meetings. You will have stopped calling your recovery support people. Your defenses will go back up and you may take exception to the feedback of significant others who tell you that you are acting like you used to before recovery.
You won't be able to see that you are on the road to relapse. You won't be able to understand why they are concerned. You won't be able to identify the behavioral changes that scare them because you will be back in denial. Being around old drinking/using environments and friends don't scare you. You can't understand why it would scare your significant others. After all, you told them that you are not going to relapse. You have learned your lesson. What more do they want?
After awhile, you will begin to think that you have your drinking or using under control now. When you think of addiction as a thing of the past, that you now have it under control, you will begin to entertain the notion that you can now drink or use without negative consequences. If any of this sounds like your recent experience, you are in big trouble. You are in the relapse process and unless you do something now, you will relapse--and soon.
Peggy's note: If you found this article helpful you might find my ebooks, Preventing Addiction Relapse: Protecting Your Recovery in Post-Surgery Pain Days", and "Understanding Cross Addiction To Prevent Relapse" helpful. They can be purchased here at www.peggyferguson.com/ServicesProvided.en.html
Manage Those Cravings and Prevent
Addiction Relapse
By Peggy L. Ferguson, Ph.D.
Cravings don't cause relapse. If cravings were all it took for recovering alcoholics/addicts to relapse, no one would ever acquire any long term sobriety. Cravings are however, a common and typical experience in the recovery process. In an addiction context, a "craving" or an "urge" is a strong yearning for something to alter one's mood. Although cravings are very common in the early days of abstinence and are usually experienced more intensively and frequently during the detox process, they can persist over the long haul, or stop then return periodically. Cravings can involve physical and psychological/emotional symptoms.
Physical symptoms, like "shakes", racing heart, rapid breathing, might be accompanied by obsessive thoughts about needing the chemical to not feel the physical symptoms. Defense mechanisms serve the purpose of making it "ok" in the newly recovering addict's mind to use. "Denial", an example of a defense mechanism, is seen as an integral part of addiction and serves the purpose of distorting reality to the addict so that s/he can continue to use in the comfort of not fully recognizing the extent of their problem.
Common examples of defense mechanisms (including denial), paired up with ambivalent feelings about quitting could sound something like these examples: "I don't have to do this; I can quit tomorrow", "I'll just drink/use a little and not get drunk/loaded", "It's nobody's business but my own", "I don't really have a problem", "Just a little to take the edge off", or, "Nobody will know". Obsessive thoughts about the chemical, along with psychological defense mechanisms and ambivalence about quitting could be a deadly combination.
Perceptual and psychological cues can trigger cravings. Perceptual cues could involve intentionally or unintentionally being around old using friends, places, or things. They could involve smells or music that has been associated with your using. Cravings could be cued by accidentally finding a long lost stash in a pocket of an old housecoat.
Psychological cues generally involve uncomfortable emotional states. Cues that could trigger cravings might involve feeling angry and frustrated and remembering that you used to use alcohol and/or other drugs (AOD) to chill out. Psychological cues could involve being restless, bored, and lonely, and remembering that drinking at the bar seemed to fix that-at least temporarily.
Cravings don't cause relapse. You can have cravings and still not use. Cravings are not intolerable. Cravings don't last forever. If you don't use, they will go away. Cravings usually hit their peak after a few minutes then begin to subside and go away. Cravings are usually pretty strong in early abstinence, but as you practice using abstinence skills in fighting the cravings, they continue to decrease in intensity and frequency. If you act on them by using, you keep putting yourself back in the early abstinence stage, where cravings are most frequent and most intense.
Cravings don't cause relapse. If cravings were all it took for recovering alcoholics/addicts to relapse, no one would ever acquire any long term sobriety. Cravings are however, a common and typical experience in the recovery process. In an addiction context, a "craving" or an "urge" is a strong yearning for something to alter one's mood. Although cravings are very common in the early days of abstinence and are usually experienced more intensively and frequently during the detox process, they can persist over the long haul, or stop then return periodically. Cravings can involve physical and psychological/emotional symptoms.
Physical symptoms, like "shakes", racing heart, rapid breathing, might be accompanied by obsessive thoughts about needing the chemical to not feel the physical symptoms. Defense mechanisms serve the purpose of making it "ok" in the newly recovering addict's mind to use. "Denial", an example of a defense mechanism, is seen as an integral part of addiction and serves the purpose of distorting reality to the addict so that s/he can continue to use in the comfort of not fully recognizing the extent of their problem.
Common examples of defense mechanisms (including denial), paired up with ambivalent feelings about quitting could sound something like these examples: "I don't have to do this; I can quit tomorrow", "I'll just drink/use a little and not get drunk/loaded", "It's nobody's business but my own", "I don't really have a problem", "Just a little to take the edge off", or, "Nobody will know". Obsessive thoughts about the chemical, along with psychological defense mechanisms and ambivalence about quitting could be a deadly combination.
Perceptual and psychological cues can trigger cravings. Perceptual cues could involve intentionally or unintentionally being around old using friends, places, or things. They could involve smells or music that has been associated with your using. Cravings could be cued by accidentally finding a long lost stash in a pocket of an old housecoat.
Psychological cues generally involve uncomfortable emotional states. Cues that could trigger cravings might involve feeling angry and frustrated and remembering that you used to use alcohol and/or other drugs (AOD) to chill out. Psychological cues could involve being restless, bored, and lonely, and remembering that drinking at the bar seemed to fix that-at least temporarily.
Cravings don't cause relapse. You can have cravings and still not use. Cravings are not intolerable. Cravings don't last forever. If you don't use, they will go away. Cravings usually hit their peak after a few minutes then begin to subside and go away. Cravings are usually pretty strong in early abstinence, but as you practice using abstinence skills in fighting the cravings, they continue to decrease in intensity and frequency. If you act on them by using, you keep putting yourself back in the early abstinence stage, where cravings are most frequent and most intense.
Take Action Now to Stop Drug Cravings
By Peggy L. Ferguson, Ph.D.
Most people in the very earliest days of addiction recovery experience cravings. It is a common experience in addiction recovery. Alcohol or other drug (AOD) cravings do not mean that you are not working a good program of recovery. With continued abstinence over time, cravings will be reduced in intensity and duration. Eventually, cravings may disappear altogether. To reduce the impact of alcohol/drug cravings, it is appropriate very early on, to identify the "when", "who", "where", "what" factors in triggers for cravings. Ask yourself the following questions:
- "When am I most likely to have cravings?"
- "Who am I most likely to be around when I have cravings"
- "Where am I most likely to be when I have cravings?"
- "What kinds of things am I doing when I have cravings?"
- "What kinds of things am I thinking when I have cravings?"
- "What kinds of things am I feeling when I have cravings?"
Identifying these factors can help you avoid some triggers. Identifying these craving cues can also help you develop a plan to manage and reduce the impact of the ones you cannot avoid. Techniques for coping with cravings and being able to maintain your sobriety in the face of those cravings are listed here:
1. If you find yourself in a dangerous situation, leave. Get out of there. Fast. You don't have to make any excuses or apologize; just leave.
2. Use distraction as a tool. Find something else to do--something to occupy your thoughts, time, behavior. Distract yourself with a new (or old) hobby like knitting, cross-word puzzles, reading, anything that does not involve cues for cravings.
3. Have a harmless temporary substitute available. Substitutes that do not involve other chemicals, or obsessive compulsive behaviors can be used in a pinch. Substitutes like candy, trail mix, gum, stirring straws may help. Substitutes like sex, spending, gambling, may be tendency toward cross-addictions and should be avoided.
4. Reach out to others. Call someone that supports your not drinking/using. Call your accountability partners. Call someone in AA/NA, your spouse, your sibling, anyone that will encourage you to not use. Have a phone list, where you can go down the list calling in the reinforcements to help you resist cravings before you use. Have a list so that someone will always be available. Keep calling until you get the support you need.
5. Keep an ongoing list of reasons why you want to quit using. Post it around the house. Recite the reasons that you decided to quit drinking/using in the first place. Some people find it helpful to have a "reasons for quitting" list in their wallet. Others find it helpful to have "reasons for quitting" list posted around the house and in the automobile.
6. Keep an ongoing gratitude list. Add to it when craving. Add the positive benefits that you have derived from not drinking/using that day, week, or month.
7. Challenge your distorted thinking processes. Identify any positive expectations that you may be harboring about using, and tell yourself the truth about what happened in the past when you used. Remind yourself why you decided to quit in the first place. Challenge the expectation that the chemical will have a positive effect, that it will do for you what you want it to. Tell yourself the truth about what the chemical did "to" you, rather than "for" you.
8. Challenge any self-pitying self-talk that you may have about "having to give up the chemical". Remind yourself of the negatives that you are "giving up" by quitting. Replace thoughts of loss with affirmations of positive choices to re-gain control of your life and your happiness by eliminating the source of the problem.
9. Think through the first drink/drug into the negative consequences. Remind yourself that you cannot have "just one" and that the negative consequences are sure to follow.
10. Use prayer to resist cravings.
11. Make a list of the roles that the chemical played in your life. Identify at least three healthy alternatives as replacements. Think about what you want the chemical to do now. Use the healthy alternatives instead.
12. Write a letter to someone you love and explain to them why you are not using.
13. Use thought stopping techniques to combat compulsive thoughts about using. An example might be to visualize a stop sign, or rubbing a rubber band on your wrist to ground you in the here and now. If you keep seeing the chemical in your mind's eye, visualize a skill and cross bones superimposed over it.
14. If your defenses kick in and you are thinking that you can use some other drug besides your most recent drug of choice, tell yourself the truth, that it's all the same thing.
15. Pull out your desire chip from AA or your NA key chain and rub it.
16. Read recovery literature; go to a meeting.
17. Combat each craving, one at a time, one day at a time, or if necessary, one hour or minute at a time. Do what you have to do resist the craving and not use.
Keep reminding yourself that the craving will go away if you don't use. Also remind yourself that you don't have to quit forever, just this one day, or one hour, or one minute. Then the next day, hour, or minute, decide to stay sober another day, hour, or minute. The cravings will pass, and one day you will have a lot of minutes, hours, and days, months, and years, back to back, when you have been, and are, clean and sober.
By Peggy L. Ferguson, Ph.D.
Although definitions of "Addiction" seem to be continuing to evolve, addiction is still "a primary, chronic, progressive, and relapsing disease". The last decade of research has led to a refined definition of addiction as a "brain disease which is manifested by compulsive behavior".
Cross addiction means that an addict can be addicted to any mood altering drug which s/he ingests. Cross addiction can be an example of relapse and/or a trigger to returning to one's previous drug of choice. Cross-addiction usually refers to switching one or more current mood altering drugs for another or others.
The idea that you can change drugs of choice without the same negative consequences that you have been experiencing with your old drug of choice is very seductive to an addict. They want to believe that this is possible despite all evidence to the contrary. The song by Huey Lewis and The News, 'I Want a New Drug", epitomizes the addict's steadfast search for a "new drug" that won't have all the negative consequences. This fantasy can have lethal consequences.
Switching one mood altering drug for another constitutes relapse. To prevent cross-addiction relapse, make sure that you are doing the following:
1. Really understand what you are dealing with. Make sure that you understand the nature of addiction, the nature of mood altering drugs, and the nature of cross-addiction. Remember that it is the mood altering properties of drugs that you are addicted to.
2. Identify your own defense mechanisms and errors in thinking that could make it acceptable for you to pick up another drug in place of the one you quit using.
3. Become aware of the experience of other addicts who have relapsed and the role that cross-addiction has played in their relapse. Did they think that their situation was different? Did they use some of these classic denial statements to make relapse acceptable: "I don't have a problem with alcohol (or some other drug)." "I never really even liked using alcohol". "I used it so rarely that it could not possibly cause me any problems to use it now, because I still don't like it". "If the doctor prescribes it, it must be ok". "I can't sleep and this helps me go to sleep".
4. Make sure that all of your medical support people, including pharmacist, knows that you have addiction. Question them about what they understand about addiction. Seek out medical professionals who are in the know. If you receive a prescription for something and are not sure if it is mood altering, call your pharmacist.
5. Be proactive and responsible. Read the labels of all medications, including over the counter medications. If it says, "may cause drowsiness", it could be mood-altering.
Plan Your Vacation,
Not Your Relaspe
By Peggy L. Ferguson, Ph.D.
Do You Need "Detox" After Relapse?
Addiction is appropriately treated as the chronic disease that it is. Recovery is a process that occurs over time. It often involves progress in an inconsistent series of starts and stops. Relapse is a symptom of addiction and a common piece of the recovery experience. Relapse is a symptom of most chronic diseases. Addiction is no exception. Although relapse is predictable and preventable, it is nevertheless, a fact of life, in the dynamics of addiction and recovery.
For those is relapse, it may difficult to re-engage in recovery groups and support systems because of guilt or shame, but the very life of an alcoholic or addict depends on that. For those in relapse or returning to recovery, questions about what to do about detox, are common.
For some people, depending upon their drug(s) of choice, dosage(s) and period of time in relapse, it may be appropriate or even necessary for formal detox assistance. For some, outpatient or inpatient treatment should be used during or after detox assistance. Detox services could involve supervision by your primary care physician, a social detox, where you check in and stay until you are physically detoxed, or a medically assisted detox, that involves medication and possible other medical treatments.
Each person should be assessed for detox severity, possible complications and need for services based on individual conditions. One indicator of the probability for need for medical detox assistance is a prior detox history that was problematic. Any historic or current symptoms of DTs, seizures, or hallucinations (tactile, visual, or auditory) indicate a need for professional supervision. Anyone experiencing these symptoms should be taken to the hospital. Delirium and seizures can be very dangerous and can ultimately be life threatening. Taking into account previous detox history is important in assessing need for a variety of services. Detox experiences tend to get worse as the disease progresses.
Most people would be appropriately advised to consult with their primary care physician about their history of chemical abuse and their current detox situation. Although detox is not something to take lightly, many people do not require formal or medical detox services. Many people have flu-like symptoms with detox. Although not fun and not pleasant, most people do not go to the hospital for the flu.
When recovering people have a history of several attempts at formal inpatient treatment, followed by relapse, a long term inpatient treatment facility may be the most appropriate level of care.
For others, again depending upon length of time in relapse, drugs and dosage used during relapse, an appropriate course of action could be to return to outpatient counseling and 12 step group involvement. Some people in relapse may need only to return to their 12 step involvement.
It is crucial to keep in mind that addiction requires personal attention throughout a lifetime. It often requires professional attention off and on throughout a lifetime. If you are a recovering person and you have relapsed, do not be so hard on yourself to the point that you just give up. Recovery as a process is often discouraging and frustrating. Recovery is rarely smooth sailing. Do not give up.
Addiction is appropriately treated as the chronic disease that it is. Recovery is a process that occurs over time. It often involves progress in an inconsistent series of starts and stops. Relapse is a symptom of addiction and a common piece of the recovery experience. Relapse is a symptom of most chronic diseases. Addiction is no exception. Although relapse is predictable and preventable, it is nevertheless, a fact of life, in the dynamics of addiction and recovery.
For those is relapse, it may difficult to re-engage in recovery groups and support systems because of guilt or shame, but the very life of an alcoholic or addict depends on that. For those in relapse or returning to recovery, questions about what to do about detox, are common.
For some people, depending upon their drug(s) of choice, dosage(s) and period of time in relapse, it may be appropriate or even necessary for formal detox assistance. For some, outpatient or inpatient treatment should be used during or after detox assistance. Detox services could involve supervision by your primary care physician, a social detox, where you check in and stay until you are physically detoxed, or a medically assisted detox, that involves medication and possible other medical treatments.
Each person should be assessed for detox severity, possible complications and need for services based on individual conditions. One indicator of the probability for need for medical detox assistance is a prior detox history that was problematic. Any historic or current symptoms of DTs, seizures, or hallucinations (tactile, visual, or auditory) indicate a need for professional supervision. Anyone experiencing these symptoms should be taken to the hospital. Delirium and seizures can be very dangerous and can ultimately be life threatening. Taking into account previous detox history is important in assessing need for a variety of services. Detox experiences tend to get worse as the disease progresses.
Most people would be appropriately advised to consult with their primary care physician about their history of chemical abuse and their current detox situation. Although detox is not something to take lightly, many people do not require formal or medical detox services. Many people have flu-like symptoms with detox. Although not fun and not pleasant, most people do not go to the hospital for the flu.
When recovering people have a history of several attempts at formal inpatient treatment, followed by relapse, a long term inpatient treatment facility may be the most appropriate level of care.
For others, again depending upon length of time in relapse, drugs and dosage used during relapse, an appropriate course of action could be to return to outpatient counseling and 12 step group involvement. Some people in relapse may need only to return to their 12 step involvement.
It is crucial to keep in mind that addiction requires personal attention throughout a lifetime. It often requires professional attention off and on throughout a lifetime. If you are a recovering person and you have relapsed, do not be so hard on yourself to the point that you just give up. Recovery as a process is often discouraging and frustrating. Recovery is rarely smooth sailing. Do not give up.
Addiction is appropriately treated as the chronic disease that it is. Recovery is a process that occurs over time. It often involves progress in an inconsistent series of starts and stops. Relapse is a symptom of addiction and a common piece of the recovery experience. Relapse is a symptom of most chronic diseases. Addiction is no exception. Although relapse is predictable and preventable, it is nevertheless, a fact of life, in the dynamics of addiction and recovery.
For those is relapse, it may difficult to re-engage in recovery groups and support systems because of guilt or shame, but the very life of an alcoholic or addict depends on that. For those in relapse or returning to recovery, questions about what to do about detox, are common.
For some people, depending upon their drug(s) of choice, dosage(s) and period of time in relapse, it may be appropriate or even necessary for formal detox assistance. For some, outpatient or inpatient treatment should be used during or after detox assistance. Detox services could involve supervision by your primary care physician, a social detox, where you check in and stay until you are physically detoxed, or a medically assisted detox, that involves medication and possible other medical treatments.
Each person should be assessed for detox severity, possible complications and need for services based on individual conditions. One indicator of the probability for need for medical detox assistance is a prior detox history that was problematic. Any historic or current symptoms of DTs, seizures, or hallucinations (tactile, visual, or auditory) indicate a need for professional supervision. Anyone experiencing these symptoms should be taken to the hospital. Delirium and seizures can be very dangerous and can ultimately be life threatening. Taking into account previous detox history is important in assessing need for a variety of services. Detox experiences tend to get worse as the disease progresses.
Most people would be appropriately advised to consult with their primary care physician about their history of chemical abuse and their current detox situation. Although detox is not something to take lightly, many people do not require formal or medical detox services. Many people have flu-like symptoms with detox. Although not fun and not pleasant, most people do not go to the hospital for the flu.
When recovering people have a history of several attempts at formal inpatient treatment, followed by relapse, a long term inpatient treatment facility may be the most appropriate level of care.
For others, again depending upon length of time in relapse, drugs and dosage used during relapse, an appropriate course of action could be to return to outpatient counseling and 12 step group involvement. Some people in relapse may need only to return to their 12 step involvement.
It is crucial to keep in mind that addiction requires personal attention throughout a lifetime. It often requires professional attention off and on throughout a lifetime. If you are a recovering person and you have relapsed, do not be so hard on yourself to the point that you just give up. Recovery as a process is often discouraging and frustrating. Recovery is rarely smooth sailing. Do not give up.
Peggy's note: If you found this article helpful you might find my ebooks, Preventing Addiction Relapse: Protecting Your Recovery in Post-Surgery Pain Days", and "Understanding Cross Addiction To Prevent Relapse" helpful. They can be purchased here at www.peggyferguson.com/ServicesProvided.en.html
Addiction and Recovery:
The Emotional Highs and Lows of Early Recovery
By Peggy L. Ferguson, Ph.D.
When someone makes a decision to get the help that they need to quit drinking and using other drugs, everything begins to change. As an addict’s body begins to detox and as she is consciously trying to interrupt the momentum of addicted use of a chemical (including alcohol), she goes through all kinds of changes. Physical detox can involve a wide range of possible symptoms, including physical, psychological, and emotional. The addict who is involved in trying to separate herself from the chemical often experiences an emotional rollercoaster. Depression is common. Anxiety and fear are common. Mood swings are equally common. She might cycle quickly from sadness, shame, and guilt to hope and joy about quitting.
Early recovery is also a time of introspection. As emotions are changing quickly, the newly recovering person tries to make sense of this flood of emotion. They are also assessing their relationships, their work, their social life, their motivations, their beliefs, and their history, trying to make sense of it all.
Because emotions are often so labile in early recovery, family members often make the assumption that the addict is still using. They don’t know how else to explain it, since they expect that the addict will begin to be better immediately and steadily. However, a roller coaster effect of emotional high and lows is to be expected in early recovery as the chemicals leave your body, a little at a time, and as you confront issues that have been stuffed come to the foreground.
In early recovery, feelings return to life. Recall that alcohol and other mood altering drugs, do just that; they alter your mood. Your feelings or emotions are part of your mood. Think about the times that you used alcohol or other mood altering drugs to change to how you felt, whether you were bored, angry, tired, hurt, sad, lonely, or helpless. Alcoholics and addicts even use chemicals to alter positive feelings such as joy. So, if over a long period of time, you had been using drugs to numb those feelings and you stopped numbing them, they would rebound with a vengeance.
When you or your addicted loved one feels those ups and downs, recognize that the body and mind are detoxing. Being aware that a rollercoaster effect on the emotions are common to early recovery helps to keep this temporary condition in its proper perspective. An helpful way to look at these highs and lows, is to acknowledge the need for new feelings management skills and to develop new skills regarding those uncomfortable, pesky feelings. Early recovery is a golden opportunity to learn how to appropriately identify, label, own, express, and work through feelings. Some alcoholics and addicts have these feelings management skills. If you don’t, now is a good time to learn. You are going to need those skills for the rest of your life.
26. One More Tool For Early Recovery -- Structure
By Peggy L. Ferguson, Ph.D.
Addiction usually brings with it a loss of daily structure and organization. An addict's lifestyle often becomes chaotic and haphazard, with the loss of work and other personal and family routines. Addicts often have eating and sleeping patterns that are outside of the mainstream, that also tend to help create the lifestyle of chaos and disorganization.
An addict that is seeking recovery, often goes to inpatient treatment. There are many benefits of this type of treatment. One benefit of inpatient treatment is the organizing structure of the program itself and the daily routine that develops by being engaged in treatment. The structure usually consists of a regimented wake up time, a scheduled amount of time for meals served at the same time daily, rules and treatment expectations. Patients in treatment are expected to sleep at night and be engaged in treatment during the day, attend sessions, and focus on recovery. When a newly recovering person leaves the safety of inpatient treatment s/he is called upon to develop structure for herself/himself.
Obsessive thoughts about drinking/using are reduced by closely scheduling your day. Boredom, which is highly correlatede with those obsessive thoughts about using, is reduced. Active addiction is characterized by the addict's life revolving around getting the drug, using it, and getting over using it. In abstinence the loss of this behavior represents a loss of structure. The newly recovering addict is called upon to figure out how to replace the old drinking/drugging routine with new, recovery enhancing routines.
A change in routine is necessary to develop a lifestyle that encourages and nurtures recovery instead of addiction. This often involoves a complete change and restructuring of time, activities, and attention.
A recovery lifestyle can be developed more easily by using a day planner, appointment book, or other similar tools to build a daily schedule of recovery enhancing activities. In this schedule should be counseling and sponsor appointments, planned personal and family events like parent/teacher conferences, date night, lunch with the girls, etc. Self-care activities, such as daily physical exercise, meditation time, personal relaxation routines, should also be scheduled in.
Having a tightly scheduled day in early recovery is very helpful in preventing relapse. It helps to eliminate excessive free time, which can lead to cravings, and thoughts about drinking/using. It also helps eliminate boredom, depression, and anxiety by maintaining a level of busy-ness and reducing opportunities to ruminate or worry. By not dwelling on the things that may be bothering you emotionally, depression and anxiety are reduced. A tight schedule also helps cut down on the negative emotional thoughts about self, others, and the world that feeds depression and anxiety.
Keeping a daily schedule also helps with prioritizing tasks and activities that recovering people are called upon to participate in. Sometimes people in recovery feel as if they are pulled in too many directions and are scheduled too tightly. In this case, a schedule that is too densely scheduled, serves to increase rather than decrease their stress. A schedule that is too densely committed, may serve as an indicator of the need to learn and practice assertiveness. It is important to learn to set and maintain appropriate boundaries in early recovery. Learning to say "no" to a request for your time, can be difficult, but with practice, can build or reinforce positive self esteem and self-confidence. Knowing that you are engaged in too many activities can also help you to improve your ability to prioritize. Without this ability, it is easy to become frustrated and overwhelmed, thereby increasing your stress.
Increased stress, regardless of whether it comes from too mjuch or too little structure, increases the likelihood of relapse if left unchecked. People in early recovery are called upon to learn how to balance the conflicting demands for their time and attention. Learning this balance takes time, awareness, and practice.
27. Addiction and Recovery- Defenses Distort Reality
To Enable Continuing Alcohol & Drug Use
By Peggy L. Ferguson, Ph.D.
Alcoholics and addicts have defense mechanisms that allow them to distort their perception of reality enough to continue to drink and drug despite the obvious problems caused in their lives by that behavior. Addicts often define "The Problem" as some piece of behavior that is associated with the drinking or using. A common example is being arrested for DUI. Despite uncountable episodes of driving after drinking, and despite a multitude of other life problems associated with the drinking, the alcoholic defines the problem as either the arrest or the actual drinking and driving. They then seek to solve the problem by a conscious effort to not drink and drive. The obvious solution of stopping the drinking, is not considered. An alternative and acceptable solution (to the alcoholic) of not driving after drinking, is based on identification of drinking and driving as the problem. For non-alcoholics, this could be correct problem identification. Not everyone who is arrested for DUI is alcoholic.
Quite often, however, people who have a DUI arrest, are in fact, alcoholic. When the alcoholic decides to solve the problem by quitting driving when drinking, they are chasing an illusion of control. This solution assumes that there is no addiction, because if there is addiction, there is loss of control. Although they may intend to follow through with that plan, addiction gets in the way. Alcoholics in treatment often describe a scenario where they made pacts with friends to be the "designated driver". When the "designated driver" gets drunk, someone drunk is probably going to be driving. They are trying to take control over the disease by trying to regain control over the consequences. The rationale is that if you have control over the consequences of the drinking, you have control over the drinking.
Family members often reinforce that rationale and defense mechanisms by focusing on the inappropriate drunken or drugged behavior. They often approach the problem by trying to get the addict to quit misbehaving while drinking/using. They also erroneously believe that if the addict would just act differently when drinking, that their drinking would not be a problem.
Family members tend to view the alcoholic's drugged behavior as something that they are deliberately doing to try to destroy themselves or the family. Neither the alcoholic nor family members understand the effects of mind/mood altering chemicals on the brain, the body, and in various other aspects of a person's life over time.
Family members also usually fail to see the impact of their interactions with alcoholic on their own decisions and behavior. Family members feel compelled to try to take control for the addict, and begin to feel the negative consequences of their own maladaptive behavior. These spouses and parents, fueled by the same defenses, compulsively persist in their same problem solving behaviors despite the fact that those behaviors are not working to change the addict.
That is the parallel between the compulsive behavior of the alcoholic and the compulsive behavior of the family member. The alcoholic's addiction centers on compulsive consumption in the face of negative consequences of that consumption. The maladaptive family dynamics also center on compulsive behavior - the compulsive attempts to gain control over the addict's behavior. This compulsive behavior persists in the face of obvious repeated failure and the occurrence of negative consequences of those efforts.
Defenses operate unconsciously. When you know that you are using defense mechanisms to change how you look at things or what you feel about those things, those defenses do not work. Lying and denial are not the same thing. If you know that you minimize the effects of your drinking on your family members, you cannot comfort yourself with that same defense.
Addiction and Recovery: Cross Addiction - Chasing The Illusion of Control
By Peggy L. Ferguson, Ph.D.
The earliest efforts in addiction recovery involve attempts to interrupt the momentum of the addiction by abstaining from the chemical. Unfortunately, many people in early recovery have limited awareness of the impact of their drug use on their lives over time. They often do not fully understand the nature of addiction and rudimentary elements crucial to recovery. Many people attempt to halt their addiction by using a “trial and error” process. Addicts, in trying to regain control over their using, often try to make the least amount of change to their lives overall, while eliminating negative consequences.
Many people attempt to regain control by changing their drugs of choice. They may believe that oxycontin is causing major problems in their lives, and that when they were “only” drinking, that life was more manageable. Addicts, whose spouses are threatening to leave them over the last DUI, continuing fights, blackouts, and broken promises, may be motivated to quit drinking, but can easily maintain the defense that their cannabis smoking has not caused these negative consequences. The spouse may even believe it. However, switching to a different drug of choice rarely solves the problems identified. Essentially, in the process of trying to regain control by switching drugs, alcoholics/addicts in the early efforts toward recovery may be chasing an "illusion of control."
The idea that switching drugs will restore control is an almost irresistible notion to someone who cannot imagine a life without mood/mind altering drugs. In fact, this latest attempt at control does not and will not have a lasting effect over “control”. They may be lulled into a false sense of security as they perceive things to
be better or under better control. Control has typically not been re-established, and any seeming reduction in consequences and problems from the chemical are only illusory or temporary.
The cognitive distortions and defense mechanisms that assist the addict to persist in addictive behavior also operate to reinforce an addict’s tendency toward cross addiction to other drugs. An addict will seek any evidence that supports the belief that complete abstinence is not necessary. When they seem to be less hostile, less depressed, or make some minor behavioral changes, this evidence of “improvement is given great credence. Disconfirming evidence that indicates that the problems and consequences are still there will be minimized or disregarded.
Regardless of which new drug an addict may switch to, the disease continues to progress—consequences and all. It is only a matter of time, usually a short amount of time. If you substitute another drug for your drug of choice you are still addicted. And you will continue to experience the same negative consequences of active addiction. You cannot regain persistent control over drug use by changing drugs. Believing that you are successful in regaining control with a different drug is the “illusion of control”.
There is a caveat, however. Some addicted people have serious mental illnesses that make it necessary for mood altering or mind-altering medication under doctor's supervision. It is common for people in early recovery to experience depression and/or anxiety. Many of these recovering can benefit from an antidepressant. Xanax, ativan, valium, klonipin (and other similar drugs) are not antidepressants, and are usually not recommended for people in recovery. The exceptions being serious mental illness under medical supervision.
Peggy's Note: My ebook, "Understanding Cross Addiction to Prevent Relapse" is available for purchase and download on my ServicesProvided page.
Recovery Worksheets
Relapse is a symptom of addiction. Relapse is a symptom of many, if not most, chronic diseases. Addiction should be treated as the chronic disease that it is and relapse should be treated as a symptom of addiction. Relapse is not a character flaw or a moral failing. When you think of addiction as a chronic illness, you must conceptualize treatment and recovery from the same world view.
In any other disease, when someone relapses, the sufferer or patient does not typically just give up, go hide somewhere and die. They go back to the doctor for a medication change or for further instructions on what to do next. They may step up their treatment regimen, alter it, or let reassessment guide treatment planning.
With other chronic diseases, family members typically do not just give up on the patient either. When treating other chronic diseases there is an expectation that relapse serves as a reminder and a wakeup call, to assist the patient in taking whatever action is necessary to get their recovery back on track.
For people in addictions recovery, getting back on track means going back to meetings, possible going back to some level of treatment, and renewing one's commitment to honesty, open mindedness and willingness to do whatever is necessary to recover. It means evaluating the effectiveness of your efforts before relapse, and identifying realistically what your efforts should be at this point in recovery. It usually involves looking at what was and was not working. Much of the time the recovering person was in the relapse process quite some time before he or she actually used the chemical.
As you recall, the relapse process involves a return to old thinking, old feelings, and old behavior. Sometimes when people relapse, they had either cut back or entirely stopped attending meetings, using prayer and meditation, going to counseling, and using program solutions to life's daily ups and downs. They may have embraced self-pity. They probably began to entertain relapse thinking, where permission to relapse (though unconsciously) is granted to oneself. Before the chemical is consumed the recovering person has usually stopped doing many of the things that he was doing that allowed him to achieve sobriety in the first place. Many people stop doing the very behaviors that improve their health and wellbeing as soon as they feel better, only to discover that their symptoms soon return. Alcoholics/addicts in recovery are no different on this score.
Those who have relapsed can use their relapse to strengthen their recovery. They can review their efforts before relapse and make a plan to increase those efforts to an appropriate level. "Half-measures avail us nothing." (AA Big Book, p ).
Relapse Assessment Guide
Positive recovery actions
How many meetings were you attending per week?
How many meetings were you talking in?
How many invitations did you accept from others in the program to socialize with them?
Did you use a daily prayer and meditation time?
Did you have a sponsor? Did you call him/her?
Did you go to meetings early and stay late to help set up or make coffee, or help clean up?
Did you do a daily tenth step at the end of your day, assessing what you did well that day and areas needing improvement?
Did you entertain thoughts that you are not a "real" alcoholic/addict?
Did you read recovery literature daily?
Did you use daily structure to assist you? Did you occupy a lot of your time with recovery activities or did you have a lot of unstructured free time?
Relapse behaviors
Identify the relapse behaviors that you were engaging in before you actually took the chemical.
__Denying what you know to be true about the disease of addiction. Seeing it as not pertaining to you.
__ Thinking that this time, you would have control over your drinking/drugging.
__ Not accepting cross addiction.
__Being unwilling to be honest with others about your thoughts and feelings about recovery, using, and how you fit in.
__Not appropriately managing your stress.
__Not appropriately managing you feelings.
__Lack of a spiritual program of recovery.
__Negative, hostile, world view.
__Immature wish to "just be happy".
__Wanting to be "normal".
__Feeling stuck and not asking for help.
__Not talking about triggers you might have experienced.
__Not giving others permission to tell you that you are back in old thinking, feelings, and behavior. Instead, you get mad or defensive.
Identify what happened in your recovery that contributed to your relapse. Take immediate steps to remedy those situations. Go back to meetings. Tell the group you relapsed. Tell your important significant others and once again, ask them to tell you when they see old, relapse behavior. Don't entertain the notion that you can stay out there "just a little longer". Many people die before they make it back.
4. A Relapse Prevention Tool –
By Peggy L. Ferguson, Ph.D.
The Emotional Cues For Cravings in Relapse Worksheet
By Peggy L. Ferguson, Ph.D.
Continuing Recovery Lifestyle Worksheet
You have been working on the first steps and have looked at the damage in all major areas of your life. You have been clean and sober for awhile now. You feel better physically and emotionally. Your life is changing for the better. Use this worksheet to assess where your progress and areas needing work. This self-assessment will help you to identify your strengths and areas needing work for your continuing growth in recovery. Apply the following questions to each of the major life areas below. Use separate paper to assess yourself and write about how you are doing on each item.
Questions:
1. How is your recovery and abstinence from alcohol and other drugs affecting these areas in your life currently?
2. What changes have you noticed in these areas?
3. What changes have others noticed?
4. Which areas need focus and more work?
5. What kinds of changes do you want to make?
1. Partner/spouse relationship
a. the level of emotionality you experience with your spouse/partner.
b. how you deal with emotions and conflicts with your spouse/partner.
c. the level of contribution that you make to the relationship or the family.
l. chores
2. finances
3. fun/entertainment/joy
d. your ability to be supportive of your spouse/partner
e. your ability to sometimes put others' needs ahead of yours
f. your patience and tolerance over annoyances
g. romantic gestures/activities, dates, and showing of affection
2. Money and finances
a. the level of responsibility or follow-through in financial goals
b. being proactive in making decisions about how money is spent and planning ahead c. consulting with spouse/partner and working as a team financially d. making financial amends
3. Balancing recovery, home, work, and other priorities
a. maintaining structure or a schedule that assists with prioritizing, stress management, and goals
b. practicing assertiveness and being able to say "no" to requests that would lead to imbalance or more unmanaged stress.
c. consulting with spouse/partner about conflicting demands and problem solving priorities together
d. communicating your needs and being responsible for your recovery. Work responsibilities a. maintaining positive, healthy attitude about work b. managing stress as it occurs and replacing worry with pro-active problem solving
4. Job performance
a. positive relationships with co-workers and boss.
b. willingness to hear and consider feedback.
c. dependability, punctuality, and focus
5. Friendships and other relationships
a. willingness to spend time with in-laws and other relatives
b. making amends to family members
c. dealing with conflicts as they occur in a healthy manner
d. communicating your needs. e. taking others' feelings into account.
f. practicing patience and tolerance of others.
6. Spirituality
a. maintaining a helpful connection to spiritual advisors
b. maintaining helpful routines
c. applying an attitude of gratitude to your life
d. being of service to others. Using The Problems Checklist
One of the main things that I teach newly recovering alcoholics/addicts to do, is to identify the roles that chemicals play in their lives. This is especially important since the chemical has occupied so many crucial roles or functions and that removing it from a person's life leaves big, gaping holes in their behavioral repetoire. When you identify the roles previously played by the chemical, you then identify possible healthy alternatives to replace the roles with. Early on, it is usually simple things like meetings, prayer, meditation, exercise, calling people for help, etc. Its pretty difficult to learn sophisticated living skills when you are hanging on by your fingernails. A little later in recovery, we are still working on replacing the roles with healthy alternatives, but we are focusing more on developinig more indepth living skills, and working to solve the most pressing of problems.
Often, by the time that someone finds his way to recovery, he has focused so much on getting the next drug, using it, and getting over it, that they don't have a full grasp of the disarray that his life is truly in. The bills may be stacked up and unpaid. There may be impending court dates. Extended family members may not be speaking to him. He may be unemployed or underemployed. He may lack frustration tolerance, stress managment, feelings expression skills, and inability to communicate and problem solve with others. The following problems list can help the recovering person begin to repair the damage caused in his life by addiction. To use this checklist, identify which problems you have, rank them from most pressing to least pressing, taking into account the items as short term and long term goals.
The Problems Checklist
Check the problems on this list that you have currently. Identify whether you look at these items as short term or long term goals. Rank the ones you identified in terms of most pressing to least pressing, (i.e. #1, #2, #3).
Check Rank
____ ____ Housing, or appropriate place to live
Many recovering people who begin the process of becoming clean and sober, harbor the notion that they can continue to hang on to some remnants of an old drinking/using lifestyle. They often initially believe that specific drugs are The Problem. Initially alcoholics/addicts may not consider use of other drugs (including alcohol) as problematic. When the idea of being addicted to all mood altering drugs does come up, the idea is often dismissed as not being applicable. Denial and an absence of insight makes other historical drug use or even recent drugs used to "help with getting over" a drug problem, seem unimportant. When addicts compare the impact of the most recent drug of choice on their lives with other drug episodes, the other drugs probably pale in comparison.
These comparisons often fail to take into account the impact of "progression of the disease". Progression is the increasingly harmful course that addiction takes over time. Progression typically involves tolerance. Progression of the disease is not only marked by an increase in the use of the chemical, but is marked by a pile-up of negative consequences. These negative consequences tend to get bigger and more frequent. Progression of the disease is summed up succinctly by an old proverb that goes like this: "A man takes a drink. The drink takes a drink. The drink takes the man."
Many who make the decision to get clean and sober, hang onto the hope that they can continue to use "other drugs" without negative consequence. The idea of living drug free if often unfathomable in the beginning. Yet, to continue to hang on to those obsolete, counter-therapeutic and non-recovery thoughts, is to leave yourself more vulnerable to relapse. To assist in challenging the memories and distorted beliefs that you may still have about your relationship to drugs, use The Cross Addiction Worksheet. It has six items or questions that asks you to recall your other drug use/abuse and to look for connections between your relationship with those other drugs and continuing vulnerability to relapse. Only three of the worksheet items are shown here.
Cross Addiction Worksheet
1. Start at the beginning of your alcohol and other drug use. Develop a time line where you write down your first use of alcohol and/or other drugs, how much you used of what, how often, and any recollections of problems or negative consequences from that use (even if you did not make the connection between the drinking/using and the consequences at the time).
Example:
"1971 10th grade Started smoking pot; smoked pot weekends only; best friend stopped hanging out with me because he didn't smoke pot and didn't like it that I was smoking pot. Mom found stash. Grounded for one month."
"1972 11th grade - Smoking pot daily; drinking alcohol on weekends, getting drunk. Started skipping school and got caught several times, getting suspended each time. Grounded. Car taken away by parents. Car was run into at a party. Car insurance went up. When drinking, was trying to impress a girl and made fool of myself."
Follow this time line to present day, taking into account any DUIs/DWIs, Public Intoxication Charges, other arrests, school suspensions, loss of relationships, dropping out of school and other activities, theft, use of pharmaceutical drugs, friends' parents not letting them hang out with you because you are a "bad influence", overdoses, close calls with wrecks, being in dangerous places with dangerous people at dangerous times, starting projects that you don't finish, loss of ambition/goals, etc.
2. Name your most recent drug(s) of choice. Identify the roles that the chemical has recently played in your life. Did you drink or use other drugs to be more outgoing, to not feel feelings, to reduce stress, to help you sleep at night, to forget problems or events? Write down a list of "things" that you used the chemical for. Look back at your use of other drugs (including alcohol) and identify other drugs that you used for the same purposes.
3. Addiction exists in a social and cultural context. Alcoholics/addicts tend to pick people for their "friendship networks" that are using alcohol and other drugs the way that they are. Make a list of people that you have used alcohol and other drugs with. Name the drugs that you did with these friends/acquaintances. Identify which of the people on this list have been a part of your most recent group of drinking/using friends? What drugs are they likely to have? Who on this list have you decided to not be around in recovery? Which ones were involved in your using other drugs at other times in your life. Which people on the list present a link to your old drugs of choice, or to other drugs? Who, on your lists do you need to avoid?
Associations between particular feelings, people, places, and events becomes intertwined with the alcoholic or addicts drinking and drugging behavior. When alcoholics and addicts find their way to recovery, the old associations between the drinking and drugging and the old feeling, people, places, and events persist, often triggering cravings to drink or use. When these cues trigger drinking or using memories and perhaps euphoric recall, unless you take action to prevent cravings and possible relapse, you remain extremely vulnerable to losing your recovery. These cues are ever present, but relapse can be averted.
It is important to avoid the external triggers that are your most dangerous and that are within your power to avoid. Many of these would be the obvious ones such as hanging out with old drinking/using friends, or going to bars or liquor stores. Triggers that can't be avoided can be neutralized. To be ready and able to neutralize triggers that arise, you need to be able to anticipate and identify them, then have a plan of action on how you will deal with them without drinking/using.
Who are the people you used to drink or use drugs with? Make a list.
Places
Where did you used to drink or use drugs?
Events
What kinds of events did you routinely participate in while drinking or using drugs?
Celebrations
What are some of the celebrations or special events that you might participate in that could serve as a trigger for relapse? Make a list. Examples might include: weddings, graduation, birthdays, vacation, holidays (with or without extended family members).
Other stressful events or activities
Identify other stressful events or activities that could serve as a trigger. Examples might include such things as deaths of family members, divorce, separation, money problems, getting paid, getting a raise, calls from creditors, paying bills, group meetings, long work hours, unemployment, having a baby, retiring, home alone, vacation, going by an ATM machine, home alone, finding paraphernalia, a long "to do" list.
Relationship events
What kinds of relationship events were associated with your drinking or drug use?
Time
When did you usually drink or use?
Making a plan.
Looking back over your lists above, identify actions that you can take to reduce the threat to your recovery. Which events can you avoid?
Learn From Your Recent Relapse
By Using "The Relapse Assessment Worksheet"
By Peggy L. Ferguson, Ph.D.
To assess your efforts before relapse ask yourself these questions about positive actions and these questions about relapse behavior.
Peggy's note: If you found this article helpful you might find my ebooks, Preventing Addiction Relapse: Protecting Your Recovery in Post-Surgery Pain Days", and "Understanding Cross Addiction To Prevent Relapse" helpful. They can be purchased here at www.peggyferguson.com/ServicesProvided.en.html
Associations between particular feelings, people, places, and events becomes intertwined with the alcoholic or addicts drinking and drugging behavior. When alcoholics and addicts find their way to recovery, the old associations between the drinking and drugging and the old feeling, people, places, and events persist, often triggering cravings to drink or use. When these cues trigger drinking or using memories and perhaps euphoric recall, unless you take action to prevent cravings and possible relapse, you remain extremely vulnerable to losing your recovery. These cues are ever present, but relapse can be averted.
It is important to avoid the external triggers that are your most dangerous and that are within your power to avoid. Many of these would be the obvious ones such as hanging out with old drinking/using friends, or going to bars or liquor stores. Triggers that can't be avoided can be neutralized. To be ready and able to neutralize triggers that arise, you need to be able to anticipate and identify them, then have a plan of action on how you will deal with them without drinking/using.
Social and Environmental Triggers for Cravings Worksheet
Who are the people you used to drink or use drugs with? Make a list.
Places
Where did you used to drink or use drugs?
Events
What kinds of events did you routinely participate in while drinking or using drugs?
Celebrations
What are some of the celebrations or special events that you might participate in that could serve as a trigger for relapse? Make a list. Examples might include: weddings, graduation, birthdays, vacation, holidays (with or without extended family members).
Other stressful events or activities
Identify other stressful events or activities that could serve as a trigger. Examples might include such things as deaths of family members, divorce, separation, money problems, getting paid, getting a raise, calls from creditors, paying bills, group meetings, long work hours, unemployment, having a baby, retiring, home alone, vacation, going by an ATM machine, home alone, finding paraphernalia, a long "to do" list.
Relationship events
What kinds of relationship events were associated with your drinking or drug use?
Time
When did you usually drink or use?
Making a plan.
Looking back over your lists above, identify actions that you can take to reduce the threat to your recovery. Which events can you avoid?
The Emotional Cues For Cravings in Relapse Worksheet
We experience sensory, emotional/psychological, cognitive, environmental, and physical cues on a daily basis in early recovery. These cues or triggers, if left unchecked can turn into powerful cravings for the chemical. Cravings can lead to relapse. In order to avoid relapse it is crucial that you identify your cues, take action, and not let them turn into cravings.
One powerful set of cues that can set off cravings are emotions or feelings. Uncomfortable feelings, usually negative emotions, have probably been among the cues or triggers associated with your drinking and using in the past. Identify how these feelings have been linked in the past to your drinking or drugging behavior and the how they may be serving as cues for triggers today using the Emotional Cues For Cravings in Relapse Worksheet.
Emotional Cues for Cravings in Relapse Worksheet
First, put a check by each emotion that you believe is associated with drinking and/or using. Check the emotion if you believe that it has led to drinking or using, or the emotion has been altered by your drinking or using drugs.
Then give three examples of how that has happened in the past.
Then give three examples of how these emotions are currently connected to your thinking about drinking or using.
___1. Fear. Other descriptors connected to fear might include afraid, anxious, nervous, scared, apprehensive, insecure.
___ 2. Anger. Other descriptors connected to anger might include mad, frustrated, annoyed, miffed, resentful, aggravated.
___ 3. Guilt. Other descriptors connected to guilt might be remorseful, sorry, responsible, bad.
___ 4. Shame. Other descriptors connected to shame might include embarrassed, less than, inadequate, humiliated.
___ 5. Hurt. Other descriptors connected to hurt might include abused, crushed, disappointed, pain, taken for granted, taken advantage of, bruised.
___ 6. Sadness. Other descriptors connected to sadness might include grief, melancholy, sorrowful, somber, solemn.
___ 7. Loneliness. Other descriptors connected to loneliness might include left out, neglected, abandoned, alienated, dejected.
___ 8. Helplessness. Other descriptors connected to helpless might be paralyzed, despair, defeated, shaken, stuck.
___ 9. Overconfident. Other descriptors connected to "overconfident" might be ungrateful, reckless, prideful, imposing, in control, dominating.
___ 10. Boredom. Other descriptors connected to bored might be disconnected, disinterested, withdrawn, not caring, subdued.
___ 11. Stressed. Other descriptors connected to stressed might be overwhelmed, exhausted, worried.
___ 12. Joy. Other descriptors connected to joy might be happy, elated, excited, confident, cheerful, adored, affectionate, delighted.
You have identified feelings or emotions that have served as triggers for cravings and/or relapse in the past. You have identified current feelings or emotions that are connected to thoughts about drinking and/using.
In recovery, you must learn to replace the chemical with healthy living skills. Learning to deal with feelings appropriately is a very important healthy living skill. Make a list of things that you can do to deal with feelings or emotions in a healthy way. (Hint: Pouring alcohol or other chemicals on them is not a healthy way). Make your own list.
Associations between particular feelings, people, places, and events becomes intertwined with the alcoholic or addicts drinking and drugging behavior. When alcoholics and addicts find their way to recovery, the old associations between the drinking and drugging and the old feeling, people, places, and events persist, often triggering cravings to drink or use. When these cues trigger drinking or using memories and perhaps euphoric recall, unless you take action to prevent cravings and possible relapse, you remain extremely vulnerable to losing your recovery. These cues are ever present, but relapse can be averted.
It is important to avoid the external triggers that are your most dangerous and that are within your power to avoid. Many of these would be the obvious ones such as hanging out with old drinking/using friends, or going to bars or liquor stores. Triggers that can't be avoided can be neutralized. To be ready and able to neutralize triggers that arise, you need to be able to anticipate and identify them, then have a plan of action on how you will deal with them without drinking/using.
Social and Environmental Triggers for Cravings Worksheet
Who are the people you used to drink or use drugs with? Make a list.
Places
Where did you used to drink or use drugs?
Events
What kinds of events did you routinely participate in while drinking or using drugs?
Celebrations
What are some of the celebrations or special events that you might participate in that could serve as a trigger for relapse? Make a list. Examples might include: weddings, graduation, birthdays, vacation, holidays (with or without extended family members).
Other stressful events or activities
Identify other stressful events or activities that could serve as a trigger. Examples might include such things as deaths of family members, divorce, separation, money problems, getting paid, getting a raise, calls from creditors, paying bills, group meetings, long work hours, unemployment, having a baby, retiring, home alone, vacation, going by an ATM machine, home alone, finding paraphernalia, a long "to do" list.
Relationship events
What kinds of relationship events were associated with your drinking or drug use?
Time
When did you usually drink or use?
Making a plan.
Looking back over your lists above, identify actions that you can take to reduce the threat to your recovery. Which events can you avoid?
We experience sensory, emotional/psychological, cognitive, environmental, and physical cues on a daily basis in early recovery. These cues or triggers, if left unchecked can turn into powerful cravings for the chemical. Cravings can lead to relapse. In order to avoid relapse it is crucial that you identify your cues, take action, and not let them turn into cravings.
One powerful set of cues that can set off cravings are emotions or feelings. Uncomfortable feelings, usually negative emotions, have probably been among the cues or triggers associated with your drinking and using in the past. Identify how these feelings have been linked in the past to your drinking or drugging behavior and the how they may be serving as cues for triggers today using the Emotional Cues For Cravings in Relapse Worksheet.
Emotional Cues for Cravings in Relapse Worksheet
Then give three examples of how these emotions are currently connected to your thinking about drinking or using.
___1. Fear. Other descriptors connected to fear might include afraid, anxious, nervous, scared, apprehensive, insecure.
___ 8. Helplessness. Other descriptors connected to helpless might be paralyzed, despair, defeated, shaken, stuck.
___ 9. Overconfident. Other descriptors connected to "overconfident" might be ungrateful, reckless, prideful, imposing, in control, dominating.
___ 10. Boredom. Other descriptors connected to bored might be disconnected, disinterested, withdrawn, not caring, subdued.
___ 11. Stressed. Other descriptors connected to stressed might be overwhelmed, exhausted, worried.
___ 12. Joy. Other descriptors connected to joy might be happy, elated, excited, confident, cheerful, adored, affectionate, delighted.
You have identified feelings or emotions that have served as triggers for cravings and/or relapse in the past. You have identified current feelings or emotions that are connected to thoughts about drinking and/using.
In recovery, you must learn to replace the chemical with healthy living skills. Learning to deal with feelings appropriately is a very important healthy living skill. Make a list of things that you can do to deal with feelings or emotions in a healthy way. (Hint: Pouring alcohol or other chemicals on them is not a healthy way). Make your own list.
By Peggy L. Ferguson, Ph.D.
To Assist In Your Ongoing
Recovery Efforts
By Peggy L. Ferguson, Ph.D.
____ ____ Medical or dental problems or need for checkups
____ ____ Regaining custody of children or finding Appropriate childcare
____ ____ Legal and court problems
____ ____ Relationship issues
____ ____ Social network problems (i.e. drug using friends/acquaintences)
____ ____ Feeling management skills
____ ____ Education issues such as going back to school, GED, additional training, etc.
____ ____ Psychololgical issues like anxiety, depression, mental confusion, mood swings, etc.
____ ____ Lack of structure and time management skills
____ ____ Lack of stress management skills
____ ____ Impatience, lack of frustration tolerance, demand for immediate gratification
____ ____ Lack of self-esteem, self-confidence, or positive identity
____ ____ Shame and guilt about hurting family or need to make amends
____ ____ Poor communication skills and/or poor conflict management skills
____ ____ Other obsessive compulsive behaviors
____ ____ Alienation, not feeling like you fit in, loneliness, isolation
____ ____ Lack of motivation or Procrastination
____ ____ Reliable Transportation
____ ____ Financial concerns or unpaid bills
____ ____ Job training or employment
The Cross Addiction Worksheet
By Peggy L. Ferguson, Ph.D.
Remember that addiction is a brain disease that is manifested in compulsive consumption of mood/mind altering drugs. It is chronic. It lasts a lifetime. It cannot be cured. Once you have addiction, you cannot return to "social use". It is a compelling fantasy that keeps a recovering person vulnerable to relapse.
The newly recovering person often wants family members to accept at face value that they are done with drinking and using for good. They may be telling the partner or family members that they are willing to go to 12 step meetings, but one thing after another has gotten in the way of actually attending those meetings. From the addict's point of view, the willingness and the intention of doing so should be accepted and regarded as evidence that the alcoholic is "in recovery".
Alcoholics may feel insulted when it is suggested that for family members to believe that they have changed, that they actually must change. Words are not enough. Family members have been through promises and declarations of "quitting for good" for years. These verbalizations do not mean anything to the family if not followed by behavior change.
Family members often assert that their addicted loved ones have lied to them about wanting to get sober or by making unfulfilled promises of "giving it up". People with addiction usually mean it when they make the promises that they will quit, that they will go to meetings, and that they will engage in any form of recovery activities. The addiction gets in the way of the promises to themselves and others. The cravings or urges set in and the defenses mechanisms make it alright to drink or use "just one", "just one more time", "only for today", "only beer", or "only pot". And of course, the first one only leads to the rest.
The newly recovering person often has difficulty really understanding that family members will regain their trust as the alcoholic regains "trustworthiness". Behavior, that is dependable, responsible, constant, and predictable, is trustworthy behavior. Trust comes back the same way it was lost-a little at a time. As the addict does what he says he will do (i.e., going to meetings, not drinking one day at a time, getting a sponsor, etc.) family members' perception of his "trustworthiness" goes up. When he tells the truth instead of lying to avoid conflict, his "trustworthiness" rating goes up some more. This process continues as the trust in the relationship is restored. All the arguing and promising in the world won't make it happen sooner. In fact, this behavior slows down the process since it is not "recovery behavior".
Family members will also be reassured about a loved one's ongoing abstinence when they observe that the appearance of new living skills. The chemical must be replaced by healthy living skills or the recovering person remains vulnerable to relapse. When the chemical use is removed from the newly sober person's problem solving skill set, it leaves big gaping holes where something that had a purpose used to be. When the need arises for the role that the chemical played, and healthy replacements have not been found, relapse is a strong possibility. Spouses and parents in early recovery live in fear of their loved one relapsing. They feel less fear when they are able to observe that their loved one now has alternatives to chemicals when he feels uncomfortable feelings, is stressed, or has problems that he is struggling with.
An example of the need for living skills would be stress. Addicts without stress management skills, in the wake of elevated stress, would want to use a drug to manage that stress because at some point it worked--at least temporarily. Recovering people not practicing good stress management skills would tend to be irritable, anxious, and might employ other diversionary tactics to not feel stressed. Spouses and parents will notice when a loved one is practicing stress management skills because their old behavior associated with stress will be changed. They will see that the alcoholic is changed and is engaged in working a program of recovery.
"Working a program" is not just about attending meetings. It is about utilizing what you learn in those meetings to effectively manage one's life. To regain trust in the relationship one must actively work a program of recovery.
Important Factors in Learning How to
Love in Recovery
By Peggy L. Ferguson, Ph.D.
There are many important early recovery tasks. One that is important to successful relationship skill development as well as abstinence maintenance, is the development of a new identity. This happens over time in recovery. In this process, the old identity of drinker/user gives way to the new identity of drinker/user who is not drinking/using. That identity is eventually replaced with a broader identity of a multifaceted individual who is recovering, and whose life is defined by many things including recovery. In order to be able to be truly intimate in a relationship you have to have a clear and comfortable sense of self. It is hard to be in a relationship with someone else when you can't feel comfortable in your own skin. When we don't have a firm, positive sense of self, we may enter into romantic relationships on a sort of "self-finding" mission, only to discover later that we have actually lost ground in that endeavor.
Sometimes we look to our significant other as an extension, reflection or definition of self. There is also the possibility of transferring our dependency on our higher power to that significant other.For at least the first year in recovery, the primary focus of a recovering addict's life should be developing a solid foundation for recovery. This would involve going to many meetings, acquiring and using a sponsor, being of service to others, and learning how to replace the chemical with healthy living skills.
One of the most important living skills to be developed is relationship skills. Relationship skills include ability to effectively communicate and problem solve, ability to put yourself in others' positions (role taking), ability to ask for what you want and need directly, ability to trust, ability to appropriately identify, communicate and work through feelings, ability to manage stress, ability to take responsibility for one's own issues and let go of responsibility for others' issues. When you engage in a new relationship without these much needed relationship skills, you endanger your fragile recovery.
Think about it. What do alcoholics and addicts do when they have emotional pain, conflicts, or feelings and problems that they don't know what to do with? They use alcohol or other drugs to fix it, or escape from it. One of the ways that entering into a romance can sabotage recovery is that your routine changes as you incorporate the new person into your life and your schedule.
You have probably worked pretty hard to set up the structure and daily routine that not only helps with maintaining your abstinence and recovery, but that also helps to build self-discipline skills. Twelve step meetings may give way to rendezvous. Romance with another recovering person is particularly precarious, especially when you both go to the same 12 step home group.
Relationships require some of the same coping skills and resources that sobriety requires. While you are learning these new living skills and applying them to recovery, you are simultaneously called upon to work through old unresolved relationship issues. In order to have healthy relationships in recovery, you must resolve old emotional relationship baggage. Otherwise, you would tend to repeat the past.
Having a healthy relationship in recovery demands that you develop a solid sense of self, mind your priorities, which should continue to be recovery, and practice new living skills. Sponsors really come in handy as you grapple with taking on a romantic relationship in early recovery. As we turn to sponsors to help us navigate other turbulent waters of early recovery, so can we use experienced guidance in the realm of developing intimacy skills. It is particularly important to have as a sponsor someone who seems to have some solid recovery in the area of relationships.
If you have never learned intimacy skills, you may not know the difference between healthy and unhealthy relationships. Hopefully, your sponsor can guide you through the process when it is time. You can recover in the area of relationships. As you find yourself recovering to greater and greater levels of "wellness", you will notice that the people that you are attracted to, and that are attracted to you, have also achieved similar levels of wellness.
If you don't have a clear sense of self, aren't able to take care of most of your own needs, and don't know you want from yourself or others, then you are probably not ready to be in a healthy relationship yet. Work on your own issues. When you're ready, there will still be time.
In Your Addiction Before You Do.
Listen Up!
By Peggy L. Ferguson, Ph.D.
The family dynamics of recovery is rarely smooth sailing. Relapse, which is a process, has a tremendously negative effect on significant others. Family members who have labored and struggled to remain with the addict through all the active years of addiction, to assist them in finding their way into recovery, find their hopes and dreams dashed in the midst of relapse.
Anyone in a relationship with an alcoholic/addict is affected by addiction. Loved ones would understandably be upset and angry with the alcohol/other drug (AOD) addict when they relapse. Recovering spouses (or parents) who have developed and worked a program of recovery of their own, and who have struggled to mind their own program and practice healthy detachment may feel not only betrayed by the addict for the relapse, but by the sponsors and counselors who have repeatedly told them that it was not their job to work the addict's program for him/her. While they have learned and internalized the fact that they cannot keep the addict sober, they may blame themselves for giving up the hyper vigilance and "letting them relapse".
Warning signs can surface early in the relapse process. The spouse or parent of the addict may think back on the various red flags that they observed which would indicate impending relapse. They may have tried to communicate to the addict that they are observing relapse symptoms.
Alcoholics/addicts usually have difficulty hearing that they are exhibiting relapse symptoms and may feel criticized or controlled. The addict and their family members may engage in escalating conflicts and arguments.
In the midst of the relapse process before the actual chemical is ingested, the addict and spouse or parent may have renewed their struggle over the chemical. An example would be when the family member is attempting to tell the addict that they are afraid and anxious when the addict is once again spending time with the people that they used to use drugs with. They point out that they are also staying up all night and sleeping all day, things they routinely did while in the active addiction. The addict may view this as an attempt to control him/her. The addict may or may not see family members as trying to create a barrier between them and the chemical. In this example, they are in a struggle over the chemical-even before it is used again. The addict, then can justify using because "they are already being accused of it".
These are common examples of what happens in the family dynamics of addiction and recovery, and typical of the relapse process. Simplified, the relapse process, involves a return to old thinking, (e.g., rationalization, minimization, denial, blaming, etc.), old feelings (e.g., resentments), and old behavior.
Family members know long before the addict has any awareness of it that the addict is gearing up to relapse. The relapse process, like the disease, is predictable and preventable. Spouses and parents, who think that they understand addiction, may find themselves confused and angry about how the addict would let themselves get to this position once again.
Family members may think that the addict is consciously, deliberately, and maliciously trying to destroy his/her life and the very fabric and survival of the family. The addict's exhortations that they will not use, mean nothing in light of obvious relapse behavior.
Family members may know that the addict cannot see that they are in the relapse process and that they still believe that they are in control. The addict believes his/her own excuses and justifies going back to "using" places, with "using" friends, and not needing 12 step meetings or counseling. The addict believes that because s/he has decided to quit and stay quit that that is all there is to it. Family members remember when s/he said that before, and then relapsed.
Concerned relatives be sure that the addict is headed to relapse and the addict is positive that s/he is solid in her/his recovery and not thinking about using. They get frustrated in their attempts to verbally reassure the family. The best thing that the addict can do in this situation is to show them by exhibiting recovery behavior. All the verbal reassurance in the world does not stack up to letting the family see their behavior positively changed.
They can show that they are in recovery by using healthy living skills. One of the most important tasks in recovery is to identify the roles that the chemicals have played in your life and to replace the chemical with healthy living skills. If spouses or parents observe that the recovering person is using meetings, relaxation tapes/meditation/yoga, walking/exercise, and talking to others as new ways to manage stress (rather than drinking/using), these relatives will feel reassured about the addict's continuing abstinence and recovery. Compare that to the worried spouse observing the addict's irritability, dishonesty, sleeping until noon, avoiding meetings and not talking to anyone, as a way to manage stress. What would you think?
One of the things that family members learn in their own recovery is to trust their own intuition, observation, and judgment. Family members also learn that they don't have to re-engage in the game of "prove it", where they feel compelled to ferret out the truth, and if they can't, then they must believe the unbelievable. Recovering significant others also learn to identify their own bottom lines. They get to decide what they are willing to tolerate in their own lives. They have every right to decide not to stand by and watch their loved one slide down the slippery slope into relapse.
Significant others are invaluable to a recovering person's ongoing abstinence and relapse prevention. It is recommended that addicts and their close relative (i.e., spouses, parents, children) have a written relapse contract, which includes:
4. Early Addiction Recovery:
Essential Things You Need to Know For
Your Marriage To Survive Recovery
By Peggy L. Ferguson, Ph.D.
The first year of addiction recovery is often cited as the most difficult period of time in recovery-not just because early recovery is so fragile and the probability of relapse is greatest-but because relationships change in early recovery. Many marriages that survived decades of alcohol/drug addiction, do not survive early recovery.
The alcoholic/addict is making major changes in the first year of recovery and family members still feel neglected and unimportant. As the alcoholic/addict struggles to maintain sobriety, regroup with work and career goals, and recapture a positive sense of self, the spouse or other family member is usually still smarting over past hurts. They observe the alcoholic focusing on their own recovery and issues and wonder when they will carve out some time and attention for the family.
Family members who have picked up the slack as the addict has abdicated more and more responsibilities within the family, may now be expecting the recovering addict to reclaim those responsibilities. Once the drinking/using has stopped, family members expect the addict to be the person that they always want him/her to be. Family members may not even know that they hold this expectation, and are often confused by their anger at the addict over not changing fast enough, working a good enough program, or not accepting enough responsibilities.
Family members may also have the hidden expectation that the addict in recovery will be able to say or do something that will erase all the pain caused by the addiction. They think that when the addict "makes amends in the proper way" by being sorry enough, or really understanding how the family member feels, that it will take away the pain.
Although family members harbor these hidden expectations, they fear talking to the recovering person about them. They fear that such a discussion could cause a relapse in the addict. The fear is often rooted in memories of past behaviors and discussions.
Sometimes when they try to talk about the issues, the addict gets defensive and wants to leave the past in the past, and not dwell on old hurts and angers. The addict often does not want to hear about the pain of the family members brought about by his/her addiction because it hurts to hear it. The addict usually carries around a great deal of shame and guilt about having the addiction, about things that they did in the addiction, especially misdeeds involving loved ones. They still have denial and defenses that have kept the extent of the pain caused by the addiction to not be fully revealed to them.
Alcoholics/addicts often have skill deficits that keep them from effectively communicating and problem solving, or even identifying and managing feelings. Couples in recovery are often handicapped in problem solving on important issues because they operate from this skill deficit position and from a history of failed attempts. These failed attempts create more emotional debris that gets in the way and makes it more difficult the next time that they try to solve that same problem. As a result, the recovering couple is often trying to resolve old relationship issues that they have been unsuccessful in resolving. They may also be struggling over changes in power in the relationship, which may further hamper resolution.
In the midst of all the changes occurring in early recovery, relationships and families seek to regain a certain equilibrium or balance. Recovering couples and families struggle to redefine relationships, to restore old roles, responsibilities and power in the relationship(s). Sometimes it is not quite so simple or easy for the family member who has taken on all the addict's roles and responsibilities to give them back. The addict trying to regain their roles and responsibilities can be experienced as a threat to the family member.
The recovering addict may still be acting irresponsibly, continuing to lie, or continuing to be completely self-absorbed and narcissistic. The recovering person may, according to the perception of the family member, that they care little about the needs or feelings of others. The recovering person may want to be rewarded for the extreme sacrifice of giving up the chemical. Family members struggle to understand this line of thinking, hopefully watching and waiting for the recovering person to step up to the plate and take care of business-without being asked, bribed or rewarded for doing so. So, often the family has different expectations for the addict in recovery than the addict does. Often when this happens, the addict still feels controlled. Family members still feel taken for granted, taken advantage of, and often manipulated.
The newly recovering addict may also be making new friends and relationships and this can be threatening as well. The addict may not be as dependent as they were in active addiction. As they return to their previous level of functioning (or even higher), they may be growing past the level of functioning of the family member.
Another factor that threatens the relationship in early recovery is the extreme emotional ups and downs that the addict experiences. In trying to figure out what is going on with all this emotion, and with figuring out how they ended up where they are, the addict often questions their feelings about the marriage-whether they love their spouse, or even whether they ever loved their spouse. Addicts in early recovery often think about, or actually act upon, leaving their spouse.
The non-addicted family member often experiences a similar reaction, with trying to figure out if there is anything left that they have in common, or if too much damage has been done to the relationship. Family members may even feel that now that the addict is clean and can take care of himself/herself, that they are free to leave them. Or family members may be overwhelmed with a fear of relapse and think that they will never stay clean and sober.
Other stressors on the newly recovering marriage could include the unrepaired damage of the disease including legal problems, financial problems, career and work problems, unresolved anger and resentment among the in-laws-all of these want repair or resolution at a time when couples are often least equipped to resolve them. So often, the recovering addict and the family member have the expectation that when the using stops, everything will just fall into place. In most circumstances, nothing could be further from the truth. Being armed with knowledge about the typical difficulties of the marriage in early recovery, empowers a couple to begin to problem solve and work through those difficulties. Marriages strengthened by recovery of the members can ultimately be among the healthiest, happiest, and most secure marriages. But first, they have to make it past early recovery.
You may have resistance to change, saying to yourself or to others, "I need to make a change, but....." You might even ask others for help in making a change, then discount their suggestions with "Yes, but....". Perhaps you have "logical" or reasonable explanations for why their solutions or suggestions won't work for you. Perhaps your logical explanations for your limitations have to do with others. You might even blame others for being stuck. You may tell yourself that you could do something different if only your circumstances were better or your family members were different or more supportive, or less selfish.
You may have analyzed your situation and discovered the reasons and the factors involved in your uncomfortable immobility. You might know exactly why you are stuck. You may even know what it would take to get unstuck. But, how can you change when you lack the courage, the self-discipline or motivation to do so?
You cannot get unstuck and not change. Although change may be a scary thing, you have to embrace change to get unstuck. Small ongoing changes can make a big impact. Try some or all of these things and see what happens.
Sad? Bone-weary? Can't get enough potato chips, pasta or sweets? Not wanting to get up in the morning? Got the blues? Would you be surprised if someone said that you are depressed? Have you felt like this before during the winter only to find you feel better when the sun comes back out in the spring/summer? It might be Seasonal Affective Disorder (SAD). Sometimes the symptoms are mild; sometimes they are debilitating.
If you have this pattern that tends to occur during the fall and winter months, only to have the symptoms go away of their own accord in the spring and summer, it could be SAD. Most people that get SAD have normal mood the rest of the year. Some say their symptoms just seem to spring out of nowhere and others say that they began to feel this way gradually and that they kept getting worse.
The symptoms of Seasonal Affective Disorder vary among people. Those symptoms can include sadness, depressed mood, fatigue/low energy/lethargy, loss of interests, craving of carbohydrates, weight gain, social isolation and withdrawal. Other symptoms might include decreased sexual interest, and hopelessness. In extreme cases suicidal thoughts could be present and require immediate attention. The symptoms of depression can be mild to severe.
Where does SAD come from? Most sources link SAD to a general lack of sunlight in winter which affects brain chemistry and a person's biological clock or circadian rhythms, which puts them out of step with their own daily routine or schedule. Most sources believe that January and February are the most difficult times for SAD sufferers. It has also been suggested that some people are more pre-disposed to Seasonal Affective Disorder than others.
How can it be treated? If you are having these symptoms, it is appropriate to seek an accurate diagnosis for your symptoms, then help to reduce those symptoms. Most respected sources agree that increased exposure to sunlight can reduce the symptoms of SAD. So, you can look at your schedule and daily routine and figure out how you can maximize your exposure to sunlight on a daily basis. You could go for one hour walks daily. You might make sure that you let the sunshine into your home or office and move your furniture around so that you spend time in that sunlight. There is also "light therapy" that your doctor might recommend with an appropriate diagnosis of SAD. It has also been suggested to put your bedroom light on a timer where it will come on before you want to awaken. This could be helpful in one of your symptoms is difficulty awakening in the morning. Other options might include psychotherapy and/or antidepressants, especially SSRIs. Daily exercise and a balanced diet wouldn't hurt. Proactive problem solving, including being aware of and planning for lowered energy levels, can help reduce your stress and thus help manage your depression and other SAD symptoms.
Psychotherapy, especially cognitive therapy, is helpful. One of the ways that cognitive therapy helps is in challenging the negative triad of depression. These negative thoughts about self, the world, and the future, might tell you that you have always felt this way, deserve to feel this way, and will always feel this way. If you know that you have SAD, you can challenge those cognitive distortions with the reality that it is a real illness, that you didn't feel this way before the fall/winter, and that you will be feeling better by the spring/summer. Being aware of your symptoms and taking steps to take care of yourself is the first step in feeling better. There is no good reason to wait until you feel worse. Take action now and feel better soon.
Self-esteem is more than just feeling good about yourself. Self-esteem comes from how you think and feel about yourself. The concept encompasses not only the cognitive and emotional appraisals of self, but also has behavioral components. These three components reinforce each other in a circular fashion.
Self-esteem is an evaluation of self, which involves thinking about oneself and how you measure up to what you value and aspire to be. When you look inward and find yourself to be lacking those attributes or behaviors that you value, the emotional component comes into play. Perceptions of self and how they measures up to perceptions of others may set the stage for shame, guilt, sadness, loneliness, fear, and anger. The feelings you have when you think that you are less worthwhile than others, also sets the stage for your behavior.
If you evaluate others from an outsider's position and perception, then evaluate yourself from an insider's position and perception, you may fall short in the comparison. Most people forget when looking at others that they see a tiny portion of who that person is. They compare their "idealized perception" of the other person to the harsh intimate awareness of themselves--warts, fears, and all. Valuing comes into play here, as well. When you apply your values or standards to the idealized version of others, they look good. They appear competent, confident, worthy, and happy. When you apply the same standards or values to yourself, you may feel less competent and less worthy than they. When you determine that you are worth less, you may think you deserve less. These perceptions and assessments influence your behavior in all areas of your life.
If you lack self-worth and self-confidence, you may be reluctant to take risks to try new things for fear of failure. If you fail, you might be exposed as incompetent. If others know how incompetent you are, you would be abandoned or rejected. Because you don't want your incompetence to be exposed, you may adapt a host of defensive maneuvers that keep people at a distance and keep them from knowing you. You may act arrogant or egotistical. You may be judgmental or contemptuous of others. You may manipulate or put others down to feel better about self. Because low self-efficacy goes with low self-esteem and self-confidence, you may do everything you can to avoid responsibility for self, and blame others for your shortcomings.
Low self-esteem is related to all kinds of living problems in all three domains, cognitive, emotional, and behavioral. Some of these are: domestic violence, (on the receiving and offending side of the equation), alcoholism and other drug addiction, depression, anxiety, teen pregnancy, giving up on educational pursuits, eating disorders, and acting out behavior like delinquency, bullying, pathological lying, theft. Low self-esteem is linked to lack of assertiveness. If you do not demand to be treated appropriately, you will not be treated with the respect that you deserve. Low self-esteem and lack of self-efficacy is related to inability to make decisions, procrastination, and perfectionism. Lack of self-esteem, self-confidence, and self-worth keeps people quiet when they need to speak up to have their needs met and to take care of self.
If you don't think that you deserve good things in your life, this belief will determine in a negative way, a huge range of choices that you make. You may be afraid to take a risk to learn something new, to enter into a relationship, to take a new job, to move to a new place, to get out of a bad relationship, or to even nurture and take care of yourself. Your self-esteem determines the quality of the life you choose.
Self-esteem is not about being narcissistic, self-absorbed, or arrogant. It is about having a realistic appraisal of self. It is appropriately perceiving your value to self, others, and society in general. It is about identifying your strengths (as well as weaknesses), achievements, areas of competence, and determining that you have inherent worth. It is about believing that you have the most impact over your life and that you can determine your own destinies. It is also about knowing that you deserve all the happiness and success in your life that you can bring to yourself. It is also about taking responsibility for your own happiness and doing what is necessary to achieve it.
People with low self-esteem have a low estimation of their inherent worth. They tend to see themselves as inadequate, incompetent, unworthy, less than others, and unlovable. Low self-esteem is closely related to low self-efficacy. Self-efficacy means that you have power to produce effects.
This sense of low self-efficacy also extends to not being able to trust their feelings and judgement. They tend to have a hard time sensing "trustworthiness" in others. They distrust their own gut reactions to others. Since they have a great deal of difficulty being assertive, they tend toward extremes of passivity or aggression. They may tend to let people walk all over them, until they reach some threshold of tolerance, then they withdraw into passive aggression or become aggressive. Or they may generally present an aggressive stance that keeps people at a distance.
When people trample on their boundaries, they either don't notice, don't believe that there is anything they can do about it, or think that it's because of something that they did.
These self-doubting folks tend to people-please, trying to project an image of what they imagine others want them to be.
Self-esteem and self-concept are deeply related. Self-concept is that world view of self, or how you think about who you are. Self-concept includes beliefs, attitudes, and opinions that you hold about yourself and your relationships with the environment and people in it. People with low-self esteem have great difficulty describing self, their beliefs, and opinions. They don't know who they are.
They tend to see self as a sum of the roles they play and usually believe that they don't do well at the roles. They are self-deprecating. People with low self-esteem engage in negative self-talk. They say hurtful things to themselves inside their own heads that they would not say to others. When complimented they down play the compliment with qualifications or rejection like, "yes, but", or "you're just saying that; you don't mean it". Self-deprecating people focus on the negative aspects of themselves, while ignoring, discounting, or negating positive attributes.
People suffering from low self-esteem tend to have chaotic and conflicted relationships. They have trouble communicating wants and needs. They tend to expect others to know what they want and need and to give it to them without having to be asked. They expect that because that's how they interact with others. Self-effacing folks tend to feel angry and hurt when others don't reciprocate and do the same thing. They believe them to be self-centered and selfish. Conflict is inevitable due to inability to take risks and put themselves out there.
If they can't risk letting down defenses long enough to directly tell others what they want and need, the potential for confusion and conflict is immense. Without assertiveness no one can be direct and effective in their communication with others. Folks with low self-esteem tend to vacillate back and forth from passive to aggressive or to engage in passive-aggressive communication. They tend to be emotion driven. They over-react to interpersonal situations in their lives. They believe that their perception of an interpersonal event is the way that it is or was, that there is no other possible way to view it.
They don't know how to be truly intimate, so they tend to engage in pursuing/distancing dynamics. This is where one person needs a higher level of closeness at any given moment than the other person. The person with the higher need for closeness takes the other's lower need for closeness as evidence of a lack of caring, regard, or interest, and pursuing reassurance that they are still loved. People with low self-esteem have trouble being intimate with others, because to do so, they have to let down their defenses and risk exposing who they really are to someone else. They can't let others see who they really are, because they don't know who they really are. If you don't have a solid sense of self, you can't share it with another person. That is what intimacy is.
Sometimes they are self-sabotaging. They may fear success, or failure, or both. That fear is acted out in subtle ways that keeps things status quo. Fortune-telling of dire consequences of taking chances on change for growth and development keeps them stuck. They fear change. Fear of the unknown is much worse than any discontent and discomfort that they have with present circumstances.
Fortunately, it is possible to improve one's self-esteem and to change one's self-concept. To improve self concept it is necessary to get to know oneself. This includes getting to know and appreciate one's body, feelings, thoughts, relationships, tastes, opinions, and motives. This is a process. In the midst of self-discovery, it is appropriate to practice self-acceptance, recognizing oneself as less than perfect, yet still worthwhile. Changing how you think is necessary to improve self-esteem. Using cognitive therapy to challenge negative cognitive distortions about oneself, the world, and the future will help. A change in feelings follows a change in thinking.
Willingness to risk is crucial. While practicing taking risks, one should begin looking for the benefits of those risks. You cannot learn new things without risking. With trying out new things and discovering one's own competence, more self-efficacy is gained. Taking risks to reveal glimpses of the real person you are, is usually met with acceptance from others rather than their anticipated abandonment. These outcomes help increase self-confidence and a sense of worthiness. When you take the risk to tell others what you want, need, and feel, you learn assertiveness and practice intimacy skills. When you spend time thinking about the connections between your decisions and your situations, you begin to take responsibility for your own decisions and happiness. When you take responsibility for self, you are empowered.
Self-esteem really is an "inside job." Regardless of the deprivation, abuse, abandonment, or any other negative contributions from your family of origin, you can begin today to improve your self-esteem, empower your self-confidence, and begin to change your own life. Here is a list of suggestions to start doing immediately:
1. Start writing. Write about things you like, things you dislike, things that drive you crazy, things that inspire awe. Write about your feelings. Identify them. Label them. Own them. Say them proudly. "I feel .....". Period. No arguments from anyone about your feelings. You are the expert on them. Get to know yourself.
2. Identify what your own values. Question where you learned your values and identify if, indeed, the way you behave or the things you do, reflects YOUR values. If they don't do match, change your behavior to fit your values. Don't worry about what others may or may not think about that. Worrying about what others think about you, keeps you feeling fearful and less than. Let go of that. Always do what you believe to be right.
3. Cultivate relationships with people who affirm you rather than criticize you. Spend time with people who bring you up rather than putting you down to feel better about themselves. Eliminate or greatly reduce the amount of time and energy that you put into negative relationships. Find people to have fun with that you can enjoy, rather than feeling drained when you are around them. Cultivate friendships with people who can teach you new things and help you grow.
4. Learn and practice assertiveness. Identify the areas that you have problems being assertive in and the ones that you feel confident in. Ask yourself what you are doing in those areas where you are assertive that is different from what you are doing in the non-assertive areas. Most of the time you will find that the difference is "risking." Assertiveness skills are transferable. All it takes is to take the risk to do what you already know how to do, in an area where you have been afraid to try.
5. Pay attention to the kinds of things that you say to yourself in your own thoughts. Do you call yourself stupid when you make a mistake? Do you look in the mirror and focus on any negatives that you might see? Stop the self-criticism. Stop it all together. When you catch yourself criticizing yourself, replace the criticism with a positive. If you find yourself saying something like "I look horrible!", replace it with something like "I have such pretty eyes" or "I look better with makeup on", or "I look better when I shave."
6. Practice accepting compliments graciously. When someone compliments your hair or clothes, say something like, "Yes, this is a nice dress, isn't it" or "Thanks; I really like the way it looks today, too." Practice acceptance of someone's affirmation that you do something well. Say, "Yes, I do, don't I", or "Thank you." Period.
7. Try new things. Accept that you will not be able to do new things perfectly. Some new things you try, you won't even be able to do well. Try them anyway. If you have an interest in something, check it out. Who says you have to be perfect at everything you do? If it is you, who are saying it, stop it. Give yourself permission to try something new just because it would be fun, even if you are lousy at it.
One of the most powerful tools in working through feelings in addiction recovery is the use of Cognitive Therapy. I have been using this with my clients since the l980s when the technique was called Rational Emotional Theory (by Albert Ellis). Aaron Beck is credited with Cognitive Therapy, which seems to have evolved from RET by application and further development. Some time ago, I came across a worksheet entitled, "The ABCs of RET", that had a very simple format. It explained how to use this technique to identify the Activating Event (A), the Belief about that event (B), and the Feelings associated with the Belief (C). I believe that D) the behavior came along along later. This worksheet used the example of seeing a mouse. This is how it works:
1. What is the Activating Event? Example: My spouse says "I'm leaving" in the middle of an argument.
At this point, you go back to #1, the activating event, which remains the same, then challenge the automatic thought that you had about the event.
What is Depression?
By Peggy L. Ferguson, Ph.D.
By Peggy L. Ferguson, Ph.D.
One of the most difficult experiences you can have in your entire life, is the loss of a loved one. It is one of the most stress life events there is. No one is ever fully prepared for the death of a loved one--even when they have been sick for some time. You may think that you know how you will feel, but chances are good, that what you expected to experience is not what happens.
Grief is such a solitary experience that it often feels as if we are going through it all alone. This is despite the probability that we have others in our families or in our lives who are also grieving the person we have lost. The experience of grief is one that most people past a certain age have had. It is a universal life event. Yet, we feel so all alone in our experience of it.
We each experience and deal with grief in our own unique, individual way. There are no "rights" or "wrongs" in how we grieve. There is no published time table or established norm for the length of time appropriate for mourning the loss of a parent, a spouse, a child, or a friend.
Many people expect others to be devastated by the loss of someone that they love, yet do not believe that they should experience the pain that they have. We know that others will be having emotional and psychological symptoms, even physical symptoms. Yet when we experience some of those, we may shame ourselves or put ourselves down for being “weak”. We may believe that we should recover quickly from the loss and get on with our lives. We may not expect to feel angry.
Many people go through a brief shock or emotional numbness. It may even surprise you when you begin to feel the overwhelming loss and sense of separation/absence. You miss, or even long for the person, their presence, their contributions, their help, even their annoying habits. There is often a period of disorganization where you have trouble concentrating, or following through with anything. You may feel generally incompetent and incapable of accomplishing anything. It is as if you need to relearn to do the normal things in your life without that person.
Eventually, you seem to regain a kind of personal balance and are able to reorganize your life and regain your ability to focus. Sooner or later you will be able to see a project from beginning to end and will be able to envision a life without them. Eventually we adjust to their being gone. There is no disloyalty in adjusting to reality.
Anger is also a normal part of the grieving process. This anger usually needs a focus, so it often comes out sideways. Sometimes the focus gets projected onto the funeral home, the hospital, the nursing staff, or cousin Bob that was never there before the end, God, or yourself for not saving him/her. Often the person you are angry with is the one who died. You feel angry with them for abandoning you. The whole idea of being angry with someone that didn't want to die, seems absurd or somehow "wrong", yet, that is often the case.
People often feel angry with God over their loss and this may sit just as uncomfortably with folks who believe it is just plain "wrong" to be mad at God, yet that is exactly what is going on.
Anger is just a feeling. It is not wrong to feel anger. It is not wrong for it to have a focus that doesn't make any sense to you. The thing to do about the anger you experience with grief is to keep talking about it. Write about it; feel it. Ask yourself about the meanings that you give to the things that you are angry about. Don't act out your anger. Remember that anger can come out sideways toward other family members. They may actually have very little to do with it.
Many family members come apart when significant people die and the cohesion and unity of that family is lost. Acting out of anger can increase the probability of that happening. One of the ways that anger is acted out, is in blame. Many times, we don't know why someone dies and we will never know why they died. We have a "should" in our minds that the people we love should live for a long, long time, and if they don't, someone must be at fault.
Guilt is similarly a normal part of the grieving process. Many people who experience the loss of a loved one will find something to feel guilty about. It just seems to go with the territory. We may feel guilty about not spending enough time with them, about being cranky when they were demanding, or for “not knowing or understanding” some information that might have changed the outcome. Children feel guilty as well, so it is important to check with the kids to see what they are thinking and to re-assure them that it is not their fault.
The best things to do to deal with your grief is to give yourself permission to grieve and the time that you need to do it. Feel what you feel. Talk about it. Let other people be there for you. If they try to tell you how to grieve or how long to cry, tell them that their suggestions are not helping. You can be assertive with others who don't know what to say or do to help you, by giving them the feedback of what is helping and what is not.
Family culture has a big impact on how you deal with grief. If your family members jus shut down and believe that if you don’t think about it, it will go away, you may think that this is the best way to handle it. This is usually not the case, however. Similarly, some families routinely visit the grave site of family members who have died, while other families never return, except to bury another member. You have to decide what is right for you in how to grieve and how to celebrate the lives of your loved ones.
Sometimes people in your life will get frustrated with your ongoing grief because they can't fix it. For many people the experience of helplessness moves right into anger. If you need a willing ear, join a grief group or go to counseling. Get whatever help that you need to accomplish the process. Don't shame yourself for grieving. When someone that you love dies, you are supposed to grieve.
Below are suggestions to assist you in getting through the grieving process:
1. Write about your favorite memory of the person you lost.
2. Pull out some pictures that are not too painful and talk about the event or the time that the picture was taken.
3. Seek out people who have experienced a similar loss and who understand what you are going through.
4. Keep a journal.
5. Read about grieve and loss- to tolerance.
6. Talk about the person.
7. Identify, own, and express your feelings. Keep in mind that fear, anger, guilt, hurt, sadness, and abandoned are common.
8. Talk about any anger that you might have toward God or the person who died.
9. Do things to get out of self. Volunteer, garden, or do something for your neighbor.
10. If you are in charge of their stuff, get help to sort through it all. Have someone else present. Take lots of breaks. Cry. Talk about your feelings. Do it to tolerance.
11. Maintain your social life. Get out and about -- to tolerance again.
12. Go to a grief support group.
13. Don't pretend to feel what you don't feel. Be real.
14. When you are hit with another wave of grief when you least expect it, just acknowledge it and feel it. Don’t beat yourself up about not being finished with grieving yet. Give your self credit for making it through each wave.
15. Use this time to nurture yourself.
16. Try to be tolerant of others when they say dumb stuff that is not helpful. They probably mean well and are using their own family culture norms to try to help you through the process.