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In a lamp lit room, a group of six casually dressed people sit in chairs which are arranged in a circle.  All, but one, seem to be engaged in two or three different conversations as a more formally dressed woman enters the room. She sits in one of the vacant seats of the circle as the people in the room gradually turn their eyes toward her. “Good morning,” she says, “you guys are a bubbly group this morning.” She smiles wryly as a tall gray-haired man in the group says, “Well, Amy started it.” He turns his gaze onto a thirty-year-old blonde woman sitting to his left who smiles as she begins to explain, “I picked up my six-month chip last night. It’s the longest I have been sober since I started drinking fifteen years ago.” Members of the group all offer her their congratulations in various ways. John, the quiet one, glances up quickly and says in a flat voice, “Keep up the good work, Amy.” “You don’t seem yourself today, John. What is going on with you,” asks the more formally dressed woman, a therapist facilitating this relapse prevention therapy group. Looking down at the floor, John reveals to the group that he used yesterday.

Like everyone else in this therapy group, John is an addict. Most of the people in the room have at least 90 days clean and are now working on relapse prevention skills. If they are not actively using drugs or alcohol, why are they still in treatment? What are relapse prevention skills? And, what is a “relapse”?

One reason to remain in treatment after discontinuing the use of substances is because the physiological addiction is only part of the challenge. Long after the individual has ceased substance use, the psychological and behavioral elements of addiction remain. Many addicts struggle with how to cope with stress, celebrate, socialize, or even go to sleep without relying on a substance.    These elements of addiction need to be addressed or most addicts slip right back into substance use.

Another aspect to consider is that “withdrawal symptoms” can actually last for up to two years after cessation of use. While the acute symptoms may alleviate within a few weeks, there are “post acute” withdrawal symptoms that follow. During this time, changes that occur in the brain, as the brain is adjusting to no longer having the effects of the substance use, can trigger a person to want to use. It can even cause them to have very vivid dreams of using that are so real, the individual may have trouble telling the difference between the dream and reality.

This is what happened to John mentioned earlier. He awoke one morning having had a “using dream.” It felt real, as if he had used his drug of choice and actually felt high. Realizing this was a dream, he tried to put it out of his mind, but he just kept thinking about it. He didn’t share his struggles with anyone, feeling like a dream was a silly thing with which to trouble his sponsor and other friends. Later that day, he received a call from an old using buddy whose car had broken down and who needed a ride. John picked up his friend, and when he dropped that friend off, the friend repaid him for his help with his drug of choice. John tried to decline, but his friend left the drugs on the seat of the car and waved goodbye. John returned home to an empty apartment and used.

The bottom line is, getting sober is different from staying sober. To recover from substance addiction requires learning a new lifestyle, developing a support system that will help you maintain that lifestyle, and learning how to cope with life on life’s terms… without using. The relapse prevention phase of treatment focuses on achieving these goals. While someone, like John, might slip up and use while in the process of learning such skills, they can remain connected with support and treatment, using the experience as a learning tool, and preventing a complete return to his/her former way of life.

After John shared with the group, they offered him support. Amy said, “John, I know how hard it was to come in here and say that. I know I’d be worried that people would judge me, so thank you for sharing and showing us that it is safe to do so.” Others chimed in and echoed Amy’s commendation. One group member shared, “When I feel like I  want to use, I call someone from our group and call my sponsor. I keep calling numbers until I get someone on the phone.” Another said, “When I am craving, I get out of wherever I am and go somewhere safe. I like to walk on the beach. It clears my mind and calms me down.” Then, the therapist facilitated a discussion around the various elements of John’s story and the skills that any group member could use should any of them face similar things in the future.

  • I am a Psychologist and Clinical Addictions Specialist at the Chrysalis Center. I have successfully treated individuals who struggle with addiction for eight years. I also treat individuals with binge eating, anxiety, depression, and trauma challenges. To schedule an appointment to see me, please call the Chrysalis Center at 910.790.9500. ~Lillian Hood, LPA, LCAS

*John and Amy are fictional characters used to demonstrate the real experience that individuals under these circumstances tend to face.



Lisa*, a 41-year-old woman, wakes up at 5:45am to the screeching sound of an alarm clock. She rolls over and slaps it furiously to silence the brain piercing sound. She sighs and says in a determined whisper, “Thirty-six days.” As she begins her daily routine, worries swirl around her mind…”Did I forget to wash my coffee cup before I went to bed last night? If I left it out again, I will get fined by the recovery house manager. What if the bus is running late this morning… they’ll fire me if I’m late again. How am I going to make it to my therapy appointment today? I think my roommate hates me. She’s always so mad that I have to be up before she wants to get up when I work a morning shift. Am I going to have enough money to pay my rent?” Her chest feels tight, and she is filled with dread before the day even begins. Lisa lives in a recovery house. A recovery house is a place where addicts live with other addicts who are working on recovery from addiction. The recovery house provides structure, accountability, and support to those who are willing to comply with the rules of that recovery house’s program and who are actively pursuing recovery. Lisa shares a room with another woman who is in recovery from heroin. She has been sober from heroin for 31 days, and Lisa has been sober from alcohol for 36 days. However, Lisa faces a challenge in her recovery that her roommate does not. Lisa has Generalized Anxiety Disorder in addition to her addiction.

The National Institute on Drug Abuse (NIDA) states that individuals diagnosed with a substance use disorder are twice as likely as a member of the general population to be diagnosed with a co-occurring mental health disorder. In addiction, when an individual stops using a substance such as alcohol or another drug, the body goes through a period of time, called withdrawal, where it is adjusting to the absence of the substance. During this time, it is particularly difficult for an individual to refrain from using since using is the easiest way to stop withdrawal symptoms. These symptoms vary depending on the substance(s) used by the individual and can include extraordinary pain, depression, sweats, goose flesh, vomiting, diarrhea, and seizures. This is considered “acute” withdrawal. Depending on the amount and duration of substance use, this can last for a few weeks. After these symptoms subside, a person will go through “post acute withdrawals” which can include forgetfulness, inability to focus, confusion, emotional disregulation, sleep disturbance, emotional numbness, depression, anxiety and more. This can last up to two years after completely ceasing use and generally lessens over time. During post acute withdrawal, the extreme experience of emotions, depression, anxiety, and feelings of boredom are major triggers to use.

So, as you think about Lisa’s story, imagine what it is like to have used alcohol to cope with anxiety, only to have become addicted to alcohol. Having realized that her life had become unmanageable, she sought help at a recovery house and at a clinic where they treat people who have co-occurring mental health and substance use disorders. She is motivated to “get her life back” and tries hard to follow the advice given by those who know more than she knows about the road to recovery, but she still struggles daily with overwhelming feelings of anxiety, all the while her brain is begging her to fix it the old way… with alcohol. She is also not immune to the emotional effects of post acute withdrawal symptoms that are common at this point in her recovery, and her anxiety can be exacerbated by these symptoms. She can seek medical attention for her anxiety but is afraid of becoming reliant on a pill to cope with anxiety. She only considers this as an option because the symptoms of her generalized anxiety are so severe that she is afraid she will relapse on alcohol if she doesn’t stabilize her mental health.

Individuals who suffer from co-occurring mental health and substance use disorders face the challenge of staying sober while not being able to lean on the substance that they have used for so long to medicate their mental health disorder. They also face the challenge of coping with mental health symptoms complicated by post acute withdrawal symptoms. Structure, accountability and support is often not enough to help them overcome this special challenge. Frequently, medication and psychotherapy are necessary to stabilize their mental health disorder symptoms while they build the skills for living a sober lifestyle. Programs that include this combination offer hope to those who are determined to make a change and willing to work hard to begin a new life.

*Lisa is a fictional character created to represent real circumstances and challenges faced by those who suffer from co-occurring mental health and substance use disorders.

Lillian Hood, LPA, LCAS
Psychologist and Clinical Addictions Specialist
At the Chrysalis Center, I specialize in treating individuals with co-occurring disorders. This includes working with individuals who have trauma, depression, bipolar, anxiety, and/or eating disorders along with an addiction. I use evidence-based practices to help patients develop skills for successfully facing this unique challenge.

Reference:
National Institute on Drug Abuse www.drugabuse.gov
National Association for Alcoholism and Drug Abuse Counselors www.naadac.org


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