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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.



Michael*, a 52-year-old man who has recently reconciled with his wife, walks in his front door shortly after 9:00pm on a Monday evening. His wife is sitting on the sofa watching Law & Order on Netflix. She looks over at him suspiciously, “Did you work late today?” “No,” he says,” I went to a meeting.” “You go to your meetings on Tuesdays and Thursdays…” she says with a “gotcha” tone.  Michael, fighting becoming exasperated, looks her in the eye and says, “I’m going to have to work late tomorrow and I’ll end up missing that meeting, so I went today to keep up my routine of two meetings a week.”  Michael’s wife still looks discontented. Looking away, she says, “Fine.” Then she mutters, “Are you going to go to two of those meetings a week for the rest of your life? And, aren’t you still doing therapy too? I thought we’d eventually get our life back.”

Michael is an alcoholic and has been attending AA meetings for about nine months now, and has been in therapy for just as long. Why does he do both? How long will this go on?  First, AA or Alcoholics Anonymous is a self help group, and it’s not the only self help group out there for individuals struggling with an addiction. Let’s start by looking at what self help groups are and then we can look at what role therapy plays in a person’s recovery.

Here, in the Wilmington, NC area, we have a few different self-help/self-empowerment groups for those seeking self help for addiction. I’m going to talk about AA (Alcoholics Anonymous), NA (Narcotics Anonymous), CR (Celebrate Recovery), and SMART Recovery (Self Management And Recovery Training).  Most people have at least heard of AA and NA. These two groups are aimed at helping people in similar ways. The major difference is that AA is specifically geared toward alcoholics and NA is open to a variety of chemical dependency addictions. These two groups provide a support network and guidance for individuals who have a desire to live a clean and sober lifestyle. Individuals are encouraged to get a sponsor, someone who has experience in recovery and the AA/NA “program,” otherwise known as the 12-step program.  A sponsor guides the addict through working the steps and provides support for recovery and a lifestyle free of addictive behaviors. This program asks members to acknowledge a “higher power” to whom they will give over their will and in whom they trust to help them with their addiction. Although this program originally began based on biblical principles and Christianity, currently the wording is changed to include all forms of belief in a power greater than yourself.

Celebrate Recovery, on the other hand, is strictly a Christian self help group. This group covers all addictions, habits, and hang-ups that a person wants to change and can include everything from alcohol to sex, co-dependency and gambling. This program is similar to AA/NA in many other ways including a 12-step program and sponsorship.

SMART Recovery is not based in any form of spiritual belief system. It is specifically based on scientific research and the principles of cognitive-behavioral therapy. They teach the “4-Points” which include working on motivation, learning how to deal with urges, managing thoughts, feelings and behaviors, and living a balanced life. In SMART Recovery, there are usually fewer meetings offered in a community, and there is not as broad of a community of support as tends to be available through AA/NA and CR. Which one should you choose? Anecdotally, I know of success stories from individuals who have used each of these programs. I’m a firm believer in doing what works for you!

Why should a person do therapy and engage in self help? Self-help groups offer a level of support that is just not available through meeting with a therapist. However, a trained professional is able to identify and treat problematic behaviors and mental health issues. This is not something that self help groups are truly able to do. For example, individuals who have survived a trauma are especially vulnerable in a way that is best addressed by someone who is trained to do so. I have seen many trauma survivors relapse because someone well meaning addressed the individual’s trauma in a way that triggered nightmares or flashbacks that the trauma survivor was not skilled enough to handle yet. Issues related to mental health and trauma frequently rise to the surface once the addiction isn’t masking them. This is why many of the individuals who are successful at managing an addiction often attend therapy in addition to participating in self-help groups. It allows an individual to benefit from the strengths of both methods and increase the likelihood of success in reaching recovery goals.

Michael, mentioned in the outset, is a trauma survivor. He attends AA meetings to address his addiction, develop a new lifestyle, and gain support from those who understand his journey. He participates in therapy for all of those reasons and also to address his trauma and develop the skills he needs to deal with trauma symptoms without drinking. He will attend some kind of 12-step meeting for the rest of his life as part of his program of recovery. When his sponsor agrees that he is ready, he will sponsor those who need help and request his guidance. He will provide support for other members of AA and for “new comers” for years to come. Michael attended 90 meetings in the first 90 days of his sobriety, as suggested by his sponsor, and has now reduced down to twice per week. His personal goal is to always attend at least one meeting per week. However, if he finds himself struggling for whatever reason, he will attend as many meetings as he can, and he will call members of his support system for help. As far as therapy goes, when he started nine months ago, he attended intensive outpatient therapy for the first 90 days of his sobriety. This means that he attended nine hours of group therapy and one session of individual therapy per week. Upon completion of intensive outpatient therapy, he began attending two individual therapy sessions per week and is still doing so six months later. As he accomplishes therapy goals related to addiction and trauma, he will reduce down to attending one session per week, then one session every other week, then once per month, and then at some point, he will no longer need to participate in therapy. In the mean time, he also faces the challenge of helping his loved ones understand what he needs to do to be a healthy person. He will probably discuss this with his therapist and his sponsor before addressing the issue with family members who are struggling to understand how he spends his time and what it takes for him to stay in recovery. With support and the application of what he learns through AA and therapy, he has a good chance of succeeding!

*Michael is a fictional character used to demonstrate the real experience that individuals under these circumstances tend to face.

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.

References:

Alcoholics Anonymous  www.aa.org

Celebrate Recovery       www.cr-inside.com

Narcotics Anonymous   www.na.org

SMART Recovery  http://www.smartrecovery.org


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