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DRUGS of ABUSE

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RECOVERY LIFESTYLE

Champagne.LCDC — Thu, 26 Apr 2007 01:56:47 CDT

The 12 Steps of Alcoholics Anonymous

We admitted we were powerless over alcohol--that our lives had become unmanageable.
Came to believe that a Power greater than ourselves could restore us to sanity.
Made a decision to turn our will and our lives over to the care of God as we understood Him.
Made a searching and fearless moral inventory of ourselves.
Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
Were entirely ready to have God remove all these defects of character.
Humbly asked Him to remove our shortcomings.
Made a list of all persons we had harmed, and became willing to make amends to them all.
Made direct amends to such people wherever possible, except when to do so would injure them or others.
Continued to take personal inventory and when we were wrong promptly admitted it.
Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

Overview of the 12 Step Program
The 12 Step program has its origin in the formation of Alcoholics Anonymous (A.A.) in the 1930s. The major text for A.A. is called "Alcoholics Anonymous", also known as "The Big Book". The Big Book has gone through four editions, with the latest version available from the Alcoholics Anonymous World Services, Inc.. The Big Book is an account of Bill Wilson (Bill W.), Dr. Bob and friends and how the formation of A.A. came about and how it worked for them. The book is primarily biographical in nature and lays out the 12 steps in the context of the lives of those in A.A. There are other books that lay out the steps in a more methodical manner, such as the book Twelve Steps and Twelve Traditions, (known as the "12 and 12") also from Alcoholics Anonymous World Services, Inc..

Since the 12 Step program has been the most successful overall recovery program to date for alcoholism and has been applied to other addictions as well, then there are of course a myriad of other books and websites that cover the 12 step program in a variety of contexts and from different angles (for example, you can browse at Barnes and Noble or Amazon.com for various 12 Step and recovery books).

Since the Big Book is the classic book on the 12 step program, we make reference to and have excerpts from that book on all of our pages dealing with a given step (You can also read the entire Big Book, second edition, online in our references section).

The pages for any given individual step can be reached from the top menu items under The Steps. You can read through the original text of the Big Book that relates to a given step by clicking the "More about Step..." link on the web page for that step. We also have comments about the step from other authors. The summaries on these pages for individual steps should give you an overview of what the step is about. For further details, you can read the aforementioned texts, visit some of the other websites, or read one of the books that deals with 12 step programs in greater detail.

The 12 step program as it has been propagated since the days of A.A. is about finding freedom from the pull of addictive behaviors. That may sound like a simple thing to some people, but anyone who has battled addictive behaviors knows that in practice it can be anything but simple. It can be difficult, frustrating, confusing and sometimes life-threatening or lethal as one tries to battle the sly ways of their addiction. Hopefully at this 12Step.org site you will find some information and tools that will help you to better understand how 12 Step programs work and decide if they are applicable to your life or the life of someone you care about. The 12 Step program, worked well, can bring order, simplicity and clarity to the recovery process and make it easier to experience the serenity and strength that comes from true recovery.

As mentioned, the 12 Step program has proven successful in dealing with alcoholism and has been applied to many other addictive behaviors. In dealing with other addictive behaviors besides alcoholism, however, comments from the book Twelve Steps and Twelve Traditions (p. 64-65) about Step 6 are quite relevant. It brings up the relevant question of how much an addictive behavior is based on natural, God-given instincts versus how much an addictive behavior is contrary to our natural instinct to survive and so can more simply be done away with entirely.

The 12 Promises
The 12 promises are from pps. 83-84 of the Big Book.

If we are painstaking about this phase of our development, we will be amazed before we are half way through . . .

We are going to know a new freedom and a new happiness.
We will not regret the past nor wish to shut the door on it.
We will comprehend the word serenity.
We will know peace.
No matter how far down the scale we have gone, we will see how our experience can benefit others.
That feeling of uselessness and self-pity will disappear.
We will lose interest in selfish things and gain interest in our fellows.
Self-seeking will slip away.
Our whole attitude and outlook upon life will change.
Fear of people and of economic insecurity will leave us.
We will intuitively know how to handle situations which used to baffle us.
We will suddenly realize that God is doing for us what we could not do for ourselves.

Are these extravagant promises? We think not. They are being fullfilled among us - sometimes quickly, sometimes slowly. They will always materialize if we work for them.

MORE ABOUT METHAMPHETAMINE

Champagne.LCDC — Thu, 26 Apr 2007 01:40:57 CDT

Effects of Meth
Meth does a lot of damage to people who use it. (As a matter of fact, death may not be the worst of its potential effects.) And you can find out about that type of thing in symptoms, and detecting a user.

But users aren't the only ones who are affected it effects family, neighbors and those that effected by the crime that arises from meth use.

Meth labs regularly blow up in ordinary neighborhoods, damaging ordinary people who may not even know what meth is.

And then there's meth-related crime. Its victims aren't limited to users of meth either. The truth is you don't necessarily have to be involved with meth to feel its effects.

Some of the symptoms of methamphetamine use are:

Sleeplessness
Loss of appetite and weight loss
Nausea, vomiting, diarrhea
Elevated body temperature
Skin ulceration and infection, the result of picking at imaginary bugs
Paranoia
Depression
Irritability
Anxiety
Increased blood pressure
Seizures
For pregnant women - premature labor detachment of the placenta, and low birth weight babies with possible neurological damage.
For intravenous (IV) users -AIDS, hepatitis infections and sores at the injection site, and' infection of the heart lining and valves.

Range of Effects
Common immediate side effects.:

Euphoria
Increased energy and attentiveness
Diarrhea, nausea
Loss of appetite, insomnia, tremor, jaw-clenching (Bruxism)
Agitation, compulsive fascination with repetitive tasks (Punding)
Talkativeness, irritability, panic attacks
Increased libido
Dilated pupils

Side effects associated with chronic use:

Drug craving
Weight loss
Withdrawal-related depression and anhedonia
Rapid tooth decay ("meth mouth")
Amphetamine psychosis, mainly due to sleep deprivation

Side effects associated with overdose:

Brain damage (Neurotoxicity)
Formication (sensation of flesh crawling with bugs, with possible associated compulsive picking and infecting sores)
Paranoia, delusions, hallucinations
Rhabdomyolysis (Muscle breakdown) which leads to Kidney failure

Death from overdose is usually due to stroke or heart failure, but can also be caused by hyperthermia or kidney failure.

Meth Mouth

Methamphetamine addicts may lose their teeth abnormally quickly, a condition known as "meth mouth". This effect is not caused by any corrosive effects of the drug itself, as per commonly repeated myth. According to the American Dental Association, meth mouth "is probably caused by a combination of drug-induced psychological and physiological changes resulting in xerostomia (dry mouth), extended periods of poor oral hygiene, frequent consumption of high calorie, carbonated beverages and tooth grinding and clenching."[8] Similar, though far less severe symptoms have been reported in clinical use of other amphetamines, where effects are not exacerbated by a lack of oral hygiene for extended periods

Like other substances which stimulate the sympathetic nervous system, methamphetamine causes decreased production of acid-fighting saliva and increased thirst, resulting in increased risk for tooth decay, especially when thirst is quenched by high-sugar drinks.

Sexual Behaviour

Users may exhibit sexually compulsive behaviour while under the influence. This disregard for the potential dangers of unprotected sex or other reckless sexual behavior may contribute to the spread of sexually transmitted infections (STIs).

Among the effects reported by methamphetamine users is an increase in the need and urgency for sex, the ability to have sex for extended periods of time, and an inability to ejaculate or reach orgasm or physical release. In addition to increasing the need for sex and enabling the user to engage in marathon sex sessions, methamphetamine lowers inhibitions and may cause users to behave recklessly or to become forgetful.

According to a recent San Diego study, methamphetamine users often engage in unsafe sexual activities, and forget or choose not to use condoms. The study found that methamphetamine users were six times less likely to use condoms. The urgency for sex combined with the inability to achieve release (ejaculation) can result in tearing, chafing, and trauma (such as rawness and friction sores) to the sex organs, the rectum and mouth, dramatically increasing the risk of transmission of HIV and other sexually transmitted diseases. Methamphetamine also causes erectile dysfunction due to vasoconstriction.

Addiction
Methamphetamine is potentially addictive, particularly when injected or smoked. While not life-threatening, withdrawal is often intense and, as with all addictions, relapse is common. To combat relapse, many recovering addicts attend 12 Step meetings, such as Crystal Meth Anonymous.
In an article about his son's addiction to methamphetamine he said to his son that you need to quit being such a stupid stoner, a California writer who has also experimented with the drug put it this way:

This drug has a unique, horrific quality. In an interview, Stephan Jenkins, the singer in the band Third Eye Blind, said that methamphetamine makes you feel 'bright and shiny.' It also makes you paranoid, incoherent and both destructive and pathetically and relentlessly self-destructive. Then you will do unconscionable things in order to feel bright and shiny again.

Former users have noted that they feel stupid or dull when they quit using methamphetamine. This is because the brain is adapting a need for methamphetamine to think faster, or at what seems to be a higher level. It is possible that daily administration of the amino acids L-Tyrosine and L-5HTP/Tryptophan can aid in the recovery process by making it easier for the body to reverse the depletion of Dopamine, Norepinephrine, and Serotonin. Although studies involving the use of these amino acids have shown some success, this method of recovery has not been shown to be consistently effective.

Serious drug addiction correlates with poor hygiene and general self-care, and even minor health problems can lead to serious complications when left untreated. Striking health problems popularly associated with methamphetamine addiction, such as severe tooth decay or massive skin infections, are caused by unsterilized needles and a lack of hygiene. Even long-term use does not generally result in outward symptoms, but may lead to hypertension, damage to heart valves, and increased risk of strokes.

MORE ABOUT CRACK COCAINE

Champagne.LCDC — Thu, 26 Apr 2007 01:13:08 CDT

How Do People Get Addicted to Crack?

Cocaine is a highly addictive substance. People who take it can become physically and psychologically dependant upon it to the point where THey can't control their cravings. Researchers have found that cocaine-addicted monkeys will press a bar more than 12,000 times to get a single dose of it. As soon as they get it, they will start pressing the bar for more.

Crack and other addictive drugs chemically alter a part of the brain called the reward system. As mentioned previously, when people smoke crack, the drug traps the chemical dopamine in the spaces between nerve cells. Dopamine creates the feelings of pleasure we get from enjoyable activities such as eating and having sex. But in crack users, dopamine keeps stimulating those cells, creating a "high" -- a euphoric feeling that lasts anywhere from five to 15 minutes. But then the drug begins to wear off, leaving the person feeling let-down and depressed, resulting in a desire to smoke more crack in order to feel good again.

The brain responds to the dopamine overload of the crack high by either destroying some of it, making less of it or shutting down its receptors. The result is that, after taking the drug for a while, crack users become less sensitive to it and find that they must take more and more of it to achieve the desired effect. Eventually, they cannot stop taking the drug because their brains have been "rewired" -- they actually need it in order to function. How long does it take to become addicted? That varies from person to person, and an exact number is difficult to pin down, especially when physical addiction is paired with psychological addition.

Of course, not everyone reacts the same way to extended use. Some users actually become more sensitive to crack as they take it. Some people die after taking a very small amount because of this increased sensitization.

When an addicted person stops taking crack, there is a "crash." He or she experiences the symptoms of withdrawal, including:

Depression
Anxiety
Intense cravings for the drug
Irritability
Agitation
Exhaustion
Anger

Side Effects of Crack Use
While crack is creating a feeling of exhilaration in the user, it is also leaving a number of significant and potentially dangerous effects on the body. People who take it even a few times are at increased risk for heart attack, stroke, respiratory problems and severe mental disorders.

As crack moves through the bloodstream, it first leaves the user feeling energized, more alert and more sensitive to sight, sound and touch. Heart rate increases, pupils dilate and blood pressure and temperature rise. The user may then start to feel restless, anxious and/or irritable. In large amounts, crack can make a person extremely aggressive, paranoid and/or delusional. Because of its effects on the heart rate and breathing, crack can cause a heart attack, respiratory failure, strokes or seizures. It can also affect the digestive tract, causing nausea, abdominal pain and loss of appetite.

If crack is taken with alcohol, the two substances can combine in the liver to produce a chemical called cocaethylene. This is a toxic and potentially fatal substance that produces a more intense high than crack alone but also raises heart rate and blood pressure more than crack alone, leading to its potentially deadly results.

MORE ABOUT MARIJUANA

Champagne.LCDC — Thu, 26 Apr 2007 01:00:24 CDT

How Marijuana Works
Marijuana and the Brain

THC is a very potent chemical compared to other psychoactive drugs. An intravenous (IV) dose of only one milligram (mg) can produce serious mental and psychological effects. Once in your bloodstream, THC typically reaches the brain within seconds after it is inhaled and begins to go to work.

Marijuana users often describe the experience of smoking marijuana as initially relaxing and mellow, creating a feeling of haziness and light-headedness. The user's eyes may dilate, causing colors to appear more intense, and other senses may be enhanced. Later, feelings of a paranoia and panic may be felt by the user. The interaction of the THC with the brain is what causes these feelings. To understand how marijuana affects the brain, you need to know about the parts of the brain that are affected by THC. Here are the basics:

Neurons are the cells that process information in the brain. Chemicals called neurotransmitters allow neurons to communicate with each other.
Neurotransmitters fill the gap, or synapse, between two neurons and bind to protein receptors, which enable various functions and allow the brain and body to be turned on and off.
Some neurons have thousands of receptors that are specific to particular neurotransmitters.
Foreign chemicals, like THC, can mimic or block actions of neurotransmitters and interfere with normal functions.

In your brain, there are groups of cannabinoid receptors concentrated in several different places. These cannabinoid receptors have an effect on several mental and physical activities, including:

Short-term memory
Coordination
Learning
Problem solving

Cannabinoid receptors are activated by a neurotransmitter called anandamide. Anandamide belongs to a group of chemicals called cannabinoids. THC is also a cannabinoid chemical. THC mimics the actions of anandamide, meaning that THC binds with cannabinoid receptors and activates neurons, which causes adverse effects on the mind and body.

High concentrations of cannabinoid receptors exist in the hippocampus, cerebellum and basal ganglia. The hippocampus is located within the temporal lobe and is important for short-term memory. When the THC binds with the cannabinoid receptors inside the hippocampus, it interferes with the recollection of recent events. THC also affects coordination, which is controlled by the cerebellum. The basal ganglia controls unconscious muscle movements, which is another reason why motor coordination is impaired when under the influence of marijuana.

Other Physiological Effects
In addition to the brain, the side effects of marijuana reach many other parts of the body. Marijuana is filled with hundreds of chemicals, and when it is burned, hundreds of additional compounds are produced. When marijuana is inhaled or ingested in some other form, several short-term effects occur. Some of the marijuana's side effects are:

Problems with memory and learning
Distorted perception
Difficulty with thinking and problem solving
Loss of coordination
Increased heart rate
Anxiety, paranoia and panic attacks

Ongoing studies now show a number of possible symptoms associated with the cessation of marijuana use. These symptoms most commonly include: irritability, nervousness, depression, anxiety and even anger. Other symptoms are restlessness, severe changes in appetite, violent outbursts, interrupted sleep or even insomnia. In addition to these possible physical effects, psychological dependence usually develops because a person's mind craves the high that it gets when using the drug.

MORE ABOUT ALCOHOL

Champagne.LCDC — Thu, 26 Apr 2007 00:47:13 CDT

The Effects of Alcohol

If you have seen someone who has had too much to drink, you've probably noticed definite changes in that person's performance and behavior. The body responds to alcohol in stages, which correspond to an increase in BAC:

Euphoria (BAC = 0.03 to 0.12 percent)
- They become more self-confident or daring.
- Their attention span shortens.
- They may look flushed.
- Their judgement is not as good -- they may say the first thought that comes to mind, rather than an appropriate comment for the given situation.
- They have trouble with fine movements, such as writing or signing their name.
Excitement (BAC = 0.09 to 0.25 percent)
- They become sleepy.
- They have trouble understanding or remembering things (even recent events).
- They do not react to situations as quickly (if they spill a drink they may just stare at it).
- Their body movements are uncoordinated.
- They begin to lose their balance easily.
- Their vision becomes blurry.
- They may have trouble sensing things (hearing, tasting, feeling, etc.).
Confusion (BAC = 0.18 to 0.30 percent)
- They are confused -- might not know where they are or what they are doing.
- They are dizzy and may stagger.
- They may be highly emotional -- aggressive, withdrawn or overly affectionate.
- They cannot see clearly.
- They are sleepy.
- They have slurred speech.
- They have uncoordinated movements (trouble catching an object thrown to them).
- They may not feel pain as readily as a sober person.
Stupor (BAC = 0.25 to 0.4 percent)
- They can barely move at all.
- They cannot respond to stimuli.
- They cannot stand or walk.
- They may vomit.
- They may lapse in and out of consciousness.
Coma (BAC = 0.35 to 0.50 percent)
- They are unconscious.
- Their reflexes are depressed (i.e. their pupils do not respond appropriately to changes in light).
- They feel cool (lower-than-normal body temperature).
- Their breathing is slower and more shallow.
- Their heart rate may slow.
- They may die.
Death (BAC more than 0.50 percent) - The person usually stops breathing and dies.

Alcohol's Effects on Other Body Systems
In addition to the brain, alcohol can affect other body tissues. It has the following effects on other systems in the body:

Irritates the linings of the stomach and intestine - This can lead to vomiting.
Increases blood flow to the stomach and intestines - This increases secretions by these organs, most notably stomach acid secretion.
Increases blood flow to the skin - This causes a person to sweat and look flushed. The sweating causes body heat to be lost, and the person's body temperature may actually fall below normal.
Reduces blood flow to muscles - This can lead to muscle aches, most notably when a person recovers from the alcohol (the "hangover").

All of alcohol's effects continue until the ingested alcohol is eliminated by the body.

RELAPSE PREVENTION THERAPY

Champagne.LCDC — Thu, 26 Apr 2007 00:09:17 CDT

Relapse Prevention Therapy (RPT) was originally designed as a maintenance program for use following the treatment of addictive behaviors although it is also used as a stand-alone treatment program (Marlatt & Gordon, 1985; Parks & Marlatt, 1999).

In the most general sense, RPT is a behavioral self-control program designed to teach individuals who are trying to maintain changes in their behavior how to anticipate and cope with the problem of relapse. Relapse refers to a breakdown or failure in a person's attempt maintain change in any set of behaviors.

Like other cognitive-behavioral therapies, RPT combines behavioral and cognitive interventions in an overall approach that emphasizes self-management and rejects labeling clients with traits like "alcoholic" or "drug addict."

The Relapse Process
Relapse rates, usually measured as any use of a substance after a period of abstinence, are notoriously high. Research has demonstrated that the temporal patterning of the relapse process and circumstances under which relapses occur are similar across addictive behaviors.

These commonalties provide clues to a general relapse process. As we conceptualize the relapse process, it involves clients experiencing a sense of perceived control and self-efficacy while maintaining changes gained through quitting or moderating their use. The longer the period of successful abstinence or controlled use, the greater the individual's perception of self-efficacy.

This continues until an individual experiences a high-risk situation that poses a threat to their perceived control, decreases self-efficacy, and eventually increases the probability of relapse. In an analysis of relapse episodes obtained from clients with a variety of addictive behavior problems, we identified three high-risk situations that were associated with almost 75% of the relapses reported (Marlatt & Gordon, 1985). They were negative emotional states, interpersonal conflict, and social pressure.

If an individual has an effective coping response to deal with a high-risk situation, the probability of relapse decreases significantly. When a person copes effectively with a high-risk situation, he or she is likely to experience an increased of self-efficacy. As the duration of abstinence (or controlled use) increases, an individual has the experience of coping effectively with one high-risk situation after another and the probability of relapse decreases accordingly.

However, what happens if a person has not learned or cannot implement an effective coping response when confronted with a high-risk situation? Failure to master a high-risk situation is likely to create decreased self-efficacy and a sense of powerlessness. This is followed by positive expectancies for the effects of alcohol or drugs as alternative coping mechanisms. At this point, a lapse is likely.

If a slip does occur, an abstinence violation effect (AVE) follows which consists of cognitive dissonance and the attribution of responsibility for the lapse to internal and stable characteristics of the person. The AVE combined with the intoxicating effects of substance use increases the likelihood that a full-blown relapse will occur.

Relapse Set-Ups
In most of the relapse episodes we have studied or worked with clinically, the first lapse is precipitated in a high-risk situation that clients report they were not expecting and/or were poorly prepared for. Often, our clients found themselves in rapidly escalating circumstances they could not deal with effectively.

Usually, after extensive debriefing, the lapse or subsequent relapse appear to be the last link in a chain of events that preceded exposure to the high-risk situation itself. It seems as if, perhaps unknowingly, even paradoxically, clients set themselves up for relapse because they did not or could not see the early warning signs.

Cognitive distortions such as denial and rationalization make it easier to set up one's own relapse episode. The process of relapse set-ups is determined by a number of covert antecedents that eventually lead to exposure to a high-risk situation, but also allow the individual to deny any responsibility for it.

Relapse Prevention Therapy
RPT intervention strategies can be grouped into three categories: coping skills training, cognitive therapy, and lifestyle modification. Coping skills training strategies include both behavioral and cognitive techniques.

Cognitive therapy procedures are designed to provide clients with ways to reframe the habit change process as learning experience with errors and setbacks expected as mastery develops.

Finally, lifestyle modification strategies such as meditation, exercise, and spiritual practices are designed to strengthen a client's overall coping capacity.

In clinical practice, coping skills training forms the cornerstone of RPT, teaching clients strategies to:

(a) understand relapse as a process,
(b) identify and cope effectively with high-risk situations,
(c) cope with urges and craving,
(d) implement damage control procedures during a lapse to minimize its negative consequences,
(e) stay engaged in treatment even after a relapse, and
(f) learn how to create a more balanced lifestyle.

RELAPSE PREVENTION

Champagne.LCDC — Thu, 26 Apr 2007 00:05:46 CDT

Relapse Prevention: Planning for Success
When you decided to quit drinking, using other drugs or gambling, you took the first step towards recovery. This step was the beginning of an important change in your life.
You may have expected all your problems to go away when you quit, but somehow many problems are still with you. Recovery is building a new life, and like any major change it takes time. It also involves mixed feelings. One moment you can feel good about the new possibilities, and the next you can feel sad to leave old friends and habits behind. It can be confusing. It can even make you doubt your commitment to this new direction that you know in your heart is right for you.

A technique called Relapse Prevention Planning can help. In fact, it can make all the difference in the world. By thinking ahead, and by working out ways to handle the pressures that might lead you back to your drinking, drug use or gambling, you can approach your new life with a greater sense of confidence. Relapse Prevention Planning is planning for success.
Relapse Prevention Planning is based on the experiences and successes of many people just like you who have already traveled the road to recovery. It recognizes that the road often has many rough patches, and that to succeed on this road you will need a relapse prevention plan.

Your Goal is Recovery
Your use of alcohol, drugs or gambling probably caused you many problems - at home, at work, with the law. Still, you may have been afraid to face everyday life without them. That is why your decision to stop was so difficult and important. Recovery involves finding new ways of taking care of yourself, and new ways of acting with friends, with family, and at work. It also involves avoiding relapse - falling back into your habits of using alcohol, drugs or gambling to deal with problems and stress.

You can stay in control by setting goals in important areas of your life and by working towards these goals. You will need to plan to achieve your goals in each of your major life areas (such as your physical and emotional health, your relationships, your job, your recreation and your relaxation). Reaching these goals is a matter of making it happen rather than just wishing it will happen. It is a matter of creating a set of plans for yourself to deal with situations that may interfere with your recovery. Old ways of behaving need to be replaced with new carefully planned actions.

What Is Relapse?
Relapse is a process that begins when you start slipping back into old behaviour patterns. A relapse begins long before you take your first drink, drug or gamble. Some things that can lead to relapse include:

feeling that you have the problem under control and taking a chance to use or gamble again
not working out stresses and problems at home, work or school, and when these build up or a crisis happens, you go back using or gambling
not dealing with stresses such as problems with your finances, with your health, or with the legal system
not handling negative feelings such as boredom, loneliness or anger
giving in to cravings or urges to use or gamble
when under stress you don't see any other way to cope other than to use or gamble
not working on your recovery plan or letting it slide (e.g. not going to self-help meetings)

To avoid relapse:

1. Handle day-to-day feelings and problems as they happen. Your plans should involve handling feelings and problems as they happen. This way, pressure and stress do not build up. The stress you may already feel will only get worse if you put off dealing with problems with family, friends or work.

2. Keep your life in balance...a way to reduce stress. It is important to find ways to balance work and relaxation. Having fun with family or friends, without including alcohol, drugs or gambling, can be challenging. Be kind to yourself. Give yourself simple rewards that give you pleasure - a walk, time with a hobby, a chance to read a book. Writing out a plan for your day may help you find a balanced routine. Fill in free time with a variety of activities. Try a few new ones; you will find some you enjoy.What you eat can affect how well you cope with pressure. Lots of good basic foods like fruit, vegetables, cheese, whole grain cereals and breads, fish, and meat help cut down stress. Food rich in B vitamins helps to reduce craving for alcohol and to keep stress manageable. Caffeine (coffee, soft drinks), nicotine (cigarettes, cigars) and too much sugar can make you tense.

3. Gain support and trust. Family, friends, your boss, a co-worker, a support group or a counsellor can talk with you about the pressures you are feeling in recovery. They can watch with you for the warning signs of relapse and help you handle the stress. Let them know your goals and your plans so that they can help you out.

4. Identify and plan for high-risk situations. Everyone faces high-risk situations at some time - you will find yourself in situations where you are more likely to drink, use drugs or gamble. These situations can be handled more easily if you know ahead of time what they will be. Have at least three ways to handle them, so that if one does not work, you do not give up. Practise what you will do or say, so you do not worry about what to do under pressure. You can stay confident and in control.

Here is an example: At a dinner party with friends, alcohol is served. You want to relax and enjoy yourself, but you do not want to drink.

With relapse prevention plans, you might:

Carry a non-alcoholic drink with you to avoid being pressed to drink alcohol.
Have an answer ready, such as: "No thanks, I don't drink anymore."
"No thanks, I'm driving."
"No thanks, I'm on a diet."
"No thanks, I'm an alcoholic.

Agree with your spouse ahead of time that you will leave if you feel uncomfortable.

Abstinence: The feeling
What Feelings Do You Have About Abstinence?
Emotions I have had in the first few months after stopping drinking/using drugs or gambling:

What Are the Advantages and Disadvantages of:
Using alcohol/drugs or gambling:
Not using alcohol/drugs or gambling:
Can you identify with these statements?

In the beginning, abstinence:n is confusing and disorienting
is nothing like the way I believed it would be
can be lonely and overwhelming

These negative feelings are usually worse when a person is under stress or is tired. The symptoms gradually go away. Because there is confusion and fear in the first few months, people are more likely to relapse. These are uncomfortable feelings, and it's hard to resist taking the easy way to get out of dealing with them: a drink, drugs, or a bet. To help you "wait it out" you can:

talk about it
get plenty of sleep
eat well, exercise regularly
actively reduce stress

The following information can help you recognize stress in your life and suggests ways to help reduce that stress.

Managing Your Stress
Stress is a common part of everyone's life. We deal with most of our stressful experiences successfully. It's the small percentage that we have difficulty managing that causes problems.
Because stress is a part of life, it makes sense to develop a variety of ways of handling it. There are many ways - the following are some basic, common sense methods:

Organize yourself. Take better control of the ways you're spending your time and energy.
Control what and who is surrounding you. Stay away from people who cause you to doubt your decisions.
Develop a supportive network of caring people around you. Feeling alone or apart from others builds stress. Being in touch and talking to others reduces it. Family, friends and self-help sponsors can help.
Build up your strength. If you're in good physical condition, you'll be better able to stand up against your stress.
Find ways to laugh each day. Laughter is one of the purest and most total releases of tension.
Learn to relax. Do something relaxing for 20 minutes each day. You will think more clearly and will be better prepared for decision-making.

Managing Your Cravings
When you quit using alcohol, drugs or gambling, you are likely to experience cravings. Cravings are a normal part of recovery. They will lessen over time. Cravings may be stronger in high-risk situations. An important part of relapse prevention is learning how to cope with these urges.

One way to minimize these temptations is to focus on specific actions or thoughts in dealing with them. Examples of specific actions might include:

talking to someone who understands, carry a list of phone numbers of people you can call
writing down your thoughts
distracting yourself, do for a walk, work out, clean the house.
removing yourself from the situation
trying relaxation techniques
keeping a record of how you have coped in the past

Examples of thoughts that might be helpful include:

thinking of the negative consequences of using/gambling (remembering how bad things were when you were using)
thinking of the reasons why you do not want to use/gamble any more
reminding yourself that cravings are a normal part of recovery
visualizing the craving as a wave that you are simply going to ride out
using positive self-talk or picturing a STOP sign in your mind

Resources
Because stress affects the whole person, good stress management skills allow you to manage all parts of your life. The following list is things you can do to help keep stress under control.

Get Physical: Build up your strength and stamina.
Relax: Develop a list of activities you find relaxing and do them regularly.
Eat Well: Eat good basic foods such as whole grain cereals and breads, fish, meat, fruits and vegetables. Avoid too much caffeine (coffee, soft drinks), nicotine (cigarettes and cigars), and sugar.
Take Care of YOU: Treat yourself kindly. Don't push beyond your limits.
Exercise: Learn to get the benefits of regular exercise.
Use Your Mental Skills: Use your mind to help cope with stress more effectively.
Manage Your Time Well: Pause to think about what is really important and give time to those things.
Organize: Seek order. Don't let things pile up.
Problem Solve: Address issues as they come up. Don't hesitate to ask others to help.
Build a Support Network: Develop a network of resources and people that you can count on.
Use Family and Friends for Support: Your family and friends may help you solve problems and reduce stress.
Keep Life in Balance: Make sure you set aside time for home as well as work commitments.
Enjoy Time with Others: Spend time with those you care about, doing things that everyone enjoys.
Settle Conflicts: Look for solutions where all sides win.
Getting Along with Others: It's important to build relationships that will help you in dealing with stress in your life.
Try New Things: Discovering healthy new ways to have fun is a great way to reduce your tension level. Try new recreational activities and find new hobbies.
Stay Open to Change: Try new approaches.
Believe in Yourself: Trust others. Share and show feelings. Share your burdens with your family and friends. Be direct about your wants, needs, and feelings.
Learning: Take a class. Exercise your mind.
Enjoy Music: Play an instrument. Join a choir. Work: Volunteer for something worthwhile.
Get Away: Spend more time alone.
Play: Go out with a friend.

The easiest way to add to your methods for handling stress is to develop one new habit at a time. Remember you have the power and ability to decide to deal with stress.

Personal Stress Management Plan
You may want to draw from the stress management ideas outlined below when developing your own Stress Management Plan.

1. Maintain a Healthy Stress Level:
While some stress is good - it pushes us to learn and grow - too much can be dangerous to your health. The trick is establishing a healthy level of stress and maintaining that level. Identify the kinds of stress in your life.

2. Deal with pressure:
Stress is not pressure from the outside, as some people think. It's the physical reaction within your body that prepares you to meet that pressure - and to fight back.

What is causing you trouble?
Analyse the area of pain - where is it coming from?
Who is involved?
What are you doing that contributes to the problem?
How can you minimize or get rid of it?

3. Identify your Values and Goals:

Define your goals - specifically, what do you want to change and when?
Assess the importance of each goal.n Identify blocks to goal achievement.
Identify risks and/or consequences of each action.
Are others involved? Can others help?

4. Have a Plan of action:

Establish specific steps to reach your goals.
Identify resources that can help you.
Assess your progress - set a date to evaluate your success.
Make an alternate plan if needed.n Take time to reflect on your success - what have you learned?
Can it work for you in other ways?

You may find it helpful to make a stress management plan with the assistance of a friend or counsellor.

Are These High-risk Situations for You?
High-risk situations are those situations where you are most likely to relapse. Check off the danger areas that apply to you:

when I pass a pub, lounge or place I used to gamble
when I'm with others who are drinking, using drugs or gambling
when I feel no one really cares what happens to me
when I have to meet people
when I feel depressed when there are problems at work
when I feel I am being punished unjustly
when I feel afraid
when I'm on holidays
when I feel happy with everything
when I have money to spend
when I remember the good times when I was drinking, using drugs or gambling
when there are hassles and arguments
when feel resentful
when I feel irritable or tired
when I'm at a party
when I start thinking I am not really hooked on alcohol, drugs or gambling
when I feel myself getting very angry
when there are special occasions like Christmas, birthdays, etc.
when I start feeling frustrated and fed up with life
when I feel disappointed that other people are letting me down
when I feel lonely or bored
when I feel pressured by debt or lack of money
when I remember the excitement of a "big win" or a "great high"
Others

Reasons for Relapse
The following are major reasons for relapse:

not handling negative feelings such as boredom, loneliness, anger
difficulty in handling social pressures to drink, use drugs or gamble, or just being around people who are engaging in those behaviours
not resolving conflicts with others
having urges or temptations to use alcohol, drugs or gamble
difficulty in handling positive feelings
problems dealing with withdrawal symptoms or health conditions
testing to see if drinking, drug use or gambling can be controlled
not keeping life in balance (not eating well, not sleeping regularly, not keeping active, spending too much time at work)

When Do Relapses Occur?
Consider the following information: Approximately 2/3 of all relapses for any addiction (alcohol, drugs, gambling, smoking, diets) occur within the first 90 days. The reasons for relapse are the same whether the addiction is to alcohol, other drugs or gambling. During the first 90 days after withdrawing from alcohol, drugs or gambling people may experience some periods of poor memory or concentration, or they may overreact to stress. This may lead to relapse. The longer a person is abstinent, the better these things will get, but handling stress as it comes up is an important way to prevent relapse. Not coping with stress is a major reason for relapse.

Recognize the Danger Signals
A return to alcohol, drug use or gambling does not just happen. There is a process leading to the return. When you begin to backslide or "slip," you go through changes that could lead to a possible relapse. Some of the danger signals might be:

You begin to isolate yourself from others and feel bored and lonely much of the time.
You find yourself easily irritated and relationships become strained.
You doubt your ability to stay abstinent.
You act impulsively under stress, which causes even more stress.
You think you will never use alcohol, drugs or gambling again, so you don't need a recovery program - you don't attend support groups or counselling, and you reject offers of help.
You try to impose abstinence on others.
Your eating and sleeping patterns are disturbed and you cannot get things done.
You cover up your feelings of unhappiness and helplessness.
You frequently feel sorry for yourself.
You begin to think that you can handle alcohol, drugs or gambling again and it will help you feel more at ease.

There are also other danger signals. What are yours?

Handling High-Risk Situations

My Plan for High-risk Situations
The following may serve as a guide to help you form your personal Relapse Prevention Plan.

A. Figure out the high-risk situations that might lead you to start drinking, using drugs or gambling.

1. What days are you most likely to start to drink, use drugs or gamble?
2. What times of the day are you most likely to start drinking, using drugs or gambling?
3. In what locations are you most likely to start to drink, use drugs or gamble?
4. Who are you most likely to start drinking, using drugs or gambling with?
5. What moods or feelings are most likely to lead you to start drinking, using drugs or gambling?
6. a) What positive things do drinking, using drugs or gambling do for you? b) List some high-risk situations that may result from the above.

B. For each high-risk situation, think of three things you can do to handle the situation so you won't start to drink, use drugs or gamble to feel good.
Here is an example high-risk situation - Staff party where there will be drinking.

Plan 1. Order a non-alcoholic drink before joining the group.
Plan 2. Arrange to leave the party early.
Plan 3. Have three responses ready for when you are asked if you want a drink.

Handling Relapse
Sometimes you just cannot control everything in your life, or handle every situation the way you plan to. There is a possibility that you might relapse and start drinking, using drugs or gambling again. Think about how you would feel if you relapsed. Some people have overwhelming feelings of guilt, anger, shame, or fear. These feelings could drive you to continue to use or gamble after a slip. How would you deal with a relapse? It is important that you do not give up. You have other choices. There are ways you can regain control and prevent a slip from becoming a full relapse.

If you relapse, you could talk to a counsellor or friend about it. You can learn from the situation and find different ways of handling the pressures that led to the relapse. If you use a relapse as a learning opportunity rather than viewing it as a failure, you can prevent it from happening again. Plan to stop a slip from becoming a relapse. Don't let a slip be an excuse to keep on drinking, using drugs or gambling.

1. Figure out how you feel about relapse ahead of time. Record your feelings.
2. Figure out the best way for you to handle those feelings and how you would stop drinking, using drugs or gambling. Record your ideas.

DEVELOPING RP PLAN

Champagne.LCDC — Wed, 25 Apr 2007 23:54:30 CDT

How To Develop A RP Plan
By Terence T. Gorski

People who relapse aren't suddenly taken drunk. Most experience progressive warning signs that reactivate denial and cause so much pain that self-medication with alcohol or drugs seems like a good idea. This is not a conscious process. These warning signs develop automatically and unconsciously. Since most recovering people have never been taught how to identify and manage relapse warning signs, they don't notice them until the pain becomes too severe to ignore. There are nine steps in learning to recognize and stop the early warning signs of relapse.

Step 1: Stabilization:
Relapse prevention planning probably won't work unless the relapser is sober and in control of themselves. Detoxification and a few good days of sobriety are needed in order to make relapse prevention planning work. Remember that many patients who relapse are toxic. Even though sober they have difficulty thinking clearly, remembering things and managing their feelings and emotions. These symptoms get worse when the person is under high stress or is isolated from people to talk to about the problems of staying sober. To surface intense therapy issues with someone who has a toxic brain can increase rather than decrease the risk of relapse. In early abstinence go slow and focus on basics. The key question is "What do you need to do to not drink today?"

Step 2: Assessment:
The assessment process is designed to identify the recurrent pattern of problems that caused past relapses and resolve the pain associated with those problems. This is accomplished by reconstructing the presenting problems, the life history, the alcohol and drug use history and the recovery relapse history. By reconstructing the presenting problems the here and now issues that pose an immediate threat to sobriety can be identified and crisis plans developed to resolve those issues.
The life history explores each developmental life period including childhood, grammar school, high school, college, military, adult work history, adult friendship history, and adult intimate relationship history. Reviewing the life history can surface painful unresolved memories. It's important to go slow and talk about the feelings that accompany these memories. Once the life history is reviewed, a detailed alcohol and drug use history is reconstructed.

This is be done by reviewing each life period and asking four questions:

(1) How much alcohol or drugs did you use?
(2) How often did you use it?
(3) What did you want alcohol and drug use to accomplish? and
(4) What were the real consequences, positive and negative, of your use?

In other words, did the booze and drugs do for you what you wanted it to do during each period of your life?
Finally, the recovery and relapse history is reconstructed. Starting with the first serious attempt at sobriety each period of abstinence and chemical use is carefully explored. The major goal is to find out what happened during each period of abstinence that set the stage for relapse. This is often difficult because most relapsers are preoccupied with their drinking and drugging and resist thinking or talking about what happened during periods of abstinence.

Comprehensive assessments have shown that most relapsers get sober, encounter the same recurring pattern of problems, and use those problems to justify the next relapse. As one person put it "It is not one thing after the other, it is the same thing over and over again!"

A 23 year old relapser named Jake reported drinking about a six pack of beer every Friday and Saturday night during high school. He did it in order to feel like he was part of the group, relax and have fun. at that stage in his addiction the beer did exactly what he wanted it to do.

That all changed when Jake left school and went to work as a salesman. He had to perform in a high pressure environment and felt stressed. The other salesmen were competitive and no matter what he did they wouldn't let him belong. He began drinking bourbon every night to deal with the stress. He wanted to feel relaxed so he could cope better at work. He consistently drank too much and woke up with terrible hangovers that caused new problems with his job. Every time Jake would attempt to stop drinking he would feel isolated and alone and become overwhelmed by the stress of his job. Even when with others at Twelve Step Meetings he felt like he didn't belong and couldn't fit in.

Is the stress grew he began to think "If this is sobriety who needs it?" Each relapse was related with his inability to deal with job related pressures. By comparing the life history, the alcohol and drug use history, and the recovery relapse history Jake could see in a dramatic way the recurrent problems that caused him to relapse. The two major issues were (1) the need to drink in order to feel like he belonged and (2) the need to drink in order to cope with stress. It wasn't surprising that Jake discovered that during every past period of abstinence he became isolated, lonely and depressed. The longer he stayed sober the worse it got. The stress built up until he felt that if he didn't take a drink to relax he would go crazy or collapse.

Step 3: Relapse Education:
Relapsers need to learn about the relapse process and how to manage it. It's not a bad idea to get their family and Twelve Step Sponsors involved. The education needs to reinforce four major messages: First, relapse is a normal and natural part of recovery from chemical dependence. There is nothing to be ashamed or embarrassed about.

Second, people are not suddenly taken drunk. There a progressive patterns of warning signs that set them up to use again. These warning signs can be identified and recognized while sober.

Third, once identified recovering people can learn to manage the relapse warning signs while sober. And Fourth, there is hope.

A new counseling procedure called relapse prevention therapy can teach recovering people how to recognize and manage warning signs so a return to chemical use becomes unnecessary. When Jake entered relapse prevention therapy he felt demoralized and hopeless. That began to change when he heard his first lecture that described the typical warning signs that precede relapse to chemical use. He felt like someone had read his mail. "Since someone understand what causes me to get drunk," he thought, "perhaps they know what to do in order to stay sober.

Step 4: Warning Sign Identification:
Relapsers need to identify the problems that caused relapse. The goal is to write a list of personal warning signs that lead them from stable recovery back to chemical use. There is seldom just one warning sign. Usually a series of warning signs build one on the other to create relapse. It's the cumulative affect that wears them down. The final warning sign is simply the straw that breaks the camel's back.

Unfortunately many of relapsers think it's the last warning sign that did it. As a result they don't look for the earlier and more subtle warning signs that set the stage for the final disaster. When Jake first came into relapse prevention therapy he thought that he was crazy. "I can't understand it," he told his counselor, "Everything was going fine and suddenly, for no reason at all I started to overreact to things. I'd get confused, make stupid mistakes and then not know what to do to fix it. I got so stressed out that I got drunk over it."

Jake, like most relapsers, didn't know what his early relapse warning signs were and as a result didn't recognize the problems until it was too late. A number of procedures are used to help recovering people identify the early warning signs relapse.

Most people start by reviewing and discussing The Phases And Warning Signs Of Relapse (available from Independence Press, PO Box HE, Independence MO 64055, 1-800-767-8181).

This warning sign list describes the typical sequence of problems that lead from stable recovery to alcohol and drug use. By reading and discussing these warning signs relapsers develop a new way of thinking about the things that happened during past periods of abstinence that set them up to use. They learn new words with which to describe their past experiences.

After reading the warning signs they develop an initial warning sign list by selecting five of the warning signs that they can identify with. These warning signs become a starting point for warning sign analysis. Since most relapsers don't know what their warning signs are they need to be guided through a process that will uncover them.

The relapser is asked to take each of the five warning signs and tell a story about a time when they experienced that warning sign in the past while sober. They tell these stories both to their therapist and to their therapy group. The goal is to look for hidden warning signs that are reflected in the story. Jake, for example, identified with the warning sign "Tendency toward loneliness."

He told a story about a time when he was sober and all alone in the house because his wife had left with the children. "I felt so lonely and abandoned, he said. I couldn't understand why she would walk out just because we had a fight. She should be able to handle it better than she does."

The group began asking questions and it turned out that Jake had frequent arguments with his wife that were caused by his grouchiness because of problems on the job.

It turned out that these family arguments were a critical warning sign that occurred before most relapses. Jake had never considered his marriage to be a problem, and as a result never thought of getting marriage counseling.

Jake had now identified three warning signs: (1) the need to drink in order to feel like he belonged, (2) the need to drink in order to cope with stress, and (3) the need to drink in order to cope with marital problems.

In order to be effectively managed each of these warning would need to be further clarified. I then had Jake to write these three warning signs using a standard format and identify the irrational thoughts, unmanageable feelings and self defeating behavior that accompanied each.

He wrote:
(1) I know I am in trouble with my recovery when I feeling lonely and unable to fit in with other people; When this happens I tend to think that I am no good and nobody could ever care about me. When this happens I tend to feel lonely, angry and afraid. When this happens I have an urge to hide myself away so I don't have to talk with anyone.
(2) I know I am in trouble with my recovery when I feel unable to cope with high levels of job-related stress; When this happens I tend to think that I need to try harder in order to get things under control or else I will be a failure. When this happens I tend to feel humiliated and embarrassed. When this happens I drive myself to keep working even thought I know I need to rest.
(3) I know I am in trouble with my recovery when I irrationally angry at my wife. When this happens I tend to think that I'm a terrible person for treating her that way, but a part of me believes she deserves it. When this I happens I tend to feel angry and ashamed. When this happens forget that the incident ever happened, put it behind us and get on with our marriage.

With this detailed description of the relapse warning signs Jake was ready to move on to the fifth step of relapse prevention planning, warning sign management.

Understanding the warning signs is not enough. We need to learn how to manage them without resorting to alcohol or drug use. This means learning nonchemical problem solving strategies that help us to identify high risk situations and develop coping strategies. In this way relapsers can diffuse irrational thinking, manage painful feelings, and stop the self-defeating behaviors before they lead to alcohol or drug use. This is done by taking each relapse warning sign and developing a general coping strategy. Jake, for example developed the following management strategy for dealing with his job related stress.

Warning Sign: I know I am in trouble with my recovery when I feel unable to cope with high levels of job-related stress.

General Coping Strategy: I will learn how to say no to taking on extra projects, limit my work to 45 hours per week, and learn how to use relaxation exercises and meditation to unwind. The next step is to identify ways to cope with the irrational thoughts, unmanageable feelings, and self-defeating behaviors that accompany each warning sign. Jake developed the following coping strategies:

Irrational Thought: I need to try harder in order to get things under control or else I will be a failure.

Rational Thought: I am burned out because I am trying to hard. I need to time to rest or I will start making more mistakes.

Unmanageable Feelings: Humiliation and embarrassment.

Feeling Management Strategy: Talk about my feelings with others. Remind myself that there is no reason to embarrassed. I am a fallible human being and all people get tired.

Self-defeating Behavior: Driving myself to keep working even thought I know I need to rest.

Constructive Behavior: Take a break and relax. Ask someone to review the project and see if they can help me to solve the problem.

Now Jake is ready to move unto the sixth step of recovery planning.

A recovery plan is a schedule of activities that puts relapsers into regular contact with people who will help them to avoid alcohol and drug use. They must stay sober by working the twelve step program and attending relapse prevention support groups that teach them to recognize and manage relapse warning signs. This is why I call relapse prevention planning a "Twelve Step Plus" approach to recovery. Jake needed to build something into his recovery program to help him deal with job related stress. He decided to enter into counseling with a counselor who specialized in stress management, understood chemical dependency and had a background as an employee assistance counselor. By doing this Jake was forced to regular discuss his problems at work and review how he was coping with them. By identifying job related problems early, he could prevent getting overwhelmed by small problems that became overwhelming.

The seventh step is inventory training. Most relapsers find it helpful to get in the habit of doing a morning and evening inventory. The goal of the morning inventory is to prepare to recognize and manage warning signs. The goal of the evening inventory is to review progress and problems. This allows relapsers to stay anticipate high risk situations and monitor for relapse warning signs. Relapsers need to take inventory work seriously because most warning signs are deeply entrenched habits that are hard to change and tend to automatically come back whenever certain problems or stresses occur. If we aren't alert we may not notice them until it's too late.

The eighth step is family involvement. A supportive family can make the difference between recovery and relapse. We need to encourage our family members to get involved in Alanon so they can recover from codependency. With this foundation of shared recovery we can beginning talking with our families about past relapses, the warning signs that led up to them, and how the relapse hurt the family. Most importantly we can work together to avoid future relapse. If we had heart disease we would want our family to be prepared for an emergency.

Chemical dependency is a disease just like heart disease. Our families' needs to know about the early warning signs that lead to relapse. They must be prepared to take fast and decisive action if we return to chemical use. We can work out in advance, when we are in a sober state of mind, the steps they should take if we return to chemical use. Our very life could depend upon it.

The final step is follow-up. Our warning signs will change as we progress in recovery. Each stage of recovery has unique warning signs. Our ability to deal with the warning signs of one stage of recovery doesn't guarantee that we will recognize or know how to manage the warning signs of the next stage. Our relapse prevention plan needs to be updated regularly; monthly for the first three months, quarterly for the first two years, and annually thereafter.