Seemingly Irrelevant Decisions – A Roadmap to Relapse Prevention

Recovery from addiction that place individuals and others at risk is a process, it is not a single step. Although it begins with an extremely important and essential single step—the personal decision to change, which for many involves coming into residential treatment—recovery itself occurs in a long series of steps.

It’s like setting out on a long, and sometimes difficult, journey—a journey towards recovery and a healthier lifestyle. Many that take the very first step in their journey of recovery enter treatment having the intention to live a healthy lifestyle, many may even believe that this is enough. It isn’t. When individuals enter treatment, their goal seems very clear (they are not going to use any more) and the way to achieve this goal also seems clear (they often say: “I just need to make up my mind not to use again”). Indeed, the road to recovery is always paved with good intentions. Good intentions are certainly a place to start, but they are not enough to prepare individuals for what lays ahead along the road to recovery. This road is not straightforward, so it is vital that those entering treatment understand the principles of seemingly irrelevant decisions and the impact on their recovery.

Awareness of Seemingly Irrelevant Decisions or SIDs is critical to sustaining difficult changes, whether that is dealing with addictions or just adopting new lifestyle choices.

A huge risk to recovery is ignoring what is going on for the person in recovery, ignoring thoughts, feelings and the risks posed to by these and the environment. To keep moving forward in recovery it is essential, then to be honest to yourself and acknowledge any vulnerabilities and insecurities otherwise individuals jeopardise their recovery by making poor decisions.

SIDs are those decisions which directly contribute to making lapse and relapse a more likely outcome and can be anticipated and acted on to prevent or reduce the risk of lapse and relapse. These decisions can be a direct contributor to a lapse or contribute to the general conditions which result in the person in recovery feeling or being less resourceful when confronted with a high-risk situation.

For example, someone is a week out of treatment and they decide to go into town on a nice sunny day. There are many routes into town, but they decide they are going to use a route where they have to pass an old drinking haunt they used to frequent. “Surprisingly” it is packed with their old drinking crowd who are all sat outside who encourage them to stay. They decide to stay as “what harm can it do” only to find themselves still there in three hours’ time and are now drinking. Five hours later they stagger in the door at home and blame “their mates for pressurising them into drinking and leading them astray”.

SIDs are those decisions which directly contribute to making lapse and relapse a more likely outcome and can be anticipated and acted on to prevent or reduce the risk of lapse and relapse. These decisions can be a direct contributor to a lapse or contribute to the general conditions which result in the person in recovery feeling or being less resourceful when confronted with a high-risk situation. Having a robust relapse prevention plan is key in terms of managing SIDs.

The following is a list of questions adapted from: Chiauzzi, E., Villapiano, A., Budman, S., & Goldman, R. (2003), Time-Effective Treatment: A Best Practices Manual for Substance Abuse Professionals. Center City, MN: Hazelden Foundation around relapse prevention planning. These are not the panacea for success but nevertheless should be some of the questions those looking for long term recovery should be asking themselves:

  1. Have you set goals related to staying clean and sober? What will staying clean and sober allow you to accomplish?
  2. Assess your alcohol and/or substance abuse practices:
  3. what stimuli set you off? (money, people, behaviours, etc.)
  4. who in your work/home/social environments use alcohol and/or drugs?
  5. what is the availability of alcohol and drugs in your environment?
  6. what is the availability of money to obtain alcohol and drugs? Will you be receiving any significant sums of money soon?
  7. Have you reviewed all your high-risk situations?
  8. Do you have plans for all anticipated high-risk situations?
  9. Have you discussed the feelings of loss or deprivation that accompany getting clean and sober?
  10. Do you feel cheated because you can’t use/drink anymore?
  11. Are you aware of how you justify your alcohol and/or drug use?
  12. Are you aware of the ways that you have tried to control your use?
  13. Are you prepared for the highs and lows of life without the resorting to drink or drugs? If so what have you anticipated and what are your strategies for dealing with these situations
  14. Have you taken steps to limit the availability of alcohol and/or other substances?
  15. Have you told all important people in your life about your addiction(s)?
  16. Do you expect treatment to be a “cure” or “magical” solution?
  17. How do you “test” yourself in recovery?
  18. How will you limit exposure to people who use drugs or drink?
  19. Are you aware of how you make the “chain” of decisions that lead to your drinking and using?
  20. Have you examined past relapses? Do you see them as mistakes, failures, or episodes of weakness?
  21. What personality traits do you have that may interfere with recovery and what are you doing about this?
  22. Do you feel entitled to use drugs or drink?
  23. How well can you keep track of how you are feeling?
  24. How well do you solve problems? Do you jump at the first apparent solution?
  25. Do you assume that if you don’t have cravings now you won’t have them in the future?
  26. Do you see craving as something that has a life of its own, something out of your control?
  27. What lifestyle changes have you made? Do you need to change the way you structure things?
  28. Do you seek out help or wait for it to come to you?
  29. What are your plans to reduce complications or crises in your life?

If you are not sure about how some of the above questions will impact on preventing relapse or are unsure what to do with the answers you have come up with, then perhaps you might want to think about reaching out. Aside from the team at Strong Hope there are a range of addiction professionals and support groups who would are only too willing to help.

If you are struggling with an addiction, or know someone who is, then the team at Strong Hope are on hand. All enquiries are taken in strictest confidence and if our service cannot meet your needs we are more than happy to signpost you to appropriate alternatives.

 

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