Relapse Prevention

As we neared discharge we spent more and more time on relapse prevention. Rehab instructed that 12-Step programs provide a mechanism to keep relapse triggers at bay and tolerate the anxiety of sober living instead of turning to chemicals to cope. The program prescribes a rigorous, ruthless, moral inventory and an informal confessional. That responsibility be taken and amends be made to those wronged in order to free us from regret, guilt, and shame, emotions that can trigger the craving for relief and a first drink or drug. (This is sometimes called “cleaning house” or “cleaning up my side of the street,” at meetings.) Continuing daily ethical inventories and action to make things right serve the same purpose in an ongoing way.

By following these dictates, I was told, addicts are given a constructive way to deal with their feelings, rather than stuffing them and turning the emotions inward. It’s a method to deflect the “fuck you” impulse to people, places, and things which can lead to relief-in-a-bottle default thinking.

To make sure we were on our way in this process we were assigned to get a sponsor and start to working the Steps.

We were also required to submit a “Continuing Care Plan,” a six-page schedule of our weeks, detailing what AA meetings and Aftercare session we’d attend and listing all the phone numbers in our 12-step support network. We had to record our “new outlets” for “expressing negative feelings,” explain our concept of a higher power (I wrote, “I’m not really sure”), and describe how we’d keep in touch with it (“I don’t really feel ‘in touch’ yet, so I guess I’ll just keep trying through meditation and prayer”). We had to script what we’d say if anyone offered us a drink or drug (“No thanks, I don’t play that shit no more,” I wrote, adopting what I once heard one of my staff favorites suggest, though I don’t recall ever actually saying it).

We were assigned to list our known relapse triggers, the things we could anticipate that might cause a flash of desire to use, and provide three different strategies for dealing with each one. (But how many times can you write, “Call someone” or “Go to a meeting”?).

We even had to define what we’d do for relaxation. A form called “Let’s Do It!” listed sober activities for those of us with no imagination, more than 80 of them, from Aerobics to the Zoo, and we were expected to do them with others in recovery. Our Continuing Care Plans were rejected if we didn’t “list five nice things you will do for yourself in your recovery each day,” which I thought was a bad joke.

In addition to generic directions for everyone, each patient was given individual  instructions about the staff’s view of the continuing obstacles we each faced. One such instruction I didn’t understand at all was that I “participate more” in my sobriety. Recovery, they said, wasn’t passive, it wasn’t just not drinking, the way I was thinking about it. Recovery is an active thing, something I had to do, something I had to practice.

If we remembered to keep our sobriety first, if we practiced a spiritual program like the one AA offered, if we took advantage of the tools we’d been trained to use, if we asked for help and accepted it, and if, when able, we offered help to others, we stood a good chance of staying sober, they said.

But the relapse numbers belied this optimism. “Look around the room,” the counselors told the dozen-or-so of us, “and only 2 or three of you are likely to make it.”

So rehab facilities walk a tightrope when it comes to relapse prevention. The danger can’t be minimized because relapse results in death so regularly. But you don’t want addicts to think that once they’ve relapsed all is lost, for fear they’ll decide another chance at sobriety is impossible. That too leads to dead addicts. Sometimes it seemed an inconsistent message: avoid relapse at all cost, but (wink, wink, nod, nod) if you do slip, and almost everyone does, try to remember your sobriety training as soon as possible and make it back with a minimum of damage. But once someone took that first drink or drug all bets were off and there was no telling what would happen. The hope was treatment would plant seeds of sobriety in our brains that couldn’t be ignored, even high.

Planning for life on the outside was all very rational, very ordered. But no matter how much planning you did, the fear of being an addict responsible for your own sobriety was so overpowering as to be nearly incapacitating. One day at a time, they stressed. You can stay sober just for one day, can’t you? I wasn’t so sure.


For the next article in the Treatment series click here.

To return to the Treatment Menu click here.

Subscribe to the Addict Science Newsletter


cover of A Whole Lot of Medicine

Leave a Reply