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Relapse prevention is similar across most populations, but there are some unique issues and challenges facing people in recovery who have a criminal record. Learn how to identify and address these issues
3. Objectives
Define relapse in terms of addiction as well as mental
health
Examine relapse prevention techniques
Explore needs of the person: Psychosocial and Maslovian
4. What is Relapse
Relapse is the return to addictive behaviors or the
recurrence of mood disorders
Relapse often starts long before the person uses again
Get caught up in day-in-day-out
Start acting “mindlessly”
Stop going to meetings/counseling/church/lifeline
Begins running out of energy to do new behaviors
Frustration, irritability and exhaustion set in
Caveat…an extreme stressor can prompt “immediate
relapse”
5. Extreme Stressors
Those things that overwhelm an individuals ability to
cope
Thrust them into the fight or flight
New coping skills and support resources may not even be
considered, or only half-heartedly
Have clients identify or practice dealing with these types
of situations in group
Divorce
Death
Job Loss
Diagnosis of a terminal or chronic illness (Cancer, ALS, HIV)
6. Beginner Tools for Extreme Stress
Get support… You are outnumbered!
Self-soothing/De-Escalation
Systematic Desensitization
Cognitive Behavioral Therapy
CPT Note Card
I feel… because ……
What am I upset about
What are the FACTS for and against this belief
Am I using all or nothing thinking or jumping to conclusions
I need to call _______ to get an objective perspective or
what would _____ do
7. Psychosocial Needs
Represent tasks that must be accomplished or needs that must
be met as the people grow up
These tasks help people learn self-control, confidence and
esteem
Problems in achieving these tasks/needs can lead to problems
in development
Problems later in life may cause people to question their
earlier conclusions
These tasks are not linear and final
Part of the treatment process is helping people learn how to
“parent” themselves.
Clinicians initially take the part of the parental figure
modeling how to resolve issues
8. Psychosocial Needs
Trust vs. Mistrust
If people receive consistent, predictable and reliable care,
they will develop a sense of trust/faith in themselves and
others
They will be able to feel secure even when threatened.
This leads to developing hope that as new crises arise,
there is a real possibility that other people will be there
are a source of support, they have the strength to endure
and their intuition is correct.
I can trust myself (thoughts, intuition)
I can trust those around me
Example: Child abuse survivor
9. Psychosocial Needs
Autonomy vs. Shame and Doubt
Explore the limits of their abilities within an encouraging
environment which is tolerant of failure
The aim has to be “self control without a loss of self-
esteem” (Gross, 1992). Success in this stage will lead to the
virtue of will/discipline/courage.
If people are criticized, overly controlled, or not given the
opportunity to assert themselves, they begin to feel
inadequate in their ability to survive, and may then become
Overly dependent upon others
Lack self-esteem
Feel a sense of shame or doubt in their own abilities.
10. Psychosocial Needs
Initiative vs. Guilt. ...
People learn to initiate activities with others, and feel
secure in their ability to lead others and make decisions.
If this tendency is squelched, either through criticism or
control, people develop a sense of guilt, feel like a
nuisance to others and will therefore remain followers,
lacking in self-initiative and self-confidence.
A healthy balance between initiative and guilt is important.
Success in this stage will lead to the virtue of purpose.
11. Psychosocial Needs
Industry (competence) vs. Inferiority. ...
People’s peer groups are a major source of self esteem.
They feel the need to win approval by demonstrating specific
competencies that are valued by society, and begin to develop
a sense of pride in their accomplishments.
If this initiative is not encouraged, people begin to feel
inferior, doubting their own abilities and therefore may not try
or may give up at the first sign of failure.
Some failure may be necessary so that the person can develop
some awareness of personal limits.
12. Psychosocial Needs
Identity vs. Role Confusion
In response to an identity crisis a person may begin to
experiment with different lifestyles (e.g. work, education or
political activities).
People experience identity crises in adolescence, adulthood and in
response to major stressors
Pressuring someone into an identity can result in rebellion.
People must define what recovery looks like for them and be
motivated to do it for themselves.
13. Psychosocial Needs
Intimacy vs. Isolation
Sharing of ourselves and being accepted and loved for who we
are
Successful in this stage can lead to a sense of commitment,
safety, and care within a relationship.
Avoiding intimacy, fearing commitment and relationships can
lead to isolation, loneliness, and sometimes depression.
Exploring past relationships is often a task for therapy
Relapse prevention involves
Increasing awareness of what healthy relationships look like
Reminding themselves that what happened in the past with a
different person is not necessarily going to happen again.
14. Maslow
Biological
Housing (create safety and remove/address triggers)
How can they make the best of what they have
Safe routes to and from work
Make their home or room a safe haven
What are the negative and positive triggers and solutions in
their current environment
People
Times of day/week
Things
15. Maslow
Biological
Medical Care (Eliminate vulnerabilities)
Chronic pain
Mental Health
Substance Abuse (Buprenorphine, Antabuse, Methadone, SSRIs)
Food and water, sleep (Create a recovery environment)
Self care is a new skill for many clients, go slow
Routine…routine…routine
16. Maslow
Safety
From physical or psychological injury by self or others
From peer pressure
Relationships
Nurturing
Encouraging of sober behaviors
(honesty, hope, faith, courage, discipline, integrity)
17. Self-Esteem
A sense of pride in who they are
Acceptance of strengths and weaknesses
Lack of self-esteem can lead to a need for external
validation
Self-Esteem workbooks abound to develop positive self
esteem
Eradicating harsh, self-critical self-talk is the second part
Be aware of the imposter phenomenon.
18. Mindfulness
Relapse often begins when mindfulness ends
Mindfulness is being aware of
Who you are
How you feel (emotionally, mentally, physically)
What you want (and what you actually need)
Are you eating because you are hungry or stressed
What not getting wants met mean to you
Activities
Morning and evening journals
Behavior Interruption esp. regarding substitute addictions
20. Summary
Relapse prevention begins with remaining aware of your wants,
and needs
Relapse begins when the old behaviors start to surface
Avoidance
Minimization
Rationalization
Denial
Numbing
People need to learn how to self-govern as a part of recovery
People need to learn how to meet their basic needs and how
these needs impact their recovery.