Category Archives: Addiction

Picking up the Pieces after a Relapse (Part 1)

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Melissa Killeen

One of the worst feelings your client will have is waking up after drinking or drugging for a week straight and realizing that their hard-won sobriety has veered into the ditch. Not only do they hate themselves for relapsing, they know they have let down you and their loved ones, as well. I have seen men break down and cry knowing that their kids won’t allow them to come back into their lives, their wife is filing for divorce or their mother will never hug them again. Often this was their “last chance” and they blew it. It’s now time to make some hard decisions and that is where a recovery coach really can help their client.

The recovery coach has to be there for the client, because the client fears everyone has abandoned them. Show the client you are there, whether it is a text two or three times a day or a phone call that goes into voice mail. But be there. Say something welcoming in these messages; show your client you have not left them. You want to help them to right this ship, to allow them to resolve this temporary setback. Emphasize the phrase: temporary setback.

Let’s say I just left a message on my client’s voice mail, urging him to stop isolating, stop hiding the fact he has slipped and immediately seek help regaining his sobriety. I tell him to go to a meeting, have a cup of coffee with another member, and call me, his recovery coach! He knows there is a great deal of hard work ahead of him. Even though he may not want it, sobriety is the only answer. He already knows how difficult the first few days and weeks of sobriety are. He’s been there before, at least once. So he can do it again. And that was just one message. I will three the first day, and will continue every day until I hear from him.

Making a return call is going to be difficult; your client will feel terrible and shame-filled. There’s no getting around that. But it is a call they will need to make. If they can’t find the courage to speak about relapse on the phone, text or email, it may be the end of your recovery coaching contract with him. However, if they do call, make yourself immediately available for a face-to-face meeting. Perhaps the client was discharged from an Inpatient/Outpatient Program (IOP) or other outpatient program due to the relapse. Helping the client find another program is important, and a program’s group therapy sessions are an integral component of recovery. Meeting with a therapist certified in addictions is also very important. Have a list of the therapists in the region and give this information to your client. A recovery coach should have an ample supply of agency addresses that can offer low- or no-cost outpatient treatment. Bring that information with you at your meeting with the client.

There are a few other pieces that will need attention. The family is always disappointed. This is where a recovery coach can help. Speaking to a spouse in the company of the addict/alcoholic, or perhaps alone with the spouse so that they can open up an avenue of discussion previously not raised. When beginning the discussion first quote the research that shows that 80% of recovering people relapse within the first year after treatment. It isn’t a matter of your client begging for forgiveness. It is a matter of your client resolving to make things right and taking the necessary action to do so. Urge the family to begin focusing on their recovery, taking care of their needs, and therefore releasing the addict/alcoholic to focus on their recovery.

Family Recovery Coaches are a perfect solution for helping families recover from the presence of an active addict in their household. Ala-Non or Nar-Anon are certainly important components of support for the family. Recently Parents of Addicted Loved Ones (PAL Groups) and Families Anonymous groups can be seen springing up for all families with an addicted loved one. Therapists are also receiving certification in Family Reunification. Originally Family Reunification Programs were offered by a State’s Child Protective Services. The services were aimed at working with families in which one or more children have been placed in foster care and are coming back into the home. The effectiveness of these programs with reunifying families has subsequently led to adapting this program model to serve families affected by mental health and substance abuse problems.


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Relapse

In the course of most recovery coaching assignments, there is a relapse. The client often 30–60 days into their sobriety becomes confident that they have this “recovery” thing down pat. They may conclude that their problems are over, and that there is no need to do anything more to maintain their sobriety. They feel good and can now handle the world.

The pink cloud of recovery can sustain some or it can allow others to slide down that slippery slope. It depends on the client and how they react to various triggers. Perhaps, there is a bit too much euphoric recall on how the drug or drink made them feel, sparked by a bottle of Xanax found in the luggage, or a whiff of scotch while enjoying a dinner out.

Relapse is inevitable. I know a relapse has happened when a coaching call is missed or, say, a commitment to a homework assignment is not kept. The usual reason a relapse occurs is that the individual stops putting enough effort into staying free of addiction. They start ignoring their problems and stop asking for help.

In fact, as a coach I am prepared for relapse to happen. Once identified, the beginning of a relapse-prevention plan can be put into place. Such a plan allows for introspection, the looking inside oneself and trying to figure out “why I picked up.” A focus is placed on the healthy fear of the consequences of a relapse and is pivotal to a client’s understanding of why they “slipped.” Indeed, my own personal fear of the pain of withdrawal kept me sober for years. A relapse early in recovery for clients can be devastating, with such results as an angry spouse, mandatory discharge from an Inpatient/Outpatient Program (IOP), a night in jail or a visit to the detox. These consequences can be positive influences on the client’s recovery process.

I look for the signs that the client has obtained a small level of humility. As a result of the relapse, does the client recognize they are neither God, nor the son or daughter of God? They are human, with the basic frailties and insecurities that every alcoholic/addict has. The first slip is a good time to examine who this client is. Is there still an air of superiority, the “I can beat this addiction” mentality? Or has a spiritual component started to appear in their conversations, such as “Higher Power” or “Your will not mine?”

Post-relapse is the best time to write a relapse-prevention plan. Ensuring the client has a week or two sober, I pull out the book by Mary Ellen Copeland, WRAP-Wellness Recovery Action Plan, or print out the template on the NAMI website[i] and hand it to my client. During the next week, the client uses the experience of a relapse to create their relapse-prevention plan. The following week, we both meet and review their plan, and discuss how to integrate it into their overall recovery plan and their life.


[1] The pdf version of the WRAP plan with authorization by Ms Copeland to reprint. Blank WRAP Forms

 

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Consequences

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Melissa Killeen

It is a good sign when a client can see the consequences of his or her drinking, drugging, gambling or acting out sexually. The consequences include a spouse that is mistrusting, a mother that cries a lot, a bank account that is overdrawn or a friend that won’t stop by anymore. When the fog begins to clear and a client becomes more conscious, it seems that the subject of consequences comes up.

I am always very happy when I hear the client speak about their remorse and sadness over the consequences of their addiction. Even better to let the client talk on, bringing all of this remorse into the light. The coach can sit back and just listen. Talking about the consequences drives home the insidious nature of the addiction while validating that the client does not want to go down that path again. The client can see their addiction has hurt the people they love the most: their spouse, their family and their friends. When I hear a client talk about consequences, then I know he or she is really starting to “get it,” truly grasping sobriety and the benefits of clarity.

A discussion on consequences is a great opportunity to bring forth the ambiguity of how addiction obliterates one’s moral compass. One client went on talking about his compulsive lying. He lied to everyone. He lied about using. He lied to avoid conflict or arguments. Soon he lied just because a lie rolled off his tongue easier than the truth. He lied for no reason at all. Of course, in time, these lies started to catch up to him. He regretted the loss of trust he had with his wife and his best friend, because of his compulsive lying.

This client also regretted the loss of his commitment to his wife. Under the influence, he slept with other women. He now fears taking an HIV test. He knows that if he was not using, the situation would have never presented itself. He loves his wife—she is everything to him. He fears if she finds out about his lack of commitment to the marriage, she will seek a divorce. Should the results of the HIV test prove positive, his marriage will be equally threatened.

The discussion of consequences can be very difficult for a client. Often, the client will cry, express guilt, admit to being ashamed. They may discuss their feelings of powerlessness. As a client meeting ends, it is a very good time to reframe the discussion into a positive message. If the client realizes that they don’t want to return to their addiction, remind the client to keep these thoughts in mind, and as “green” as possible. A client can journal about the consequences, refer back to the journal when thinking about picking up again. Also, while the remorsefulness is fresh, it is a good time to mention that in the future (not now), they will be able to complete a ninth step with the people he or she has hurt and make amends to them. This will bring the client into a state of hope.

Lastly, discuss that feeling of powerlessness. I interject the 12-step mentality of having a higher power, that your higher power always has your back. I also mention that I firmly believe in the Buddhist philosophy of surrender. If a client has any doubt about how surrendering will help their sobriety, I hand over a small card with this quote:

“Doubt comes from the absence of surrender” –Ramana Maharishi

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