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Hope Aftercare Manual

by Hope Rehab Thailand

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Chapters Introduction ……..4 Staying Motivated …….6 Your Recovery Toolbox …….15 Relapse Prevention……...31 Lifelong Wellness……….45 Mindfulness ……...54 Family Issues ……..63 Helping Others…..74 12 Step Work ……..79 Getting back on Track ……..83

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Introduction Congratulations on completing the program at Hope Rehab. Your recent efforts will be life­changing so long as you continue to push forward with your recovery ­ in fact, your real journey only begins once you return home. The treatment we offer here at Hope Rehab is usually referred to as ‘holistic’. This means we don’t just see you as someone with an addiction problem but as a unique individual trying to find a better way of living. You have emotional, mental, physical, and spiritual needs, and these all need to be addressed so you can build a solid sobriety. If you stop working on your recovery once you return home, the likelihood is that you will slip back to old behaviours. These maladaptive ways of coping are seductive because it is what you are used to – it can be like slipping on a pair of comfortable old slippers. The risk is you will drink or use drugs again because you just don’t have a better way of dealing with life.

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The program at Hope Rehab is divided into four main pillars – 12­step work, mindfulness, cognitive­behavioural therapy, and wellness therapy. Unfortunately, these pillars will only strengthen your sobriety for so long you keep working them. For example, our wellness program will improve your health, but this progress will be lost if you return home and spend all day watching TV and eating junk food. It is the purpose of this manual to provide suggestions on how you can continue to build on the work of rehab once you return home. Creating a solid sobriety is all about balance, so it is suggested that you try to work on the different areas of your life rather than just focusing on one – for example, if you put too much emphasis on physical fitness, you may be ignoring other key aspects of your life (you could even use fitness as a type of addiction substitute).

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Staying Motivated after Rehab “For changes to be of any true value, they've got to be lasting and consistent.” Anthony Robbins You have likely already heard it said that ‘recovery is a process and not an event’. This wisdom is so often heard that it can start to sound a bit glib, but appreciating the value of this statement is important. In order to maintain your recovery after rehab, you need to keep on doing the right things, and for this to happen, you need to remain motivated. What is motivation?

The word ‘motivation’ is popular in everyday speech but have you ever stopped to think about what it actually means? What are we saying when we use words like “I’m motivated enough to build a strong recovery”?

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One way to describe motivation would be to say that it is a reason for why we act in a certain way. It is the driving force behind our behaviour. For example, if you decide to going for a run every day, you will need a good reason to do this or you won’t remain committed. Staying clean and sober requires doing things we would normally not do. There are going to be days when doing this stuff (e.g. going to fellowship meetings or meditating) feels like a sacrifice, and if our motivation isn’t strong enough, we’ll find an excuse not to do it. Intrinsic and Extrinsic Motivation

Psychologists differentiate between intrinsic and extrinsic motivation. If you behave in a certain way because you fear punishment, or because you are looking for an external reward (e.g. praise or a job promotion), this would be described as extrinsic motivation. If your reason for choosing a certain action is that it makes you feel good, this would be described as intrinsic motivation.

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Extrinsic motivation can be effective in the short­term, but it is not so powerful for encouraging lasting change. When you first quit drugs, there will probably be plenty of people around to offer you encouragement and praise, but these external rewards are going to diminish over time. There is also the likelihood that your fear of the negative effect of substance abuse will also diminish over time (there is a downside to time healing all wounds because it means we can forget). The other major drawback with extrinsic motivation is referred to as the ‘overjustification effect’. This is a somewhat strange phenomenon whereby extrinsic motivation reduces your intrinsic motivation. For example, if you love painting as a hobby, you might lose some of this passion if you were to win prizes for your art. The overjustification effect happens because once we feel like we need to be bribed (by getting rewards) to do something, we stop recognising its intrinsic value. The research into intrinsic and extrinsic motivation suggests that both can be helpful, but it is better if your reason for staying sober is it makes you happier. This requires taking a leap of faith in the beginning. You need to believe that this new path is going to take you somewhere better than your old way of doing things.

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Why Do We Lose Motivation?

There are many possible reasons for why we lose motivation, but the most common is that we start to take the improvements in our life for granted. During the first few weeks of recovery, there can be fairly dramatic changes in our mental and physical health, but then the pace of change slows down. As time goes on, we can forget how much things have improved for us, and this leads to a drop in our motivation. Some of the other common reasons for why we run out of steam would include:

Failure to treat symptoms of anxiety or depression Overconfidence Getting stuck (e.g. we stop making progress because of resentment)

Unethical behaviour Romancing the drink or drug (i.e. welcoming memories of the times when substance abuse seemed to be enjoyable)

Ambivalence towards recovery (i.e. we are not 100 percent committed)

Putting other things ahead of our recovery

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Not taking care of our physical and mental health (see the chapter on wellness)

Spending time in high­risk environments such as bars Stinking thinking and self­loathing Not getting enough support Unrealistic expectations which lead to disappointment

How to Stay Motivated After Rehab

“We have to pursue recovery with the same tenacity and enthusiasm that we had when we were drinking or using drugs” Allen Berger – 12 Stupid Things That Mess Up Recovery If you don’t clearly see the benefit of being in recovery, you are unlikely to keep putting in sufficient effort to maintain this new life. So, one of the keys to remaining motivated is to regularly remind yourself what is at stake. Some of the ways you can avoid becoming complacent about recovery would include: Regularly attend recovery meetings Read recovery literature (this could include stuff like blogs as well as books)

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Maintain a daily journal where you can review your progress (this is so you can be aware of the progress you are making)

Keep a gratitude journal (gratitude supercharges your motivation)

Help other people in recovery (see the chapter on helping others)

Build a network of sober friends who contact on a regular basis

Set goals in recovery (but don’t become too obsessed with them)

It is said we become the average of the five people we spend most of our time with. I’m not sure about the scientific validity of this claim, but it does make a lot of sense. If we spend too much time around toxic people – those who are overly­negative or unsupportive – it can start to be a drain on our motivation. Staying close to a recovery fellowship is a good idea because it means you are going to be around those who share your desire for a better life and can offer encouragement and inspiration. Hearing the stories of newcomers will also remind you of what you could go back to if you drank or used drugs again.

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Another key to staying motivated is to develop some healthy daily routines that strengthen your recovery. This should include things that improve your mental and physical health such as exercise and meditation (we will be talking more about these in the chapter on Lifelong wellness). Other beneficial daily routines would include: Journaling and gratitude list Inspirational reading Positive visualisations (see the next chapter) Affirmations (see the next chapter) Praying

Motivation and Goal Setting

The benefit of setting yourself some goals is it means you have something to work towards – it is a way to harness your motivation so you use it more effectively. It is important not to become too obsessed with reaching these goals, as this can lead to disappointment, but having something to aim toward in recovery can help to keep you committed. In order to set appropriate goals, it helps if you think carefully about what it is you want from your new life. What makes you

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feel passionate? You have to learn to trust your intuition and don’t be afraid if you feel pulled in a completely new direction. The most important thing when setting goals is not to allow anything to get in the way of your recovery. This has to come first. If achieving a certain goal requires that you put your sobriety at risk, you need to abandon this goal. You are going to have many more opportunities now that you are free from addiction, but you will have to take certain steps to turn these opportunities a reality. These step may involve leaving your comfort zone and doing things that appear hard at first – for example, if your goal is to get fit, you will need to get up off the sofa and do some exercise. The steps to using your motivation most effectively to achieve your goals in recovery would include: Set goals based on your desires and values Find out what you need to do to achieve this goal Assess your own strengths and weaknesses as well as your resources for achieving this goal

Develop a plan for achieving your goal

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Break ambitious goals down into smaller goals Expect failure along the way and be prepared to deal with it

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Your Recovery Toolbox One way of looking at recovery is to say it is a process whereby you accumulate a set of tools to allow you to perform more effectively in life. The more of these tools you have in your toolbox, the easier things are going to become for you. During your time at Hope, you will be introduced to the most important items you need to have in your toolbox. You will also have the opportunity to experiment with these tools in a safe environment ­ this means you will feel more comfortable and confident about using them once you return home. It is likely going to take many years before your recovery toolbox is completely full. You will pick up more tools as you face new challenges in your life, and you find ways to overcome these obstacles. Eventually you can reach a stage where you have so many effective tools that you can easily deal with any hurdle in life ­ it means you have achieved the top prize in mental health (aka serenity). Your toolbox is not going to look the same as everyone else’s. This is because what works for one person might not work for

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somebody else. There are some core items we suggest you put in your toolbox right away including: Gratitude

So long as you remain grateful for your sobriety, it is highly unlikely you will ever relapse. It is most often when you start to take things for granted that you put your sobriety at risk. Gratitude is lost when we focus on what we are missing rather than what we already have. This sense of lack can fill us with dissatisfaction and reduce our motivation to stay sober (see the previous chapter on motivation). It is therefore vital that you are able to recognise all the good stuff that is happening in your life. Being sober means your life should be steadily improving over time. The problem is once you get beyond early recovery, these improvements can occur so gradually you barely notice them. This makes it easier to take such improvements for granted.

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The secret to being happy is not to keep accumulating more belongings and successes but to appreciate what you already have. Gratitude means you always have a reason to feel happy! Gratitude is a skill you can develop by maintaining a daily gratitude diary. This only has to take a couple of minutes, but it can have a profound impact on your life. You will have written a gratitude list while completing the Hope Rehab workbook (page 23), and you can use this template for your gratitude diary when you go home. Loving-Kindness Meditation

Addiction and low self­esteem tend to go hand­in­hand. This means you may have to cope with a great deal of inner­negativity (aka stinking thinking). If your thoughts are overly critical, it causes you to become your own worst enemy. It means when life become challenging, you start to berate yourself when what you most need is support and encouragement. This negative inner­chatter can also lead to depression and chronic anxiety.

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Loving­kindness (metta) meditation is a technique that helps you to develop compassion for yourself as well as other people. It is something you will have already practiced during your mindfulness class. If you intend to continue with a meditation practice once you go home, you can spend the last few minutes of each session focusing on loving­kindness. There are a number of ways you can perform loving­kindness meditation, but here is one suggested way of doing things: Do your usual meditation practice Near the end of the session, bring your attention to the area around your heart

Say these words internally ­ “may I be happy, may I be healthy, may I be safe, may I be mentally at ease” ­ repeat for a minute or two

Picture somebody you care deeply about (this should not be a person you are romantically involved with) and repeat the above changing the’ I’ to ‘you’ (e.g. may you be happy)

Picture somebody you have no strong feelings towards (this is usually somebody you don’t know very well) and repeat the phrases

Picture somebody you currently dislike and repeat the phrases for them too

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Complete the meditation with the following aspiration “may all beings be happy, may all beings be healthy, may all beings be safe, may all beings be mentally at ease”

Positive visualisations

“Visualization is daydreaming with a purpose” Bo Bennett Positive visualisation (aka creative visualisation) is where you use your imagination to influence your body and mind. This technique has been used for thousands of years, and it is credited with helping people such as Tiger Woods, Bill Gates, Anthony Robbins, Jim Carrey, and Will Smith. Some of the claims made for positive visualisation can make it sound a bit supernatural, but there are plenty of practical reasons for why this tool can benefit you in sobriety such as: It helps to keep you focused on your goal It boosts your energy levels so you are better able to achieve your goals

It can boost your self­esteem and confidence

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There are many successful athletes who are convinced that visualisation can be a way to practice their skills – the idea is that the brain doesn’t differentiate much between doing an action and imagining you are doing that action

It can be a type of meditation It can allow you to see things in a different way and think outside of the box

Visualising your goals may be a type of stress­buster Regularly visualising your goals may reduce the likelihood of relapse – it reminds you of what you are trying to achieve with your new life

It can boost your mood It can encourage you to leave your comfort zone It boosts your creativity

In order to benefit from positive visualisation, this needs to be something you do on a regular basis. Doing it right before you get out of bed in the morning can be an excellent way to begin your day. It only needs to take a few minutes. All you need to do is get your body relaxed and then visualise your goal in as much detail as possible – try to use all of your senses. There are audio guided positive visualisations available if you want a more structured technique, and you’ll find many of these

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are free on YouTube (just search for ‘guided positive visualisations’ and choose one you like) . One of the nice things about these audio tracks is that they will usually begin with some type of progressive relaxation to get you into the right mental space. You can also record your own guided positive visualisations.

Affirmations

If you have an inner­soundtrack that is overly­negative, it can suck away your motivation and hold you back in sobriety. It is not really possible to stop these critical thoughts from arising completely, but you can learn to challenge them. You can also start to deliberately cultivate positive thoughts, and this is what affirmations are all about. You will already have heard some recovery affirmations at Alcoholics Anonymous or Narcotics Anonymous meetings. The most popular ones would include: one day at a time, first things first, this too shall pass, expect miracles, and it works if you work it.

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Affirmations are basically short positive sentences designed to offer you encouragement. Just as negative self­talk can bring you down, these words can have the opposite effect. These affirmations can be huge help on the tough days, and you can use them to boost your self­esteem and to help you develop a more positive view of life. If there are areas of your life where you feel you need encouragement, you can write your own affirmations for this. It is recommended that this should be a relatively short and simple sentence that are written in the present tense (e.g. ‘I have confidence’ rather than ‘I will have confidence’). It is also important that your affirmations focus on your behaviour rather than the behaviour of other people. If you are stuck for ideas for your affirmations, here are a few suggestions: I am full of energy I am in charge of my life I am positive and love my life My career is moving in the right direction I am bursting with creativity I am healthy I choose to be happy today

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I look forward to each new day I am a loving person I am a strong person I am financially secure

One way to look at affirmations is to see them as nutrition for your soul. They are there to counteract any self­hatred that may be holding you back in life. If you get into the habit of repeating some affirmations throughout the day (it only has to take a few seconds), it can benefit your life, and you’ll remember to use them when times are tough. Anger Management

Uncontrolled anger is one of the biggest threats to your new life. The problem is that once you are caught up in this emotion, it is like your brain is functioning at a more primal level – this means your reasoning ability is diminished. An outburst of anger could easily lead to a relapse, so you need to develop healthy strategies for dealing with this emotion.

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What is Anger?

Anger is a normal human emotion. It is triggered by the feeling that we are somehow being threatened – this perceived threat can be real or imaginary. Anger causes our body to move into a heightened state of awareness. This can be helpful if the threat is real, and you are in control of this emotion – e.g. some people use their anger of injustice as a motivation to do something positive. Your feelings of anger can also help you develop important insights that you can then use to strengthen your recovery. For example, if you find yourself flying off the handle over something minor, this suggests that there is some underlying problem that you need to deal with Feeling angry is a part of life. You are likely to experience this emotion many times in the future, and it doesn’t have to be a problem. The real danger is when you allow your anger to drive your behaviour to such an extent that you are out of control.

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Acting Out, Reactive Anger and Toxic Anger

‘Acting out’ is a term used by psychologists to refer to negative coping strategies we can use to deal with thoughts and feelings we feel unable to express in a healthier way. A person who has a temper tantrum in response to criticism could be described as ‘acting out’ because he/she is behaving this way due to not being able to handle the feeling of being judged. If we want to stop acting out, we need to find a better way to deal with troubling thoughts and emotions. Reactive anger is when this emotion causes us to act in a negative way. This could involve becoming physically violent or verbally abusive. Passive aggression (e.g. ignoring people) is also a type of reactive anger. If you have a tendency toward reactive anger, it is a sign that you must develop new more positive strategies for dealing with this emotion. You have to learn to control your anger so it no longer controls you. If your response to anger is to try to avoid it or ignore it, it can begin to fester inside of you – this is referred to as ‘toxic anger’. It is sort of like you are turning yourself into a pressure cooker. The anger you ignore isn’t going anywhere ­ we just keep pushing it down until it becomes so strong that it triggers an

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explosion. This way of coping with anger can be particularly dangerous because when we do explode, it can mean dire consequences for ourselves and other people. A Mindfulness Approach to Anger

Mindfulness offers a particularly effective strategy for dealing with anger. Rather than trying to push this emotion away or acting out on it, you just observe it in a more objective way. When you do this, you will notice that anger is just experienced as a feeling of high­bubbly energy in the body (usually in the upper­chest). If you can just observe the physical sensation of anger, you won’t lose control because it will keep you grounded. Reactive anger and ‘acting out’ occurs because we slip into habitual ways of behaving – this means we are basically functioning on autopilot. Once you have slipped into autopilot, it means your awareness is diminished as well as your reasoning ability. The benefit of mindfulness is it can prevent you from slipping into this state.

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‘Breathing Space’ is a simple mindfulness technique that was developed by Mark Williams at the University of Oxford. It only takes 3 minutes to perform, and it can be an effective strategy for preventing your mind slipping into autopilot. Breathing space involves 3 simple steps: Focus your attention on what is happening in your body right now. What is your posture like? Do you notice any physical discomfort? How are you feeling?

Now focus on the rising and falling of your breath in the abdominal area.

Return your attention to the whole body noticing any physical sensations or feelings

You can do this technique anywhere, and you can spend roughly one minute on each step. Depending on the situation, you can close your eyes while performing a breathing space, but you don’t have to do this for it to be effective. 24 Hour Plan

The thought of staying away from drugs and alcohol for the rest of your life may feel a bit overwhelming. Luckily, you don’t have to think so far ahead but instead take it one day at a time. The 24 hour plan is a simple tool where you commit to staying

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sober ‘just for today’. You can also use this same strategy for other parts of your life you are trying to change. Acceptance

God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference A major source of unnecessary suffering in our life can come from trying to fix things that are beyond our ability to fix. If we become too obsessed with these parts of life beyond our control, it will lead to frustration, resentment, feelings of powerlessness, and unhappiness. Examples of parts of life that are beyond our personal control would include: Other people Our genetic inheritance (genes) The weather The government The economy Other cultures Past mistakes Society

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Our childhood (it is already gone) If we devote too much energy to the things we have no real hope of changing, it means we will have less energy to focus on the things we can change. Banging our head against a brick wall will also reduce our self­esteem and confidence. Acceptance is a skill you can develop in recovery. When you learn to let go of things that are beyond your control, it means your load is lighter going forward – this is something you need to do if you hope to develop emotional sobriety and serenity. Acceptance can be an incredibly effective recovery tool but only when it is properly applied. If you choose to accept negative circumstances that you could change, this is going to increase your suffering. The Phone

One of the worst things you can do when things start to get tough in recovery is to isolate. The urge to hide away from the world to ‘lick your wounds’ may be strong, but this means you are going to be alone with your negative thoughts. Isolating is a

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common behaviour of people just before they relapse so giving into this urge is putting your recovery at risk.

If you belong to a recovery fellowship, it should be easy to collect the telephone numbers of some other members. These can then be people you call when you need some support and an understanding ear. It’s a good idea to get a sponsor who will then be the first person you phone when times are hard. It may also be worth adding the numbers of trusted friends to your list of people to contact when times are hard – just be sure these individuals support your recovery.

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Relapse Prevention The biggest fears most of us are going to have when leaving rehab is that at some point in the future we are going to return to alcohol or drugs. This would mean undoing all of our good work, and we may not get another chance to recover (there are too many stories of people who relapse and die soon afterwards). It is therefore something we want to avoid at all costs. It can appear as if the pull towards relapse is some sinister force that we have no real control over. This is not how the reality of your situation. A return to substance abuse is not inevitable, and it has nothing to do with luck. There are things you can do to prevent, but first you need to understand why it happens. Why Do We Relapse?

Why would we put so much effort into changing our lives only to later return back to where we started? It usually doesn’t take

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long to see the benefits of living in recovery, so why would we ever want to give this up? A study by Marlatt & Gordon (1985) found that the most common causes of relapse among alcoholics were: Negative emotional states (e.g. anxiety or anger) 38% Social pressure 18% Interpersonal conflict 18% Urges and temptations 11%

The study also looked at heroin users and found the causes of relapse were similar: Social pressure 34% Negative emotional states 28% Urges and temptations 28% Interpersonal conflict 13%

The fact that negative emotional states are such a danger for people in recovery shouldn’t come as a huge surprise, as it is often the ability to handle emotions that makes substance abuse an attractive option in the first place. This is why it is vital to pick up new tools in rehab (such as mindfulness or ABCs) to help you deal with your emotions in a more constructive way.

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We are influenced by those we spend our time with, and this explains why social pressure is another cause of relapse. It is interesting that in the study by Marlatt and Gordon, heroin addicts are slightly more at risk of this than negative emotions. This may have something to do with the fact that the subculture associated with this type of drug abuse is particularly close­knit due to the illegality of the behaviour. The risk from social pressure explains why you need to surround yourself with the right people to strengthen your recovery – or as they say in the 12­step groups ‘stick with the winners’. One of the other reasons for why we become more susceptible to relapse is we just forget how bad it all was. Human memory is a fickle thing, and it is easily to forget where we have come from unless we take steps to remind ourselves on a regular basis. Another clue for why we relapse is to be found in incentive sensitisation theory. If we repeatedly expose our brain to an addictive substance, it leads to a situation known as hypersensitisation. It changes our brain in such a way that there are now unconscious processes that trigger urges to repeat the behaviour. These urges can continue to appear long after we

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give up alcohol or drugs, and this is why we need to be on our guard. Understanding the Relapse Process

The relapse process is a description of what tends to happen before people pick up a drink or use drugs again. It comes from the work of the addiction expert Terry Gorski. This theory doesn’t claim to be an exact depiction of what happens, but it does provide useful information that explains how we can end up in this situation. The stages of the relapse process are divided into: We get stuck in recovery We deny we are stuck We deal with the discomfort of being stuck by turning to maladaptive behaviours/compulsions (e.g. internet addiction)

There is some type of trigger event (this can be something small like a family argument that we blow out of all proportion)

We become dysfunctional on the inside (i.e. stinking thinking)

We become dysfunctional on the outside (e.g. we start taking our inner­turmoil) out on other people

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We start losing control Addictive thinking (i.e. thoughts justifying relapse) We use an addictive substance We lose control again

Relapse Triggers

A relapse trigger is any situation that has the potential to cause you to use drugs again. It includes certain behaviours and environmental factors and there are going to be triggers that are unique to you (e.g. you may associate certain songs with substance abuse). In the 12 Step program, the list of factors that could cause a relapse is summarised with the description ‘people, places, and things’. HALT

The four relapse triggers that can be most dangerous to people in early recovery can be easily remembered by using the acronym HALT which stands for: Hunger Anger Loneliness

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Tiredness Anger is probably the most dangerous of all of these threats to recovery because when we are angry, we are more likely to act impulsively. The other problem with this emotion is it is hard to think rationally when we are under its sway. This is why it is so crucial that we have strategies for dealing with anger (see the recovery toolbox chapter). Tiredness and hunger are potential triggers because our defenses are weaker when we experience these physical states. There is also the risk of hunger and tiredness triggering cravings at a time when we feel too weak to put up a fight against these urges. It is recommended that you avoid hunger and tiredness during early recovery, and if you experience either, you will want to rectify the situation right away (e.g. take a nap). We humans are social animals so loneliness can be hard for us to deal with. Giving up alcohol or drugs often means limiting contact with former friends, and if we are not quick to build a new social network, we can start feeling isolated. One solution is to join a recovery fellowship where you can begin to meet new people who share your sober values.

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Other Common Relapse Triggers

Resentment Stress Uncomfortable feelings Romancing the drink/drug Dishonest behavior Spending time in high­risk situations (e.g. being around people who are using)

Complacency Self­pity Symptoms of depression Unrealistic expectations (which lead to disappointment) Taking on too much Putting other things before your recovery

Slip or Relapse?

When people in recovery use alcohol or drugs again (even if it is just a sip of champagne at a celebration) it is always a big deal. The person who does this is in serious jeopardy. It is what the individual does immediately after the return to substance abuse that is going to determine the damage caused by this decision.

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It is helpful to differentiate between a slip and a full­blown relapse. A slip is when a person uses alcohol or drugs on the spur of the moment but automatically regrets the decision and is able to stop. A full­blown relapse can start off as a slip, but the person is unable to stop. The word ‘slip’ can sound kind of innocent and minor, but it isn’t at all ­ it is going to require a redoubling of effort to get back on track following this event. Signs of an Impending Relapse

“What makes matters worse is that our opponent – our addiction­ knows everything about us. It is part of us; it has all the intelligence, capabilities, insights, and knowledge that we possess.” Allen Berger – 12 Stupid Things That Mess Up Recovery It can appear to the person afterwards that the relapse just seemed to happen out of nowhere. In reality, there are usually plenty of signs that we have gone off­track before we pick up a drink or drug. The main reasons we can fail to see these signs is

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that we don’t know what to look for, we have become complacent, or we are deliberately ignoring them. Some of the most common indications that we are heading towards a relapse would include: Disengaging from the recovery community (e.g. you stop going to meetings)

Stinking thinking – a persistent negative outlook on life Romancing the drink or drug – you enjoy thinking about those days when substance abuse seemed to work for you (memories of using are not the problem but enjoying them is)

Unethical behaviour such as lying Isolating – spending less time around other people Using an addiction substitute such as exercising or working too much

Using any mind­altering substance (e.g. drinking alcohol if you are in recovery from methamphetamine addiction)

Allowing other things to get in the way of your recovery Cynicism about recovery Feeling stuck in recovery Putting yourself in high­risk situations (e.g. spending the afternoon with old drug using friends)

Joking about relapse Making excuses for why you might relapse

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Threatening family and friends that you will relapse unless certain things happen

Taking on too much Not taking care of your mental and physical health

How to Prevent Relapse

So long as you remain grateful for your recovery, you are highly unlikely to relapse. It is also important that you continue to do the things you need to do in order to remain strong. This will include commitments such as going to recovery meetings, getting involved in the recovery community, journaling, and spiritual practices. Addiction not only involves abusing mind­altering substance but also a engaging in a plethora of bad behaviours (e.g. being manipulative and behaving dishonestly). These negative habits will have been moving your life in the wrong direction, and this is why you suffered so much. The goal of recovery is to develop new healthy habits that will move your life in a better direction ­ it will also put some distance between you and the substance abuse. Making these

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healthy habits part of your life is one of the key components of preventing relapse. First Aid to Prevent Relapse

If your recovery is in jeopardy, you need to speak to somebody right away. One of the worst things you can do at this point is to isolate because this can mean you are at the mercy of thought processes that support the addiction. If you have a sponsor, now is the time to call this person. Otherwise, you need to get to a meeting and share about how you are feeling. You can also contact us here at Hope (this should be ‘as well as’ rather than ‘instead of’). N.B. If you feel close to relapse, reach out for help right away Using the ABCs to Prevent Relapse

It is often our beliefs surrounding a particular event, rather than the event itself, that can put us at high risk of a return to

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addiction. For example, if you believe everyone is judging you unfairly, you may see this as justification to relapse. We humans are notoriously bad when it comes to separating beliefs from reality and this leads to a great deal of unnecessary suffering. By now you will have had plenty of practice with using the ABC model. This tool from cognitive­behavioural therapy can be used to root out damaging beliefs that are putting your recovery in danger. If something is happening that is a threat to your new life, you need to break it down using the ABC tool. So let’s imagine you are getting worked up because people are treating you unfairly. Get out pen and paper and write down the ‘activating event’, ‘beliefs’, and ‘consequences’. This will allow you to see what is happening in a more objective way, and it can help you regain control. Mindfulness S.O.B.E.R Technique

S.O.B.E.R is a tool used as part of Mindfulness­Based Relapse Prevention (MBRP). It is based on the understanding that people who relapse do so because they slip into automatic pilot mode.

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The purpose of the S.O.B.E.R. tool is to prevent this from happening. If you feel your sobriety is under threat, you need to: Stop ­ do not take any action at this point because you are likely to later regret it

Observe ­ bring your attention to the sensations in your body as this will move you out of automatic­pilot mode

Breathe ­ by focusing on your breath, it will still your mind so you can see things more clearly

Expand ­ now that you have pulled out of automatic­pilot behaviour, you are in a much better position to assess your situation objectively

Respond mindfully ­ e.g. if you are in a high­risk situation, you need to leave

Stress and uncomfortable feelings can be major relapse triggers. By maintaining a daily mindfulness practice, you will be better able to face these challenges. Basically, the more mindful you become, the easier it gets to handle the ups and downs of life. Additional Strategies for Avoiding Relapse

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Know your relapse triggers and have a plan for dealing with these threats (see your recovery map)

Build a network of sober friends Never take your recovery for granted Go to regular recovery meetings ­ this can be like putting money in the bank for a rainy day

Keep taking steps to improve your life Never forget how bad it once was Share honestly about how you are feeling ­ it can be when you start keeping secrets that you become most at risk

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Lifelong Wellness “If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” Hippocrates (the father of western medicine) It is usual for our body to have suffered a tremendous amount of abuse by the time we enter rehab. Some of us will be malnourished due to years of eating a poor diet, and we may not even be able to remember the last time we exercised. The wellness program at Hope Rehab is designed to help you begin improving your health. This is done gradually through gentle exercise and a balanced diet. If it has been a long time since you engaged in much physical activity, it will be important to start off slowly, but you should reach a reasonable level of fitness by the time you return home. It is important recommended you continue to look after your health once you return home ­ failure to do so means you won’t be able to get the most out of your sobriety. There is also a risk

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you will become so disheartened by the lack of energy and mental sluggishness associated with poor physical fitness as an excuse to relapse. Some people experience post­acute withdrawal symptoms (PAWS) that can last months or even years. This may be experienced as constant tiredness, low or flat mood, insomnia, and concentration problems. Physical exercise and a healthy diet can help you recover from PAWS much faster. Benefits of Staying Well

Higher energy levels Increased productivity Controls your body weight Makes your bones and muscles stronger Improved mental outlook Reduced risk of insomnia Reduced risk of depression Reduced risk of cardiovascular disease Improved mood Improved mental health Lower risk of developing diabetes Lower your risk for certain cancers

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Stronger immune system ­ lower risk for many diseases Improved body image Increased confidence It can mean you live for longer It strengthens your sobriety

How Much Exercise?

The latest exercise recommendations from NHS Choices for adults aged between 19 and 64 is either: 150 minutes of moderately intense (e.g. fast walking) aerobic exercise per week with at least two days of muscle strengthening activities

75 minutes of vigorously intense exercise (e.g. running) per week with at least two days of muscle strengthening activities

a mix of moderate and intense exercise per week with at least two days of muscle strengthening activities

What Type of Exercise?

You will have gotten to try a few different exercises during your stay at Hope Rehab such as swimming, cycling, walking, aerobics, pilates, Thai boxing, and yoga. It is suggested that you incorporate the activities you enjoy into your life once you return home. Other possible exercise activities would include:

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Martial arts Tennis Football Running Mountain climbing Hiking Dancing Gym workouts

What is a Healthy Diet?

The food you eat is going to have a huge impact on your physical and mental health. It is usual for people in early recovery to be lenient when it comes to diet choices ­ the argument is that it is better to eat some chocolate than to relapse. If you continue with a poor diet long­term though, it is going to have a negative impact on your physical and mental health. A common reason for why we choose sobriety is we become ‘sick and tired of feeling sick and tired’. The problem is that a poor diet can mean you continue to feel bad even though you have taken a major step towards improving your life.

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The Dangers of Comfort Eating

Comfort eating can be described as an attempt to eat away our emotions – it means we use food as a tool to distract ourselves from things we perceive as unpleasant. The association between eating and escaping problems usually originates in childhood when food can be used as a reward for good behaviour (e.g. you are given a chocolate snack for doing your homework). The mental link that is forged in your brain between food and reward means eating can become a type of addiction substitute. It can mean you habitually turn to food whenever you feel mentally uncomfortable. Gorging on your favourite snacks offers a temporary distraction but it is not going to solve your problems. If you get into the habit of using this coping strategy, it can also lead to negative outcomes such as: Obesity Health problems Low energy Depression Body­image issues and low self­esteem

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Occasionally overdoing it with junk food in early recovery is preferable to relapse, but you don’t want this to become a habit. The negative effects of comfort eating make sobriety less satisfying, and this can then be used as an excuse to return to alcohol or drugs. Mindful Eating

“The cycle goes like this: overeat, feel bad, criticize yourself, feel bad about yourself, eat to soothe yourself, repeat” Susan Albers (Eating Mindfully) We will be focusing more on mindfulness in a later chapter, but let’s consider one aspect of this approach here known as mindful eating. The most common reason for why we make poor food choices is that we are just not paying attention to our bodies. This means we fail to notice when we have satisfied our hunger, and we comfort eat even though this habit doesn’t actually help us in any real way ­ it just gives us more things to feel bad about (e.g. obesity).

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One of the reasons for the current obesity epidemic is people engage in a type of eating behaviour known as ‘grazing’. Food today is so readily available that we no longer wait until we feel hungry before we eat ­ in fact, it may have been years since some of us really experienced hunger. This is bad news because it means we are not listening to our body but instead allowing habit to determine when we eat. Mindful eating offers a permanent way to change your relationships with food. It is based on the understanding that if you give your body what it truly wants, you will naturally move towards a more healthy way of eating. Mindful eating is not about calorie counting or crash diets but about learning to appreciate and enjoy your food more. The majority of us are so out of touch with our bodies that we rely on outside cues to tell us when to stop eating. Instead of putting down the fork when our hunger feels sated, we only stop eating when our plate is empty. There is no benefit of eating after we already feel satisfied, and it just means we are consuming additional calories we don’t need.

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One of the other disadvantages with our mindless approach to food is that we fail to appreciate what we are putting into our mouths. TV dinners can be consumed without hardly tasting anything on the plate because we are so distracted. It means that although we may have dealt with our physical hunger, we still feel unsatisfied afterwards, and we may deal with this dissatisfaction by eating more. So, let’s summarise the dangers of mindless eating: It means we eat when we are not hungry We don’t feel fully satisfied after a meal We make poor diet choices because we can’t appreciate how different foods make us feel

We eat more than we need We eat for reasons other than hunger (e.g. comfort eating)

Mindful eating means being aware of what is happening in your body before, during, and after you eat. It involves recognising if you are actually hungry or if your desire for food is just out of habit. It means observing what is happening as you eat and stopping when you feel satisfied. Mindful eating also requires that you pay attention to what is happening in your body after you eat as this will help you make better choices in the future.

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Eating more mindfully is also about showing yourself some compassion. Beating yourself up over bad food choices can make you feel so bad that you feel the need to comfort eat. There is nothing wrong with wanting comfort from food, the only problem is this solution doesn’t actually work. Once you gain this insight through mindful eating, you will no longer need to struggle with food.

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Mindfulness “The tragedy for too many of us is not that our lives are too short, but that we take so long before we start to live them. “ Mark Williams The challenge with mindfulness training isn’t that this is a difficult skill to master but that it is so easy to forget to do it. If things are going well in your life, you might not feel like there is any need to concern yourself with mindfulness practice, but this means you will be at risk of returning to mindless coping strategies when things get hard. Life offers a banquet of experiences and emotions, and this means there are going to be bad days as well as good. Mindfulness can help you to truly appreciate the happy times ­ it means you are going to be fully present in the moment and not distracted by worries and concerns. It also gives you the ability to deal with the bad days in life so you never feel overwhelmed or tempted to relapse.

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Reclaim Your Life by Escaping Autopilot Mode

We can only consciously focus on one task at a time so how is it that we are able to drive a car, listen to the radio, and plan our dinner all at the same time? This is possible because the brain has the impressive ability to automate tasks we have done in the past. As we get older, it is normal for the number of tasks we are able to do on autopilot to increase. It is doubtful that humanity would have progressed so far if it wasn’t for our ability to do certain tasks on autopilot. If we have to pay close attention to every action we take, we would end up getting a lot less done ­ multitasking would become impossible. Our ability to develop habits definitely has its advantages, but we do pay a high price for this functionality. When we are acting on autopilot, it means we are in a mindless state. This is easy to recognise for yourself by recollecting examples of this from your own life – for example, have you ever driven home from work yet failed to remember anything about the journey afterwards? It wouldn’t be so bad if we used these periods of performing on autopilot were used to relax, but this is not what usually happens – instead the mindless state

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most usually involves being lost in thoughts about the past and future. Functioning on autopilot leads to a situation where we are focusing on the stories in our heads rather than what is actually happening around us. This means we are missing out on reality in favour of our stories about reality. Imagine arriving in Thailand with a copy of the Lonely Planet guidebook and spending every minute reading this book – this is what happens when we live our lives on autopilot. One of the biggest drawbacks of allowing habits to control so much of our lives is that many of these automated responses are unhealthy. Some of the stuff we do on autopilot will be causing problems in our lives, and these automated responses will continue to cause problems until we find a way to escape them. Violent anger can be an example of an unhealthy habit that becomes so ingrained in our behaviour that it keeps getting us into trouble. In their book, ‘Mindfulness – Finding Peace in a Frantic World’, Mark Williams and Danny Penman describe autopilot as being like opening a software program on a computer. What happens

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if we open too many windows on a computer? Things started to slow down until the system eventually crashes. The same thing happens to those of us who approach life in a mindfulness way – we can have so many programs running in the background of our mind that we begin to feel overwhelmed. “You need to learn to close down some of the “programs” that have been left running in the background of your mind.” Mark Williams and Danny Penman – Mindfulness: Finding Peace in a Frantic World Mindfulness is the answer if you want to reclaim your life from the limitations of existing on autopilot. Every time you bring your attention to what you are doing in this moment, you escape the mindless state. You may then be amazed to find that even mundane tasks like washing the dishes or brushing your teeth can be fun and interesting. Mindful Tools and Mindful Practice

The aim of the mindfulness program at Hope Rehab is to encourage you to take up some type of long­term mindfulness practice such as meditation, yoga, or tai­chi. If you commit to

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one of these activities on a daily basis, your mindfulness will increase over time. We also teach you some mindfulness tools that you can use right away – once mindfulness becomes a part of your life, there will be less need for these tools. Urge Surfing for Lingering Cravings

Even after you return home from rehab, you may still have to deal with the occasional craving. You may also find that you develop new cravings for things like sugary snacks. One way to deal with these urges is to just distract yourself, but this is not always possible. Another option is to deal with your cravings mindfully – the more you do this, the easier it becomes. Urge surfing is a mindfulness technique that was devised as a tool by Gordon Alan Marlatt as part of his Mindfulness Based Relapse Prevention (MBRP) program. It involves just allowing yourself to experience cravings in an objective way without resistance or judgements like ‘I can’t stand this’. A craving is similar to a wave in the sea. It starts off small and then gets bigger and bigger until it crashes on the shore. If you observe your cravings, you may notice they follow a similar

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pattern. They rarely last more than 20 minutes. You can try to fight this wave, but the likelihood is you will drown. Urge surfing is about experiencing it until it passes – when you do this you will understand that these urges can’t harm you. Urge surfing is a skill you can develop. You can practice it on other things for example, not giving into nicotine or caffeine cravings right away or just observing an itch without scratching it. Knowing that you can just sit with cravings is a powerful insight and it means you are no longer a slave to these urges. Dealing with Relapse Triggers

There are going to be things in your home environment that remind you of using drugs or drinking. This can be something as simple as hearing a song that reminds you of being intoxicated or seeing drug paraphernalia. You may also react to a stressful or emotional situation by thinking about relapse. One way of dealing with a relapse trigger is the S.O.B.E.R technique used as part of the MBRP program. If you feel in danger you need to use the following steps:

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Stop – don’t allow yourself to slip into auto­pilot Observe – what is happening in your body (e.g. you may notice signs of stress such as tension in your stomach). By putting your attention on physical sensations, it can be enough to move you out of the ‘fight or flight’ response.

Breathe – take some deep breaths as this will help to ground you

Expand – move your attention to your surroundings and try to view things more objectively

Respond – in a mindful way now that you are no longer acting on the heat of the moment

Continuing Your Mindfulness Practice

The aim of mindfulness practice is to increase the likelihood that you will be mindful in the rest of your life. This is not something that is going to happen overnight because you will be going against a lifetime of habitual behaviour. The key to building your mindfulness is to have a daily mindfulness practice you can commit to. Here are some suggestions for creating your mindfulness practice:

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Ideally, you want to be meditating (or doing some other mindfulness practice) twice a day for 10 to 20 minutes per day. This is something you can build up to over a few months.

1 minutes of mindfulness practice a day is much better than no practice at all

It is better to practice for 1 minute per day than 10 minutes once per week

If you treat mindfulness practice as something that you just need to get out to the way, you probably won’t benefit much from it

You can do any type of mindfulness practice mindlessly Don’t feel guilty about missing a mindfulness session – just practice being mindful for a minute instead

Consider joining a mindfulness class as this will keep you motivated

Living Mindfully

The act of turning to addictions for recovery from pain or difficult situations is deluded self­help. We are looking in the wrong place for happiness. This misguided kindness toward ourselves perpetuates a cycle of pain. Valerie Mason­John and Dr Paramabandhu Groves (Eight Step Recovery)

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Mindfulness is an approach that will benefit every area of your life. It can improve your relationships, increase your creativity, improve your focus, and make you far more resilient to ups and downs. This practice can also have the surprising benefit of releasing your potential – it’s amazing what can happen when you start getting out of your own way. You may find that mindfulness gives you the type of life you once hoped could be found through alcohol or drugs. It means you feel comfortable in your own skin, and you can once again experience things with the wonder of a child.

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Family Issues It is common for family members to have been negatively impacted by our substance abuse. It is usually our nuclear family that suffers the most, and these individuals may have needed to adapt negative coping strategies in order to deal with our behaviour. Some example of this would include: Family members lying to hide the shame of addiction Children unwilling to invite friends home in case a parent is intoxicated

A spouse lying to protect the partner’s career (e.g. phoning his work to say he/she is sick)

Young children taking over adult responsibilities (e.g. minding younger children)

Family members ‘walking on eggshells’ because of the unpredictable behaviour of their loved one who is addicted

Co-Dependency

Co­dependency refers to a type of enabling behaviour that occurs when an individual puts the needs of another person before his/her own. This maladaptive coping strategy can develop in response to a loved one who is addicted to alcohol or

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drugs. It leads to symptoms such as low self­esteem, loss of personal identity, and unhealthy boundaries. The simplest definition of co­dependency would be to describe it as ‘dependent­with’. The concept of co­dependency first became popular back in the sixties. It became noticed that family members of alcoholics often developed maladaptive behaviours even though they were not actually addicted. This behaviour was originally labelled as ‘co­alcoholic’ but researchers discovered that these characteristics were surprisingly common in the general population so the term was changed to co­dependent. It may be the case that the person who ends up in a co­dependent relationship with a substance abuser may have had these traits to being with. This way of interacting with other humans can develop in early childhood in response to growing up in a dysfunctional family. Characteristics of co­dependency: People pleasing Low self­esteem

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Rescuing Choosing a partner who need ‘rescuing’ Difficulty being alone Taking responsibility for others Feeling responsible for the behaviour of others Weak boundaries in relationships High reactivity to the emotions of other people Loss of personal identity – putting the needs of other people before their own

Difficulties communicating needs (due to loss of identity) Dealing with Co-dependency

There is no such thing as a ‘perfect family’ and co­dependency is common – if you recognise some of these characteristics in yourself, it is nothing to feel ashamed about. Recovery is all about progress and not perfection, so your goal should be to develop healthier relationships. This means moving from co­dependent to a more inter­dependent relationships (i.e. relationships based on give and take and healthy boundaries). Co­Dependents Anonymous (CoDA) is a 12­step group where the goal is to support members who are trying to develop healthier relationships.

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Social Behaviour and Network Therapy (SBNT)

SBNT is an approach from the UK that uses the strength of a social network to help people remain free from substance abuse. There is no doubt the person caught up in addiction can have a negative impact on loved ones, but the complete opposite can be true in recovery – family and friends can have a positive impact on the individual attempting to escape addiction. If you have lots of family and friends supporting/helping you to build a strong recovery, it should make your job a bit easier. This is not to say that anyone else can or should be doing the work of rebuilding your life for you but having a strong social network can definite advantage. The SBNT approach involves gathering a team of people who are going to help you in early recovery. Your team will attend some educational sessions (usually 8 to 10) together where you will all learn coping skills and support strategies – the overall goal of these sessions is to create a strong enough network to support lasting change. Your chosen team will also be there to help you develop a plan for avoiding relapse, and to help you follow this plan.

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SBNT is a relatively new approach, and the availability of this support will depend on where you live. The Danger of Expectations Involving Family

It is reasonable for us to expect our life to improve now we have started to do the right things. Turning our back on addiction is one of the most powerful things we can do to improve our life, and we can expect there to be obvious rewards as a result of this decision. It is important to appreciate though that expectations can become a source of sourcing in recovery, and this is particularly likely to be the case where our expectations involve other people. Now that we are trying our best to improve ourselves, and make up for past mistakes, we can feel entitled to forgiveness for any hurt we have caused in the past. The reality is we have to earn the trust of our loved ones, and it may take some time before they are entirely ready to forgive. There may also be instances when the person feels we have hurt them so much that they no

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longer want to have anything do with us – if this is the case, it is something we have to learn to accept. The fact that other people seem unwilling to forgive us can appear incredibly unfair. After all, weren’t we caught up in a disease process that caused us to behave badly? Unfortunately, learning the truth about addiction provides an explanation for we behaved like we did, but it doesn’t mean we are exempt from the consequences of this behaviour. One mistake we want to avoid is using our recovery as a bargaining chip in an attempt to manipulate our loved ones. This would be the case if we suggest the possibility of relapse unless these people begin to treat us a certain way. We are the ones who would suffer the most should we relapse, and to use this threat against a family member only further creates the impression that we still can’t be trusted. Making amends can certainly be beneficial, but the most important thing we can do to salvage our relationships is to remain committed to recovery. It is our improved behaviour that is going to impress other people rather than our promises of

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change. It may take a long time, but even our harshest critics may eventually decide we are worthy of forgiveness. Mindful Relationships

Getting things back to how they once were is unlikely to be a satisfactory goal in recovery. The reality is most of us who fall into addiction will have had problems with other people even before the substance abuse – in fact, it may have been our social discomfort that made drugs so appealing in the first place. Recovery offers the possibility for improved relationships with other people. You can become the type of person who feels completely at ease in social situations ­ a person who is viewed as a source of strength by family and friends. As you become more at ease in your own skin, this is going to be noticed by others, and they will want to be around you. Instead of feeling ashamed of your addiction and bad behaviour, you can become a confident person and positive role model. Mindfulness provides an effective path for improving your relationships, and two of the most important aspects of this are mindful listening and mindful speech.

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Mindful Listening

The ability to listen to other people is one of the most underappreciated skills in the modern world, and the sad reality is that most of us are not very good at it. Problems with communication is one of the most common causes of relationships breakdown, and it is hard for people who love the sound of their own voice too much to develop deep friendships. Listening can be the most important thing we can ever do to help another person. When people feel they are being listened to, it can help them better deal with emotional pain or other mental distress. It could even save a person’s life because it can be the belief that nobody understands or cares that makes suicide feel like an attractive solution. Mindful listening is a skill you can develop, but there is a lot more to it than simply keeping quiet long enough for the other person to speak. There are three main features of this kind of listening

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Self­awareness – e.g. noticing when you are starting to get distracted so you can return your focus to the other person

Mindfulness – listen without judgement or resistance (at least while the other person is speaking

Concentration – this is so you can remain focused on what the other person is saying

To listen mindfully, you need to focus on what the other person is saying. You also have to be self­aware enough to notice when you are getting distracted or when you are having a physical response to what is being said (e.g. your facial expression shows disgust). If another person is opening up to you in a meaningful way, the most helpful thing you can do for them is listen – this can often be of more benefit than any solution you can offer in regards to the problem. It is a good idea to count to 10 after the person has stopped speaking so as to make sure they are actually finished. This pause also you to digest what they have said and to plan your response – this planning is not something you should be doing while listening mindfully.

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Mindful Speech

Most of us underestimate the damage our words can have on our relationships. It is like we expect people to be able to see inside of our minds instead of judging us by what we say. We can easily remember when the words of other people caused us pain, yet we can be blind to the negative impact of our own speech. If you are not mindful of your speech, you are going to be more likely to cause insult and harm. Some examples of mindless speech would include: Gossip (this can ruin an innocent person’s reputation) Exaggeration or minimisation Using the truth as a weapon (i.e. hiding behind the ‘just saying’ excuse to inflict pain on another person)

Making mountains out of molehills Saying whatever comes into your head Verbal abuse Bullying Showboating – monopolising conversations Spreading dangerous misinformation Promoting dangerous behaviour (e.g. encouraging a friend to relapse)

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Mindless speech is often something people do out of habit. The key to overcoming it is to become more mindful about what you are saying and why you are saying it. Sometimes it is much better to not say anything at all rather than engaging in gossip or mindless chatter. Tips for how you can speak more mindfully Just because you believe something is true doesn’t mean you are doing the right thing by saying it (e.g. being harsh about a friend’s appearance)

Avoid saying things that will hurt another person Become comfortable with silence and avoid the urge to fill it with gossip or mindless chatter

Walk away from conversations if you feel unable to control your anger

Avoid arguing for the sake of arguing Speak honestly and in a straightforward manner

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Helping Others “A major breakthrough occurred for me in rehab when my therapist suggested I try helping other people. I initially felt dubious about the idea, but I agreed to give it a try. It turned out to be exactly what I needed. I had devoted so much of my life up until that point obsessing about my own thoughts and problems, and it came as a huge relief to focus on somebody else for a change. I began doing some voluntary work with people dealing with severe learning difficulties – it was a wonderful experience that boosted my self­esteem and changed my perspective on life” Paul G. If you are looking to strengthen your recovery, one of the most effective things you can do for this is to focus more on other people. It is important though that any attempt to help others is done with the right attitude – this means with humility and the understanding that you are likely benefiting more from the experience than the person you are trying to help. You also need to be careful not to focus on other people out of a desire to escape dealing with your own issues – fixing other people is not going to fix you, and your unresolved issues could mean you end up damaging the people you are trying to help (e.g. if you are not fully committed to recovery, your cynicism could reduce the motivation of a newcomer).

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Benefits of Helping Other People It means we feel useful, and this increases our self­esteem Spending time with those in early recovery reminds us of where we have come from (this can keep you motivated)

It is a way to give something back People who do volunteer work are less likely to suffer from depression

It can give us the opportunity to learn new skills It improves our communication skills It puts your own problems in perspective Voluntary work can be a stepping stone to paid work Thinking more about other people means you become less self­absorbed

It makes our conversations more interesting (we don’t just talk about ourselves all the time)

It gives us something to do –boredom is a major relapse trigger

The Importance of Helping Other People with an Attitude of Humility

If we approach volunteer work as a type of ego­trip, it is likely to blow up in our faces. It means we will come across as

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patronising and insincere, and this attitude is also going to cause us personal suffering. We don’t help others because we are superior but because of compassion and the knowledge that we will benefit from this activity. We help others because we have needed help in the past and will need it again in the future. Another danger with helping others is that it can become a type of addiction substitute. It is always going to be easier to deal with the problems of other people than it is our own, and we can get so involved in service that it becomes a way to avoid reality. By taking too much on, we weaken our own sobriety, and this can lead to exhaustion which then becomes an excuse to relapse. Service and the 12 Steps

One of the nice things about belonging to a 12 step group is it means you will have no problem finding opportunities to do service. These groups couldn’t exist without the willingness of members to do unpaid work, and the whole philosophy is based around one addict helping another. Here are just some of the options if you want to do service in the fellowship:

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Greeting newcomers Tea/coffee making duties Acting as secretary at a meeting Telephone service Taking responsibility for meeting literature Being the main speaker at a meeting Prison service Meeting treasurer Becoming a sponsor

Even sharing a positive message at a meeting could be considered a type of service because your words can help those who are currently struggling. Service Outside of the 12 Step Groups

You don’t have to limit this willingness to help other people to just the 12 step groups. The person you are trying to help doesn’t even need to have an addiction problem. Here are some other ways you can be of service to other humans: Do volunteer work at a rehab Start a recovery blog Volunteer to talk about your experience at schools

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Get involved in any voluntary organization that you feel is a worthy cause (e.g. feeding the homeless)

Do a charity run Become a hospital visitor Do odd jobs for elderly neighbours

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12 Step Work Hopefully by this stage you appreciate how recovery is a process rather than an event. You won’t be cured during your stay in rehab, and it will be the continued work you do once you leave that is going to determine your future. Remaining part of a 12 Step fellowship such as Alcoholics Anonymous or Narcotics Anonymous can increase the likelihood of you remaining committed to your recovery and doing the necessary work to maintain it. Do I Need to Keep Going to Meetings?

By continuing to go to meetings once you return home, you improve your chances of remaining free of drugs long­term. You are going to be going through a period of adjustment to normal living, and it is vital that you get sufficient support during this time. Even if you feel uncertain about the value of the meetings, we strongly suggest you keep going for at least the first year after rehab.

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There are some compelling reasons for why you might want to keep going to 12 step meetings long­term. Human memory is a fickle thing, and it is all too easy to forget where we have come from. If we are not reminded of the risk of addiction, there is the possibility of becoming complacent and this puts us on a path to relapse. There are plenty of examples of people who were sober for decades yet somehow still returned to the misery of active addiction. Benefits of 12 Step Meetings

You will be around people who share your goals You will receive support and encouragement If you follow the steps, your life will improve You can gain from the experience of people more experienced in recovery

You will have the opportunity to do service (see the last chapter on helping others to find out why this is beneficial)

You will be reminded of where you have from – and what you could go back to

You can find a sponsor who will give you 1­to­1 guidance It makes easier to begin building a sober social network It means you have somewhere to go when you feel vulnerable

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It gives you something to do in early recovery – boredom can be a huge relapse trigger

You can get to enjoy sober events such as conferences and parties (e.g. if you live in a city, you will usually find there is a New Year’s party)

Importance of Working the Steps

The goal of the 12 step program is far more than to just keep you away from alcohol or drugs. It is a path to a better way of living where you will no longer have any need to get intoxicated. Going to the meetings might be enough to keep you clean and sober, but it is the steps that will give you with emotional sobriety and serenity. The 12 steps are not something you complete and then forget about. It is an ongoing process that leads to steady improvements in your life. The benefits of working the steps are mentioned on Page 83 of the AA Big Book and include: You will know a new freedom and higher level of happiness

You will have no regrets about the past You will develop serenity You will be capable of helping other people

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Your self­esteem and self­confidence will increase You will become less selfish and self­obsessed You will develop a more positive outlook on life You will no longer fear economic insecurity You will develop powerful intuition You will be able to let go of problems

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Getting Back on Track The goal of the treatment program here at Hope is to get you on the right path for a better future. Your own journey is going to be unique to you, but it should involve steady improvements in your mental, physical, and emotional well­being and your ability to cope with life. The speed by which you progress along your path is not so important once you know you are on the right track. We hope you live happily ever after once you return home from treatment but life is rarely that simple. There are days when you are going to feel challenged, and if you fail to deal with these challenges appropriately, you could easily end up getting stuck in recovery. When this happens, the temptation is going to be to relapse or turn to new maladaptive behaviours, and this leads to you once again being on the wrong track and heading towards disaster. If you take a wrong turn in your recovery, you need to be able to recognise this as soon as possible. Unfortunately, it is all too easy to ignore the warning signs telling us we are in trouble, and we can end up a long way off track before we recognise something is wrong. One of the great benefits of having a sober

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network of friends is that these people will often be able to spot the warning signs before we will, and they can alert us to the danger. In the chapter on relapse prevention, we discussed the signs that your recovery might be in danger, but it is worth restating here the most important symptoms you need to be on the lookout for which are: • Romancing the drink or drug • Wondering if your substance abuse problems were really all that bad • Becoming cynical about recovery • Looking for ways to drink or use drugs ‘safely’ • Threatening to relapse • Isolating from family and friends • Spending time with old drug using friends or drinking buddies • Stopping recovery meetings • Stinking thinking (i.e. anger, negative thinking, resentment, cynicism, and enjoying watching other people fail) • Feeling stuck in recovery • Putting yourself in high­risk situations (e.g. going to a bar) • Resentment • Disappointment over your progress in recovery (this is

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usually due to unrealistic expectations) • Joking about relapse • Inability to shake off feelings of guilt and remorse (this can then become a justification for relapse) If you have gone off­track in your recovery, you need to take action or you risk losing everything. Don’t rely on the idea that you will just snap out of it. You have put a great deal of hard work into improving your life, so you don’t want to risk losing your progress. The suggested actions you should take if you feel you have lost your way include: • Contact us here at Hope Rehab • Speak to your sponsor • Go to more meetings and share about how you are feeling • Tell trusted friends and family how you are feeling – don’t isolate or pretend everything is okay • Get more involved in the recovery community • Speak to your recovery coach or therapist The above are the most important actions you need to take, but the following suggestions might also help (these should be as well as the above rather than instead of the above): • Read recovery literature

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• Look for support at an online recovery meeting • If you have a blog, write about how you are feeling • Do some journaling about how you are feeling • Do a gratitude list • Remember what you could lose if you relapse • If you have not been looking after your health, consider doing more exercise and improving your diet

What If I Relapse?

If you have used alcohol or drugs again, getting back on track becomes much more of a challenge. This is why there is so much emphasis on preventing this from happening. A relapse means you are now being pulled back into the depths of addiction, and it is going to take a significant amount of effort to escape this downward spiral. “I remember thinking I would just drink again for a few days, and if it didn’t work out, I would return to recovery straight away. By the time I’d finished my first beer, I knew I’d made a terrible mistake. It took me almost ten years to quit again, and I consider myself one of the lucky ones – I’ve seen lots of people die soon after they relapsed”

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Paul G. Abstinence Violation Effect

The abstinence violation effect can be summed up with the old saying ‘I might as well be hung for a sheep as a lamb’. It happens because we become so disappointed about relapsing that we use it as an excuse to keep using drugs. The abstinence violation effect means our self­esteem and self­efficacy (our belief in our ability to change) is reduced, and this makes it much harder for us to stop. It means that instead of getting the help we need to return to recovery, we allow self­hatred to drag us back down to the pits of addiction. If you can return to recovery right away, all your hard work up to now will not be lost. You will be able to learn from this experience, and this means you will be stronger going forward. There is no need for you to hit another rock bottom before you stop again – the risk is that if you wait for this to happen, you might not survive to experience another recovery.

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Action to Take If You Relapse

• Contact us here at Hope Rehab (it is best to do this when you are not intoxicated) • Go to recovery meetings and share about your relapse • Consider returning to rehab • Understand that the sooner you stop, the easier it will be to stop • Avoid beating yourself up to much but understand that you are at serious risk until you stop

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