At Hope Rehab Thailand we draw strong focus on raising awareness around “triggers”. Triggers are cues and impulses to use drink or drugs again – often as a way of coping or responding to events that cause stress, or simply being offered the chance to use.
National Institute on drug abuse Drug (NIDA)
Addiction is a complex illness characterised by intense and, at times, uncontrollable drug craving, along with compulsive drug seeking and use that persist even in the face of devastating consequences. While the path to drug addiction begins with the voluntary act of taking drugs, over time a person's ability to choose not to do so becomes compromised, and seeking and consuming the drug becomes compulsive. This behavior results largely from the effects of prolonged drug exposure on brain functioning.
The body itself has been conditioned to respond to routine behaviour. Most living creatures have an internal timing system that makes them automatically respond to the course of the day to meet their needs. For example, people feel the urge to drink after work, have an evening joint, bedtime pill, weekend of meth, a binge, daily fix or even hourly fix. We’ve become programed to expect something.
Unfortunately, without setting yourself clear goals and using tools to cope, it is very common for most people with addiction issues to experience relapse and remission.
In the 1800’s Ivan Pavlov conducted experiments on how cues around dogs would stimulate them to respond to eating. For example: whenever a bell was rung the dogs would receive food. Eventually, the dogs would salivate as soon as the bell was rung. This is known as classical conditioning , it now forms part of the basis of the relapse prevention work we cover at Hope Rehab.
Although common, the harm and impact this has on your life should not be minimised. Instead, one should consolidate the reasons behind this and work to avoid those triggers in future. Remission is the beginning of a relapse. Slipping back into old ways of behaving can often be on the cusp of relapse back into drink or drug use. You have to be honest with yourself, where have you gone wrong before?
Not all relapse triggers are external cues - some come as stress builds up from pre-existing conditions such as depression, psychosis, obsessive behavior, bi-polar and other psychiatric illnesses. Non-compliance with medical treatment and medicines can lead to self-medicating with more mind-altering substances such as alcohol and other drugs.
Dual-Diagnosis - Those with dual-diagnosis (the co-existence of substance-use and psychiatric issues) need to factor in special consideration for this and often draw support from planning with Hope and addiction groups like Dual Recovery.
Relationships – supportive relationships can often be difficult and can unfortunately lead to stressful factors and even present direct triggers to use. It is not recommended that in early recovery you pursue new romantic relationships. Sexual relations and non-sexual relations can be both a source of pain and pleasure, in other terms –emotional stress. Stress is well regarded by text-books, addicts and experts alike as being one of the primary causes of a relapse back into drink or drug use. It’s often recommended that we invest our interests in our recovery first and form a healthy relationship with ourselves.
The Environment around us forms one of our largest triggers. It comes in the shape of People, Places and Things, some of which will have strong associations with your using. These are known as the external or sensory triggers. When combined with internal triggers such as emotions and thoughts, they can impact us greatly. Below are some of the external triggers that can influence your decision-making:
- People: Parents, friends, family members, co-workers
- Places: Bars, neighbourhoods, home, holidays
- Things: Cash, paraphernalia, bottles
- Events: Weddings, funerals, BBQ’s, birthdays, weather,
- Sensory: Smells, sight, sound, taste
- Emotional: Anger, depression, anxiety, euphoria, memories
Relapse Prevention – Euphoric Recall
The recovery map
The recovery map is the last exercise of the client’s treatment. It helps the client to get a clear view of their new recovery life, what they are going to do, plans and commitments etc., as well as of their personal triggers and slippery behavior, which would lead the client back to the addiction.
Clients fill in their bottom lines in the centre of the recovery map. Bottom lines are the things they cannot go back to, i.e. alcohol, medication, heroin and/or cocaine. They also write down their clean date at the bottom of the bottom lines.
After the bottom lines, the focus is on the outer part of the recovery map, the four corners about health and lifestyle, work and education, relationships and their recovery. It is important that clients honestly describe what they are going to do after treatment, and not make a ‘wish list’.
A few examples:
- Health / Lifestyle – Yoga 3 times per week, biking to work at least twice a week, healthy cooking
- Work / Education – Back to the old job, start a study, applying for new job, enroll in a course
- Relationships – New friends from meetings, taking girlfriend to the zoo, contacting old ‘good’ friends
After the centre and the outside of the recovery map, it is time to write down the triggers and slippery behaviour.
What leads the client from their new recovery life back to their addiction/bottom lines?
A few examples:
- Health / Lifestyle – Laziness, boredom, not sticking to the goals, not exercising
- Work / Education – Stress, not finding a job, not doing homework, coming late
- Relationships – Anger, visiting old using friends, mother in law, lack of assertiveness
- Recovery – Complacency, excuses, not going to meeting, lack of routine, going to a bar
When finished, the recovery map helps the client back in their home situation evaluate where they are in their recovery. Do I write down my gratitude list? Have I done my exercise this week or did I lay lazy on the couch? Did I go to the meetings or did I make excuses? Am I seeing my old using friends again while I know that is a trigger?
“Relapse is a process not an event, its best avoided – Sadly I have known too many addicts relapse and die. I don’t want to relapse again. The only thing I had to change in recovery was EVERYTHING. But attitude is a little thing that makes a big difference in recovery. Be prepared the change somethings you don’t want to, that’s what will make the most difference”
Scientific research by NIDA over the last 50 years shows that treatment can help patients addicted to drugs stop using, avoid relapse, and successfully recover their lives.
- Address underlying issues
- Long enough period of time is critical
- Individual counselling
- Group work
- Diagnose mental disorders
- Medically assisted detoxification
- Treatment voluntary or coerced
Take the Hope program with you and continue it in the community
Counseling and Therapy: Tell your counselor everything, they are a special person who is there to help you
Groupwork: open up to the group and listen to the feedback.
CBT: This stands for Cognitive Behavioural Therapy - Known as short term therapy with long term results. Identify what gives rise to your negative thinking.
Addiction program: Create some health daily rituals
Mindfulness program: Meditate 5 minutes daily,preferably early in the morning and at night. Don’t forget the here and now, live in the present moment, don’t waste too much energy thinking about the past or future.
Fitness and exercise program: I say "get up bright and early before your addiction wakes up". You will take charge of the day and your thinking. And drink a grass of water.
Treatment assignment tasks: Hope workbook is 100 pages long, so plenty to do, good news is it is simple but effective. Goal setting like the paradoxical behaviours to do that help change life-long habits.
Activities: Weekend activities include many new sober fun things to do - The clients usually choose to go to the beach.
Relapse Prevention: These classes raise your awareness and teach you to manage triggers and cravings for cannabis.
Aftercare: We begin your aftercare plan before you leave Rehab and as part of treatment, you will also sign up to the aftercare online groups.
Gratitude therapy: Write a daily list and be grateful for the difficult times and what you learn from them, Be grateful for your recovery, this increases the likelihood you will remain clean and sober.
Important suggestions to follow
Avoid the tendency to isolate specially when your mood is low – because then your addiction will get hold of you again.
Remember your addiction is your comfort zone so avoid this too, by doing this it develops you in may ways.
Replace you negative self talk with positive and inspiring thoughts such as ‘I can do this’ or 'I am stronger than my addiction'
Understand the importance of nutrition: A balanced diet is the key to a strong sobriety so avoid too much comfort eating. Everything in moderation, a balanced diet.
Get some exercise every day even if it is only a half hour run, walk or in the gym. The best time is early in the morning, get up before your addiction does.
Avoid blaming although its natural to blame it’s also a waste of energy and time, and it can justify using – remember if its someone else’s fault then the have all the power – empower yourself and take responsibility.
Its also natural to judge others but try not to judge other people too harshly – most of us are just trying our best with the cards we have been dealt. Practice compassion for others and yourself.
Avoid thinking about using – euphoric recall or teasing yourself, flirting with the idea – memories can be tricky and ignore the true misery.
Affirmation are a great way to reprogram yourself. So create a mission statement reflecting your meaning and purpose in life – then repeat it daily. Prey for willingness to be willing and eventually it will happen.
Goal setting is important both daily micro goals and larger life goals. Review your goals lists daily.