[FONT=Arial, Arial, Helvetica]Step 4: Warning Sign Identification: [/FONT]
[FONT=Arial, Arial, Helvetica]Relapsers need to identify the problems that caused relapse. The goal is to write a list of personal warning signs that lead them from stable recovery back to chemical use. [/FONT]
[FONT=Arial, Arial, Helvetica] [FONT=Arial, Arial, Helvetica]There is seldom just one warning sign. Usually a series of warning signs build one on the other to create relapse. It's the cumulative affect that wears them down. The final warning sign is simply the straw that breaks the camel's back. Unfortunately many of relapsers think it's the last warning sign that did it. As a result they don't look for the earlier and more subtle warning signs that set the stage for the final disaster. [/FONT][/FONT]
[FONT=Arial, Arial, Helvetica] [FONT=Arial, Arial, Helvetica]When Jake first came into relapse prevention therapy he thought that he was crazy. "I can't understand it," he told his counselor, "Everything was going fine and suddenly, for no reason at all I started to overreact to things. I'd get confused, make stupid mistakes and then not know what to do to fix it. I got so stressed out that I got drunk over it." [/FONT][/FONT]
[FONT=Arial, Arial, Helvetica] [FONT=Arial, Arial, Helvetica]Jake, like most relapsers, didn't know what his early relapse warning signs were and as a result didn't recognize the problems until it was too late. A number of procedures are used to help recovering people identify the early warning signs relapse. [/FONT][/FONT]
[FONT=Arial, Arial, Helvetica] [FONT=Arial, Arial, Helvetica]Most people start by reviewing and discussing The Phases And Warning Signs Of Relapse (available from Independence Press, PO Box HE, Independence MO 64055, 1-800-767-8181). This warning sign list describes the typical sequence of problems that lead from stable recovery to alcohol and drug use. By reading and discussing these warning signs relapsers develop a new way of thinking about the things that happened during past periods of abstinence that set them up to use. They learn new words with which to describe their past experiences. [/FONT][/FONT]
[FONT=Arial, Arial, Helvetica] [FONT=Arial, Arial, Helvetica]After reading the warning signs they develop an initial warning sign list by selecting five of the warning signs that they can identify with. These warning signs become a starting point for warning sign analysis. Since most relapsers don't know what their warning signs are they need to be guided through a process that will uncover them. The relapser is asked to take each of the five warning signs and tell a story about a time when they experienced that warning sign in the past while sober. They tell these stories both to their therapist and to their therapy group. The goal is to look for hidden warning signs that are reflected in the story. [/FONT][/FONT]
[FONT=Arial, Arial, Helvetica] [FONT=Arial, Arial, Helvetica]Jake, for example, identified with the warning sign "Tendency toward loneliness." He told a story about a time when he was sober and all alone in the house because his wife had left with the children. "I felt so lonely and abandoned, he said. I couldn't understand why she would walk out just because we had a fight. She should be able to handle it better than she does." [/FONT][/FONT]
[FONT=Arial, Arial, Helvetica] [FONT=Arial, Arial, Helvetica]The group began asking questions and it turned out that Jake had frequent arguments with his wife that were caused by his grouchiness because of problems on the job. It turned out that these family arguments were a critical warning sign that occurred before most relapses. Jake had never considered his marriage to be a problem, and as a result never thought of getting marriage counseling. [/FONT][/FONT]
[FONT=Arial, Arial, Helvetica] [FONT=Arial, Arial, Helvetica]Jake had now identified three warning signs: (1) the need to drink in order to feel like he belonged, (2) the need to drink in order to cope with stress, and (3) the need to drink in order to cope with marital problems. In order to be effectively managed each of these warning would need to be further clarified. [/FONT][/FONT]
[FONT=Arial, Arial, Helvetica] [FONT=Arial, Arial, Helvetica]I then had Jake to write these three warning signs using a standard format and identify the irrational thoughts, unmanageable feelings and self defeating behavior that accompanied each. He wrote: [/FONT][/FONT]
[FONT=Arial, Arial, Helvetica](1) I know I am in trouble with my recovery when I feeling lonely and unable to fit in with other people; When this happens I tend to think that I am no good and nobody could ever care about me. When this happens I tend to feel lonely, angry and afraid. When this happens I have an urge to hide myself away so I don't have to talk with anyone. [/FONT]
[FONT=Arial, Arial, Helvetica](2) I know I am in trouble with my recovery when I feel unable to cope with high levels of job-related stress; When this happens I tend to think that I need to try harder in order to get things under control or else I will be a failure. When this happens I tend to feel humiliated and embarrassed. When this happens I drive myself to keep working even thought I know I need to rest. [/FONT]
[FONT=Arial, Arial, Helvetica](3) I know I am in trouble with my recovery when I irrationally angry at my wife. When this happens I tend to think that I'm a terrible person for treating her that way, but a part of me believes she deserves it. When this I happens I tend to feel angry and ashamed. When this happens forget that the incident ever happened, put it behind us and get on with our marriage. [/FONT]
[FONT=Arial, Arial, Helvetica]With this detailed description of the relapse warning signs Jake was ready to move on to the fifth step of relapse prevention planning, warning sign management. [/FONT]
[FONT=Arial, Arial, Helvetica]Understanding the warning signs is not enough. We need to learn how to manage them without resorting to alcohol or drug use. This means learning nonchemical problem solving strategies that help us to identify high risk situations and develop coping strategies. In this way relapsers can diffuse irrational thinking, manage painful feelings, and stop the self-defeating behaviors before they lead to alcohol or drug use. [/FONT]
[FONT=Arial, Arial, Helvetica] [FONT=Arial, Arial, Helvetica]This is done by taking each relapse warning sign and developing a general coping strategy. Jake, for example developed the following management strategy for dealing with his job related stress. [/FONT][/FONT]
[FONT=Arial, Arial, Helvetica]Warning Sign: I know I am in trouble with my recovery when I feel unable to cope with high levels of job-related stress. [/FONT]
[FONT=Arial, Arial, Helvetica]General Coping Strategy: I will learn how to say no to taking on extra projects, limit my work to 45 hours per week, and learn how to use relaxation exercises and meditation to unwind. [/FONT]
[FONT=Arial, Arial, Helvetica] [FONT=Arial, Arial, Helvetica]The next step is to identify ways to cope with the irrational thoughts, unmanageable feelings, and self-defeating behaviors that accompany each warning sign. Jake developed the following coping strategies: [/FONT][/FONT]
[FONT=Arial, Arial, Helvetica]Irrational Thought: I need to try harder in order to get things under control or else I will be a failure. [/FONT]
[FONT=Arial, Arial, Helvetica]Rational Thought: I am burned out because I am trying to hard. I need to time to rest or I will start making more mistakes. [/FONT]
[FONT=Arial, Arial, Helvetica]Unmanageable Feelings: Humiliation and embarrassment. [/FONT]
[FONT=Arial, Arial, Helvetica]Feeling Management Strategy: Talk about my feelings with others. Remind myself that there is no reason to embarrassed. I am a fallible human being and all people get tired. [/FONT]
[FONT=Arial, Arial, Helvetica]Self-defeating Behavior: Driving myself to keep working even thought I know I need to rest. [/FONT]
[FONT=Arial, Arial, Helvetica]Constructive Behavior: Take a break and relax. Ask someone to review the project and see if they can help me to solve the problem. [/FONT]
[FONT=Arial, Arial, Helvetica] [FONT=Arial, Arial, Helvetica]Now Jake is ready to move unto the sixth step of recovery planning. A recovery plan is a schedule of activities that puts relapsers into regular contact with people who will help them to avoid alcohol and drug use. They must stay sober by working the twelve step program and attending relapse prevention support groups that teach them to recognize and manage relapse warning signs. This is why I call relapse prevention planning a "Twelve Step Plus" approach to recovery. [/FONT][/FONT]
[FONT=Arial, Arial, Helvetica] [FONT=Arial, Arial, Helvetica]Jake needed to build something into his recovery program to help him deal with job related stress. He decided to enter into counseling with a counselor who specialized in stress management, understood chemical dependency and had a background as an employee assistance counselor. By doing this Jake was forced to regular discuss his problems at work and review how he was coping with them. By identifying job related problems early, he could prevent getting overwhelmed by small problems that became overwhelming. [/FONT][/FONT]
[FONT=Arial, Arial, Helvetica] [FONT=Arial, Arial, Helvetica]The seventh step is inventory training. Most relapsers find it helpful to get in the habit of doing a morning and evening inventory. The goal of the morning inventory is to prepare to recognize and manage warning signs. The goal of the evening inventory is to review progress and problems. This allows relapsers to stay anticipate high risk situations and monitor for relapse warning signs. Relapsers need to take inventory work seriously because most warning signs are deeply entrenched habits that are hard to change and tend to automatically come back whenever certain problems or stresses occur. If we aren't alert we may not notice them until it's too late. [/FONT][/FONT]
[FONT=Arial, Arial, Helvetica] [FONT=Arial, Arial, Helvetica]The eighth step is family involvement. A supportive family can make the difference between recovery and relapse. We need to encourage our family members to get involved in Alanon so they can recover from codependency. With this foundation of shared recovery we can beginning talking with our families about past relapses, the warning signs that led up to them, and how the relapse hurt the family. Most importantly we can work together to avoid future relapse. [/FONT][/FONT]
[FONT=Arial, Arial, Helvetica] [FONT=Arial, Arial, Helvetica]If we had heart disease we would want our family to be prepared for an emergency. Chemical dependency is a disease just like heart disease. Our families' needs to know about the early warning signs that lead to relapse. They must be prepared to take fast and decisive action if we return to chemical use. We can work out in advance, when we are in a sober state of mind, the steps they should take if we return to chemical use. Our very life could depend upon it. [/FONT][/FONT]
[FONT=Arial, Arial, Helvetica] [FONT=Arial, Arial, Helvetica]The final step is follow-up. Our warning signs will change as we progress in recovery. Each stage of recovery has unique warning signs. Our ability to deal with the warning signs of one stage of recovery doesn't guarantee that we will recognize or know how to manage the warning signs of the next stage. Our relapse prevention plan needs to be updated regularly; monthly for the first three months, quarterly for the first two years, and annually thereafter.[/FONT][/FONT]
