The Process of Recovery and Relapse Prevention - It's not just about the withdrawal.
I have been mulling over the idea of starting a "process" thread for some time. I've been reluctant to do it because I've really no idea what, if anything, I want to say or ask. But the idea just won't go away, so here is an incomplete question and an incomplete answer: a thread in search of a purpose.
I've noticed so often in life and on here that addicts, particularly opiate addicts, believe that recovery is simply about getting the drugs out of the system and managing the withdrawals before normal bodily function returns. Yet many, many people manage to get through the agonies of the initial withdrawal only to relapse soon afterward.
I wanted to post this thread as a roadmap to those who are contemplating setting off on the journey into recovery, or those further along the way. I hope that those further along the road will contribute too as well as those who have only just begun the journey. What obstacles are there, what pulls, what pushes.
So the basic question is how to go from dependence to freedom. How to find contentment, intimacy with others, a feeling of purpose and fulfillment. It is so broad a question that no one-size-fits-all solution exists.
I think two good points of departure are managing the early days, and seeing the addiction as a symptom and not a cause of problems; this is only a partial picture, but is useful here. I'm not going to cover detox here. There is plenty of good information under the various specific drug sub-sections.
A lot of the early journey seems to be about how to manage urges and cravings, so as not to use on them. Think about what you would do if you suddenly had a craving for a hit of heroin, a drink, a rock of crack, some speed or whatever. Is there anyone you can call for support? Are there activities you can use as a distraction, can you use "thought substitution" to transform a thought about how great a hit would be to remembering overdosing waking up in hospital with parents staring down at you, or some other horrible consequence or comedown. Another tool might be to sit with the feeling until it passes. For those of you aware of operant conditioning, we are essentially working, initially at least, with unlearning a conditioned response. Every time an urge is encountered and is not acted upon, the psychological link between urge and drug use is weakened.
Another tool is identifying triggers. Triggers are those people, places, things, emotions, etc. etc. that stimulate an urge to use drugs. They may be such things as negative or positive feelings, people you used to use with or score from, money, spoons, needles, cigarette lighters, tin foil, pipes, any other paraphernalia, places you used in, scored from, etc. etc. It could be something completely specific to you.
Here there are roughly two approaches. The first, and perhaps best one in early recovery is to simply avoid as many of the triggers as possible. Do not hang around with using friends. Clear the house of drugs and paraphernalia, don't walk down the drinks aisle of the off-license, etc. In certain cases it may be impossible or impractical to do this, in which case it is good to have considered how to handle meetings with people, and have mini action-plans in place for unavoidable situations. I remember my cat was about three months clean and he saw someone handing out or selling pills at a party, and it bought up a lot of feelings. Pills were never his thing particularly, but just being around drugs was strange and intense. As time goes by and self-confidence increases, the number of things needed to be avoided decreases, and eventually recovery ceases to be dependent on avoiding anything.
Some people like to break down time. The classic 12-step mantra "just for today" can be empowering if things seem impossible. All things change, and feelings in early recovery change quicker than most things. The all-consuming "I must use" feeling will not last forever. Just try and get through the next day, hour, 5 minutes, etc. etc. Batten down the hatches and wait it out.
I think an appropriate level of support is essential. It might be empowering hearing stories of those who did it "on their own", but for a lot of us, at a lot of times, it's a must. There are 12-step groups nearly everywhere, which offer the chance of building up a network of non-using friends, even if you are not into "working the steps" (I've written a sticky in this section about NA if you're considering a 12-step approach). In the UK, at least, it seems that quite a lot of relapse prevention work is based on a CBT/Social Learning model. This encourages reintegration into social groups (college, work, recovery groups, activities etc.): act like a non-user, and chances are you won't use being the theory.
For many there is a huge void inside when drugs or alcohol are withdrawn, and people can try to fill that with all manner of things, especially relationships and sex. My own experience is that meditation really helps. Just so you know my own prejudice, I sit zazen (seated Zen meditation) daily, and a member of a Zen group. It's my spiritual niche, and I would wholeheartedly encourage it to others. It is an example of more general advise sometimes given to "sit with yourself". Although distraction can be vital at times, ultimately we need to learn to just be with whatever is going on inside. This is not always easy, and although sometimes when I sit zazen it is comfortable and pleasant, at others it is more akin to a form of torture for back, knees, hips, ankles especially. The mind can be tranquil or all-over-the-place, but I try and sit for my alloted time with whatever I'm going through.
Exercise and diet also seem to be important. I found when my cat cleans up his desires for various forms of exercise and diet changes. This time round cat was virtually supine for 3 months and couldn't exercise. He felt really frustrated, and somewhat guilty that he was being lazy and unmotivated. In fact listening to your body is really important, and this is a lifetime journey, and not a sprint. I find yoga and tai chi really benefitial. I've also enjoyed more full-on martial arts in earlier years, and may find myself doing more martial arts at some future time: who knows! Others swear by running, or weight training.
This thread has already meandered away from where I thought it would go. I had intended to look, perhaps in more nebulous terms, at a longer recovery process. My initial impetus was from being drawn to the 12-steps, as containing within an outline of a recovery process that exists in a general sense, and not solely within the confines of NA/AA etc. I know another member on here had a similar thought to me about this, but as far as I know never posted anything.
Where I am at in my journey is being drawn to a form of step 4 - which says "We made a fearless and searching moral inventory". I have got to a point where I want to know who I am and understand how I act. It seems that the first part of any change process is accepting what is currently going on. I think one difference between now and in the past is that I do not feel a need to dig for issues.
I speculate that understanding oneself, and making one's peace with the wider world, and apologising and making amends where appropriate are all part of the process.
I think taking away the drugs opens the door for a wider journey into life. I have tried to provide some basic relapse prevention information, but would love to hear more thoughts about how people see the recovery process, once the focus is no longer on avoiding drugs, and horizons broaden. How are we to open this oyster to reveal the whole world?
A little adaptation to end:
When someone asks you
What is true recovery
You don't need to open your mouth
To explain.
Please: Just show them all the faces
Of your zazen posture.
Then the spring breeze will blow,
Tease open the dazzling blossoms of the early plum.
Re: The Process of Recovery and Relapse Prevention - It's not just about the withdraw
swim thinks the psychological aspect of recovery is the hardest part for some addicts in recovery. after they break their relationship with drugs, and are over the withdrawal phase, they find they are completely different people than where they started out. more to the point, they dont know who they are, they have to "find themselves".
there is a significant amount of emotion, regret and grief involved, and its overwhelming. people dont appear how they used to. places seem different. its the equivalent of waking from a coma, and being out of touch with life itself.
the next part of the recovery is to "find yourself".
another thing swim had problems with, is that some people treated her differently. it was highly frustrating that people could not understand that she wasnt anything like her opiate addicted self was. her days as a drug addict was in no way a reflection of her true self, she was a mere robot then.
another problem swim had, was her family's skepticism over her clean up. it took her mother a good year to finally accept that she had changed for good. also people bringing up things from the past that swim couldnt even remember doing was a hard one to deal with. all you can do really is apologize, and explain that you would never had done that if you were normal.
it takes a long time to rebuild the trust that you lost with your loved ones, and to bridge friendships with old mates who dont take drugs- who walked away from you when you were a mess. these people tend not to look at you the same anymore. swim lost touch again with all her old clean mates from school days, because they simply couldnt understand her.
another hard thing swim found, was she had the uncontrollable urge to go out and be social, yet she didnt have any friends. real friends. mostly people realize they are on their own, and its extremely difficult to deal with. its very hard to go out and make new friends, especially considering after drug addiction, you will find it very hard to trust people, etc.
swim sometimes felt the need to tell people she used to be an addict, and tbh, this puts people off sometimes. however, swim had been through so much, and needed to know that people still wanted her around knowing her past experiences. just in case it came out later on, and she ended up losing a friend. if such information was going to put people off her, then it was best to get it out in the open early in the friendship, to save some hurt/anger later.
went a little off topic there with past experiences, but hey, its DF. aint no better place to get these things off your chest eh.
Re: The Process of Recovery and Relapse Prevention - It's not just about the withdraw
So my friend Goobie has only been clean for about 1 1/2 weeks but she feels like she can go ahead and add her input on here. + Bump the thread
The PAWS article was absolutely amazing and has given her a ton of great ideas to use and go by. Exercise and sunshine are an absolute MUST for her - she's in a MUCH MUCH MUCH happier, better mood after taking the little one to the park! And sleep (as needed) really helps keep her energy up. She's been noticing that her stomach is CONSTANTLY sick/aching in the morning but continues to use Promethazine, Tagament and Tums (which seem to do the trick!).
Sometimes she tends to psych herself out - telling herself that she could just use a little bit and be okay. To counteract these cravings she just moves onto something else (cleaning, reading, music, RP games - new to her!, and some movies). Her emotions are all sorts of wacky at the moment, but she's working hard to get ahold of them!
She knows that N/A is definitely what she NEEDS, but can't seem to get herself to go there. :/ She feels like the outcast - being young and not a "typical" druggie. Always second guessing herself is a major problem for her, as well as fearing the worst possible. A lot of things have to change still and now that she's actually clear and level-headed enough she's really been able to think/plan things out. Writing everything down really helps her get it all out too - and keeps her mind in the right place.
So that's my experience so far...
P.S. Sorry if this wasn't exactly the response you had in mind, Dickon.
Re: The Process of Recovery and Relapse Prevention - It's not just about the withdraw
Red Rock is at the young age in his early twenties as well and finds that at being a little over 14 months clean from heroin now, he is handling recovery quite well. In NA/AA's eyes, they would say he is not in fact in recovery because he still dabbles in psychedelics and occasional alcohol usage. However, he has found a plan that works for him and his life has improved so much.
Red Rock agrees with ex-junkie in that the psychological aspect of addiction, especially opiate addiction, is one of the hardest things to kick. Many addicts Red Rock has spoken to claim that enduring the physical withdrawal is the easy part of ending one's addiction while the psychological part is much, much tougher. Cravings, triggers, situations, and emotions will all come up during this time period; even more so than an average person. THis is because one's emotions are still overintensified and one is more susceptible to all of this. One thing Red Rock realized is that this is all part of life. As an addict, some people, including him, tried to control many things that were simply out of their control. Red Rock realized that he just has to take what comes to him and deal with it the best way he can without using anything.
After making it through the physical part, Red Rock had to find a replacement for the "hole" that was missing in him. He tried many things to cope with it including excessive exercising, posting like a mad man here on DF, eating lots of junk food, etc. That really didn't fill that gap or that void in him. He is still working on that part but has gotten much better than before. Posting here on DF like crazy sure has gotten him through many a tough times though.
Another thing he had to realize was the reason/reasons why he felt the need to keep using no matter what the negative consequences were. One thing that he always felt the need to use was to be more social, lose anxiety, and depression. He had to realize that he could be himself and be liked by others. He didn't have to be anybody but himself and people should like him for who he is and if they don't, well the hell with them.
Cravings are another thing that will constantly pop up. They will be more frequent in early recovery than later down the road, but they can still pop up no matter how much time one has away from their drug of choice. One must learn how to cope with these the best they can without using and for Red Rock, he found that talking about it with other people helped tremendously. Most of this talking was done here on DF with trusted members but some of it was with some of the few true friends he has left. This concept can be tied in with triggers. Triggers can easily occur such as being at a party and seeing drug use going on, getting a call from an old friend, an advertisment (alcohol), hearing a song one used to always get high to, emotions, financial situations, etc. One must be prepared for this and Red ROck thinks its good to try to formulate a plan in preparation for all of one's triggers. They will come up and if one can minimize the surprise of it and know how to handle the triggers and cravings, it can help prevent a lapse/relapse.
All in all, one has to have a plan that will work for them. No matter whether they believe in NA/AA, will power, one's own program, counseling, etc, it must work for them. NA/AA is the most well known program, but other programs do exist such as Rational Recovery, Self Management and Recovery Training Recovery (SMART Recovery), Cognitive Behavior Therapy, and Rational Emotive Behavior Therapy. Hell, even for some people, sheer will power and determination or creating their own program have worked. There are many choices out there that can aid in one's recovery. However, tHe genuine desire to want to be in recovery must be present as well in Red Rock's opinion. If one doesn't have this, then Red Rock thinks they might get a few months here and there, but no long term recovery. Red Rock personally believes this is the key to recovery.
And sleep (as needed) really helps keep her energy up. She's been noticing that her stomach is CONSTANTLY sick/aching in the morning but continues to use Promethazine, Tagament and Tums (which seem to do the trick!). 
