What is a mental health relapse?

By David Joel Miller

Do people with depression, anxiety or emotional problems relapse?

Wellness and Recovery

Wellness and Recovery
Photo courtesy of Flickr (Portland Prevention)

The term “Relapse” is increasingly being applied to mental illnesses and for good reasons.  Many people are familiar with the idea that people with a substance use disorder, alcoholics and drug addicts can relapse. The idea that people with a mental illness can relapse is becoming a recognized part of the mental (or behavioral) health field.

Wellness and recovery.

We know more now than ever before about mental and emotional illness. Professional’s no longer think of the mentally ill as somehow different from others. We now know that them is us. In their lifetime half of all Americans will experience the occurrence of an emotional or mental health problem that meets the criteria for a mental illness.

Looking at mental health issues as chronic conditions rather than once and forever problems has helped us to understand how someone with a mental health issue can “relapse.”

Mental health and illness lie on a continuum.

There are not two discrete groups, the well and the ill. People who appear to be emotionally and mentally well may gradually develop symptoms. Disorders can come on suddenly or slowly. People with mental health issues can and do recover. They get better.

Along this continuum, people can move from unwell (ill) to less unwell to well. Others can move from well to unwell. Across your lifespan, you will probably make many trips back and forth on the continuum. You get sad and depressed or anxious and then you get better.

People can have a mental illness and then get better.

For professional treatment, we have set the point at which people get diagnosed as mentally ill very far over on the continuum. Your condition needs to interfere with school or work, prevent you from having good relationships, upset you or impair some important part of your life for it to be diagnosed as a mental illness.

Plenty of people get life problems that almost, but not quite reach the point of being mental illnesses. These people benefit from counseling also if they are able to get some. For milder issues (subclinical) self-help books, blogs like this one, religious and social activities and so on can help them maintain their mental health.

Mental illnesses are often chronic conditions.

Mental and emotional issues are a lot like being overweight and developing type two diabetes. Once you have been diagnosed as a diabetic it is unlikely that this will come off your medical file. You may take medications, exercise and watch your diet. All those things may get your blood sugar back under control.

With chronic conditions, and mental and emotional disorders fit this pattern well, even once you recover there will be things that you need to do to keep your condition under control.

Our understanding of the need to do things to maintain mental health recovery is informed by the stages of change model. See Stages of Change for a list of all the posts on this process.

In that model, we discovered that when someone recovers from a condition, excess weight, substance use, depression or just the normal problems of life, there are things that they will need to do to maintain those changes. We call that recovery the “Maintenance steps or Maintenance Stage of Change.

People with mental illnesses do relapse.

By relapse, I mean a return to symptoms or an increase in symptoms that were previously under control. Sometimes that relapse is a result of new life events. Someone with PTSD or complex trauma may experience another trauma or something that reminds them of past trauma.

Someone with depression or anxiety may have an experience that is sad or makes them anxious. As these levels of emotion rise, the person may become overwhelmed. If their support system is not being supportive or their coping skills are overwhelmed then the person moves to being less well, less able to cope and they may experience another episode of whatever we chose to call their mental or emotional issue.

This continuum of wellness and the possibility of recovery is easier to see when we talk about relatively well know conditions. Anxiety, the most common of all mental illness, and depression, that cousin of sadness, are good examples of how the journey from wellness to illness and back may occur.

We have all experienced some anxiety and can see how it may get better or worse. Depression is understandable. Sometimes in life, we get sad, if we get too sad or stuck there too long that might turn into Major Depressive Disorder.

What about really serious mental illnesses, the ones where it is harder to understand the symptoms. Do people with Borderline Personality Disorder, Schizophrenia or Dissociative Identify Disorder ever recover?

There sure do. There are treatments for all those conditions. Most of these treatments are skills based. Someone who hears voices all the time, they can learn to listen to the police officers voice and not the one in their head. This is not easy, it takes lots of skill development and practice, but many people with even the most serious of emotional issues do recover.

Do you get the picture that I and other mental health professions are coming to be strong believers in wellness and recovery? Recovery happens. If recovery happens, sometimes there may be a return of symptoms. When that happens we expect a return to doing the things that helped the first time to help them recover even faster than the first time.

If there are other skills they need to learn, well during a relapse is a really great time to try out new skills and find a way to create your happy life, however, you define it.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

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Is relapse a part of recovery?

By David Joel Miller

Is relapse a necessary part of recovery?

Relapse Prevention

Relapse Prevention

You will hear this a lot if you hang around treatment facilities, even self-help groups. I suppose it comes from seeing people relapse and feeling helpless to prevent those relapses. But is relapse really a necessary part of recovery?

Mostly this is applied to substance abuse, drugs, and alcohol, but more and more we are seeing that other emotional, mental and behavioral challenges can follow the same processes. People get unhealthy; they may get sick and then they recover.

Do symptoms have to get worse before they get better?

Every time one of my colleagues says that relapse is a part of recovery I cringe. It feels like saying that heart attacks are a part of treating heart disease. I do not believe that good treatment should accept any negative outcome as a part of the recovery process.

Relapse is common, but it is not universal. Some people, more than you might think, recover and never relapse.  A surprisingly large number of people report that they were able to quit drugs, get over their depression and anxiety and stay quit and recovered.

So how do they do recover without relapse?

We need to talk about several things. What is recovery, what is relapse, and how do people go about changing?

Emotional challenges and substance use problems are a lot like chronic physical disorders. If you have had a stroke there has been some damage done. If you have been diagnosed with diabetes you will never be “cured.” Some changes will always remain as a result of your experience.

While you will never be “cured” you can, and most people do, recover from that disorder. The same thing happens to those people who have had an emotional or substance use disorder. They can and do recover but they are never fully cured. There is a risk that if they are not careful they may slip back into an active stage of their problem but if they are vigilant about their recovery they do not need to keep getting sick again and returning to their provider to, again and again, be treated and recover over and over.

These ideas about substance use problems and mental health problems are both included in the The Big Book of Alcoholics Anonymous. Bill W. wrote about the issues that those with Bipolar Disorder will face that may make their recovery more difficult than that experienced by people who do not have an underlying mental health disorder.

Bill W also wrote that in the early days of those who came to the program and stuck (meaning actually continued to attend and participate in the program) 50% quit drinking forever. That does not sound to me like he believed that relapse needed to be a part of recovery.

He went on to report that of the remaining half about 25 % had to quit a few times to get it right but those people did eventuality stop for good.

What about that last 25%? The big book reports that while some people never did manage to stay stopped those people, while attending A.A. were much improved. I take that to mean that while the treatment for a mental or emotional problem may not fully effect a cure, reducing your symptoms is a way to reduce the harm that a mental, emotional or substance use problem creates.

These days we are applying the stages of change model to both mental health and substance use disorders. Take a look at some of the books on how people change such as Changing for good.

Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward

I have written posts in the past on this model and how it can help you change and stay changed.

In this model, we see that people need to recognize they have a problem, gather information, get ready to change and then go through the process of making real meaningful changes in their lives. In this model, we see that maintenance, those things you need to do to stay changed once you have made a change, those maintenance steps are the key to preventing relapses.

Relapse is a failure to maintain recovery.

Relapse is not a part of recovery, but the result of failing to continue doing the things that helped you get better in the first place. Whatever you did to get your emotional problem or substance use issue in remission in the first place, those actions need to continue to be a part of your life if you want to insure yourself against relapse.

If you do relapse, do not beat yourself up. Get back into recovery and practice the things you need to stay well. Just know that repeated relapses do not need to be a part of recovery if you practice your maintenance program.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What causes an eating disorder relapse?

By David Joel Miller.

Relapse PreventionCan we predict who will have an eating disorder relapse?

People who work in the recovery field are struggling to figure out how relapses on mental health issues are like and how they are different from relapses involving substance abuse.

Eating disorders are a strong example of that difference.

With substance abuse, most authorities think any return to using or drinking constitutes a relapse. Some authors have tried to differentiate a “Lapse,” a single case of starting to pick up followed by a decision not to return to active use, from a relapse.

Most recovering people are uncomfortable with the idea that any case of picking up can be excused. Rule one for their recovery is “Don’t pick up.” Still, if you do relapse the sooner the return to recovery behaviors the better the chances.

With eating disorders we understand everyone needs to eat, many of us may worry about our weight and sometimes do something excessive to control that weight. To be a relapse on an eating disorder we think we need to see not just one incident but a return to the overall pattern of bad relationships with food.

That part of an eating disorder relapse is similar to relapse to other disorders. The relapse begins before the picking up or purging behaviors. It begins with changes in thinking and failure to maintain your recovery.

Four key factors appear to predict who will have an eating disorder relapse (Per McFarlane et al 2008.) These factors may have an application for other mental health challenges.

1. How bad was the eating disorder before treatment?

The more severely affected the person was the more it will take to change those behaviors. People who have been starving, binging or purging or even overeating for decades do not become cured overnight.

They may make significant progress in a short period of time but they will need a lot more time to consolidate those improvements if they have had the disease for a long time and the symptoms have gotten severe.

2. Higher level of eating disorder symptoms at end of treatment.

This makes intuitive sense. Someone still running a fever is at more risk than someone whose temperature has returned to normal to relapse into a physical health crisis.

The more the urges and cravings, the harder it will be to continue on the path to recovery and not lapse back into old behaviors.

Sometimes professionals are in too much of a rush to fix people and we may send them out of treatment before they are ready. With eating disorder symptoms the more there are and the larger the symptoms are the more the risk of relapse.

Pressure from managed care systems to cut costs is one source of the rush but there are others. Patients want to get this over with and get home. They often think they were cured when the professional known the symptoms are not even all gone yet.

3. Slow response to treatment predicts an eating disorder relapse.

Clients who enter a 28-day program need to hit the ground running. There is no time to waste. Unfortunately many are still not sure they want to change or that they really have a problem. In drug treatment, it is not unusual for clients to avoid treatment for the first thirty days. Somewhere along the way, they see others getting better and they want that result for themselves.

Eating disorder clients who do not start to make progress until three weeks into treatment will not be better, regardless of what that scale says, at the end of the 30 days.

Clients who are slow to respond to treatment need longer to consolidate gains and they are at a higher risk of relapse which means they need more support as the treatment frequency decreases.

4. Higher weight-related self-evaluation predicts relapse.

When your idea of your self-worth is based on an outward characteristic, like weight, it is hard to give up any control over your eating no matter how slight the risk.

This whole area of self-evaluation is a cause of a lot of mental illness and just plain unhappiness. Learn to like yourself for who and what you are inside and anyone who only likes you for your outward appearance is not worth your time.

Selling people things is big business. Sell people on the need to have and eat certain foods, sell them on the joys of eating large and high-calorie foods, make extra fat a standard menu item on fast food menus and you will make money. Then when we get done selling you high-calorie food we tell you it is your fault that you have gained weight.

Don’t buy the yo-yo. Learn to eat healthy in the first place but accept that no one keeps that elementary school figure without giving up a lot of life.

There is a whole lot more inside you than what will show on the scale. The secret to happiness is in keeping your life in balance, not in winning the prize for self-deprivation.

People who think their self-worth is all about their weight will never get happy. Get happy first and you will like yourself regardless of your weight.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What is a dry Drunk – putting down without really getting clean.

By David Joel Miller.

They quit drinking and using but nothing else changed.

Bottles of alcohol.

Alcoholic Beverages.
Photo courtesy of Pixabay.com

They quit drinking, they put down the drugs. The family hopes. They have heard this before. “I am done,” this is the last time. The now-former drinker starts talking a good game. They swear they are not doing drugs. Things will change now. The family wants to believe them. For a little while, there is hope.

Only nothing does change.

Despite the not drinking and the lack of drugs, the person behaves the same way they used to. They are miserable. Their relationships at home and work do not improve, not the way they think they should. The family and friends don’t like being around them anymore now than they did when the person was drinking and using. They are dry but they are not sober.

Suddenly without drugs and alcohol in their system, they feel feelings they have kept at bay for a long time.  Life does not miraculously become perfect. There are bills to pay, legal consequences to take care of and relationships to mend. Life becomes real with its ups and downs.

Dry drunks are easy to spot if you know what you are looking for. They turn up at meetings all across America. Some have been off the sauce for years, 5 years maybe. But they are miserable. And they make others miserable. They are full of anger, bitterness and hurt.

They may turn to a religion. The go to church and become more righteous than the preacher. They can see the flaws and failings of everyone they meet – just not in themselves.

Eventually, the stop going to meetings, that program doesn’t work they tell others. They went but they never really participated. They wanted a shortcut to recovery. One that did not require them to do the painful work of changing.

They may leap from church to church; decrying people as hypocrites and saying people there were not true believers. They learn rules on how to worship but not the values of hope, caring and compassion.

Families tire of being around them. The dry drunk thinks they deserve credit for not drinking and using. The family doesn’t see what has changed. The alcoholic or drug addict is still self-centered and unhappy.

Sometimes the family will tell the dry person “liked you better when you were drinking, you were more fun then.” Or “at least when you were drinking we knew what to expect.”

Dry drunks can go on walking around miserable for years. Eventually most either relapse or turn up in counseling. They attribute their problems to something else, a bad relationship or a difficult work situation. Yes, of course, they have problems. Just putting down the drug or giving up the alcohol does not make all your problems magically disappear.

Some become so discouraged that they stop trying. Why give up the drink if life will never get any better? We see them in multiple drug and alcohol treatment programs.

Eventually what most recovering people find is that they never really had a drinking or drug problem – they have a living sober problem. The problem was not the drugs. Drugs and drinks were their solutions. A solution that temporarily hid their problems but did not solve them.

What they learn eventually, if they learn it at all, is that what they really have is a life problem.

How do you live a happy, fulfilled life without the drugs and alcohol?

Finding that better life requires more than just not drinking or putting down the drugs. It requires an active process of change. Going to meetings is not enough, you need to actually “work” the steps, do the work of change.

Counseling also involves a process of change. The recovery, from whatever your problem is, does not happen in the sixty minutes of each session. In that time we can chart a course, teach skills and help you discover pain you didn’t know you had. The real work of recovery happens in your daily life, in that other 167 hours per week when you need to practice new skills and new ways of being.

If you or someone you know is a dry drunk, has put down but not gotten clean and sober, don’t give up. Find someone you can work with that can help you really become clean and sober.

For more on recovery topics see:

Getting your tools dirty

Getting some recovery

Is relapse a part of recovery?

Running hard after recovery

Why giving up the drugs and alcohol did not make you happy

What is hitting bottom?

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

7 steps to prepare for a recovery crisis.

By David Joel Miller.

Recovery Emergency Plan.

We all know about the importance of preparing for a physical disaster, some of us make these disaster preparations. People in recovery are likely to experience recovery crises. Are you prepared for a recovery crisis?

Just because someone enters recovery does not guarantee a perfect life. This is a real life, sometimes good things happen; sometimes things are not so good. Having a recovery preparedness plan is not just for those in substance abuse recovery. If you are in recovery from mental health or another life problem you need to make these preparations also.

Here are ways to prepare for those not so good times.

1. Enlarge your support system

When things are going well a few people in your support system is fine, but when challenges arise those few people may not be enough. Get phone numbers you can call from more people. What if your first three people are not home or unavailable? Having as at least 20 phone numbers on your support system list is recommended.

A list of numbers for organizations and national support lines is helpful when traveling. Keep your doctor or counselor’s number handy. Many fellowships have websites and there are online meetings. Add these contacts to your phone support list.

Attend support groups other than your regular meeting. Having a number of places you can go means you will not be alone in the crisis.

2.  Recharge your mind.

Practice positive affirmations. Allow yourself to spend quiet recovery time every day. Continue with your prayer and meditation. Read positive books and listen to positive programs.  Exercising your happiness keeps your mind in top shape for those attacks of negative emotions.

3. Recharge your body.

Your body can’t carry you through tough times if you neglect it in the good times. Recovering people know that hunger, thirst, and lack of sleep are all relapse triggers. Eat regular meals. Drink plenty of water and avoid high sugar drinks. Allow plenty of time for sleep.

The body needs a balance of exercise and rest to function at its best.

4. Don’t let you mind overload the rest of you.

In early recovery, people want to make up for lost time. One week out of the hospital or treatment facility and they are looking for a job, signing up for school, in a program of aftercare and seeing a therapist.

Someone who has never cooked anything that does not go in a microwave may take up cooking healthy meals while joining the gym and embarking on a weight loss program.

Overloading yourself by trying to make too many huge changes too fast increases the risk of relapse. Take small steps. Working on goals a little each day over a long period produces results. Your goal should not be a sudden transformation; it should be to make changes in your lifestyle that you can maintain.

Trying to start out on massive change projects can be a way of setting yourself up for failure and sabotaging your recovery.

Do what you can today and a little more tomorrow.

5. Be kind to yourself – give yourself credit – reward yourself.

People who only hear about their mistakes lose confidence, learn to be helpless and may stop trying. Don’t be your own worst critic. Take credit for the things you are doing right. Say positive affirmations. Give yourself small positive rewards for your efforts.

Avoid negative rewards like drugs or alcohol. Have healthy little treats. Take time to go places you enjoy being. Spend time with positive friends. Spending time in meetings and with good friends is not an interruption to your recovery – it is a part of that recovery.

Recovery should be fun. Let yourself enjoy your new and improved life.

6. Keep a book handy.

Keep recovery materials handy. When adversity comes, remember to read uplifting materials. That one recovery book may be just the thing to keep your recovery on track when the problems come.

7. Practice your maintenance steps.

Whatever program you worked to get recovery, do not stop working it. If you worked a twelve-step program, keep in touch with that fellowship. If you have a spiritual connection stay connected. Read your recovery materials. Maintain and enlarge your support system. Continue to practice the skills your counselor taught you.

Putting it all together

What is your plan to keep your recovery strong? Every person in recovery needs an emergency plan to prevent relapse.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Getting some recovery – preventing relapse

By David Joel Miller.

How do you get this recovery thing?

Relapse Prevention

Relapse Prevention

Moving from being “in the problem” to being “recovered” is a process. Many of the things that will take you from the pain to the solution are simple. That does not mean they are easy. Sometimes healing from the past can be painful also.

In past posts, we have talked about Defining Recovery and how recovery is possible for anyone, and that recovery means having the best life possible not necessarily a cure for your condition.

In another post we looked at Why giving up the drugs and alcohol might not make you any happier. Just trying to not do the negative or dysfunctional behaviors will not be enough. Recovery literature talks a lot about using “recovery tools” (see: Getting your tools dirty) and things like internal and external triggers.

What may be missing are the blueprints for creating recovery.

Reader Sue made the following comment.

How exactly should one get their recovery tools dirty? Giving up something that is bad for one, you do expect to feel better but when you don’t you feel disheartened. What’s left is yourself and your problems. So you read all the self-help books and try and work on yourself but how do you connect the practice to the theory? All those learned responses and ways of coping are very hard to unlearn – is it about keeping a record, making new goals or just trying to get through without going backwards?

There are a lot of recovery processes in use today, 12 step models, CBT & REBT therapy’s, counseling and so on. They all have their place and they all have some common elements. Here are some basic steps for transforming your life from being hopeless and suffering to having a healthy recovery.

1. What is the problem?

You don’t get chemotherapy for depression or a drinking problem. Drug and alcohol treatment is not very effective for cancer. Make sure you are treating the real problem.

For most people who come to treatment for an addiction problem, the drugs, and the alcohol is not the problem! The drugs and alcohol are their solutions. The real problem is that their coping method, drinking or drugging to ease the pain, is not working. The problem has become that they don’t know how to live without the drugs and alcohol.

Part of defining problems is to admit that your efforts to control the problem have not been working. This is sometimes referred to as “Powerlessness” which is not the same thing as being helpless. Applying this concept of powerlessness to ways to cope with family members who have the problem was the subject of another blog post.

Mental illnesses can play the same role. Depression, anxiety, and dissociation can all function to avoid a painful life experience. The current problem, the one you need to solve first is how to live life without drugs, alcohol, depression, anxiety or any other negative coping mechanisms.

Most of the time we think the solution to drugs and alcohol is to just stop doing them. This rarely works. Once deprived of your coping mechanism people just suffer. The most effective treatment is to replace the substances with something positive. With clients that I work with we start by creating a Happy Emotional Life Plan (HELP). As a counselor, I believe I am in the happy life business.

With emotional issues, as with eating disorders, it is a little more difficult. You can’t just give up sadness or anxiety and you have to eat and stay healthy. You need to learn to feel feelings without having them control you.

2. Are you ready to change? What help will you need?

Self-help groups talk about recovery being a “we” program not an “I” program. You need to be willing to accept help and support from any source that is healthy. Counselors, Therapists, 12 step groups all can assist in your recovery.

3. Change requires moving through a process

Twelve-step programs refer to “working” the steps or “taking” the steps. Counseling involves some self-examination. To really change requires a lot of action steps. For a detailed description of the process see the series of posts on “Stages of Change”

Pre-contemplation
Contemplation
Preparation or determination
Early Action
Late Action
Maintenance

4. Even after you have changed there is more work to do.

For change to be lasting you will need to do some sort of maintenance. Our old behavior patterns are deeply grooved into the structure of our life. It takes work to avoid falling back into the same old groove.

5. Progress, not perfection.

People in early recovery try to do everything now. They want to do recovery, get a job, find a new relationship and generally create the perfect life all in one week. Learn to take things “one day at a time.”

Relapse, in my view, may not be a required “part of recovery, ” but it happens often enough that it is nothing to beat yourself up about. If you relapse on substance or depression, just get back into recovery as quickly as possible and move on.

The goal, as the old saying goes is “progress not perfection.” Keep your eyes on the gains you are making, give yourself credit for anything well done and try to build on small successes until you create the bigger ones.

Life in recovery is a sort of experiment. We try things and learn from our efforts. Try to avoid experiments that result in a lot of pain or require time behind bars, but you will have to make choices and some of those choices will not work out the way you would have hoped.

This is a real life, sometimes I like it sometimes I don’t. Learning to sit and feel badly and know this will pass, but I can tolerate this feeling without using my negative coping mechanism.

So yes Sue recovery is about trudging forward, trying on new behaviors and sometimes it is hard or painful and sometimes we fall back but always keep track of what works and what doesn’t and keep moving forward.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Preventing anxiety and depression relapses

By David Joel Miller.

10 Ways to avoid a relapse of anxiety or depression.

Anxiety and Depression are treatable, but like other conditions, it is possible to relapse into anxiety and depression. There are some understandable reasons to relapse on anxiety. But what steps can you take to prevent a mental health relapse?

1. Learn and learn again.

Just learning something once is not enough. To learn it thoroughly you need to continue studying even once you think you have it. We call this form of learning “overlearning.” Learn your relapse prevention skill beyond the point of being able to recite it. Learn your relaxation techniques and thought-stopping skills until those processes become automatic.

2. Don’t quit your lessons once you pass the first test.

For substance abuse clients we know that the longer they stay in treatment past the point of getting off the drugs the better their chances of avoiding a relapse. The same is true of anxiety and depression. Fears will return. Life stressors will get you down. Having stayed in treatment will build protection from an emotional relapse.

3. Face your problems as they come.

Using avoidance and distraction only make the challenge larger. Putting things off, using substances or not thinking about your challenges may seem like a way to avoid the fear in the beginning, but fear avoided grows. Seeking out pleasure as a way to avoid anxiety or depression works for a while but eventually, you will have to face your problems.

4. Practice and train for many possible triggers for a relapse.

If you are afraid of snakes practice looking at and talking about many kinds of snakes. If your fear is public speaking make as many small presentations as possible with as many different groups as possible. Practice speaking on several topics. The more potential cues for fear you practice on the better prepared you will be for an unexpected fear.

5. Practice your relapse prevention skills in multiple locations.

It is easier to manage your fear of snakes when looking at a picture book in the library than to avoid that fear in the woods. Practice in the yard, on walks in the neighborhood and as many other places as you can find to be outside and think I can handle seeing a snake if one should cross my path. Practice public speaking in more than one place.

6. Practice relapse prevention skills at times you are slightly uncomfortable.

You don’t develop skills if there is no challenge. Your anxiety relapse prevention exercises need to create a little anxiety. Training when you are very anxious is setting yourself up for failure. Gradually increase the challenges, keeping the anxiety at a manageable level.

7. Self-improvement programs work better with a little homework.

Set some homework projects for yourself. Ask your counselor or support system for suggestions. Don’t put homework off. You grow by repeated practice.

8.  Not all homework has to be done involving real danger.

Mental rehearsals for challenges can be helpful in increasing your ability to cope with an anxiety-provoking situation. What should you do if the situation occurs? What do you wish you were able to do? Picture yourself doing the thing you most would like to be able to accomplish.

9. Use “I can” self-talk.

Telling yourself that you will be able to cope increases the likelihood you will be able to cope. People who repeatedly tell themselves they can’t find they are right. Use coping language and stories to help you picture being successful and competent.

10. Avoid emotional reasoning.

Just because something feels scary does not make it dangerous. Examine the connection between your fears, anxiety and sad thoughts and the things that cause them. You likely will find that it is the view of the situation that is causing the negative emotion.

There are 10 Ways to avoid a relapse of anxiety, depression or other negative emotion.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.