Tag Archives: relapse prevention

Urge Surfing Prevents Relapses.

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Urge Surfing Prevents Relapses.

Urge Surfing Prevents Relapses.
Photo courtesy of Pixabay.com

Don’t let urges knock you down.

Urge surfing is an idea that comes from substance use disorder treatment. Learning to cope with urges can help prevent relapses into depression, anxiety, substance use disorders, and many other mental, emotional, and behavioral disorders.

A coworker and I discussed the similarities between surfing on the ocean and surfing urges. He is an avid surfer and tells me that not having a good relationship with the waves can leave scars. Ignoring urges and what is causing them can leave mental and emotional scars.

What is an urge?

Urges are sudden, intense impulses to do something. People with urges often feel compelled to act. When the idea enters the mind, it can become a compulsion. Urges can be intense, unpleasant sensations. Once the urge arises, it is hard to avoid acting on it. Wrestling with urges results in a lot of relapses into unhelpful thinking, and unhealthy behaviors.

Urges rise and fall.

Urges, in the early stages, can come on slowly and gradually, other times they rise rapidly, like a heavy ocean swell. You could easily be swept away before you realize the danger of the urge. The challenge with urges is to maintain your position without being carried away by the urge. Typically urges last 20 to 30 minutes.

Concentrating too much on ocean waves leaves you unprepared when they arrive. You should prepare for the rising and falling urges ahead of time also.

Wrestling urges, wears you out.

The typical response to urges is to try to avoid thinking about them and resist acting. The more you struggle, the more tired you become. Trying to not think about something makes the thought grow. To defeat urges you need to do two things. First, do not give in. Sometimes giving in and sometimes not amounts to intermittent reinforcement, one of the hardest things to overcome. Second, don’t exhaust yourself swimming directly into the urge. Practice floating above the surface, riding out the comings and goings of urges.

Urges can affect your thinking, your feelings, and your behavior.

Surfers who develop a negative attitude don’t last long. If you engage in self-criticism, telling yourself you should have caught the last wave, you need to wait for the next one; you don’t surf, you get washed ashore. Having cravings and urges is a natural part of recovery. Don’t beat yourself up for having urges. Having urges can make you feel like you’re not doing recovery correctly. Don’t let your urges take you places you should not go. Stick to the behaviors that will further your recovery.

Make peace with your urges.

Surfing the urges allows you to reach a place of neutrality where you neither wrestle the urge nor give in to it. What you need to do is to step back from the urge and begin to watch it as an outside observer. From this vantage point, you will see that your urges rise and fall. If you can stay in this relaxed state for a time, the urge recedes.

Accept that it is okay to feel however you are feeling.

You do not have to take action to change your feelings. Your life is a real life. There are things you like about it, and there are things that you will not like. Sometimes you will feel happy, and sometimes sad. Sometimes you will be calm, and sometimes you will be anxious. The key to making peace with your feelings, and not being swept away by urges, is to learn to recognize what you are feeling without rushing to change that feeling.

What feeling is coming up for you?

As you feel the urges rising, work on identifying what that feeling is. Are you feeling anxious, depressed, or frustrated? When urges rise, you may be thinking about others. Are you telling yourself it’s not fair that you must quit drinking or drugging, while others are continuing to do these things?

Learn the signs of oncoming cravings.

A water surfer notices the wave coming. Begins to paddle before the wave reaches them. They are up to speed when the wave reaches them. Notice the onset of uncomfortable feelings when urges are on the rise. Pay attention to increases in unhelpful thoughts. Watch your body for signs of negative emotions, that pain in the neck, the queasy stomach.

Practice urge reduction skills before the urge waves wash over you. Learn grounding techniques, scanning your body for tension, and use other relaxation methods. Breathing is especially important when it comes to keeping your head above water. Positive self-talk, affirmations, and grounding techniques can keep you prepared for the next round of urges.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

What is Aftercare?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

What is

What is Aftercare?
Photo courtesy of Pixabay.

How does aftercare relate to treatment?

Aftercare is continuing or follow-up care that is received after the initial intense round of treatment. This is common in counseling those with a substance use disorder. It should be more common for those with most types of mental illness also. Aftercare is intended to prevent a return to active symptoms of the disorder. In the case of substance use disorders, this means aftercare should reduce the risk of relapse.

This term probably originated back in the days when the 28-day rehab was common practice. You got your initial drug or alcohol treatment in a residential treatment center and then after that initial period, you went home. Remember that while medical treatment for physical health problems has been around for centuries, treatment for substance use disorders and mental illness are relatively new procedures.

It is easier staying clean and especially sober when you are in a residential program. It is possible to get drugs and alcohol into a rehab facility but many of the people who are there are really trying to quit and they will report that kind of thing. Programs try their hardest to keep drugs out, kind of like jails do.

What often happened when people left the program was that they ended up back in the same environment as before. Everywhere you go there are people using drugs, drinking, and so on. The temptation to revert to the old ways of behavior is tremendous. Think of the alcoholic in early recovery. Everywhere they go there is alcohol. Why even the grocery store is out to get them. You have to walk past the wine to get produce and the beer is in front of the meat case.

To help people who had done a residential drug treatment program stay sober aftercare of some kind is a big help. This may be as little as one time a week or it could be more. Some aftercare’s are even a meeting every night.

Having this ongoing connection to other clean and sober people helps keep the person focused on their recovery and reduced the temptation to do what others were doing and get high or drunk. If you hang out with sober people you are less likely to drink.

Recently we have seen this same aftercare advantage with those with a mental illness. You can go see a therapist, get and take meds but if at the end of a few weeks you go back to your old way of living and nothing changes then you can end up feeling the way you used to feel. The depression has returned.

Staying connected to meds and therapy longer reduces the risk of relapse. One study I read reported that those who stayed on antidepressant meds for two years had fewer relapses even after discontinuing the medications.

Whatever you do to change your life. Keep doing it after that initial change effort starts working. That is aftercare in practice. Maintaining your changes is the primary purpose of attending an aftercare program.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5, some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

You might also want to check out these other posts Drug Use, Abuse, and Addiction 

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

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

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Liquor

Alcoholic beverages.
Photo courtesy of Pixabay.com

They quit drinking and using but nothing else changed.

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. They 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

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

7 steps to prepare for a recovery crisis.

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Ball recovery

Recovery and Resiliency.
Photo courtesy of Pixabay.com

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 to 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 the 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 to 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

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel

Preventing anxiety and depression relapses.

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Urge Surfing Prevents Relapses.

Urge Surfing Prevents Relapses.
Photo courtesy of Pixabay.com

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 makes 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 relapse triggers.

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

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

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.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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

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

For videos, see: Counselorssoapbox YouTube Video Channel