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Common High Risk Situations in Recovery and How to Manage Them

One of the most challenging aspects of recovery is that it is an ongoing process….it never really ends. When an addicted person stops using and embraces abstinence, the real journey begins. Holding onto a substance-free lifestyle is seldom a straightforward path; rather it is often marked with peaks and valleys where a return to drug or alcohol use for a time – a relapse – punctuates periods of abstinence.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimates that nearly 90% of people in recovery for alcohol use relapse at least once over a four-year period. The National Institute on Drug Abuse (NIDA) reports that relapse rates for people in recovery for all types of substance use averages around 40-60%.  These statistics, while alarming, are consistent with the relapse rates for other chronic illnesses. For instance, people with hypertension and asthma have about a 50-70% rate of failing to consistently maintain their treatment regimes, and people with diabetes have about a 30-50% rate of relapse from their treatment regimes.

To better manage the risks for potential relapse, the drug and alcohol treatment community has developed guidelines to help people in recovery recognize risky situations and develop proactive strategies to deal with them before they get out of hand.

Categories of Risk

The risk for relapse falls into three general categories: high risk, moderate risk and low risk.

  • High risk situations involve repeating circumstances under which you were most likely to use your substance of choice – circumstances similar to, or identical to, those where you may have often used before. It is very difficult to implement effective coping skills to avoid using when you are in these circumstances.
  • Moderate risk situations involve circumstances under which you could be triggered to use. You may feel confident that you can abstain in these environments, but you may not actually have sufficient practice or skills to follow through on your intentions.
  • Low risk situations involve circumstances under which you are not likely to use. Examples include revisiting times and places when, during your actively addicted period, you did not consume your drug of choice.

Factors That Predispose You to Risky Behavior

Basically, you are at risk for relapse if you fail to follow the strategies that support your recovery and, instead, put yourself in circumstances that are similar to those under which you used before. But you don’t simply “find” yourself in these circumstances. There are underlying reasons that usually lead to straying from the recovery path:

  • Difficulty dealing with emotions: Substance use is a common way that people attempt to deal with emotions­­ – positive or negative – that feel too intense or overwhelming. Many people use when they are angry, sad, frustrated, nervous, depressed, guilty, bored or lonely. On the other hand, sometimes people drink or use drugs in times of celebration, for instance, among friends at a party. If you feel you can’t manage your emotions without the help of a mood-altering substance, then you would likely benefit from learning and practicing some emotional coping skills, such as mindfulness or other cognitive-behavioral strategies. These can be gained through counseling or in a self-help education program.
  • Testing of personal control: At some point in your recovery, you may feel that you’ve achieved your goal – you feel that you have arrested your addictive tendencies and feel you no longer need to be so restrictive with yourself; you feel in control of yourself. Unfortunately, letting go “just a bit” often escalates until one has returned to old habits. The real test of control is when you can resist the urge to test your self-control.
  • Feeling deprived: Sometimes during recovery, it may feel that all the fun has been let out of your life. Your friends and coworkers can celebrate with a drink, but you can’t. Your old pals have now been banished from your social plans. You may sometimes feel that the cost of being sober is just too high. You just want to be like everyone else who can have fun and not be burdened with the need for constant vigilance and restraint. But, unfortunately, recovery does require exceptional self-discipline. You may need to remind yourself that, while your reward for this does not involve temporary relief, it does offer you a lifetime of positive experiences and increasing self-fulfillment.

Triggers for Risk and How to Manage Them

Certain specific kinds of situations are more likely to lead to risky behavior. You can remove yourself from high risk situations if you recognize them early and have a plan to move away immediately.

  • Being in a “using” environment:  If for some reason, you inadvertently find yourself in a place or among people who are using, leave immediately. You may have to abruptly leave a party without saying goodbye if someone suddenly pulls out drugs or paraphernalia. Do not worry about being rude. Your sobriety, and perhaps your life, are on the line, so social graces are the least of your concerns.
  • Substituting one addictive substance for another:  If you are recovering from drug use and have the need for pain medication, perhaps following an accident or surgery, you and your doctor will need to be extra-diligent in monitoring your pain management needs. Relapse caused by the use of prescription opioid pain medications is one of the easiest ways that slips occur. Ask your doctor to suggest non-pharmacological forms of pain control (hypnosis, relaxation techniques, massage, acupuncture) when possible.
  • Giving in to cravings:  Physical cravings and the psychological desire for alcohol or drugs may take a long time to recede, and they can reoccur unexpectedly. Fortunately, they are often short-lived and give way easily to distraction and mental focus. Plan ahead for how you can best handle your type of cravings. Use a substitute (chew gum, drink an energy drink, exercise, etc.) and have mental and emotional resources available. You might create and use a personal mantra or affirmation, such as “It’s just a craving; I am stronger than this fleeting feeling.”
  • Not having a support system: Everyone needs a support system, especially when dealing with difficult tasks such as maintaining ongoing sobriety. Having sober friends to call on when urges to use come up is the best way to stay on track. Sober peers can talk you through a risky situation, reminding you of what is at risk and reminding you of your commitment to your goals. They can offer the cool head and sensible reasoning that you may temporarily lacking and can guide you back to your center of stability. Attending regular support group meetings can further your access to assistance. Don’t go it alone. Developing and using your support system is perhaps the most important thing you can do to manage your relapse risk.


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