Psych Central

4 Tools You May Not Be Using That Could Help Prevent Drug Relapse

By David Sack, M.D.

watch for relapse triggersPeople in early addiction recovery are like ticking time bombs – relapse is often just one stressor away. For many, the holiday season is that stressor. Family conflict erupts. Reality falls short of their expectations. Stress builds. Then, friends, coworkers and family members, even those who don’t ordinarily drink, throw parties or host gatherings where alcohol is readily available. This is a powerful physical and psychological trigger for anyone in early recovery, prompting intense cravings that can feel impossible to resist.

Thanks to scientific research, we have a number of highly effective strategies for reducing the risk of relapse. Unfortunately, some of the most effective approaches are also the least utilized. Here are four relapse prevention tools that can help recovering addicts, especially those with a history of relapse, stay sober over the holidays and beyond:

#1 Integrated Treatment for Underlying Mental Health Disorders

Roughly half of individuals who struggle with drug addiction also have other addictions or mental health disorders. Because appropriate dual diagnosis treatment can be difficult to find, many people end up choosing a therapist or drug rehab that focuses exclusively on substance abuse – or, more likely, pays lip service to treating dual disorders but lacks the staff and resources needed to treat these intricately intertwined issues. Without addressing both the underlying issues (mental health disorders) and the symptom (drug abuse) at the same time, relapse rates are significantly higher.

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10 Ways to Stop Being Lonely in Recovery

By David Sack, M.D.

In an ongoing quest to find the secret to happiness, scientists have come back to the same answer time and again: relationships with other people. In a 2012 Australian study, researchers found that the quality of a child’s relationships with family friendsand friends has a greater effect on their happiness as adults than intelligence, wealth or academic success. The U.K.’s National Child Development Study showed that middle-age adults who regularly meet up with 10 or more friends have better mental health than those with five or fewer friends.

Given the connection between social ties and mental health, it comes as no surprise that people who feel socially isolated are more likely to struggle with substance abuse. New research shows the reverse is also true: Drug abuse may be the cause, not just an effect, of social isolation. According to a 2012 study in the Journal of Health and Social Behavior, teens who drink are more likely to feel like social outcasts than students who avoid alcohol.

Thus, an important part of addiction recovery is restoring close ties with other people. After bidding farewell to their drug-abusing associates as well as many of the healthy relationships they once had, most addicts in early recovery are faced with building a social network from the ground up.

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Addiction Swap: Substance Abuse and Workaholism

By David Sack, M.D.

workaholic sleeping under deskA lot of people still have a fairly simplistic view of addiction: go to rehab, maybe battle with a relapse or two and then go on with life as usual. But this disease is cunning and persistent. Even those who successfully eliminate drugs and alcohol from their lives may find themselves trying to diet away the 30 pounds they gained during rehab or losing days of their lives to online shopping or gambling.

Among CEOs, doctors, lawyers and other professionals, we often see addictive patterns surface at work. Some end up in treatment because their Type A personalities and obsession with professional perfection have literally driven them to drink or abuse drugs. One study found that people who worked at least 50 hours a week were 1.2 to 1.5 times more likely to develop alcohol-related problems than people who worked less.

Others find that they recover from an addiction to drugs only to overload themselves with work, often to avoid dealing with the same issues that drove them to abuse drugs. Now, in addition to a problem with workaholism, they are at increased risk of drug relapse.

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Addicts and Wolves: An Unlikely Pair

By David Sack, M.D.

wolf at wolf therapyBased on media portrayals and folklore, we’re led to believe that people and wolves are arch enemies that compete for food and resources. Science has a different story to tell – one not only of coexistence but even cooperation.

Today, wild spaces are dwindling and wolf populations have been slow to rebound from near extinction, but people continue to benefit from interactions with these smart, sensitive creatures. For most of us, our beloved dogs – direct descendants of wolves – are the closest we’ll ever get to a wolf. Wolf Connection, an innovative wolf therapy program and wolfdog rescue in the high desert north of Los Angeles, seeks to change that.

Wolfdogs as Therapy Animals

When the wolfdog rescue first opened in 2009, founder Teo Alfero sought to educate and empower young people by simply allowing them to spend time with the animals. Four years later, it has evolved into a therapeutic program with a set of “wolf principles,” or lessons humans can learn from wolves. Wolf Connection now serves a number of specialized populations, ranging from abused and neglected foster care children and juvenile delinquents to veterans with post-traumatic stress disorder and people struggling with drug addiction.

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Financing Addiction: 5 Ways To Stop Enabling And Become Part Of The Solution

By David Sack, M.D.

financing addictionCaring about someone who is addicted to drugs or alcohol is emotionally draining. It can also be a tremendous drain on the family finances. Whether the addict is a struggling youth or a distinguished professional, there may be little left of the family bank accounts, investments, even the home by the time they get help.

The advice for loved ones can be confusing: Support but don’t enable. Let go but stay close. Here are a few concrete ways to become part of the solution:

#1 Make an Honest Assessment.

Sometimes it’s hard to tell: Are you helping a loved one in crisis or enabling their addiction? Enablers:

• Comply with the addict’s requests for money, favors or things just to keep the peace

• Assume drug use is just a phase that will get better on its own

• Take on the addict’s responsibilities as their own

• Rescue the addict from difficult situations

• Give not only second but third, fourth and fifth chances

• Engage in destructive behaviors alongside the addict despite knowing the addict has a problem

• Do things for the addict that they should do for themselves, such as paying bills or fulfilling job or family responsibilities

Even though enablers act out of love and concern, their attempts to protect the addict prevent them from experiencing the full consequences of their actions, thereby prolonging the addiction. In contrast, true supporters allow the addict to experience the natural consequences of their actions and encourage them to accept help.

#2 Help Yourself.

Offering “help” that truly helps isn’t always second nature. For many families, it requires communicating and interacting in a way that is different from their norm. Enablers can learn to take care of themselves while offering healthy support by attending support groups for loved ones of addicts, such as Al-Anon or Nar-Anon. If an addicted loved one is in rehab, family members may be invited to participate in a family program or family counseling. It’s also advisable to seek individual counseling to address the many ways in which the addict’s behavior has changed your life and the way the rest of the family functions.

In an effort to save your loved one’s life, you may have spent the majority of your financial reserves trying to protect them from harm or get them treatment. Regardless of your addicted loved one’s recovery status, you need your own financial recovery plan. Talk to a financial counselor or life coach, attend a money management seminar, or find a book or computer program that can help you make a plan for repairing your financial health.

#3 Explore New Tools.

There are new products emerging to help addicts and their loved ones. For example, there’s a prepaid debit card that allows loved ones to provide financial support while monitoring how the money is spent. The card has built-in controls that exclude it from use at bars, liquor stores, strip clubs, casinos and similar establishments, and inform cardholders of attempts at unauthorized use. Users also cannot receive cash back with purchases or cash from an ATM.

Obviously, there are ways to circumvent the card’s protections (e.g., buying other goods and trading them for drugs or purchasing alcohol at a supermarket) but it’s one way to balance support with accountability. It’s a type of money management 101 for those who never developed basic finance skills or those who learned the skills only to lose them to addiction.

#4 Practice Financial Tough Love.

It’s not the addict’s fault that they have an addiction but it is their responsibility to manage their illness – and how you interact with them can edge them closer to responsibility or further into addiction. Emotional pleas and logic aren’t always effective with addicts; their capacities for empathy and judgment are too impaired by drugs. When other approaches have failed, sometimes loved ones must practice financial tough love.

When the addict is ignoring your rules and expectations and hurting themselves and others in the process, it’s time to get serious about not supporting their habit. With tough love, family members continue to offer emotional support and help with treatment – emotional, financial or otherwise – but cut off other types of financial support. That means no money, no car, no phone – anything that can be converted to drugs.

#5 Adopt a Whatever-it-Takes Approach.

Financial tough love is just part of the broader strategy in helping an addicted loved one. It is designed to stop any enabling behaviors on the part of family members and friends, and to help the addict see the reality of what their life has become. The next step is doing everything possible to get the addict into treatment.

Set and enforce boundaries with renewed persistence and consistency. Monitor spending with abandon. Stage an intervention. Research treatment centers. In doing so, you’ll send a clear message that you will no longer enable or rescue, making it much more difficult for the addict to maintain their habit. Use any leverage you have left so that every other option outside of treatment is extremely unattractive.

As a result of physical and psychological dependence, addicts will use any means necessary to get money for drugs, including heart-wrenching pleas, threats, guilt, theft and manipulation. Loved ones who adopt the same whatever-it-takes approach in getting the addict into treatment can stop financing addiction and start financing recovery.

David Sack, M.D., is board certified in addiction medicine and addiction psychiatry. He is the CEO of Elements Behavioral Health and oversees such treatment centers as Promises, The Ranch, The Recovery Place, The Sexual Recovery Institute, and Right Step.  David is a sought-after expert who often appears in the major media.



Does Addiction Run in Your Family? How to Talk to Your Kids About Their Risk

By David Sack, M.D.

mom talking to daughterIf you’ve lived through a family member’s addiction, whether a grandparent, aunt, cousin, sibling or your own, you intimately understand the gravity of the disease. But your children, blissfully unaware of their family history, may not take drugs and alcohol as seriously as they should – that is, until you make them.

What a Family History of Addiction Means

Genetics accounts for about half the risk of developing addiction. Those with a family history of addiction, meaning one or more blood relatives has had a drug or alcohol problem, are at a significantly higher risk of suffering from addiction and other mental health disorders. Children of alcoholics, for example, are four times more likely than other children to become alcoholics themselves. They also tend to suffer from low self-esteem, poor academic performance, abuse and neglect, and other issues at higher rates than other children.

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Money: The Lesser-Known Relapse Trigger

By David Sack, M.D.

financial-worriesWe talk a lot about the potential for stress, transitions, relationships and other major life changes to trigger a relapse. With much of the focus on the “Big Three” – the people, places and things to avoid – day-to-day issues like money lurk in the shadows as a silent threat to sobriety.

Among the first tasks of early recovery is getting a job. This is a critical step in rebuilding confidence, repaying debts and achieving goals but it also means having a steady flow of cash – something that used to be closely tied with drug use. Here are a few tips to help you safeguard your sobriety while regaining your financial stability:

Broaden Your Personal Inventory. As part of your recovery from addiction, you may have taken a personal inventory. As part of your financial recovery, you need to take an honest look at your assets, debts and expenses. The process may be discouraging so have a plan in place for dealing with negative feelings to guard against relapse. Ask a friend or family member to take inventory with you and stay focused on improvements you can make in the future rather than dwelling on past mistakes.

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Struggling to Hold Onto Your Sobriety? Try Helping Someone Else

By David Sack, M.D.

Try Helping Someone ElseAlcoholics Anonymous is founded on the concept of one addict helping another. This emphasis on service is not based on religious dogma or speculation, but rather decades of experience with what works in addiction recovery. Until recently, science has focused on discovering new medications to treat addiction. Few researchers have subjected the 12-Step principles, which have helped millions of people achieve long-term recovery, to rigorous study. As a result, many core principles of 12-Step recovery have been marginalized as “unscientific.”

Fortunately, we are on the precipice of a new era in addiction research – one that is determined to learn from the success of AA/NA and find out why 12-Step recovery has been effective for so many addicts.

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5 Signs Your Recovery Is in Jeopardy

By David Sack, M.D.

5 Signs Your Recovery Is in JeopardyGetting clean and sober isn’t easy, but managing to hold onto your sobriety long-term can be even more precarious. Why do some sustain while others fall prey to chronic relapse?

Given all the buzz about the biological roots of addiction, it may come as a surprise that it’s not necessarily having a long line of addicts in the family or an “addictive personality” that sets a recovery effort up for failure, but more to do with your willingness to get real about your disease. Here are five signs your recovery is headed in the wrong direction:

#1 Refusing to Ask for Help

While some people recover on their own, the vast majority cannot stop using without a strong network of family or friends, a trusted therapist or some other form of support. Refusing to reach out for help, whether that includes inpatient or outpatient treatment, counseling or self-help support groups, is often a sign that long-term recovery isn’t going to be a reality.

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5 Things To Know Before Dating An Addict

By David Sack, M.D.

datingIn working with the spouses and significant others of addicts, I’ve often heard it said, “I’d rather be an addict than love one.” While few people would ever walk eyes-wide-open into a chronic disease like addiction, the statement speaks to the confusion, loneliness and despair common not only among addicts but also the men and women who love them.

A history of addiction doesn’t necessarily turn Mr./Mrs. Right into Mr./Mrs. Wrong. In fact, addicts who are solid in their recovery can make excellent partners. They’ve waged a courageous battle, spending a great deal of time working to take care of and improve themselves. But before you put yourself in a position to fall for an addict, there are a few things you need to know:

#1 Love does not conquer all.

For anyone considering dating an active addict, it is important to realize that love cannot conquer addiction. Addiction takes priority over everything – you, children, career, financial security, even one’s own freedom. Before diving into a relationship, find out if your prospective partner is actively using drugs or alcohol, or if they display addictive or compulsive patterns in other areas (e.g., gambling, work, sex, food or spending).

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