The National Council of Drug Abuse (NIDA) defines high-risk situations as “those that threaten your recovery or trigger a strong craving to use substances.” One of the easiest ways to identify this is by categorizing situations as to people, places or things.
People, Places and Things …
People may be those who you have used with or who are related to your use. It could also be people who you have conflicts with, who make you want to use, persons who you celebrate with by using or those who encourage you to use either directly or indirectly. One study done by Marlatt and Gordon, indicated that interpersonal conflict situations accounted for over 50 percent of all relapse episodes. In this same study, social pressure accounted for over 20 percent of relapse episodes.
Places are those areas where you have used or where you get your drugs or alcohol. These can include bars, restaurants, clubs and concerts. The beach or the cabin can be a trigger. Also, particular aisles of grocery and drug stores.
Things are those events or objects that remind you of your using. These can include alcohol and drug paraphernalia (think corkscrews, wine glasses). They can include events such as parties, weddings and family reunions. Listening to certain music can also be a trigger.
High-Risk Situations in Recovery
High-risk situations involve a person’s internal emotional state or external surroundings. And 12-Step programs use the acronym, HALT to describe them. Hungry, Angry, Lonely or Tired. But it is also important to be aware of feelings such as shame, embarrassment, anxiety, and depression. And boredom – which can trigger a sense of powerlessness and a desire to escape emotional pain. External surroundings can trigger strong feelings to use as they remind one of either pleasant or stress-filled experiences. Our emotional state and external surroundings have certainly been impacted by the COVID-19 pandemic.
Consider the following high-risk recovery scenarios:
It’s a lazy Sunday afternoon.
You are doing laundry and come across a shirt that needs to be dry-cleaned. You haven’t dry-cleaned anything since leaving treatment and remember that the bag to keep your “to be dry-cleaned” clothes is in the garage. While you search the garage for your bag you come across a bottle of vodka, your previous substance of choice. What do you do in this high-risk situation?
You are at your cousin’s house for your uncle’s birthday.
They are cooking what looks to be a stuffed chicken dinner. Your cousin opens the refrigerator and pulls out a six-pack of beer. She pours all six beers on the chicken. Then she states that dessert involves ice cream and Bailey’s. She looks at you and says, “It’s okay because it is part of the dinner and dessert, right?” High risk! What do you do?
You are on a business trip with clients that you have never met before (risky business).
Your boss has asked you to “wine and dine them” in order to get the business contract. They have removed their masks and ordered several bottles of wine for the table to drink to the success of the business merger. You know you will never see these people again. What do you do?
You are at your mother’s home.
Mom states she has a headache and asks you to bring her some aspirin. You open her medicine cabinet and find bottles of prescribed sleeping medications among the over-the-counter medications. Since leaving treatment, you have struggled with insomnia and its consequent fatigue. What do you do?
You plan to meet up with a couple of friends you have not seen in a long time.
You get to the restaurant where you agreed to meet, however there are no outdoor tables available. Your friend suggests going to the open air Bar and Grill across the street, where you used to drink. Your other friends agree it will be fun. What do you do in this high-risk situation?
Recognizing High-Risk Scenarios …
The first step is to recognize when you are in or close to a risky situation. It is important to learn to pay attention to one’s encountered situations and be aware of changes in thoughts and feelings. This will help in detecting warning signs as soon as possible.
High-risk situations are often individual and specific to someone in recovery. The added anxiety of the pandemic is a factor. What is high-risk for one person may not be high-risk for another. Identifying high-risk situations can help individuals in recovery prepare for unplanned occurrences and may also provide insight into why they resort to drug and alcohol use in the first place.
As evidenced by the above situations, it is also significant to realize not everyone will be glad to know you have an addiction. Or to know you are doing something about it. It takes discernment to understand with whom you want to share the details of your recovery. Education can dispel stigma and persons in long term recovery express pride about their healing. Sharing stories is a way to connect with people and inspire others who may be struggling with behavioral health conditions. Your story can also demonstrate that treatment works and recovery is possible. Addiction gives people the opportunity to change their lives, which is both difficult and rewarding.
One of the best things individuals in recovery can do for themselves is to anticipate high-risk situations before they actually occur. This provides an opportunity to develop a plan of action for how they will respond. Although not all high-risk situations can be anticipated, most people in recovery can still make predictions about what may occur in the near future and develop a plan of action. Coping plans should include a detailed plan of action for how to respond to the given situation.
Terry Gorski is an internationally recognized expert within the field of substance use, mental health, violence and crime. The Gorski Relapse Prevention Model includes the following nine steps which he believes to be imperative in developing a coping or relapse prevention plan:
This first step within this model is to re-center yourself away from drugs and previous negative tendencies. Taking those first initial steps into sobriety by completing detox is your starting line.
Within the assessment step, any negative patterns or problems that contributed to past relapses are identified and resolved. This is inclusive of the following factors: life history, alcohol and drug use history, as well as recovery and relapse history.
This is where it’s time to get informed. Understanding the process of relapse is key while in recovery. This not only goes for the person in recovery but their family and twelve-step sponsors as well.
Warning Signs Identification:
Knowing what can bring you into trouble can equally help you stay away from it. Writing out a list and analyzing each warning sign helps those in recovery continue in their walk of sobriety.
Warning Sign Management:
While knowing and understanding your warning signs is great, it means nothing if you don’t have a coping strategy in place to fight these temptations. Creating and following through with exit strategies is crucial while in recovery.
Recovery isn’t meant to be done alone. In recovery planning, the recovering person is placed into contact with people who will help them resist previous tendencies.
Inventory training prepares you with morning and nightly routines to anticipate, evaluate, and avoid high-risk situations.
Getting family involved can be the make or break in many situations. Bringing your loved ones into affiliation with groups like Al-Anon will help prepare them with everything they need to know in how to care for their family in recovery.
Recovery is never static. Here, it is crucial to follow up monthly for the first three months, then quarterly for the following two years, to then annually.
Developing Coping Skills for Risky Situations
Developing coping skills happens in incremental changes, much like learning how to water ski, snowboard or ride a bike. There are repeated attempts at learning these activities, such as falling, adjusting and trying again before a person masters them. Written relapse prevention worksheets can be constructed in treatment and found online to assist with this planning. Relapse prevention and recovery groups are also ways in which to process feelings, events, cues and triggers to use and further develop strategies for sobriety.
The phrase “people, places and things” is most often used in conjunction with triggers to use. But it also has a positive side to it for recovery in managing an environment in which to thrive. Using Cognitive Behavioral Therapy, Mindfulness, Yoga, and exercise are all ways of mastering thoughts, feelings and behaviors. Especially cues and triggers for using. Making changes in new and healthy relationships, homes and environments, and self-care are all important in maintaining life balance and decision-making.
Still confused about what to do in the high-risk scenarios above? Here are some recommendations:
If you come across a bottle of alcohol or pills and you feel triggered, call a support person immediately. Ask them to help you dispose of the alcohol or medication, if necessary. Be honest with others in sharing that this substance is a problem for you. This goes for social events as well. If you find yourself in a situation where others are drinking and it is expected that you join in, have a plan in place to excuse yourself. If you cannot excuse yourself from a using situation, develop a plan to have sober support available. And think positively in the face of danger. Again, talk openly and honestly with others about your need to take care of yourself. You may be surprised at the level of acceptance and respect you receive.
Here is an example of understanding by others in a high-risk situation.
An acquaintance told me of a time when he took a ski trip with recovering friends in Colorado. After a day on the slopes, the group went to dinner and enjoyed a pleasurable evening. The evening included much laughter at the table. The savvy waiter serving them noticed both their hilarity and also that they were not drinking. After delivering the tab, he smiled and said, “You must all be good friends of Bill W.” And indeed they were.