Families In Recovery for Counseling CEUs for LPC and LMHC

Hi and welcome to your next presentation. This one is called Families in recovery, brought to you by allce.com today we're going to identify who makes up a family, discuss the phases of recovery, and identify goals for the identified patient and significant others in each phase of the recovery process. So who makes up a family? That depends on who you ask. Members of your immediate family may make up your family, but a lot of our patients really aren't engaged with their immediate family anymore. Matter of fact, some of their problems may be because of dysfunction in their immediate family, and they're not ready to re engage with those people at this particular point in time. So who does that leave? Extended family, Aunts, uncles, relatives, friends of the family. You know, that person who came over every Christmas, that person that is involved with other members of your family a lot, that might be somebody that they can call on. Colleagues from work, mentors, or anyone who will support recovery. Family are the people who are going to be there for you when you need them, and they're going to provide you healthy support. They're not going to enable, they're not going to criticize. They're going to help you pick yourself up and do the next right thing. What is addiction? Addiction is a physical, behavioral and emotional response. It's a medical disorder. It's not helpful to think of addiction in terms of morality or willpower. So, you know, of course, I just read all those to you, but what does that mean? Addiction is a physical response to something that's going on. When you start taking drugs, alcohol, your body makes certain changes in order to maintain homeostasis. When you don't have those drugs in your body, your body goes, oh, wait a minute, I don't know how to function without that. Behaviorally, addiction is craving. It's compulsion. It's a need to have that. And it can result in lying, manipulation, a bunch of other things. And we'll talk about this a little bit later. But basically, in addiction, the person has exhausted their coping skills. The addiction is the one thing that the person can count on to make the pain go away. So it becomes a very guarded best companion. That means they will hold onto that at all costs, because that's the one thing that makes the pain go away, which means they may lie to you, they may make excuses, they may blame. They may do all kinds of stuff in order to guard that. It's kind of like a mama bear in her cub. It's a medical disorder. We know there are certain genetic predispositions for addiction, but we also know that when people are detoxing, their body is undergoing changes. When they use chemicals, their brain undergoes changes. If somebody could stop using, if it were that easy, and they could just say, eh, I don't want it anymore, then we wouldn't be having this discussion. That's not the case with people who have addictions. So we need to get past this. Well, you could stop if you wanted to. So in the beginning stages of addiction, the positive aspects outweigh the negative aspects. It makes the person feel better, gives them a little bit more confidence, helps them relieve boredom, and it may help them feel like their sexual experiences are more exciting or maybe they're better at them. The negative aspects include employment disruption, maybe calling in sick because of a hangover, or getting caught drinking on the job, relationship concerns, and financial problems. As the person moves in the direction towards significant addiction, the positive aspects don't outweigh the negative aspects anymore. Addiction becomes a social currency. You will only interact with people who share your same addiction. You are expected to bring that drug or whatever it is to the social interactions. You become the one who always brings the good vodka or whatever it is. You're only now getting occasional euphoria. When you get it, it's great, but it's not nearly as frequent. So you're chasing that high that you initially got. It may help relieve lethargy. Stimulants, cocaine, those sorts of things may help people sort of medicate themselves so they don't feel tired, their body's still exhausted, don't get me wrong, but they don't feel tired anymore. The negative aspects include nosebleeds and infections. As you're using, your immune system is kind of freaking out a little bit, so you can ingest different substances that they use to cut the drugs that could cause you to get sick and infections. If you are snorting or injecting, you can get nosebleeds and infections from dirty needles. Financial jeopardy because you're using instead of paying your bills. Relationship disruption because you're lying, minimizing, blaming, minimizing your use. Everybody drinks after work. I didn't have that many denying that it even occurred. I didn't drink today. Can't walk straight, but I didn't drink. Get the picture? Blaming. If all else fails, then you blame. Well, I wouldn't have to drink if you wouldn't nag me all the time. Those are really common behaviors we see in addiction. What's the purpose? They're trying to explain away this problem so you won't focus on it and you Won't try to take it away from them. As people become more addicted, if you will, mild triggers, things that you would kind of see occasionally and occasionally use start to become generalized. So it starts out the average, you know, let's say college student goes to parties, drinks on Friday night, has some friends, not all of them, but some friends that they typically go out and hit the bars with. Maybe they take stimulants when they start to gain weight, or steroids if they want to put on some mass. If you have extra money burning a hole in your pocket, it's like, oh, I got to do something with this. In intimate situations, you may want to use drugs or alcohol, or if you're feeling depressed, you may just want to feel better. So initially, all these things, I mean, most of you are hearing that going, yeah, I drink at parties. Yeah, I drink on Friday nights quite a bit. I do have friends that drink. When I have some extra money, I may like to go out and have a fun night, going bar hopping or whatever it is. So most people are going, yeah, I do that too. Am I an alcoholic or an addict? Well, we'd say not necessarily. The strength of the conditioned connection is mild to moderate. There are things that you do that you've associated with drinking. So when you do those things, you think about the drug. You might have mild physiological arousal. You might be getting a little bit excited, like, oh, goody, goody, goody, goody. Eager anticipation of use. You might really start craving it. What I would not give for a fill in the blank. And you may use occasionally, but not all the time. Not at every party, not every Friday night, not all the money you have that happens to not be allocated to something else. So right now it's kind of under control. It's not causing multiple problems in multiple areas of your life. So, okay, you know, as the cravings get stronger, it's not just the Fridays, but you're drinking all weekend. You've started to only hang out with friends who use or engage in the same addictive behavior. You start choosing to use when you're stressed, when you're bored, when you're anxious, when you're lonely. Because you know what, your coping skills, their coping skills are often overwhelmed. And they're like, I gotta make the pain stop. I don't know how to be unbored. I don't know what to do. I'm depressed. Nothing makes me happy anymore. I just want it all to go away. So as the person gets into that mindset, as they start to lose pleasure in A lot of things, unless they have the associated drug use, they start thinking about that drug more often. Things are so much better if I just have a little bit of a buzz. They get a strong physiological arousal when they start thinking about using that drug or alcohol. Strong cravings, you can almost taste it. And frequent use because again, things are starting to go downhill in their relationships, at work, at home, in their finances. So they're having a lot more stress and they're drinking a lot more to try to hide from it or make it go away. Unfortunately, they sober up and they realize that it didn't go away. So they drink again in early use. People are going through this process and they've got a lot of various interests, significant others, friends, sports, family, and occasionally drinking or using. Fine. Nothing wrong with that. Nobody says you can't think about it ever. As those triggers get stronger, as life starts getting more difficult, you start caring less about those other things. They're not giving you that same feeling of pleasure and euphoria as your drug does. And matter of fact, a lot of times they're causing more of the stress. So you start isolating yourself from them. Any feeling is an excuse to use. During the day you're awake and you're thinking about all this stuff and you've got stress and you've got bills and you've got emails and you're just being bombarded and you want to make it stop. So you use at night, you're laying down, you're trying to go to sleep, and you know what? You start getting overwhelmed. It feels like an elephant is sitting on your chest because you're thinking about all the crap that's going wrong and how you're going to face the day tomorrow. So you want to use. Unemployment can make people want to use a lot of people. I mean, aside from the financial challenges that unemployment poses, a lot of people garner a lot of self esteem from doing their job and doing a good job. One of the things that we see when people become unemployed is they start to get very depressed as well as very anxious. They don't know how they're going to pay their next bill. They may not know where the next meal is going to come from. And work. If you're not unemployed, work can also be a stressor. So either way you got stress. You may be working in an environment where you feel underpaid, underappreciated, you may have a boss that is constantly crawling up your backside. There's a lot of stressors that can occur in the workplace. All of these things can make you want to escape. So you start obsessively thinking about the drug. If you're thinking about it and you're fantasizing about it, Then you're kind of going off into that little world that you haven't used yet, but it's helping you escape a little. And then you start having intense cravings, which pretty much almost always lead to use. So what you're thinking about now is drug, drug, drug, drug, drug. You may periodically come back and go, family, they're pissed at me. I don't really want to think about them right now. Drug, drug, drug, drug, drug. Got it. Okay. So in addiction, just to kind of recap, you start out where you're introduced to the drug, to the addiction, and it's okay, you think about it, it produces that reward. So you try it once, you're like, I'll do that again. However, it's not obsessive in the maintenance phase, you're thinking about it more often. It's becoming a habitual part of your life. It's actually integrating into a lot of things that you do. So then some people say, well, I don't know how to do this unless I'm high. And I say, well, sounds like we got to relearn something. Disenchantment is when things start to fall apart, but the addict doesn't know how to fix it. Things are so out of control now, but they've alienated a lot of their sober, sane social supports and they're overwhelmed. So they dive back into the bottle until they hit rock bottom. So family members response to drug use. During the introductory phase, Most family members are unaware of the problem. They get confused about occasional odd behaviors, maybe not remembering what you did the night before, or supposed to have so much coming home in your paycheck, but you were $200 short. Concern about occasional neglect of responsibilities, Staying out all night, not calling, coming home at 6 in the morning, getting into bed and sleeping all day Saturday instead of doing the list of honeydews, Whatever the case may be starting to cause a little bit of tension because the addiction is starting to be prized, if you will, or chosen over the relationships and the obligations of day to day life. Well, you know, go to Disneyland or clean the house. Which would you rather do? So you can see where this might happen. However, people who don't have an addiction are able to make that choice about, well, Disneyland sounds a lot more fun, but in the long run, I really need to do these other things. During the maintenance phase, family members are Aware of the problem, they attempt to solve the problem. Talking with somebody, confronting them, nagging them, spying on them, going through their stuff to find the hidden alcohol or drugs, whatever the case may be. Oftentimes they will also start taking on all responsibilities. Because the addict a lot of times is really good at saying, well, I'm just so stressed out right now, I just can't deal with life, so I can't do it. And, you know, so the significant other says, oh, well, if that'll help you out, let me do this. Let me start doing everything, and maybe you'll feel better. Well, then the addict has a whole other set of issues about guilt and shame and depression and all that other boredom. So it doesn't really help anything. But the codependent or the significant other believes that if they work hard enough and they do the right thing, that maybe they can help this person do the next right thing. So they're taking on all these responsibilities and trying to cover up some for when the addict uses too much, neglects responsibilities. Well, they take on all the responsibilities so nothing can be neglected. The person in the relationship gets tired of feeling stupid all the time. You didn't pay the bills. You were supposed to pay the bills. Okay, fine, I'll just pay the bills from now on because you can't handle that. And the addict goes, okay. The person in the relationship starts trying to save themselves, but they're also protecting the addict at the same time. In the disenchantment phase, there's avoidance of the problem. I can't even deal with that right now. They blame the person who's using. It's your fault all this is happening. You're the one who's choosing to make these decisions. You're doing this, that, and the other thing, blaming themselves. Well, maybe I shouldn't be doing this or that. Maybe I shouldn't nag them. Maybe I drove them to this. They start hearing those messages that the addict are sending them. So both of them are feeding off of each other with this blame game, which is creating guilt and shame and still avoiding the problem of, guess what? Your coping skills are overwhelmed. You can't deal with life on life's terms right now. We need to do something different. That's what it comes down to. People looking at what is causing you to not be able to deal with life on life's terms. Are you in a depressive episode? Is there generalized anxiety? Did life just really throw you a curve ball? And things suck right now? What's going on that's motivating or perpetuating these behaviors. And what can we do differently? Because clearly what we're doing right now ain't working in the disaster phase, the significant other throws their arms up and they say, I can't do it anymore. Both parties internalize bad feelings. Both parties have a sense of resignation and hopelessness and some anger and resentment thrown in there, too. And there's an establishment of unhealthful family rules. Don't talk about the alcohol. Don't talk about the problems. Don't trust anybody, because everybody's going to lie, blame, minimize, don't feel, because we don't know how to deal with feelings. They're overpowering. So in treatment, we need to get the family involved because it's a family issue, as are a lot of things, not just addiction. Participation by family members is associated with better treatment compliance and outcome. If john goes to treatment and he's doing the next right thing, and he's really trying to work the program, and he goes home to that same angry, resentful, bitter, sick, nagging, distrustful environment, what do you think is going to happen? So if we can bring the family into the process and go, yeah, I know you've been down this road six times before now, and all six times has ended up in a relapse. That doesn't mean that this time you have to go down the same path. Let's try taking a different route. Family members gain a clearer understanding of recovery Once they understand why the person was doing what they were doing. It doesn't make it magically better, but at least it seems a little bit more logical. Once they see how their behaviors and the addict's behaviors play off of one another. It helps. Once we can start talking about anger and resentment, Once we can start talking about trust and honesty, you know, step one, hello. Step one, Being honest about the way you feel with yourself and the way you feel, the way you think. Everything but being honest with yourself and with others and getting others to be honest with you, which totally runs counter to don't talk, don't trust, don't feel. So the whole family has to learn a new way or revert to the old, healthy ways of communicating. We need to start gradually working that in. It doesn't happen overnight. You don't just wake up and go, okay, I'm going to be honest from now on. Honesty is hard. Being honest with yourself is hard, Let alone being honest with somebody else who may reject you or get angry or whatever else is going on. Family members and the person in recovery, the identified Patient understand their respective goals and roles. The family member's job is not to fix the identified patient, and the identified patient's job is not to fix them or prove to them that they're wrong. Both of them have to work together to create a new family structure that's built on honesty and trust and commitment. Family members and the person in recovery get support in the recovery process. How many times have you been working with patients and their families? And the significant that, wow, significant other has come in and said, you know, he's up to the same old tricks again. I know he's using and you've been working with John and you've been drug testing him and breathalyzing him and everything. And you're like, that's news to me. You bring them together and these cues that sometimes or that came to signal a relapse in the past are occurring. So you talk about what those mean. Are there other possible explanations? We're not saying the person's wrong. We're not saying that a relapse isn't kind of looming out there. It's definitely important to put that up on our radar and start talking about it. In the past, when you've started spending a lot of money really fast, it indicated that you were starting to go down, down that hill and become impulsive and relapse. In the past, when you've been secretive or when you've been sort of moody, that indicated that you were on your way to a relapse. Now, I don't know about you, but I know I get moody and my family will attest to that. It doesn't mean I'm going to relapse. It may just mean I'm moody. Being aware of that in your own self is really important as well as communicating about it. I'll wake up and if I get up on the wrong side of the bed, I'm the first to say I'm grouchy today. You know, y' all just give me a wide berth. And most of them are like, okay. But knowing that and being able to communicate, it's not you. It has nothing to do with you. I'm just irritable. Helps a lot in family communication because the other thing that we haven't talked about in addicted families is the complete lack of boundaries. Complete lack. So generally, if the addict is upset, the addict is generally going to blame somebody else for their upsetness, which means it's your fault, which means you're going to take the blame and there's going to be a lot of Angry words and ugliness going on. Instead of the addict waking up and going, you know, I'm in a crappy mood today has nothing to do with you, and I'm not going to take it out on you because you don't deserve that. Communication, honesty, self awareness, setting healthy boundaries. So in the stages of recovery that people go through, the person with the addiction comes in, we'll say, goes to detox. Three, five days, they're at a detox and they're into treatment. They're still withdrawing, they're still craving, they're still really wanting that next drink or that next line or that next hit or whatever it is. So those cravings, they're still conditioned. Everywhere they look, they see things that remind them using. They see things that say, oh, wouldn't you like to. First two weeks withdrawal period. The next four weeks. People often enter the honeymoon period. The fog starts lifting and they start feeling pretty good. They start thinking they got it licked. They're like, oh, I'm not going to go back there again. Uh, no, that's the last time. I don't have another. I may have another relapse in me, but I ain't got another recovery, so I got to do it right. We've heard that before, we all have. So we have to look at the person and go, okay, I'm glad you're optimistic. Let's talk about what we can learn from your prior experiences and what we need to be on the lookout for because we don't want you to be overconfident and miss something. The next 12 to 16 weeks is generally after the person's gotten out of their initial residential treatment or intensive treatment and they start hitting the wall. This is where life starts coming at them and wearing them down. Slowly but surely, this bad thing happens. This bad thing happens. You know, we talk about stinkin, thinkin' that, focusing on the negative and focusing on helplessness and why me? And blaming others. Some of that may start coming back. And this is where family members as well as the person in recovery and other supports need to say, okay, time out. Let's check on this. Bad things happen. Life's not fair. We've heard all those other things. There are some things you can't control. Yada, yada, yada. And that's generally what the person in recovery will say to you, yada, yada, yada. I've heard it all before. Fix it. They're exhausted. This is the time they need the most support and the most encouragement going. You can do this. You've made it this far. Look at all the things that you've accomplished, look at all the things that you've dealt with in the past without using. You can do this. Let's figure out how to do it together. Once they get through that wall, they climb that huge hurdle, then they start readjusting. The new coping skills are becoming more habitual. The new people, places and things are becoming more regular in their lives. Readjustment is taking place and they're developing their new clean and sober lifestyle or revisiting the one they had before they started using. Depending on when they started using. Withdrawal lasts one to two weeks. There's a lot of craving. The person feels symptoms of depression. Emotionally, they may feel depressed, helpless, hopeless. And they may have a right to based on all the things that are going on around them. Some of them, maybe a lot of them a result of their actions. So yeah, they may have a right to be depressed. I'm not taking that away from them. But they've also put their body through the mill and their body's going, I don't have the energy to put a foot out of bed today. And that's okay. They need to start listening to their body. Listening to their body when it says, I'm hungry, when it says, I'm thirsty, when it says, you know what, I need to go take a nap. Because the body is trying to repair itself. They may have difficulty sleeping because of anxiety or aches and pains. Variety of reasons, that's okay, but you've got to figure out how to deal with it. Because impaired sleep is just going to make things a whole lot worse. Increased or decreased appetite. You want to look for whether they're eating because they're hungry or they're trying to meet nutritional needs or they're eating as a substitute addiction. They can't drink, so they're going to eat every feel good food that they can get their hands on. So look at the quality of food they're eating, the quantity of food they're eating, when they're eating, and ask them to evaluate why they're eating. Anxiety, irritability, you're not feeling well, you're sobering up, facing a lot of stuff. Yeah, you're probably going to be anxious and irritable. So one to two weeks. This is important for people to realize if they don't go from detox to residential, if they are in ambulatory detox, or they go from an inpatient detox for like four days to an outpatient program, their family needs to be aware that, hello, they're going to be kind of cranky and there's going to be a lot of mood variations and stuff going on. So let's talk about how to work with that and how to plan for it so it doesn't catch them by surprise. You'd be surprised at how many families come to pick up their loved one from detox and they expect them to be bright and chipper and ready to go. No, they've only been in here for three days. They still have quite a while. Think about it. When we get sick, the Average cold takes seven to 10 days to work its course. Why would you think detox would take any less? The body still has to do its thing. The honeymoon phase lasts about four weeks. Increased energy, enthusiasm, optimism. They're going to meetings, they can do this, they've got it kicked, they know what they need to do. This time they feel they're cured. A lot of family members go, oh, been there, done that. Let me just start packing your bags. For detox now, we need to try to prevent the family member from creating a self fulfilling prophecy. Like I said earlier, okay, you've been down the road six times. Let's choose a different path this time. If you tell them that they're going to relapse, if you tell it to them enough, eventually they're going to be like, okay, I can't win. We need to try to help people figure out how to deal with life on life's terms on a day to day basis. Create a schedule, have them go through and do morning and evening check ins, make sure they're going to meetings, make sure they have a sponsor. There's a lot of things in there that not only help the person in recovery, it expands their social support system and it takes some of the responsibilities off the family because it's not the family member's job to be the alcohol police. The wall, as we Talked about, lasts 12 to 16 weeks. It is the hardest stage of recovery. People still have a lot of depression and irritability, low energy, they've been worn down, they came out, they were feeling optimistic and they were like, oh crap, can I go back in those walls where it's safe and secure, there's anxiety, they're easily overwhelmed, they're still recovering. The body and brain are still recovering from the effects of the addiction, the lack of sleep, anything else that was introduced and there's a high risk of relapse. We need to make sure that we help remind the person that it's worth it and that they can do it and that they've got support. Readjustment indicates that you're starting to return to a normal lifestyle. The person is able to manage their own emotions. They've developed healthy coping skills and communication skills. They have a pretty regular routine. They can deal with day to day stuff without getting like completely freaked out. Once they've demonstrated that over a period of a few weeks, then you can start going into some of those deeper issues. You don't want to start diving into some of those other issues unless it's clinically appropriate right at the get go, especially if the person's in outpatient. So start working on emotional and psychological issues to strengthen the family goals for withdrawal. The person in recovery needs to not use learn specific techniques for avoiding relapse, calling their sponsor, going to a meeting, any other activities they can think of that will help them not use. But aside from just not using, they've got to deal with what's making them want to use, what triggered that. They need to learn about the process of addiction and about drug effects. Family members need to decide to be part or not be part of the recovery process and recognize that it's a medical condition. If they could stop, they would have during the honeymoon phase. The person in recovery needs to improve their physical health. Eat well, sleep well, exercise at least a little bit. Identify personal triggers and relapse justifications. What excuses have you used in the past when you've relapsed? What are your triggers? What do you anticipate being? Your challenges in staying clean and sober, and how are you going to deal with those? I like a 3 to 1 ratio for every trigger. I want three alternatives for every relapse justification. I want three reasons to justify not relapsing and use targeted techniques to stay abstinent. Family members just need to work to be supportive. Going to al Anon meetings is sometimes helpful. Engaging in their own therapy may be helpful and recognize in themselves and discontinue triggering interactions like nagging or always accusing the person in recovery of lying or whatever the case may be. These are behaviors that developed over a period of time so they're not going to go away overnight. But it's important to start discussing how the people interact with one another and how they trigger each other and how they can support each other instead of nagging or accusing the person of being a liar. What could you do instead? Working with the addict. Understand that trust doesn't just fall in your lap, especially when that bridge has been burned several times before. So what might that person be Able to do to allay their fears. And how is the addict in recovery going to handle that for the wall? The person in recovery needs to maintain stable abstinence from all drugs. Start repairing significant relationships. This isn't everybody and Jim's brother. This is the significant relationships. You've only got a certain amount of energy. Develop a recovery support system outside of the treatment center. 12 step programs, church, volunteer activities, social clubs, whatever it is that you do, where you can find sane, sober social supports and recognize and cope with dangerous emotions, namely anger, resentment, guilt, shame, depression, and anxiety. Yeah, those are the biggies. Family members need to decide whether to recommit to the relationship or not. You can be supportive without necessarily recommitting. If you've separated from your significant other, you can still be supportive without saying, oh yeah, we're going to get back together. Begin finding ways to enrich their own lives. It's not all about policing and caretaking the person in recovery anymore. It's about figuring out who you are, Developing healthy emotional and physical boundaries, and practice healthy communication skills. In the readjustment phase, the person in recovery monitors where they're at, recognizes relapse indicators, and prepares responses. This is ongoing for the first year to 18 months. There should be a daily check in of what were my relapse triggers today? What were my relapse warning signs? How did I handle them? Was it effective? And if not, what do I need to do differently next time? Daily it doesn't have to take two hours, but at the end of each day, it's always a good thing to just kind of review the day because in our addiction, we got out of touch with what was going on inside of us. So we need to check in again and get attuned to what our physical, emotional, cognitive needs are. And they need to set goals for continuing a new lifestyle after treatment ends. Treatment ends. They can come back and visit, but it ends. Family members accept limitations of living with a person in recovery. That means if the person was an alcoholic, probably not going to be a good idea to keep alcohol just around the house. Probably not going to be a good idea to go to parties where alcohol is flowing like water. Develop an individual, healthy, balanced lifestyle, emphasis on balance. Again, it's about that person finding their grounding and finding their center and being okay. Being okay. Monitor self for relapses to former behaviors. Suspicion, anger, resentment, holding onto resentments. Eventually it just all comes out in a bleh of done me wrongs. Don't do that. Practice. Practice honesty. Practice coping skills on Your own practice, acceptance of things you cannot change. It's not just people in recovery who need to focus on that and be patient with the process of recovery. Some days are going to be better than others. But you know what? For any two people you find on the street who are in a relationship, some days are going to be better than others. So don't just necessarily chalk that up to being with an addict in recovery. It could just be they're having a bumpy time. Be patient with the process and go back to your basic skills and say, okay, I'm at point A, which is really not a good place where I want to be right now. How do I get to point B? How have I done it before and what would I like to achieve? Open communication. Key relapse issues for people in recovery. People who use drugs, people who make them want to use drugs. That can be dealers calling, going, hey, I got some. You know, you want to buy it. That can be people in their life who just push every last button that they've got, knowing what people in your life are healthy and supportive to be around and what people you need to prepare to be around if you've got to be around them. A lack of sane, sober social supports. Emphasis on sane. You can have people who are sober, maybe not touched a lick of alcohol in their life, but they can be as crazy as a monkey. So we need somebody who's sane, somebody who is not flipping back and forth, somebody who is not, you know, one of those people that you just look at and go, oh my gosh, you stress me out. Environmental cues associated with drug use. Billboards, TV ads, whatever the case may be. Driving by the bar that you used to stop at every night, figure out what those cues are and figure out how to deal with them. You may not be able to avoid them all. So what are you going to do? Severe cravings. Some people can have protracted withdrawal. So 30 days later, 45 days later, they may start having cravings and withdrawal symptoms again, mainly with opiates and benzos. But be aware. Uncontrolled mood disorders, depression, all of a sudden, major depressive disorder, and your mood bottoms out. Be aware and communicate. Don't just assume. Well, this is part of the recovery process. It may be, however, it also may be major depressive disorder. And there may be things that you can do to stabilize your neurochemicals so you don't have to feel that much pain. Avoid extreme stress whenever possible. Plan for it, though. Always have an emergency plan. If I encounter a situation of extreme Stress, whatever it is, who am I going to call and what am I going to do? Connections between drug use and sex. Well, if you're in recovery and you're having sex, then that may be a trigger that reminds you that you might want to use. How are you going to deal with that? And boredom. Keep yourself busy. Find things to do. Key relapse issues for family members include fear of the person in recovery, returning to drug use. Trust issues. They're not going to go away overnight. Learning to openly and effectively communicate with the person in recovery is going to go a long way, but also just time and seeing that the person is doing the next right thing. Fear of being alone. A lack of individual goals and interests. If your entire world revolves around the addict and the addict goes away, then your world falls apart. So if you develop individual goals and interests, individual friends, then your life is not so contingent upon that person. So it's not such a panic, it's not such a stress to make sure to keep a tight rein on that person. Inability to release responsibility for the person in recovery. Well, there's two things that I kind of mean here. Number one, inability to trust the person with responsibilities again, so still doing everything can make the person feel inept, can contribute to depression, feelings of worthlessness, but also inability to let go of those resentments and stop holding that person hostage and responsible for every bad thing that you believe they ever did, which leads into harbored anger and resentment. That stuff's toxic. The longer you hold onto it, the more it's just going to come out here and there in little spurts in everything you do. So making sure you figure out how to deal with those, usually in early recovery. And I define early recovery as the first 12 months if there are negative things, if there's something that could be emotionally charged, I try to recommend that family members do it in the presence of a family therapist to help really establish those communication guidelines, those goals, and serve as a sounding board. Those are key relapse issues, meaning the person is going to relapse into enabling and all those other behaviors that they developed in response to the addict's negative behaviors. So, in summary, there's multiple phases of recovery. It's important to identify individual relapse triggers and warning signs. My relapse triggers may not be your relapse triggers. You need to know what does it for you. Discriminative stimuli indicating a relapse may need to be deconditioned. So things that typically indicated that the person was getting ready to relapse may not mean the same thing anymore. So you may have to be able to what we call decondition. So when the family member sees those behaviors, they don't automatically go, oh, here we go again. And both the identified patient and the significant others need to engage in recovery activities for at least the first eight to 12 months. Again, it didn't happen overnight, so don't expect it to be fixed overnight. Eight to 12 months is what it takes to run its initial course. I find that most patients who kind of rush it end up skipping over pretty big things and have to start back at the beginning. It may not be a full fledged relapse they may not use. But some of those old behaviors, the manipulation, the stinking thinking, the negativity, irritability, all those things start coming back. So it's really important to slow down and take your time. It's better to do it right the first time than have to do it over again. All right, thank you for coming and I hope you have a wonderful day.