WAYS TO GUARD AGAINST RELAPSE

Recovering from addiction of any kind presents many challenges, requiring
courage, perseverance, vigilance and the willingness to seek support from
others.

For a teen battling addiction, the challenges can be different from adults.
For one, teens have many more enablers than adults do. They are enabled by
their peers. They are enabled by their families. They are enabled by the
communities they live in.

Not all enabling is deliberate. People often mean well, but lack the
awareness and the tools to respond effectively to the problem.

One such tool is relapse prevention, which is teaching people who are
recovering from addiction how to recognize and avoid elements in the
environment that will increase their physical and mental craving to use.

Let's look at what relapse is. This is important because there is a
difference between relapse and lapse.

A relapse is when a person re-experiences all the symptoms of the illness
from which he or she had recovered. In the case of addiction, it's a return
to active use of a psychoactive substance or substances, with the
accompanying symptoms of denial, withdrawal, blackouts, mood swings,
craving and drug-seeking behavior.

A lapse is usually a single episode of use, resulting in a return to
non-use. A lapse can be a learning experience, reminding the person that he
or she is standing on the brink of disaster.

In doing relapse prevention, it's important to assess the difference
between a lapse and a relapse. Helping someone recognize what led to his or
her use again raises awareness and improves the relapse prevention plan.

Like any facet of recovery, the ultimate responsibility for staying in
recovery lies with the individual. We can show people the tools, but they
have to be willing to use them.

An important concept in relapse prevention is recognizing and avoiding
triggers. A trigger is any stimulus that produces craving. There are visual
triggers, auditory triggers, sensory triggers and olfactory triggers.

What makes relapse prevention with teens more challenging is their exposure
to triggers they can't avoid. Adults have more control over their environment.

Teens are told to avoid associating with others who use. For teens, this is
difficult if not

impossible, short of locking them up in a controlled environment. Are you
going to tell them not to go to school, not to go to work, not to go out?

One can't expect teens to live in isolation. The reality is, they are going
to be exposed to others in their environment who are either talking about
alcohol and other drugs or using them. It's a part of teen culture.

When we do relapse prevention with teens, we look at two kinds of triggers:
avoidable triggers and unavoidable triggers. Part of the art is helping
teens determine the difference between avoidable and unavoidable.

Teens need to learn how not to set themselves up for exposure to
environmental triggers by becoming aware of what those triggers are,
specific to them. One teen's trigger isn't necessarily another teen's trigger.

There's a process of helping teens pinpoint what their strongest triggers
are, followed by a concrete plan of how to avoid exposure, or what to do if
exposed.

Here's an example. A teen has identified four major triggers for his or her
marijuana use – the smell of marijuana, seeing someone roll a joint,
hearing others talk about getting high and being at a certain place in the
woods where they used to get high a lot.

They have identified safe and unsafe friends. They are at a safe friend's
house, when an old using friend shows up. (A safe friend can be someone who
isn't into using, someone they can do fun stuff with that doesn't include
using.) The old using friend says he has just scored some really good weed
and wants to know if anyone wants to go to Mine Falls and get stoned. He
pulls out a bag of weed and some papers and begins to roll a joint.

Two out of four triggers have just occurred. A relapse-prevention plan
helps this individual deal with these unavoidable triggers by making them
avoidable in the next few minutes.

The obvious plan would be to leave. Teens are big on saving face, so part
of the relapse-prevention plan would be creative refusal skills. We would
help the teen by having them rehearse things they could say that would
allow them to save face and walk away from this potential relapse situation.

If they deluded themselves into thinking they could go along for the ride
and just watch while others got high, they would be exposed to two more
relapse triggers.

The result may be a lapse, a relapse, or maybe they don't use this one
time, which reinforces a false belief that they can handle these triggers
the next time.

Another tool we can arm someone with is a positive and negative reinforcer.
We elicit a positive mental image connected to the benefits of not using.
We then elicit a negative mental image associated with use, which reminds
the person why he or she quit using.

Some examples of negative images are seeing themselves in the back of a
police car, or the looks on the faces of their parents when they had to
come get them at the police station, or their boyfriend breaking up with
them because of their use.

Positive images would be the A they just got on their report card, or being
a good role model for their younger sibling, or making the lacrosse team.

These added positive and negative images help reinforce making healthy
choices when faced with triggers.

Here's some feedback for parents of teens with substance-abuse issues:

Become aware of triggers around the home. Do you drink in front of your
teen? Do you keep beer in the fridge or booze in the house? Are there
prescription medications in the medicine cabinet to tempt a teen who's
trying not to use? Do you have family events where drinking or other
substance use is tolerated? Do you keep a little pot around for special
occasions?

If your teen's sobriety is important, then be sensitive to his or her need
for at least one place where he or she can't be exposed to triggers: home.

Until next time, stay safe out there.

Barry Timmerman is coordinator of substance abuse services at The Youth
Council in Nashua. He has been a substance abuse professional for 18 years.
Readers with questions may e-mail them to btimmerman@theyouthcouncil.org.
Questions also may be mailed to The Telegraph, Straight Talk with Mr. T, PO
Box 1008, Nashua, NH 03061, or faxed to the paper at 882-2681. Timmerman is
unable to answer letters individually, but readers with further questions
or concerns are invited to contact The Youth Council at 889-1090.The advice
in this column is intended to provide an understanding of chemical
dependency issues, but is not a substitute for treatment. It does not
reflect the opinions of The Telegraph or The Youth Council, and is in no
way a replacement for the services of a licensed professional counselor.In
addition, the youth council is mandated by state law to report any
suspicion of child abuse or neglect. Should a letter to "Straight Talk with
Mr. T" raise such concerns, the agency will report the information to the
state Division for Children, Youth and Families or the Nashua Police Department.