Written by Evan Newton, Counsellor at Bellwood Health Services.
I work as a counsellor in Bellwood’s residential addiction program, helping patients set the foundations for their recoveries, and then helping them transfer into their lives in the community. In the last couple of weeks, I’ve had several phone calls from recently graduated patients, or their family members, telling me that they are struggling to stay in recovery, and asking for guidance regarding relapse prevention. I think this is largely because of the COVID pandemic’s resulting self-isolation. The consequences of the pandemic—isolation, loss of social connection, being left to our own devices (literally and figuratively), and lack of exercise—all make life in recovery more difficult and, in combination, sound like a recipe for relapse. What do I tell these patients and their families?
(1) Reframe “Setbacks” as “Learning Opportunities”
On a training recently, I was asked to complete an exercise called “The Ten Worst Moments.” *Gulp* Okay? We were given a simple handout consisting of ten rows and four columns. In the first column, we were instructed to make a list of exactly that: the ten worst moments of our lives. Then, we were asked to add how we had felt at the time (awful); what strengths we had used to get through it; and finally, crucially, in the last column, what we had learned from the experience. What had this terrible experience taught us about ourselves, about the world? Once I was finished, I looked at that last column. Before me, one after another, were the most valuable lessons I’ve received in my life. I expected the exercise to be a really intense one, and it was, but it was also extremely useful, hammering home the idea that it’s only through difficulty that we grow, and reminding me to push myself to learn from my mistakes.
For the past three years, I’ve led a relapse prevention group at Bellwood. Our mission is to anticipate our bad habits and unhealthy patterns and actively plan to deal with them when they arise post treatment. The key is to learn from the past. I tell the group that those who have had periods of sobriety, and slipped, are actually at an advantage—you have the opportunity to be wiser. I want you to take, to extract, to squeeze all the learning you possibly can from those experiences. Why did you slip? What was working before you slipped? What did you start doing? What did you stop doing? What do you have to put in place to prevent the same pattern from repeating again? In my mind, this is the essence of relapse prevention.
Focusing on learning from our setbacks serves another important purpose. Often, when people slip in their recoveries, the negative self-talk starts: “you’re a failure, you’re a loser, you’ll never get sober, there’s no point and you know it.” This commentary is toxic, since it simply amplifies feelings of shame and self-hatred, feelings that only perpetuate the cycle of self-destruction. So, part of the power of asking yourself what you can learn from a setback is that it gets you out of this thinking pattern, and transforms a reason for self-criticism into an opportunity for growth.
They say that “relapse is part of the recovery process.” Not necessarily. It will only be part of the process if you choose to make it part of the process—if you actively try to learn from it, and employ that learning to strengthen your recovery.
(2) Recognize It’s Not “Boredom”
I heard somebody say this recently, and I was struck by it. Wait, what? But one of the most frequent emotional triggers my patients bring up is “boredom”! They feel understimulated, lacking meaning, lacking connection, a flatness. Boredom. Current patients who are contemplating going back home during the pandemic ask me, “what am I going to do with my time? How do I stay interested and stimulated when literally the whole world is shut down?” Good question.
So I was struck when I heard this friend, also a counsellor, tell me that boredom doesn’t exist. What did he mean by this? He explained that what we interpret as boredom is actually something else: it’s the difficulty of sitting with ourselves, of being uncomfortable with ourselves. Silence and inactivity powerfully expose what kind of relationship we have with ourselves.
Personally, during COVID, I’ve felt bored at times. It’s a weekend, it’s the afternoon, I’ve done some of the tasks I’ve intended to do, and I feel a malaise, a restlessness, and a feeling of incompleteness sets in. I look out the window, and it’s grey and cold outside. So what do I do? I scroll through social media. I go to the fridge. I refresh my email. Once my tasks are done, once it’s time to really just sit with myself, that’s when I feel uncomfortable. But what my friend is saying is that this is discomfort, not boredom.
(3) Understand Discomfort Is Your Teacher
A theme every addictions counsellor hears repeatedly is a negative relationship with oneself: “I don’t like myself. I don’t know who I am. I don’t know what my values are.” In this way, the enforced stillness and self-reflection the pandemic has created can be seen as gifts, as an opportunity to work on yourself. Can you meditate more? Can you read more? Can you journal? Can you spend time walking in quiet reflection? Can you have longer and more meaningful phone conversations with friends? What if, instead of trying to distract yourself from certain inner experiences, you instead treated them as learning opportunities and befriended them? For so many of my patients, this work of understanding and processing discomfort with oneself is central to successful long-term recovery and relapse prevention.
Silence can be uncomfortable, but I am trying to see it as an opportunity to develop my relationship with myself. As I understand it, this is the essence of mindfulness meditation: noticing and allowing yourself to experience the feelings that you normally avoid. This is one of the gifts of silence, and, I believe, one of the aspects of these COVID times that we are going to miss.
(4) Reach out for Help to Friends and Professionals
I am often struck by my patients’ descriptions of their lives before coming into treatment, particularly their total lack of self-care and personal boundaries: too much Netflix, too much Instagram, too much Uber Eats, not emptying the litter box, a messed up sleep schedule, etc. So a lot of the work we do in treatment is finding ways to counteract the isolation that allows these behaviours to take root in the first place. This is why the pandemic is so dangerous for people with addiction: self-isolation allows these bad habits to proliferate. So let’s say you’re struggling, and want to “hit reset” and pull yourself out of a self-isolation-induced spiral. How do you do that?
The first step out of relapse and towards recovery is to reach out. If you have been in treatment and worked on your recovery before, you will almost certainly have a handful of people to whom you can reach. Sometimes we need a nudge to reach out to those people with whom we need to talk the most—this is that nudge!
A surprisingly positive thing about this pandemic is that mental health professionals have had to get creative. They’ve had to get comfortable with delivering services digitally. So almost all psychotherapists, counsellors, and social workers now offer services through some online platform. Some people are even going so far as saying that the pandemic has ushered in a long-needed revolution in the way mental health care is provided. So if you have worked with a therapist or counsellor in the past, reach out to them, and set up a virtual session. Another nudge.
(5) Set Recovery Goals and Be Accountable
Part of therapy is of course talking about your deeper issues, attachment styles, and traumatic experiences. But at this point, those things will be less relevant. Ideally what you will focus on with your counsellor is basic goal setting, and having them hold you accountable to these goals. How much Netflix are you going to watch? How many times a week are you going to exercise? To how many people, minimum, will you reach out each day? How many online meetings a week will you attend? Is there laundry on the floor of your room? Did you meditate today? Did you take your medications today? Having a professional help you set these goals and hold you accountable to them can mean the difference between breaking out of a downward spiral or succumbing to it. Accountability helps protect your recovery against relapse in the future.
Some other good news–—you don’t have to reinvent the wheel. I’ll let you in on a trick we therapists use: sometimes, we don’t actually have to make suggestions for new behaviours. Instead, we just ask you what has already worked for you in the past. What were you doing when things were going well? What did you stop doing when you started struggling? Once you’ve identified some of these habits, your work is to simply re-implement them. I know, it’s frustrating, but we often need other people to help us do things we already know we should be doing.
(6) Join a Support Group and Regain Connection
Joining a support group will give you another valuable source of accountability. They also provide connection, inspiration, and feelings of togetherness—three important factors that self-isolation has taken from all of us, and that are critical for recovery and relapse prevention. All major mutual aid meetings—Alcoholics Anonymous, Cocaine Anoymous, Narcotics Anonymous, Sex Addicts Anonymous, Sex and Love Addicts Anonymous, SMART, etc.—have gone online, their websites providing simple Zoom links for participation.
During these times, Bellwood and the rest of EHN Canada have increased our online group availability, and our patients have really taken to it. All of our online services, including online therapy groups, are available through our Wagon, EHN Canada’s online outpatient clinic.
Overcoming Challenges Makes Us Stronger
I might close on another personal note. In times of crisis and upheaval, I’ve found the writings of Pema Chödrön, a Buddhist nun, to be a source of succor and comfort. Her book, When Things Fall Apart, is a collection of writings about how to live with difficulty, uncertainty, and heartbreak. It’s full of many wonderful nuggets, but one in particular stands out right now: “it is only when we expose ourselves repeatedly to annihilation can that which is indestructible within us be found.”
We Can Help You
EHN Canada’s Comeback Programs are specially designed to help you get back to recovery after a relapse. Please call us for more information or visit one of our Comeback Program pages.