2. 1 Integrated Relapse Prevention Is avoiding relapse twice as difficult in Dual Recovery?

3. 2 Understanding Relapse as...... the PROCESS of returning to substance use and/or active symptoms after a period of abstinence / stability

4. 3 Understanding Relapse as...... ALWAYS a risk when dealing with two, co- occurring “chronic, relapsing conditions”

5. 4 Relapse “Clues” Behavior changes Decreasing what helps; Increasing risk- taking, or what doesn’t help

6. 5 Relapse “Clues” Attitude changes Negativity “Not caring” Disowning personal responsibility

7. 6 Relapse “Clues” Mood changes Moodiness Anger Boredom Mania Depression

8. 7 Relapse “Clues” Changes in thinking Rationalization Justification Denial “Stinkin’ thinkin’” Deprivation / entitlement Irrational thoughts Delusional thoughts

9. 8 Identifying High-Risk Situations Individualized (different for everyone) Negative feelings, attitudes, thoughts, behaviors Social pressures Treatment-related problems Relationship problems Urges / Cravings / Temptations / “Teasing the addict” Others (boredom, weekends, $$, physical pain, holidays, etc.)

10. 9 Managing High-Risk Situations Individualized (different for everyone) Analyze the risk factors Identify “precursors,” the steps leading up to the high-risk situation Strategize for recovery success

11. 10 Managing High-Risk Situations Individualized (different for everyone) Write down a plan Share the plan with others Identify gaps in skills /opportunities Problem-solve and fill gaps

12. 11 Building a LONG-TERM Dual Recovery Plan Can be looked at as “aftercare” following a treatment episode, or as “maintenance” of existing gains

13. 12 Building a LONG-TERM Dual Recovery Plan May include many things: Counseling Medication / seeing a psychiatrist AA / NA / DRA meetings, other groups Working with a sponsor / mentor Daily reading of recovery literature Halfway / ¾-house, long-term housing Antabuse Educational / vocational efforts ?

14. 13 Emergency Recovery Card Designed to be carried in wallet or purse Contains a list of names and phone numbers of people supportive of your dual recovery May include professional treatment providers, natural supports, AA / NA / DRA contacts

15. 14 Relapse Response Planning “Progress, not perfection” (although, “Progress not permission” as well!) Dialectical approach, need to not let guilt / shame be an obstacle to getting back on track

16. 15 Relapse Response Planning Some important pieces... STOP IMMEDIATELY Reach out to “safe” people Get crisis care if necessary (Detox, PES, CRS, Hospital ER) Get back to doing what works Conduct a Relapse Autopsy, and adjust recovery plan

17. 16 Daily Relapse Prevention Inventory At the end of each day, take the time to review these questions: Were there any clues today that indicate movement toward relapse of substance use or re-activated symptoms? Were there any high-risk situations today that could trigger a relapse of substance use or symptoms?

18. 17 Daily Relapse Prevention Inventory If “yes” is the answer to either of these questions, make a plan to do the necessary adjusting to support dual recovery moving forward...

19. 18 Back to our initial question... Q. Is avoiding relapse twice as difficult in Dual Recovery? A. _______________________________ _______________________________

20. 19 THE END Until next time...