Relapse can occur at any time in recovery
Relapse is a constant concern for individuals who have been substance dependent. Reports note, “Statistically, 75%-90% of all alcoholics or drug addicts will relapse within the first year of release from traditional treatment programs”. Furthermore, individuals who enter a detox only program have an even higher relapse rate.
While treatment programs can be effective, oftentimes additional resources are required to support the person after completion of the program. My goal is to teach clients prevention strategies which lessen the possibility of relapse. What techniques work best?
More here on working clinically with someone who goes through relapse. Then, if you have any additional questions or would like to learn more, please use the comments section at the bottom of the page.
A review of NLP and The Stages of Change
Although I have described Neurolinguistic Programming (NLP) and The Stages of Change in previous articles, I will review them briefly. There will also be a discussion of a hypothetical scenario in which five NLP strategies are applied when working with a client who wishes to remain drug and/or alcohol free.
What is Neurolinguistic Programming?
Neurolinguistic Programming examines the fundamental dynamics between the thinking processes (neuro) and the words we use (linguistic), as well as how their interaction affects behavior (programming).
- communicate externally and internally
- process, store, and recall information
- alter communication to achieve desired results and goals
Practitioners believe human beings have an extraordinary capacity for flexibility, and there is nothing that happens mentally or spiritually they cannot learn to handle. The focus is on how a person formulates his or her thoughts and beliefs; those which maintain behavior and those that create change.
The Stages of Change Model
I believe counselors who work in the field of addiction must assess and understand the client’s willingness to change. How NLP can change addictive behavior? Thankfully, The Stages of Change model assesses willingness.
The model applies to a broad range of behaviors such as weight loss, injury prevention, and addiction. Proponents of the model believe people don’t change in a single step; rather, they progress through different stages at their own rate. Expecting behavior to shift by having a client attend “x” number of A.A. meetings in a certain time period, may not be effective.
Relapse Can Occur at any Stage of Change
Relapse to a prior stage in the model can occur at any time. For example, a person in the Action Stage can revert to the Contemplation or Pre-contemplation Stage. This knowledge leads me to believe there is a reason to monitor a client’s level of willingness.
I also believe many clients require more than a two or three-week program to completely change their long-held ways of being and to maintain those changes. My goal is to teach clients effective strategies, so relapse is less likely to occur.
NLP Strategies used in the treatment of addiction
Here, I’ll begin by discussing two NLP strategies that I use as assessment tools in helping to prevent relapse with clients: the Outcome Specification exercise and the Logical Levels process. I then introduce 4 NLP strategies which can be used by mental health specialists looking to address relapse during treatment: Anchoring, the Behavior Generator, the Swish Pattern, and Future Pacing.
Assessment tools used to address addiction relapse
TOOL #1: Outcome Specification Process
Many clients are unclear about what they really want. The nine-question Outcome Specification exercise helps clarify desires and solidify goals. Knowing what a client wants to achieve helps a counselor determine a purpose-driven course of action.
TOOL #2: Logical Levels
Similarly, the Logical Levels exercise is used with a client to organize thinking and gather information. The exercise helps establish an understanding of what makes a person “tick.” When looking for reasons why change is not occurring, an examination of a person’s neurological levels can be a way to determine exactly where a block is located and where it would be most effective to intervene. There are five logical levels: environment, behavior, capabilities, beliefs and identity. The lowest level is environment and the highest level is identity.
NLP Strategies used to address addiction relapse
Anchors trigger specific physiological or emotional states or behaviors; in other words, anchors trigger automatic reactions. Anchors can occur unintentionally. For instance, a song can evoke memories of an old friend. Anchors can also be created intentionally.
One example of an anchor being created intentionally would be connecting a certain feeling, such as confidence, with a certain physical action, such as pinching the left ear. When the person wants to feel confident, pinching the left ear can elicit the feeling.
2. New Behavior Generator
The New Behavior Generator is used in many situations that involve personal flexibility. This strategy allows a person to identify additional behavioral choices in a given context. The basic steps are
- Form a visual image of a desired behavior.
- Associate into the image on a feeling level kinesthetically.
- Verbalize any missing or needed elements.
3. The Swish Pattern
The Swish Pattern is a very useful NLP technique for replacing an unfavorable emotion or behavior with a more useful one.
4. Future Pacing
Future Pacing is a way to connect changes and resources to future situations or particular events. Future pacing uses the strategies of association, dissociation, and anchoring. By imagining and virtually experiencing situations, the resource or change is more automatic in the future.
Hypothetical Client in Treatment And Relapse Prevention
Rosie is a 35-year old single woman who recently completed a 14-day detox program. She is thrilled to be alcohol free and wants to remain so. She makes an appointment with me, an Addictions Counselor, for relapse prevention support. In terms of the Stages of Change Model, Rosie is at the maintenance stage. She wants to sustain the changes she has already made.
I planned to focus on relapse prevention initially and teach her strategies for better managing her emotions and behavior. We can then address other issues as they arise and identify other possible addictions.
I built rapport with Rosie and conducted the Outcome Specification and Logical Level exercises. My goal is to understand her perceptions and commitment to the problem, as well as gain information for creating a treatment path.
Rosie’s responses follow:
1. What do you want?
…….ROSIE: I want to be alcohol-free.
2. How will you know when you have reached the goal?
…….ROSIE: When I no longer drink a beverage with alcohol in it – period.
3. Why is your goal relevant and/or irrelevant?
…….ROSIE: The goal is totally relevant because I drank too much and I really don’t want to be an alcoholic like my mother.
4. What stops you from pursuing the goal wholeheartedly?
…….ROSIE: Most of my friends drink. I really don’t know how to socialize if I am not drinking.
5. What personal resources can you use to help achieve this goal?
…….ROSIE: I successfully completed the detox program, I am a strong person when I want to be, and I am meeting with you.
6. What additional resources will you need to achieve your goal?
…….ROSIE: Friends who don’t drink and activities or hobbies that do not include drinking.
7. How can the goal affect important people in your life, or are there any risks associated with achieving this goal?
…….ROSIE: My family is thrilled; they are extremely worried about my drinking. The risk is that my friends will no longer want to “hang out” with me.
8. What daily actions will you need to take in order to achieve your goal, and what is the first step?
…….ROSIE: I need to find other activities to interest me and I need to find non-drinking friends.
…….ROSIE: The FIRST STEP: To make a plan I can live with, because I want to remain alcohol-free.
9. Given everything you have considered to this point, is achieving the goal worth it?
…….ROSIE: It definitely is. I am just not sure, I can do it.
I conducted the Logical Levels process with Rosie as well. Her responses were as follows.
1. Environment Level – refers to what is around the person when the behavior occurs.
…………..ROSIE: I drink with friends or alone.
2. Behavior Level – refers to what the person does.
…………..ROSIE: I drink whatever there is to drink – wine, beer, margaritas, martinis.
3. Capability Level – refers to what a person is able to do.
…………..ROSIE: I am able to drown my sorrows after a couple of drinks. I have friends who drink. Drinking is a major part of my life.
4. Belief Level – refers to what a person thinks he or she can or should do.
…………..ROSIE: I can handle a lot of alcohol. Life looks better when I have a couple of drinks.
5. Identity Level – refers to what a person thinks of him or herself.
…………..ROSIE: I am a recovering alcoholic.
Based on Rosie’s responses to the two assessment exercises and her admission that a positive intent of the drinking was to socialize and be happy, I decide to intervene at the Identity Level by suggesting that Rosie change her thinking to “I was an alcoholic.” My hope was that a revised identity would allow her to have a different perspective and be open to additional options.
One strategy I use with Rosie is the New Behavior Generator. This strategy allowed her to identify additional behavioral choices. The steps and her responses follow:
1. Identify the “stuck state.”
………..ROSIE: My stuck state is drinking.
2. Ask Rosie to consider her drinking from a dissociated view point. This involves seeing “stuck Rosie” at a distance as if she were a neutral observer watching a movie.
3. From a dissociated state have her identify several other choices she can make.
……………..a. I can find a hobby. I always wanted to learn to be a portrait painter.
……………..b. I can join a fitness club or a hiking group.
……………..c. I can find a mentor to support me when I feel like drinking.
……………..d. I can volunteer somewhere such as an animal shelter. I love animals.
……………..e. I could join a church.
4. Check ecology with each alternative by asking, “What would happen if you incorporate this behavior into your situation?” For instance,
………a. If she felt an urge to drink, would portrait painting be a good alternative?
………b. If she were offered a drink, would talking with a mentor or going to church make a difference?
………c. If a friend asked her to go “nightclubbing” would her work at an animal shelter be more important than going out with them?
By going through the ecology process, Rosie realizes that learning to paint probably wouldn’t make a difference. However, having a mentor, going to church, joining a fitness club, or volunteering at an animal shelter could be more effective because she will be with other people.
5. Have Rosie step into each of the images and use each of the alternatives.
………….ROSIE: I like the idea of working at an animal shelter. I am willing to try if you will continue working with me.
Another option is the Swish Pattern. The Swish Pattern allows Rosie to replace a negative image with a more positive, motivating one. The steps are as follows:
- Identify the unwanted behavior or habit.
- Define and recognize a cue image, or reminder that can be used when the unwanted behavior occurs.
- Recall a desired self-image that is more compelling than the image triggering the unwanted behavior.
- Check ecology – or consequences- to see if any part of the mind objects to adopting this new image.
- Do a “swish” by remembering the problem behavior cue image and locating a small dark picture of the desired compelling self-image in the corner of the mind.
- Make the Swish by rapidly decreasing and darkening the cue image and simultaneously making the desired self-image larger and brighter.
- Test by thinking of the cue image for the problem state and noticing what happens. If the swish is effective, the desired self-image will immediately replace the old one, resulting in a change of state and loss of desire for going to casinos.
Rosie’s “unwanted behavior” was drinking. The cue image was her drinking a glass of wine. The desired self-image she chose was working with animals at a shelter. In doing an ecology check, there were no objections, and the swish was made. It took several attempts until she immediately accessed the new image, but it did happen and she was excited about the idea of working with animals.
The final step with either strategy is to Future Pace with Rosie:
……..a. I instructed Rosie to think of possible situations that could trigger her old behavior. We used the three situations mentioned in the previous strategies.
……..b. I coached her to imagine stepping into each situation. I asked her to see, hear, feel, smell and/or taste the experience. For example, I asked Rosie to picture going to a volunteer job at an animal shelter when friends ask her to go “bar hopping” or when she feels stressed.
……..c. I asked her to notice whether or not the change held and whether or not she responded in the way she wanted to.
……………..ROSIE: That might work, particularly if I knew someone who could help me get started. I introduced her to a friend who worked at a local shelter. The friend took her to the shelter and explained the opportunities. Rosie was thrilled.
I also taught Rosie to think of a time when she was happily working with animals and to anchor the feeling by grasping her left wrist with her right hand. When she next felt the urge to drink, she was to grasp her wrist and replace the negative image with the positive one. We practiced several times until she felt the anchor was strong enough to hold.
My goal was to provide Rosie with strategies to rely on when the desire to drink became strong. To begin with, I conducted two assessments and provided several alternative strategies to manage any desire to drink. We also agreed that additional counseling would be wise.