Relapse Prevention: People, Places and Things

This is the first in a series of blog posts that will explore relapse prevention as specific to opioid dependency.

The opioid crisis in our country presents an ever-growing and quickly changing dilemma which government and health officials are struggling to appropriately address.  According to the National Center for Health Statistics (13 Hedegaard H, Chen LH, Warner M. Drug-poisoning deaths involving heroin: United States, 2000–2013. NCHS data brief, no 190. Hyattsville, MD: National Center for Health Statistics. 2015.) "Drug overdose is the leading cause of accidental death in the US, with 52,404 lethal drug overdoses in 2015. Opioid addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related to heroin in 2015."  Heroin is becoming even more dangerous as suppliers and dealers add deadly mixtures of fentanyl and benzodiazepines to an already highly addictive substance.

Recovery and abstinence from opioids is quite challenging as the dependency and withdrawal can be overpowering.  But recovery and abstinence are possible. Currently, there are several effective medically assisted treatments that can eliminate cravings and mitigate withdrawal symptoms, allowing the individual to begin the process of rebuilding their life.

Medication alone however, is not enough to sustain successful abstinence.  Those in recovery need a clear relapse prevention plan to strengthen coping skills and avoid the traps that perpetuated drug use in the first place.

So what do we mean by People, Places and Things?

Most, if not all opiate dependent individuals have developed a strong connection to unhealthy people, settings and circumstances that quickly become associated with getting high.  Just like a mouthwatering response to the presence of a lemon, the brains of opiate users have developed strong connections to a multitude of enticing triggers.  The first step in recovery is to break ties with these reminders.

People

Although sometimes difficult to do, abandoning each and every person who facilitated a person's drug use (dealers and "friends" who use) needs to be eliminated.  This means cutting all ties, deleting phone numbers, changing your personal number, email and social media profiles.  Maintaining just one of these unhealthy connections could easily allow someone to relapse.

Places

Just as important as people; places needs to be changed as well.  An exit on a highway where one would get off to go to their dealer can be powerful trigger, causing physical, anticipatory sensations such as a racing heart, sweating and instantaneous cravings.  For this reason, routes need to be changed, certain neighborhoods avoided and locations where drug activity has taken place needs to be eliminated completely.  Bathrooms can be especially difficult places as most individuals hide their drug use by getting high in the bathroom.

Things

Things can encompass a wide variety of triggers and cannot always be anticipated.  Music, needles, tourniquets, pills of any kind, large amounts of cash and smells can be powerful reminders of when one was getting high.  It is usually important to avoid watching movies or television shows where one can likely expect to witness real or simulated drug use.

In the coming weeks we will continue to explore concrete ways to address relapse prevention, provide tools for recovery and address the need for ongoing, professional and informal supports

(It is important to note that a quick "how to" such as this blog post is not recommended as the sole method of maintaining abstinence.  Meeting with and addiction specialist, drug and alcohol counselor or recovery expert is essential in learning the steps that will help sustain success.)