Recovery Management

2. Maintain Physical and Mental Health

Get a medical specialist to help manage any medications you’re taking. A psychiatrist is recommended. Only seek medication management from a primary care physician or nurse practitioner if they are well versed in psychotropic medications and addiction issues. A specialist in addiction medicine is most helpful, so ask if they are a member of an addiction organizations such as the American Society of Addiction Medicine (www.asam.org) or the American Board of Addiction Medicine (www.abam.net). You also want to make sure you’re working with someone who knows your story and what you’ve been through – five minutes at the psychiatrist’s office to get your prescription written does not typically indicate that they are committed to giving you the attention and care that you need. There are a lot of medications that should be avoided in recovery, and a physician without knowledge of addiction is more likely to prescribe something that could put you at risk (such as a benzodiazepine for sleep).

You should also keep weekly appointments with a counselor, addiction coach, or therapist on an ongoing basis. This person should specialize in addiction, what works and what doesn’t work for recovery, and be knowledgeable about recovery support services in your area. They should work for you, not your family or probation officer – they should be your advocate. They should have a nonjudgmental attitude and foster a sense of trust so that you can feel safe speaking to them honestly and openly. They ought to be able ask about on any possible deceptions or half-truths without causing you to react too defensively. In effect, this person can act as a second sponsor (though they shouldn’t replace your support group sponsor). It should be a person you are comfortable with so that you can take their direction or suggestions to heart. This person helps us to identify potential problems and work through them. They should also be able to help you with any co-occurring conditions (such as depression or trauma) and any inner healing that lays at the root of your addiction.

3. Go to Treatment

Treatment lays the foundation for everything that is to come. It also teaches us a language to understand what we’re going through as well as what others are going through. It teaches us the concepts and practices of recovery. It gives us a foundation of sobriety time, and helps us take hold of the things in ourselves and our environment to stay sober. Treatment often involves group therapy, which is a necessary component to help us recalibrate our ability to connect with others and learn from shared experience.

4. Immerse Yourself in a Recovery Environment

Safe sober housing is critical to success in recovery, especially if your regular living environment is unsupportive. Where you live matters, and it’s important to remove yourself from an environment that supports addiction and get yourself into an environment that supports recovery. If your current living situation is not conducive to your recovery, you’ll want to think hard about making a change, especially early in recovery. Sober living homes, recovery residences, or halfway homes provide housing and peer supported living conditions for people in treatment. Now, there are some sober living homes that are poorly run and risky, especially if there is poor accountability and the residents are able to go back to using. A good sober living residence is clean, safe, is in an area that’s away from triggers, has built-in accountability tools through its house rules (e.g., random drug testing, location tracking etc.), and has ample amenities and activities for you to accomplish your daily tasks and support you throughout your stay. Find out more on our treatment options page and recommended organizations page.

5. Surround Yourself with Safe People

Your peer group is also crucial to staying sober. Who your friends are matters. Successful abstinence is founded on a fellowship of recovering peers through 12 step meetings and other support groups. Most people don’t like meetings at first, but if you keep going you’ll come to find that many people know how to do something we newbies don’t – staying sober. Simply put, we go to meetings because that’s where the people who know how to stay sober go. Today there are many different kinds of support groups, and some meetings within AA or other formats are better than others, so you can pick whichever is right for you. The important thing is that you go. We can’t do this alone, and we can’t isolate. Look for a meeting where there are at least a few people with success in long-term sobriety, and where discussions tends toward the solution and not the problem. Make time to arrive to your meeting a few minutes early and stay a few minutes after so that you can network with others. This is how sponsors are found and recovery friends are made. If you are socially anxious and think others might not receive you well, remember that it isn’t always about you and that many others may be thinking the same thing, and then take the leap and put yourself out there. You may be pleasantly surprised by the result. We need this kind of supportive social interaction in order to heal ourselves and recalibrate the unhelpful ways we’ve learned to relate to others and ourselves.

6. Take Advantage of Addiction Medicine

There are a few medications available now that can act as a barrier to relapse and help fight cravings.

Antabuse (disulfuram) is a drug that blocks the liver enzyme that is responsible for processing alcohol. It creates unpleasant, sometimes severe side effects when alcohol is consumed, including heart palpitations, chest pain, dizziness, nausea, flushing, hives, and an increase in blood pressure. It basically makes you sick to the point of vomiting and needing medical attention. Side effects can be felt with very little alcohol present. It is the threat of these effects that act as a potent deterrent to alcohol use. It is taken daily in pill form in 250mg or 500mg doses.

Naltrexone is an opioid antagonist. It blocks the effects of opioids and decreases cravings for opioids as well as alcohol. It blocks the pleasureful effects of alcohol but not the intoxicating effects. It is taken daily in pill form or monthly in a healthcare setting as an injection.

Methadone is a medication used to treat opioid use. Though technically a narcotic itself, it can help reduce the withdrawal from other opioids as well as reduce cravings. It is often administered in a healthcare setting. Beware of methadone clinics however, since they attract illicit opioid distributors who may try to sell to you.

Accountability is important when using these drugs. If taking a pill, make sure someone watches you take it, and show your open mouth both above and below the tongue so that they can be sure you haven't hidden the pill. Injections should always be administered by a healthcare professional, and methadone should be administered in an area that is free from heroin dealers.

7. Plan for Relapse

Most people who get well eventually get sick again, yet this is not as terrible as it sounds. It is an expected outcome. Don’t get upset about that, an in fact, if we’re motivated enough, we will throw ourselves into recovery so that we don’t relapse. But part of that recovery work is planning for what to do if it does happen. Statistics vary, but about 40-60% of people who complete treatment (even residential) will have at least one relapse in the first year after discharge. This does not mean we give ourselves permission to relapse. Many do complete treatment and never relapse, but even for them, ambivalence never totally goes away. We may come to resist the idea that we are addicts, and we might want to prove to ourselves that we can use again without losing control, or we might get lax in working our recovery. Even though relapse doesn’t have to be part of recovery, it’s helpful if we face realize and understand that it is a risk and to have a plan in place to offset that risk. And even if we still relapse, the plan can help it from becoming catastrophic; then, we can take stock and build on the plan. Ultimately, we will get well if we are persistent.

Relapse has to be caught quickly and end definitively. Relapse isn’t good, but ongoing relapse can be a disaster. This happens when no one knows about it because we’re too ashamed to tell anyone, and that keeps it going for weeks or even months. A good relapse plan prevents this from happening. If you do relapse, how quickly someone finds out about it and helps you could save your life.

Quote from "Staying Sober" by Gorski & Miller (p. 35):

Relapse and recovery are intimately related. You cannot experience recovery from addiction without experiencing a tendency toward relapse. Relapse tendencies are normal and a natural part of the recovery process. They are nothing to be ashamed of. They need to be dealt with openly and honestly. If they are not, they grow stronger. Relapse tendencies are a lot like poison mushrooms or mold. They grow best in the darkness. The light of clear accurate thinking tends to keep relapse tendencies very quickly.

8. Make a Record of Successes and Failures

This is especially true if you’re trying to show a judge or someone else all the hard work you’ve done. Save the results of all your drug tests, all the days you went to meetings, and hold onto your treatment records. It’s also a key principle in recovery. Since human memory is often unreliable, objective evidence of what’s going on with you can help you can help you build on success and shore up weaknesses. Drug testing done by healthcare professions that know how to correctly interpret the results can also help because they can filter out false positives so that you aren’t prone to unjust legal action. After a relapse, we need to conduct a relapse autopsy that helps us examine what we were thinking, feeling, and doing prior to our relapse, so that we can try to avoid those states and integrate that into our recovery plan.

9. Keep on Quitting

Our primary addiction can easily be replaced by another unhealthy habit. Sometimes people replace hard drugs with marijuana or alcohol, which is ultimately not true healing from addition. Additionally, nicotine, caffeine, sugar, food, and behaviors such as sex, gambling, and shopping can become replacements for drug and alcohol addiction. If you find yourself smoking, eating more than usual, or drinking more coffee than before, try to let go of that. Nicotine especially can be used as a crutch as a mind-altering drug when there's nothing else to go to. The problem is that these things still create a pleasurable effect, which keeps the addictive process going and can eventually lead us to relapse. If you stop using nicotine and ceasing other unhealthy behaviors, then you're more likely to maintain sobriety from your primary addiction. Even if you engage in replacement substances or behaviors at first, if you can manage to let go of it, you'll find that your level of recovery deepens even further.

10. Get Back to Your Life and Work

Social support, companionship, and belonging are key to life and recovery, as are hope in the future and striving for meaning and purpose in life. As long as you’re sober and safe, then you should try to get back into your work or school so that you can build up validation and self esteem through your achievements and the social bonds you make through your work. Volunteer work and acts of service in support groups can also be good means to build up social capital. Even though early recovery may be spent immersed in recovery culture and treatment, try to get back into the world as soon as you feel like you’re safe enough to do so. Hopefully you’ll have the support of faculty and employers who understand this and want to support your recovery, and if they recognize the gifts of recovery – resilience, empathy, cooperation, and so forth – they will see how recovery makes you an asset to their business or field. Taking opportunities away only makes things less safe for everyone.

11. Find a Healthy Outlet

Make an intentional effort to participate in normal activities. Engage in healthy rewarding activities that can substitute and compete with continued drug use. Exercise, hobbies, and safe social activities help us to feel good – they give us a bit of a chemical rush but at levels that are much safer for the brain. So we need to learn to play. Even if you aren’t good at a new hobby, recovery depends on it, so just put yourself out there and enjoy it for what it is.