Relapse prevention is one of the most important aspects of treatment. In a study of many different addictions, approximately one/thirds of the patients relapsed within the first two weeks, sixty percent relapsed within the first three months, and sixty-seven within twelve months. (hunt et al., 1971).
Most patients relapse within three months of leaving treatment. This is the period of highest risk. Members of Gamblers Anonymous must be willing to do almost anything to prevent relapse. They need to see themselves as clinging to an ice- covered cliff with their recovery support group holding the only rope. The most important thing they can do is go to meetings. Members who are working a daily program of recovery will not relapse. These behaviors are incompatible. Relapse is a process that begins long before making the first bet. If the new tools of recovery are not used, and the problems begin to escalate, members reach a point where they think their only option is to gamble.
The Relapse Prevention Exercise for Gamblers uses the work of Gorski and Miller (1986), and Marlatt and Gordon (1985), to develop a relapse prevention plan. Some of this work was done with alcohol or other addictions, but it is applicable for any compulsive behavior. Relapse prevention requires working a daily program of recovery. The member must take his or her personal inventory at the end of every day. If any of the relapse symptoms become evident, immediate action must be taken. Miller and Gorski (1982), working with alcoholics, developed a list of thirty-seven warning signs. Members must check these signs every day for symptoms that they are having problems. Members must develop written plans detailing the exact things they are going to do if they get into trouble. Other people need to check each member daily for relapse warning signs.
This can be done by family members, a sponsor, or someone from the workplace. This is a good reason for members to go to daily meetings and hang around other recovering people. Often other people can see what members are unable to see for themselves. The member needs to identify high-risk situations that may trigger relapse and to develop coping skills to deal with each situation. the more a member can practice these skills, the better off he or she will be in recovery. In meetings, members need to discuss high-risk situations and help each other develop relapse prevention plans.
Each member will be different, but we found that most relapses occur when patients are experiencing the followinhigh-risksk situations:
Negative emotions: Particularly anger and frustration. This could also be negative emotions such as boredom, jealousy, depression, anxiety, ect…
Social pressure: Being in a social situation where people are gambling, or being directly encouraged to gamble by someone. Interpersonal conflict: This can be a conflict with the parent, spouse, child, boss, friend, ect.. Positive emotions: Something positive happens and the member want to celebrate. This can be a promotion, wedding, birth of a child, graduation, ect..
To test personal control:
The member gambles to find out if they can control the gambling. (Any Type of Addiction)
Using the relapse exercise, members develop the skills necessary to deal with each of the high risk situations, then they practice the new skills until they become good at them. All members must role play gambling refusal situations, with an experienced member, until they can say no and feel relatively comfortable. They must examine and experience all their triggers, see through the first use, and learn how to deal with the euphoric recall.
Members must develop a plan for a slip. What are they going to do if they gamble again? Who are they going to contact? What are they going to say? This must be practiced again and again with other members.
The member must understand the behavior chain. They must also develop skills for changing their thoughts, feelings, and actions when they have problems. The members should know that gambling cravings will pass if they move away from the situation and use their new tools of recovery.
RELAPSE PREVENTION EXERCISE
Relapse begins long before you gamble again. There are symptoms that precede gambling. This relapse prevention exercise teaches how to identify and control these symptoms before they lead to problems. If you allow these symptoms to go without acting on them, gambling will result.
The Relapse Warning Signs
All relapses begin with warning signs that will signal you or your loved ones that you are in trouble. If you do not recognize these signs, you will decompensate and finally return to gambling again. All of these signs are reactions to stress, and they are a reemergence of the disease. They are a means by which your body and mind are telling you that you are having problems. Gorski and Miller (1982) recognized thirty-seven warning signs in alcoholics who relapsed. You may not have all these symptoms before you begin gambling again, but you will have some of them long before you gamble. You must determine which symptoms are the most characteristic of you, and you must come up with coping skills for dealing with each symptom.
Listed below are the thirty-seven warning symptoms.
Circle the ones that you have experienced before you gambled.
1. Apprehension about well being.
3. Adamant commitment to stop gambling.
4. Compulsive behavior
5. Compulsive attempts to impose abstinence on others.
7. Impulsive behavior.
9. Tunnel vision.
10. Minor depression
11. Loss of constructive planning.
12. Plans begin to fail.
13. Idle day dreaming & wishful thinking.
14. Feeling nothing can be solved.
15. Immature to be happy.
16. Periods of confusion.
17. Irritation with friends.
18. Easily angered.
19. Irregular eating habits.
21. Irregular sleeping habits.
22. Progressive loss of daily structure.
23. Periods of deep depression.
24. Irregular attendance at meeting.
25. Development of an “I don’t care” attitude.
26. Open rejection of help.
27. Dissatisfaction with life.
28. thoughts of social gambling.
29. Feeling of powerlessness or helplessness.
31. Conscious lying.
32. Complete loss of self-confidence.
33. Unreasonable resentments.
34. Discontinuing all treatment.
35. Start of controlled gambling.
36. Loss of control.
37. Overwhelming loneliness, frustration, anger, and tension.
What To Do When We Experience A Warning Sign:
When you recognize any of the above symptoms you need to take action. Make a list of coping skills you can use when you experience a symptom that is common for you. This will happen. You will have problems in recovery. Your task is to take affirmative action at he earliest possible moment. Remember, a symptom is a danger signal. You are in trouble. Make a list on what you are going to do. Are you going to call your sponsor, go to a meeting, call your counselor, call someone in G.A.. Now detail several plans of action.
Plan 6. _______________________________________________________
You need to check each warning symptom daily in your personal inventory. Also you need to have other people check you daily. You will not always pick up the symptoms yourself. You may be denying the problem again. Your spouse, sponsor, or fellow G.A. member can warn you when he or she feels you may be in trouble. Listen to these people. If they tell you they sense a problem, take action. You may need professional help in working the problem through. Don’t hesitate in calling and asking for help. Anything is better than relapsing. If you overreact to a warning sign you are not going to be in trouble, but if you underreact you may be headed for real trouble. Compulsive gambling is a deadly disease. Your life could be at stake.
The High Risk Situations
WE found that relapse is more likely to occur in certain situations. These situations can trigger relapse. They found that people relapsed when they couldn’t cope with life situations except by returning to their addictive behaviors.
Your job is to develop coping skills for dealing with each high-risk situation.
Thirty-five percent of the people who relapse do so when feeling a negative feeling that they can’t cope with. Most felt angry or frustrated, but some felt anxious, bored, lonely or depressed. Almost any negative feeling can lead to relapse if you don’t learn how to cope with the emotion. Feelings motivate you to take action. You must act to solve any problem.
Circle any of the following feelings that seem to lead you to gamble.
20. Left out
Develop A Plan To Deal With Negative Emotions
These are just a few of the feeling words. Add more if you need to. Develop coping skills for dealing with each feeling that makes you vulnerable to relapse. Exactly what are you going to do when you have this feeling? Detail your SPECIFIC plan of action. Some options are: Talk to my sponsor; call a friend in the program; go to a meeting; ect.. For each feeling, develop a specific plan of action.
Continue to fill out these feeling forms until you have all the feelings that give you trouble and you have coping skills for dealing with each feeling.
Twenty percent of people relapse in a social situation. Social pressure can be direct, where someone directly encourages you to gamble, or it can be indirect, as in a social situation where people are gambling. Both of these situations can trigger intense craving, and this can lead to relapse. For example, over sixty percent of alcoholics relapse in a bar.
Certain friends are more likely to encourage you to gamble. These people don’t want to hurt you. They may want you to relax, and have a good time. They want their old friend back. They don’t understand the nature of your disease. Perhaps they are compulsive gamblers themselves and are in denial.
Make a list of friends who might encourage you to gamble, drink or use drugs:
What are you going to do when they suggest that you gamble? What are you going to say? Set up a group of G.A. where the whole group encourages you to gamble. Consider carefully how you are feeling when they are encouraging you. Listen to what you say. Have them help you develop appropriate ways to say no.
High-risk Social Situations
Certain social situations will trigger craving. These are the situations where you have gambled in the past. Certain bars or restaurants, a particular part of town, certain music, athletic events, parties, weddings, family get together. All of these situations can trigger intense cravings. Make a list of five social situations where you will be vulnerable to relapse.
In early recovery, you will need to avoid these situations and friends. To put yourself in a high-risk situation is asking for trouble. If you have to attend a function where there will be gambling, take someone with you who is in the program. Go with someone who will support you in recovery. Make sure that you have a way home. You do not have to stay and torture yourself. You can leave if you feel uncomfortable. Avoid all situations where your recovery feels shaky.
Sixteen percent of people relapse when in conflict with some other person. They have a problem with someone, and they have no idea how to cope with the problem. The stress of the problem builds, and leads to gambling. This conflict usually happens with someone that you are closely involved with: wife, husband children, parents, siblings, friends, boss, ect..
You can have a serious problem with anyone, even strangers, so you must have a plan for dealing with interpersonal conflict. You will develop specific skills that will help you communicate, even when you are under stress.
You need to learn and repeatedly practice the following interpersonal skills.
1. Tell the truth all the time.
2. Share how you feel.
3. Ask for what you want.
4. Find some truth in what other people are saying.
5. Be willing to compromise.
If you can stay in the conflict and work it out, that’s great. But if you can’t, you have to leave the situation and get help. You may have to go for a walk, a run or a drive. You might need to cool down. You must stop the conflict. You can’t continue to try and deal with a situation that you feel is to much for you. Don’t feel bad about this. Interpersonal relationships are the hardest challenges we face. Carry a card with you that list people you can contact. You may want to call your sponsor, minister, counselor, fellow G.A. member, friend, family member, doctor, or anyone else that may support you.
In an interpersonal conflict you will fear abandonment. You need to get accurate and reassure yourself that you have many people who still care about you. Remember that your Higher Power cares about you. God created you and loves you perfectly. Remember the other people in life that love you. This is one of the main reasons for talking to someone else. When they listen to you, they give you the feeling that you are loved.
If you still feel afraid or angry, get with someone you trust and stay with that person until you feel safe. Do not struggle out there all by yourself! Every member of G.A. will understand how you are feeling. We have all had these kinds of problems. We have all felt lost, helpless, hopeless, and angry.
Make an emergency card that includes all of the people you call if you are having difficulty. Write their phone numbers down and carry this card with you at all times. Show this card to your sponsor. Practice asking someone for help in treatment once each day. Write the situation down and show it to another member. Get into the habit of asking for help. Call someone everyday just to stay in touch and keep the lines of communications open. Get use to it. Don’t wait to ask for help at the last minute, this makes asking more difficult.
Twelve percent of the people relapse when they are feeling positive emotions. Think of all the times you gambled to celebrate. That has gotten to be such a habit that when something good happens, you will immediately think about gambling. You need to be ready when you feel like a winner. This may be at a wedding, birth, promotion, or any event where you feel good. How are you going to celebrate without gambling? Make a celebration plan. You may have to take someone with you to celebrate, particularly in early recovery.
Positive feelings can also work when you are by yourself. A beautiful spring day can be enough to get you thinking about gambling. You need an action plan for when these thoughts pass through your mind. You must immediately get accurate and get real. In recovery we are committed to reality. Don’t sit there and imagine how wonderful you would feel if you gambled. Tell yourself the truth. Think about the pain that gambling has caused you. If you toy with positive feelings, you will ultimately gamble.
Circle the positive feelings that make you vulnerable to relapse.
A Plan To Cope With Positive Feeling:
These are the feelings that may make you Vulnerable to relapse. You must be careful when you are feeling good. Make a action plan For dealing with each positive emotion that makes you vulnerable to gambling, drink or use:
Plan 1. ______________________________
Plan 2. ______________________________
Plan 3. ______________________________
Plan 1. ______________________________
Plan 2. ______________________________
Plan 1. _______________________________
Plan 2. _______________________________
Continue this planning until you develop an approach for each of the positive feeling that make you vulnerable.
Test Personal Control:
Five percent of the people relapse to test if they can gamble again. They fool themselves into thinking that they may be able to do so normally. This time they will only use a little. This time they will be able to control themselves. People who fool themselves this way are in for big trouble. From the first bet, most people are in full-blown relapse within thirty days.
Testing personal control begins with inaccurate thinking. It takes you back to Step One. You need to think accurately. You are powerless over gambling. If you use, you will lose. It’s as simple as that. You are physiologically, psychologically, and socially addicted to gambling. The cells of your body won’t suddenly change, no matter how long you are clean. You are gambling dependent in your cells. This will never change.
How To See Through The First Temptation
You need to look at how the illness part of yourself will try and convince you that you are not a problem gambler. The illness will flash on the screen of your consciousness all the good things that gambling did for you. Make a list of these things. In the first column, mark early gambling, Write down some of the good things you were getting out of gambling. Why were you gambling? What good came out of it? Did it make you feel social, smart, pretty, intelligent, brave, popular, desirable, relaxed, sexy? Did it help you sleep? Did it make you feel confident? Did it help you forget problems? Make a long list. These are the good things you were getting when you first started gambling.
Early gambling/using~ Late gambling/using
Now go back and place in the second column, marked late gambling, how you were doing in that area once you became dependent? How are you doing in that area right before you came into the program? Did you still feel social, or did you feel alone? Did you still feel intelligent, or did you feel stupid? You will find that a great change has taken place. The very things that you were gambling for in the early gambling, you get the opposite of in the late gambling. If you were gambling to be more popular, you felt more isolated and alone. If you were gambling to feel brave, you were feeling more afraid. If you were gambling to feel smart, you felt stupid. This is a major characteristic of compulsive gambling.
Take a long look at both these list and think about how the illness is going to try to work inside your thinking. The addicted part of yourself will present to you all the good things you got in early gambling. This is how the disease will encourage you to gamble. You must see through the first use of negative consequences that are dead ahead.
Look at the second list. You must be able to see the misery that is coming if you gamble. For most people who relapse there are only a few days of controlled gambling, at he most, before lost of control sets in. There are usually only a few days or hours before all the bad stuff begins to click back into place. Relapse is terrible. It is the most intense misery that you can imagine.
Lapse And Relapse:
A lapse is the first bet. This is the first step before a full blown relapse. A relapse is continuing to gamble until the full biological, psychological, and social disease is present. All of the complex biological, psychological, and social components of the of the disease become evident very quickly. For now lets call a lapse a slip even though G.A. does not use the word slip.
The Slip Plan:
You must have a plan in case you slip. It is foolish to think that you will never have a problem again. You must plan what you are going to do if you have problems. Hunt study found of recovering addicts, that thirty-three percent of patients lapsed within two weeks of leaving treatment. Sixty percent lapsed within three months. At the end of eight months, sixty-three percent had used.
The worst thing you can do when you slip is to think that you completely failed in recovery. This is inaccurate thinking. You are not a total failure. You haven’t lost everything. You have made a mistake, and you need to learn from it. You let some part of your program go, and you are paying for it. You need to examine exactly what happened and get back into recovery.
A slip is an emergency. It is a matter of life and death. You must take immediate action to prevent the slip from becoming a full relapse. You must call someone in the program, preferably your sponsor, and tell that person what happened. You need to carefully examine why you slipped. You cannot gamble and use the tools of recovery at the same time. Something went wrong. You didn’t use your new skills. You must make a plan of action to recover from your slip. You cannot do this by yourself. You are in denial. You don’t know the whole truth. If you did, you wouldn’t have relapsed.
Call your sponsor or a professional counselor and have him or her develop a new treatment plan for you. You may need to attend more meetings. You may need to see a counselor. You may need a new sponsor. You may need outpatient treatment. You may need inpatient treatment. You have to get honest with yourself. You need to develop a plan and follow it. You need someone else to agree to keep an eye on you for a while. Do not try to do this alone. What we cannot do alone, we can do together.
The Behavior Chain:
All behavior occurs in a certain sequence. First there is the TRIGGER. This is the external event that starts the behavioral sequence. After the trigger, there comes THINKING. Much of this thinking comes very fast, and you will not consciously pick it up unless you stop and focus on it. The thoughts trigger FEELINGS, which give you energy and direction for action. Next comes the BEHAVIOR, or the action initiated by the trigger. Lastly, there is always CONSEQUENCES for any action.
Diagrammed, the behavior chain looks like this:
Lets go through a behavior sequence and see how it works. On the way home from work, George, a recovering compulsive gambler, passes the convenience store (This is the trigger). He thinks “I’ve had a hard day. Maybe I’ll do a couple of scratch off lottery tickets to unwind” (The trigger initiates thinking). George craves gambling (The thinking initiates feeling). George turns into the convenience store and begins gambling (The feelings initiates behavior). George relapses (The behavior has a consequence).
Let’s work through another example. It’s is eleven o’clock at night and Betty is not asleep (Trigger). She thinks “I’ll never get to sleep tonight unless I gamble” (Thinking). She feels an increase in her anxiety about not sleeping (Feeling). She gets up and gambles (Behavior). She losses all her money and is so depressed she can’t work the next morning (Consequence).
How To Cope With Triggers:
At every point along the behavior chain you work on preventing relapse. First you need to examine your triggers carefully. What environmental events lead you to gambling? We have gone over some of these when we examined high-risk situations. Determined what people, places, or things make you vulnerable to relapse. Stay away from these triggers as much as possible. If a trigger occurs, use your new coping skills.
Don’t let the trigger initiate old behavior. Stop and think. Don’t let your thinking get out of control. Challenge your thinking and get accurate about what’s real. Let’s look at some inaccurate thoughts.
1. It’s not going to hurt.
2. No one’s going to Know.
3. I need to relax.
4. I’ve had a hard day.
5. I’m just going to spend a couple of bucks.
6. My friends want me to gamble.
7. It’s the only way I can sleep.
8. I never had a problem with sports gambling.
9. I can do anything I want.
10. I’m lonely.
All of these inaccurate thoughts can be used to fuel the craving that leads to relapse. You must stop and challenge your thinking until you are thinking accurately. You must replace inaccurate thoughts with accurate ones. You are a compulsive gambler. If you gamble you could die. That is the truth. Think through the first bet. Get honest with yourself.
How To See Through The First Temptation
If you think inaccurately you will begin craving. This is the powerful feeling that drives compulsive gambling. Craving is like an ocean wave. It will build and then, wash over you. Craving doesn’t last long if you move away from gambling. If you move closer to a gambling situation, The craving will increase until you gamble. Immediately on feeling a desire to gamble think this thought:
“THAT IS NO LONGER AN OPTION FOR ME.”
Now, what are your options? You are in trouble. You are craving. What are you going to do to prevent relapse? You must move away from the gambling situation. Perhaps you need to call your sponsor; go to a meeting; turn it over; call your counselor; or visit a friend. You must do something else other than thinking about gambling. Don’t sit there and ponder about gambling. You will lose that debate. This illness is called the great debater. If you leave it unchecked, it will seduce you into gambling.
The illness must lie to work. You must uncover the lie as quickly as possible and get it back to the truth. You must take the appropriate action necessary to maintain your recovery.
Develop A Daily relapse Prevention Program
If you work a daily program of recovery your chances of success greatly increase. You need to evaluate your recovery daily and keep a log. This is your daily inventory.
1. Assess all relapse warning signs.
A. What symptoms did I see in myself today?
B. What am I going to do about them?
2. Assess love of self.
A. What did I do to love myself today?
B. What am I going to do tomorrow?
3. Assess love of others.
A. What did I do to love others today?
B. What am I going to do tomorrow?
4. Assess love of God.
A. What did I do to love God today?
B. What am I going to do tomorrow?
5. Assess sleep pattern.
A. How am I sleeping?
6. Assess exercise.
A. Am I getting enough exercise?
7. Assess nutrition.
A. Am I eating right.
8. Review total recovery program.
A. How am I doing in recovery?
B. What is the next step in my recovery program?
9. Read the Combo Book, or other recovery literature.
A. Pray and meditate for a few minutes.
B. Relax completely.