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How can Native American traditions and spirituality be incorporated into your recovery?

If you are a Native American in recovery, it can be helpful for you to think about how native traditions and spirituality can be integrated into your Twelve Step program. Thanks to a growing pride in Native American traditions, native people are strengthening and reviving beliefs and customs that gave strength and identity to their tribes. Their renewed spirituality and values are playing key roles in their recovery from alcoholism, a disease that has devastated Native Americans for more than 100 years.

Successes in sobriety are emerging for Native Americans in recovery who blend the Twelve Steps of Alcoholics Anonymous with traditions such as sweat lodges, talking circles, the circle of life, and drums walking the red road. Recovering Native Americans use the Twelve Steps but modify them, substituting the term “Great Spirit” for “Higher Power.” Many Native Americans find that the Steps closely align with their spiritual beliefs.

The basic Native American traditional ways—respect for elders, honor and respect of mother earth, and time for meditation and prayer—are important things to be stressed when in recovery. A return to Native American traditions will provide a solid foundation for continuing care and can increase the chances for long-term recovery.

The sweat lodge, site of traditional Indian purification ceremonies, is one cultural practice that may be incorporated into a person’s recovery program. The talking circle is another tradition, one in which individuals can share their stories of addiction. As a stick or another object is passed around the circle, the person holding it must talk and the others listen.

The circle of life is common to many Native American cultures. It acknowledges the stages of life: birth in the east, adolescence in the south, middle age in the west, and the age of the elders in the north. As the elders age and begin to show infantile behavior, they re-enter the east, completing the circle. One can also see recovery from addiction as a journey of growth and change.

The rhythm of the drum symbolizes the strength, unity, and heartbeat of Native American people. When Native American people stay close to the sound of the drum—when they remember that the drum is the first thing they heard in their mother’s womb—they remember that they don’t need alcohol or drugs.

All of these traditions can help you maintain sobriety and find new meaning in a life free from alcohol and drugs.

Recovery Action step

Journal or talk to someone about ways to incorporate your Native American traditions and spirituality into your recovery program. Reflect on how those traditions have helped you in the past.

­Addiction to alcohol and other drugs is a chronic, progressive, and sometimes fatal disease. It is also a manageable disease.

What Is Addiction?

In 1956 the American Medical Association first recognized addiction to alcohol and other drugs as a chronic disease. It is characterized by compulsive drug seeking and abuse and by long-lasting chemical changes in the brain. Addiction is the same whether the drug is alcohol, amphetamines, cocaine, heroin, marijuana, nicotine, or a prescription medication.

Continued use of the addictive substance causes changes in the brain that lead to tolerance, physical dependence, uncontrollable craving, relapse, and, in severe cases, death.

The stigma of addiction as a moral failing or a lack of willpower can keep individuals from seeking help for an alcohol or other drug problem. The concept of addiction as a disease can encourage and empower individuals to seek help.

Does Drug Abuse Affect Different People in Different Ways?

Yes. One person can take and abuse drugs, yet never become addicted, while another merely has one experience and seems to be immediately hooked. Drug addiction is a complex illness characterized by intense and, at times, uncontrollable drug craving, along with compulsive drug seeking and use that persist even in the face of devastating consequences. People with an addiction use the drug(s) repeatedly, regardless of the damage it does to

• their health
• their family
• their career
• their relationships with friends and the community

How Does Addiction Affect a Co-occurring Psychiatric Disorder?

People with a severe mental illness or an addictive disorder face many challenges. Persons with both disorders, or co-occurring disorders, face even more challenges. They have a greater tendency for violence, medication noncompliance, and failure to respond to treatment. These problems can extend to and affect the person’s family, friends, and co-workers.

How Does Addiction Affect the Brain?

Does a dependence on drugs cause an individual’s brain to malfunction? Or does the brain malfunction cause a dependence to drugs? Research has shown the latter is true. A drug on its own is not capable of producing dependence unless several factors (genetics, for example) are in place. Brain chemistry that has gone awry is what leads to compulsive use and impaired control. The drug is only a trigger for the disease.

This is a relatively new finding in the treatment field, but a rapidly growing body of evidence supports it.

Is Addiction Treatable?

Yes. Like diabetes or other chronic diseases, addiction can be treated and managed. Many treatments are available. Treatment can involve detoxification, taking medications, or receiving individual or group therapy in an outpatient, hospital, or residential setting. Evidence-based treatments, or treatments based on research, are listed at the National Registry of Evidence-based Programs and Practices (nrepp.samhsa.gov). Contact a therapist or medical doctor to find appropriate treatment.

Where Can I Learn More?

• about.com An easily searchable consumer Web site with extensive content.
• drugabuse.gov A National Institute on Drug Abuse Web site.
• familydoctor.org A consumer Web site of general health information, including addiction and mental illness.
• hazelden.org Since 1949, Hazelden has provided interdisciplinary treatment for addiction to alcohol and other drugs.
• healthyplace.com This easy-to-search consumer Web site contains extensive information about severe mental illness and specific drug use.
• samhsa.gov and csat.samhsa.gov These U.S. government Web sites are dedicated to mental health and substance abuse treatment, respectively.

What barriers to recovery do disabled people face?

Disabled people are more likely than the general population to develop substance use disorders. If you are a disabled person in recovery, you may have used alcohol and/or drugs to escape the pain, isolation, guilt, and frustration resulting from your disability. Unfortunately, disabled people may also face several obstacles to recovery, including physical barriers, learning needs, and possible family issues.

For example, if you are physically disabled you will need to find a recovery facility that’s accessible to you. You may need an entry ramp, elevators that can accommodate a wheelchair, doors that open automatically, and adequate space and parking for wheelchair access. Those who are blind may need learning materials in braille and a teacher who gives verbal cues. Those who are deaf may need a teacher or sponsor who can sign, an interpreter to attend meetings with them, or videos with closed captioning.

You may need to arrange transportation to and from Twelve Step meetings as well. Don’t let your disability stop you from going to meetings and working with your sponsor and recovery support group.

If you rely heavily on your family members for care, take a close look at those relationships. Could those members inhibit your recovery by enabling you to keep drinking and/or using?

Employment issues

It may also be beneficial for treatment programs to address employment issues. Many disabled people are underemployed or without a job, which may have led to substance use disorders in the first place. Learning skills needed for employment and independent living can aid the recovery process.

Web resources

National Association on Alcohol, Drugs and Disability (NAADD)

The NAADD website provides links to websites on substance use and disabilities, as well as articles about the progress toward improving the availability of treatment services for those with disabilities.

What is forgiveness?

Forgiveness is letting go of resentments. A wise saying reminds us that when we do not forgive we only hurt ourselves: “Holding on to resentments is like drinking poison and waiting for the other person to die.” Letting go of resentments involves the mental preparation to become willing to forgive as well as the act of forgiving itself. Forgiving may be hard until you understand that the goal is to secure your own emotional freedom. Forgiveness is a choice and an action, not a feeling. Feelings do not change immediately when we forgive; this takes time. Feelings follow choice. It may help to think of forgiveness as allowing room for—and coming to terms with—human error or weakness.

Why should you seek forgiveness?

Asking for forgiveness from yourself and others is a critical step in recovery. Success in working a Twelve Step program begins by forgiving yourself. If you choose to do that, you remove the underpinnings of shame and guilt. You aren’t telling yourself that what you did is okay. But you are allowing room for weakness and error. Self-forgiveness lifts a tremendous weight that can crush your self-esteem and confidence.

With the act of self-forgiveness, you will generate the energy and self-respect necessary to ask forgiveness from others. Steps Four through Nine will help you do just that.

How does forgiveness benefit you?

Forgiveness helps you let go of a huge barrier to recovery. Many recovering people have clung to deep resentments for years. Resentments block recovery. Resentments feed “stinking thinking.” Resentments lead to relapse. Forgiveness defuses the power that resentments have over you.

The second promise of sobriety is “We shall no longer regret the past nor wish to close the door on it.” Forgiving ourselves and others is the way to achieve this promise. The process of forgiving helps you make amends to others and let go of the past. It helps you see the past accurately and soften rigid all-or-nothing thinking. Best of all, you will realize how your past has brought you to this place and time of healing and recovery.

What about very difficult situations to forgive, such as incest or abuse?

At first thought, forgiving abusive or incestuous people may seem impossible. It isn’t. Forgiveness of a deep-seated wrong is for you, for your healing, for your recovery. It’s not about the other person. When you forgive such wrongs, you release them. You let go of the power they hold over you. In the Twelve Step recovery program, forgiveness is just one example of yielding something to gain freedom in another area of your life.

When you forgive a person who victimized you, you are not saying you like that person or believe what they did was in any way acceptable. Saying, “I forgive you,” isn’t saying, “It’s okay” or “Let’s be friends.” It also does not let others off the hook: they are still accountable for their actions. Remember, it’s not about that other person. Instead, you’re saying, “I choose to let go of this part of my past so that I can move on. I choose to free myself from the resentment this harm has caused.”

In these difficult situations, realize that forgiveness can sometimes be a process. When we have been deeply hurt, it takes time to work through the feelings to forgiveness, but it is important to do so. Otherwise our resentments can hold us prisoner to the past.

We must also realize that we may need to forgive even if we never get the apology we deserve. If we wait to forgive until the person says he or she is sorry, we may never forgive at all. In these cases we need to see, again, that forgiveness is done for our sake, not for someone else’s.

Web resources for survivors of trauma and victimization

Gift From Within

Gift From Within is an international nonprofit for survivors of trauma and victimization that offers articles on coping with trauma and post-traumatic stress and lists of support groups, conferences, and retreats.

What is the role of assertiveness in forgiveness?

Here, assertiveness means asking for what you need in a clear and respectful way. Whether you are asking for forgiveness or doing the forgiving, your goal is clear communication about your perception of the past and what you need now. The passive-aggressive approach won’t work; you aren’t putting your needs ahead of, or behind, the needs of others.

You will need to work hard to ensure that your understanding of the situation is accurate. That means pushing aside lies, rationalizations, minimizing, and denial. After you communicate what you believe to have happened, follow up by stating what you need. And stop there. You have assertively communicated forgiveness or the request for forgiveness. The rest is in the hands of your Higher Power.

How can your Higher Power help with forgiveness?

Forgiveness is the act of letting go. Much of the Twelve Step program is directed toward helping you learn to release your grip on harmful thoughts and behaviors. How? By turning them over to a power outside of yourself. Step Three asks you to turn your will and life over to a Higher Power. Step Five involves turning over specifics of your past by telling them to another person. In Step Seven, you ask to remove your shortcomings. And Steps Eight through Ten guide you through the process of letting go through making amends.

Some resentments are especially hard to rid yourself of. Even if you aren’t able to come to an understanding about them, you can turn them over to your Higher Power. Make a decision to release them. Give them up, set them aside, and move on to other things you can work on and resolve. Your Higher Power will hold these resentments until you are ready to let them go.

What is the value of asking for others’ forgiveness?

Willingness to forgive yourself is one thing; asking others for forgiveness is quite another. A great deal of humility is needed to put yourself in a vulnerable position and ask for something another person may refuse or may not be ready to forgive at that time. Remember that you are only responsible for the asking; you have to let go of the outcome because it is not yours to control. That means you should do your very best to prepare to make amends and talk to the person involved; the other person’s reaction is not the point. The goal for you is in the quality of the process you used to get there.

How can resistance affect your recovery?

Many people in early recovery are resistant to the concept of powerlessness and turning over their life to a Higher Power. Imagining a lifetime of living clean and sober and working a Twelve Step program may be beyond what you can fathom right now. Admitting powerlessness is hard because you are giving up the hope that you can ever drink or use drugs again. This is why you keep fighting instead of surrendering.

It’s not easy to accept that you are powerless. But it’s the first step to recovery. Once you accept the disease, you can then get down to the work of recovery.

If you resist turning your life over to a Higher Power it may be because as an addict you have often put your “faith” in the wrong things (drugs, alcohol, using friends, your self-will) because of your illness. You may have tried to “play God,” believing you had the ultimate plan for yourself and for others. Your quest for power and control may have temporarily crushed your spiritual nature.

If you hold on to resistance, you may remain as spiritually bankrupt as you were in your using days. You could return to your old behaviors and, ultimately, chemical use.

Members of Alcoholics Anonymous often describe the Twelve Steps of AA as a spiritual path. If you let go of resistance and embrace the Steps, they will take you on a lifelong journey of recovery. Each Step leads you to the next. Steps One through Three prepare you, Steps Four through Nine transform you, and Steps Ten through Twelve sustain you.

People can also be resistant to the idea that recovery involves relationships with others and active membership in a Twelve Step group. Many of us drank and used other drugs in isolation. The way of healing from addiction is in reaching out to others for help and support. We were not meant to work a recovery program alone.

Resistance to attending meetings, getting a sponsor, and making friends in recovery can be a big setup for failure. You need to push yourself through the resistance and do it anyway. “Fake it till you make it!”

Others too may resist your recovery, particularly those you’ve used with in the past. When you start working an active recovery program, you will find yourself changing, and not everyone will like those changes. Making hard decisions about the people you allow in your life can be one of the greatest challenges in early recovery, but it is crucial to your success.

In early recovery, it’s best to stay away from those who are resisting the positive changes you are making. If they are people you can’t distance yourself from (such as a spouse or significant other), lean heavily on your sponsor and friends in recovery for support.

What are the main issues facing health care professionals in recovery?

If you’re a health care professional recovering from addiction, you’re not alone. Like many others in this role, you may encounter some particular challenges to your recovery—issues such as shame, fear, workaholism, intellectualization, denial, controlling tendencies, difficulty asking for personal help, and handling access to dangerous substances. But if you stay alert to these potential obstacles, you can better head them off.

Shame

Shame is a very real challenge on your journey through recovery. As a health care professional, your community holds you to a very high ethical standard. You may feel deeply ashamed of your addiction and feel that you have let down your patients, friends, family, and colleagues.

Fear

If you relapse or return to consistent use, you may fear losing your ability to practice your profession. But trying to hide your use will only keep you from getting the help and support you need. In most cases such addiction issues are dealt with anonymously through monitoring programs. It is possible, however, for a professional’s addiction history to be made public through the acts of various regulatory boards and other professional organizations. This could lead to an inability to secure employment, hospital privileges, malpractice insurance, and specialty certification.

Workaholism

This is a leading cause of relapse in health care professionals. You may work long hours, including nights and weekends, in order to care for your patients appropriately. Unfortunately this hard work can take its toll. Even so, some professionals find themselves more emotionally comfortable in a clinical work setting than they are in other areas of life: relationships, children, money management, and so on. They may begin to “hide” at work to avoid participating at home.

 Intellectualization

As a health care professional you are part of a group of people with high intellectual capabilities, people who tend to work toward a sense of mastery. Caution: over-intellectualization can pose a recovery challenge. You might enter treatment planning to study hard, get an “A” in treatment, and live happily ever after. But remember that in recovery you never stop learning: “If you’re not doing, you’re dying.”

 Denial

Many health care professionals in recovery don’t see themselves as being addicted, since they go to work every day, have a good income, and don’t fit the “skid row” addict image. If this describes you, your unwillingness to fully acknowledge your own disease may hinder your recovery. Indeed, denial can lead to a relapse. The best antidote is, of course, rigorous honesty. Each of the Twelve Steps offers an opportunity to keep denial front and center in your recovery.

 Controlling tendencies

Many health care professionals are by their very nature controllers who are taught that to lack control of a clinical situation is to invite death and disaster. As this type of professional, you may feel that you should be able to master anything that comes your way. This can truly challenge your recovery: you will need to accept that you are powerless against addiction, and that you need help from your Higher Power to succeed.

 Difficulty asking for personal help

Health care professionals frequently have trouble seeking help in their own recovery. This is a critical issue since recovery cannot take place without other addicts. One basic tenet of good medical practice is that professionals should ask for help in clinical situations where they have reached the limit of their expertise. Curiously, some of the same professionals who adhere to this tenet may see asking for personal help as a sign of weakness or even incompetence. Seek help when you need it. Talk to your sponsor or recovery group—they can offer guidance and support.

 Access to mood-altering chemicals in the workplace

You may be exposed to these substances as part of your daily work routine. Physicians are no more likely to become addicted than the general population, but when they do they are three times as likely to use opiates because of the easy access. As a health care professional you could become addicted to the very chemicals you give to your patients. Your recovery could be at serious risk if you return to work and are again exposed to your drug of choice. Return to work is a problem for some, and care must be taken to minimize or avoid access.

What are the recovery rates for health care professionals?

Good news: the lifelong success rate for these professionals is approximately 90 percent—almost double the rate for the average patient in treatment. When health care professionals receive adequate care and monitoring for their addictions, lives and careers are saved, and everybody wins.

How can health care professionals protect their own recovery?

If you learned early in life that others valued you because of how much you achieved, or how smart, successful, or popular you were, you may have learned to judge yourself critically, based on external standards. You may even see yourself as worthless if you don’t achieve your goals.

If you believe you should be perfect, you’ll have a very strong desire to try to control your addiction with sheer willpower—and decades of experience tell us this won’t work. Your will is not enough; you must look outside yourself for the help you need to preserve your ongoing recovery.

Try thinking about success in a different way. If you are handling yourself with integrity and honesty, and applying your energy positively, then take pride in the journey. Don’t let anxiety and worry about the “what-ifs” stress you out. You might want to join a new Twelve Step group or a book or movie club, but what if you stutter or look foolish? What if you’re not smart enough to meet others’ expectations? Realize that it’s all right if you make a few mistakes. You don’t have to be better than everyone else all the time. We are all works in progress, and we’re all in different stages of our lives.

 These strategies may help.

1. Set realistic and reachable goals.

 Base your goals on your own wants and needs. Make them reasonable by measuring them against your past achievements and performance when you were at your best. As you reach one goal, you can set the next one at a higher level. Setting realistic goals will lead to a greater sense of achievement and self-esteem.

2. Rethink your idea of success.

 Think about any goal you would love to achieve. Now imagine that you don’t quite meet it. Instead of being dissatisfied, think about how significant it is to achieve even 50 percent of your goal. Give yourself some credit for the smaller successes— as long as you are achieving steps along the way to your goal, you’re succeeding.

3. Enjoy the journey.

 Think about success not only as achieving grand goals, but respect the energy, integrity, and time that you dedicate to your journey along the way.

4. Recognize the power of mistakes.

 Mistakes offer a great opportunity to learn. Think of a recent mistake you have made and list what you learned from it.

5. Confront your fears.

 Many of us in health care are afraid that we don’t stack up against expectations—our own or others’. Give yourself a reality check by asking, “Have I set up impossible expectations for myself? What am I afraid of? What is the worst thing that could happen if I don’t achieve my ultimate goal?”

How can you protect your recovery during a divorce or the loss of a long-term relationship?

When you were suffering from active addiction, you were probably incapable of functioning in healthy relationships. This doesn’t mean that you were incapable of love. But the pain and shame of loving the same people that you hurt may have led you to continue your addictive behavior, which in turn only hurt your relationships more. As a result, you may be experiencing such strain in your relationships that you are contemplating divorce or are actually going through a divorce.

If you are thinking about getting a divorce, you may want to consider marital counseling first, if you haven’t already. Now that you are sober, you may be able to repair some of the damage in your marriage without having to end it. Staying with the relationship will take perseverance and hard work on your part and your spouse’s part; you and your spouse will need to find new ways of relating now that you are sober. While you are going through marital counseling, it will be especially important to take steps to maintain your sobriety.

If there is no way to repair your marriage and divorce is your only option, remember to work the Steps, increase contact with your sponsor and sober support network, and also increase the number of meetings you attend. These actions will help you develop and maintain a healthy view of your life and recovery and maintain consistent serenity, even in the midst of this difficult situation.

Make a clear decision

If you are facing a divorce or the end of a long-term partnership while you are in recovery, you are facing the fact that for whatever reasons, one partner is no longer willing to be in the relationship.

You can respond to this by ending the relationship, trying to convince your partner to stay in the relationship, becoming withdrawn or depressed and bitter about your partner’s decision or your own decision to end the relationship, or choosing to wait and try to work things out.

Take care of yourself

Whatever your response is to your deteriorating relationship, the best thing you can do is to take care of yourself. There is no greater gift you can give to yourself and your relationship than being as healthy as you can be. Right now your focus is on staying clean and sober, going to meetings, and working the Steps. But as you progress in recovery, you’ll want to focus more and more on improv- ing your physical health. Nutritional therapy and exercise can help you heal your body and rebalance your brain chemistry, making you feel better, which will reduce your risk of relapse or an eventual return to use.

Don’t look back

When you know the relationship is over or when you choose it to be over, keep your focus on today. That means simply living one day at a time. There will, of course, be times of grieving and an examination of your past choices and behaviors that played a role in the loss of the relationship. But it is important not to focus on the past because nothing in the past can be changed. Focusing on the past leads to blaming, resentments, and anger, which are the greatest destroyers of serenity and sobriety. Continue your daily walk of recovery.

If your divorce is amicable, you may be tempted to try to be “friends” right away, having coffee or meeting for lunch. But if you are still emotionally attached, even periodic contact will likely cause you pain and regret and will limit your ability to move into a place of peace and serenity. After enough time has passed, you may choose to develop a friendship with this person, but not right away.

Avoid isolation

When you are feeling the pain and rejection of divorce or the ending of a long-term partnership, you may be tempted to isolate from friends and family and neglect your own self-care. But this will only hurt you and compromise your recovery. The more unhealthy you become, the less you have to give to new and existing relationships with all the people you love in life, including family, friends, and children.

Change bad habits

During our active addiction, many of us developed self-defeating behaviors— such as blaming, carrying resentments, and communicating with anger—that get in the way of developing healthy relationships. To be happy and improve our relationships now, we need to identify our self-defeating behaviors and construct a practical plan that includes taking action to change and asking others to give us feedback on our progress.

Recovery action step

You’ll need to work hard on your personal development in order to change self- defeating behaviors. Begin by assessing habits you want to change or develop.

1. Write down a list of bad habits that you want to stop.

2. Write down a list of good habits that you want to start.

Share your answers with your sponsor, recovery group, and friends and family who support your recovery. Ask them to give you feedback and hold you accountable for the changes you commit to make.

Work Your recovery program

The stress of losing a relationship can threaten your recovery. Follow these guide- lines to protect yourself from a relapse or eventual return to use:

• Stay away from triggers and slippery situations (bars, parties, using friends, stressful situations).
• Be aware of habits that harm you and your relationships (lying, blaming, rationalizing, carrying resentments, communicating with anger).
• Work the Twelve Steps.
• Take care of yourself: go to meetings, meditate, pray, exercise, and talk with your sponsor.
• Remember that you are important—celebrate the good things in your life with sober friends.
• Refuse to be your own worst enemy. You can be as happy as you choose to be.

Let others help you. Talk with your sponsor, sober friends, and supportive family members. They will need your support and help someday as well. You don’t need to go through the pain of divorce or loss of a long-term relationship alone.

Put the children first

If you are going through a divorce and there are children involved, the best thing you can do for them is to put them first. This means avoid fighting with your spouse in front of the children, don’t use your children as tools to get back at your spouse, and make sure you spend time with them. Often your children will blame themselves for the end of your relationship, so it is important that you let them know that the divorce isn’t their fault. It is also important for them to know that even though your marriage is ending, their source of security is not. Take steps to be just as actively involved in your children’s lives as you can, in spite of the divorce.

What is a character defect?

The Big Book describes character defects as “the flaws in our make-up which caused our failure.” Character defects stem from one source—self-centeredness. The Big Book says that selfishness “is the root of our troubles.” Character defects are personality qualities that can slow or block recovery and lower your quality of life.

Character defects are barriers to recovery, blocks in the path that can cause you to relapse or eventually return to use. Fear, exaggerated desires, unhealthy dependencies, and self-will give rise to the kinds of character defects that Steps Four and Five ask you to identify and admit out loud.

Of course everyone, alcoholic or not, has character defects. To the alcoholic, however, these character defects can keep us from sustaining our spiritual condition, and that could lead us to the next drink or drug. To us this is a matter of life and death.

What are some examples of character defects?

In the Big Book, the list of character defects includes resentment as “the number one offender. . . . From it stem all forms of spiritual disease.” Fear is another key character defect discussed in the Big Book.

Lying, all forms of denial (minimizing, rationalizing, blaming), grandiosity, and self-pity are also defects of character. So are traits such as anger, lust, dishonesty, impatience, poor self-esteem, overconfidence, and being overly judgmental.

Why is it important to do a moral inventory?

Addiction leads you to do and think things that often are in direct conflict with your own values. This conflict results in intense feelings of shame and guilt, which in turn undermines self-confidence and self-esteem. A moral inventory asks you to take stock of yourself, to identify, admit, and ultimately to hand over defects of character. Deep inside we know our failings. By bringing these forward we release our shortcomings to our Higher Power and another human being in an effort to break free of our self-will.

A very important part of taking a moral inventory (Step Four) and admitting your defects out loud to another person (Step Five) is recognizing your positive qualities. Sometimes it’s just as hard to identify and name what’s good about yourself as what’s negative. An honest assessment of your strengths is just as important as an admission of your weaknesses. Remember: progress, not perfection. You will not do this perfectly, but just doing it may yield great rewards.

What are some of the major barriers to recovery?

Barriers to recovery can consist of internal factors, such as character defects and negative emotional states, and external factors such as high-risk situations and events. Whether internal or external, these barriers can trigger relapse. Once you understand your personal triggers, you can plan how you will respond to them—and thereby protect your recovery.

Unchecked character defects are prime barriers. Rationalization, denial, minimizing, and the need for instant gratification—cravings—chip away at your spiritual fitness and diminish your ability to resist substance use when you are in high-risk situations. In Step One you learned to identify that you had a problem; you have the disease of addiction. Your brain chemistry is as powerless against alcohol and/or drugs as a diabetic’s body is against diabetes.

To defuse potential triggers we must take our defects, such as perfectionism, rigid thinking, resentments, grandiosity, and controlling thoughts and behavior, and turn them over to our Higher Power. Embracing Step One is often the most challenging barrier to recovery because it is often difficult to overcome this denial.

External factors that could threaten your recovery include high-risk events or situations such as conflicts with others, social or peer pressure, or being in environments where alcohol or drugs are used. Our emotions can also present barriers. Stress, anxiety, and boredom are just a few examples. And don’t forget HALT—hungry, angry, lonely, and tired. Even celebrations can trigger relapse if those celebrations are associated with drinking or using.

What particular barriers do women face?

For many women alcohol and other drug use is intertwined with experiences of partner violence, rape, sexual abuse, depression, and anxiety disorders. Sometimes these issues are not adequately addressed during treatment and can become barriers for women who struggle to maintain successful recovery.

How can you avoid or overcome recovery barriers?

First and foremost, work your Twelve Step program and rely on the support of your Higher Power and the fellowship. No one can do recovery alone. Then start understanding your specific triggers. You’ll also need to develop your communi- cation skills, new ways of thinking, and a plan to keep your life in balance.

Recovery action step

Make a list of the potential barrier situations most likely to set you up for relapse. Then pair each problem with a solution, a coping strategy for that high-risk situation. When your list is finished, make plans to learn new skills, develop new ways of thinking, and take concrete steps to keep your life in balance.

To develop new abilities, you might work on conversation skills to increase your comfort in social situations or practice ways to handle activities that in- volve drinking (such as skipping events where alcohol or drugs will be present). How can you prevent HALT? Counteract hunger by teaching yourself to cook, handle anger by finding alternatives to acting out frustrations, avoid loneliness by cultivating new friends, and prevent tiredness by establishing a sleep routine.

Keeping your life in balance is possible by keeping needs and wants on an even keel. Prayer and meditation, relaxation routines, and exercise are additional ways to stay centered.

Start practicing new ways of thinking. Give yourself positive feedback when you’ve worked hard on your recovery, and understand that if you slip and use alcohol or chemicals again, it doesn’t have to lead to a full-blown relapse. There’s still time for you to step right back into your recovery. Don’t minimize all the progress you’ve made, just go right back to the Twelve Steps and start again. It’s as simple as that. Don’t give up on yourself and your chance at a healthy, happy life just because you made a mistake. Simply learn from your mistakes and plan to avoid them in the future.

Each time you overcome a barrier to your recovery, you will gain confidence. You will understand that you can face high-risk situations, you can cope, and you can resist relapse.

Web resources

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

A branch of the National Institutes of Health, the NIAAA supports and conducts research on the impact of alcohol use on human health and well-being. Its web- site offers many articles about alcohol, addiction, treatment, and co-occurring disorders.