ORTC Articles

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.

What is self-pity?

When we pity ourselves, we tend to dwell self-indulgently on our own sorrows or misfortunes. While you were in active addiction you may have felt so much guilt and shame that you disliked yourself. It’s natural that you harbor strong feelings of self-pity if you feel that addiction has stripped all the good things from your life. But now that you’re working on your ongoing recovery, you’ll need to learn to let go of the past and start working on rebuilding a positive life in the present. Working the Twelve Steps will help you regain sanity and embrace a new, healthy life that you can feel good about. In your new, sober life, gratitude will eventually replace self-pity.

How can you rid yourself of self-pity?

Relief from self-pity is one of the Twelve Promises of sobriety. The Twelve Promises describe the benefits you will gain if you work hard on the Twelve Steps. They describe the joys of living a healthy life of recovery—a joyous state that is the reward you will earn for ongoing abstinence and hard work.

The Fifth Promise says: Feelings of uselessness and self-pity disappear.

You may have heard the phrase “working a good program” in treatment
or in your Twelve Step group. What exactly does that mean? How do you know when you’re working a good program? You’ll know it by how you feel. When you feel centered because you aren’t acting out of ego and selfishness, when your interior life is steady, and when you can respond to daily living with maturity, you’ll feel that you’re working a good program.

If not dealt with, self-pity can become a trap that is very difficult to get out of. Success in the Twelve Step program is found when you deny your self-will and self-pity, and begin to focus on your Higher Power’s will and the needs of others.

What are some ways you can develop intimacy in relationships?

Honesty and sharing are essential in developing intimacy and meaningful relationships between couples (as well as friends and family). Whether you are married or in a domestic partnership, share with each other how you feel— upset, happy, anxious, and so forth—rather than hide your emotions. In a committed relationship, you should feel safe to express any fears you have about the relationship, or personal struggles you are dealing with. Both people must be willing to admit their own faults rather than pointing out the faults of their partner. Doing these things may seem scary at first, because they require vulnerability; however, these actions illustrate trust in each other.

Besides being open and honest with each other, learn to be a good listener. This will help your husband, wife, or partner feel comfortable sharing his or her feelings. This may mean developing tolerance so that you are willing to hear the other person’s point of view. It may also be necessary to compromise when disagreements arise. Couples can create opportunities to listen and share, such as going for walks or out to dinner.

If you have broken a partner’s trust in the past, you may need to illustrate with your actions that you have changed. For instance, you can show that you have changed by no longer drinking and using, by seeking counseling, and by making amends to others you have harmed. It may take time for trust to be restored, so be patient.

How does addiction affect intimacy?

Addiction can hinder the development of intimacy. One of the priorities of an addict is to conceal his or her actions, whether they involve drinking, sexual behaviors, or drug use. If you hide your addiction, you will only feel lonely, ashamed, and isolated, while your husband, wife, or significant other may feel betrayed or ignored. When you were in active addiction you likely found that your time was consumed with addictive behavior, leaving less time to spend with family and friends to develop meaningful relationships.

When you were in active addiction, alcohol and other drugs affected your judgment, causing you to act in ways that were not considerate of other people’s feelings or needs. As substance abusers, many people acquire inconsiderate habits and traits such as infidelity, chronic lateness or absence, and rude or harsh language, just to mention a few. These behaviors lead to lack of trust and integrity. Now that you are in recovery, you will need to be patient and work hard to regain that trust. The best thing you can do for yourself and for a present or future relationship is to work on yourself—to be the best you possible.

Is intimacy different than sex?

Intimacy is more than physical actions; it involves a feeling of connectedness and closeness. For two people to be intimate, they need to be honest and willing to share their emotions and thoughts with each other. Real intimacy requires getting to know someone deeply, including that person’s fears, inadequacies, and strengths. We can always have sexual relationships without such disclosure, but these types of relationships don’t allow us to contribute the best that we have to offer. They don’t let us face our fears of acceptance.

What does your brain have to do with addiction?

Research has shown that addiction is not a matter of an individual’s strength, moral character, willpower, or weakness. Instead it can be attributed to the way an individual’s brain is “wired.” Powerful, naturally occurring chemicals called neurotransmitters control our brain’s activities, carrying messages between neurons. When we use alcohol and/or drugs, our bloodstream quickly carries these intoxicating chemicals to our brain. In the brain, drugs set off complex chemical reactions and activities that can distort our sense of reality. This causes us to feel intoxicated or “high.” Some of us find this feeling pleasurable and worth repeating. Other people find getting high an unpleasant experience and, as a result, seldom use alcohol and other drugs.

How do drugs and alcohol damage your brain?

Research on the physiological effects of drugs and alcohol reveal a number of abnormalities in brain areas involved in behavior, such as the frontal and temporal lobes. Brain scans show that the most common similarity among substance abusers is the brain’s generally toxic appearance: it tends to be more shriveled, less active, and less healthy than a normal brain. While normal brain patterns show smooth activity across the cortical surface, substance- abused brains show a wavy, rough surface. This is similar to patterns of brain damage found in patients who have been exposed to toxic fumes or oxygen deprivation.

How do substances condition your brain’s pleasure center?

To understand addiction, we need to understand the brain’s pleasure center. Located in the limbic system, the pleasure center responds to enjoyable stimulation and learns to repeat it. Neurotransmitters, including endorphins and dopamine, activate the pleasure center. Alcohol and other drugs increase the activity of neurotransmitters, resulting in feelings of euphoria or a “high.”

When you first started using, you learned quickly that with drugs and/or alcohol, if a little is good, more must be better. As you continued using, your desire to repeat the pattern developed into a need to repeat the pattern. Your body was getting used to the presence of the substance. Eventually, your brain stopped producing neurotransmitters on its own and came to rely on the substance to produce “feel good” chemicals.

How does your body build up a tolerance to substances?

Substance-induced pleasurable feelings quickly wear off, leaving you feeling worse than before you started using. Without alcohol and/or drugs in your system, you feel lower than low. Your body is now chemically out of balance. As you begin to withdraw from the substance, you feel strong cravings to use. Your need to use is more powerful than your best intentions or will to quit.

Because you can’t quit, your use becomes progressively worse. As you build up a tolerance to the substance, you have to use more to get high. The substance is upsetting the normal endorphin levels in your brain.

Even if you briefly stop, you quickly end up using again, and now your life feels even more unmanageable than before you quit. It’s as if the disease kept progressing even though you had stopped using. Without drugs and/or alcohol in your system, dopamine levels in your brain are low. You feel flat, lifeless, and depressed. Without the substances, your life seems joyless. Now you need them just to feel “normal”—to bring your dopamine levels up to normal levels.

Eventually, your brain adapts to repeated chemical use and overrides your rational thought processes. The chemical use/reward sequence that leads to the euphoria in the pleasure center becomes “hardwired,” or imprinted, into your brain. Once this occurs, normal drinking and social drug use are impossible. You’ve crossed the line into addiction. You’re no longer able to control your use.

How does cross-addiction happen?

People with substance use disorders do not crave particular drugs, but rather they crave the euphoria that a substance produces. We each have a favorite “drug of choice,” but we’re not addicted to that substance itself—we’re addicted to the feeling of intoxication. This means that we can become easily addicted to any mood-altering chemical that gives us the feeling we’re looking for.

For example, if you’re addicted to meth, you might say, “I’m going to quit meth, and I’ll just have a few drinks instead.” This strategy will never work.

You will not be able to replace your meth use with controlled use of any other mood-altering chemical, such as alcohol. Alcohol use, or use of any other drug, will eventually take you back to meth use. Why? Because it’s what your brain is craving—an instant dopamine fix. The alcohol is just a teaser—a temporary substitute for what your brain really wants.

To recover from addiction you must stop using ALL mood-altering chemicals.

How can triggers cause a return to use?

The automatic recall of emotions and memories makes staying sober more difficult. You’ve probably heard a song on the radio that reminded you of your first date and brought back nostalgic memories of youth. The smell of fresh baked goods may trigger memories of Grandma’s house and of warmth and safety. These automatic triggers work the same way with drugs. Many alcoholics and drug addicts salivate when they see a chilled beer in a TV commercial, or have intense cravings while watching drug scenes in a movie.

Recovery Action step

What situations or people trigger using urges for you? Write your triggers down and discuss them with your sponsor and recovery group. Your sponsor can help you develop a plan to avoid the triggers that could cause you to return to use.

Can you think your way out of addiction?

Is the knowledge that you’re an addict or alcoholic enough to keep you from using? Absolutely not. Experience shows that the mere knowledge that we’re addicted will not stop us from drinking or drugging. The rational, thinking portion of our brains may tell us that we shouldn’t use these chemicals, but the automatic recall of memories and emotions, along with a brain that’s hardwired to seek drugs, will always override your best intentions.

As a person suffering from the disease of addiction, you can’t stop using, even when you are faced with losing everything: your job, your family, your life. This is because you can’t control the addicted way your mind and body react to drugs and/or alcohol. This is powerlessness. This is why Step One is so important to your recovery.

“We admitted we were powerless over alcohol—that our lives had become unmanageable.”

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

What is a relapse?

People often think of a relapse as a tangible event, such as taking a drink or snorting cocaine. However, a relapse is actually a process of becoming unable to cope with life in sobriety. It begins with predictable and identifiable warning signs that start to snowball long before a return to use or collapse occurs. If you are aware of these warning signs, you’ll be able to get help before the relapse process can lead to a return to alcohol or other drug use.

Not all recovering people relapse. Some achieve permanent abstinence from their first serious attempt at recovery. Many others have a period of brief relapse episodes but eventually achieve long-term abstinence. Then still others will have chronic relapses that result in an eventual return to alcohol or other drug use.

What factors lead to a relapse?

Research has shown that immediate factors, such as putting yourself in high-risk situations, lacking coping skills, and “stinking thinking” (thinking you are powerful enough to control your use) all can lead to a relapse. Other factors may include lifestyle habits, urges, and cravings.

The truth is that you are especially susceptible to relapse in early recovery. Your stress levels are high as you go through intense emotional and physical changes. You have not had time to develop reliable coping skills for dealing with the emotional roller coaster of life, causing you to be easily overwhelmed. And your brain is still clouded by years of intoxication.

In addition, it’s easy to become complacent. You start to feel good about your abstinence from alcohol and other drugs. You may minimize the severity of your addiction and the effort needed to stay in recovery. Then you gradually forget that addiction is an illness that is hardwired into your brain. You start to believe that just because you know you can’t use, you will be able to make intelligent decisions about your use. Soon, however, you find that it doesn’t take much to push you back to using again. Because you think you have some control, you mistakenly put yourself at risk.

Why should you avoid high-risk situations?

Research has shown that, especially in early recovery, certain situations or events pose a direct threat to a person’s sense of control. Often these situations result in a relapse and an eventual return to use.

High-risk situations that all recovering people should be aware of and plan for include the following:

• negative emotional states, such as anger, anxiety, depression, frustrations, and boredom
• situations that involve conflict with another person or a group of people, such as arguments with friends, co-workers, or family members
• events with social pressure, such as being around others who are drinking or using
• positive emotional events, such as celebrations
• exposure to alcohol or other drug-related stimuli, including advertisements and driving by a bar
• a test of one’s “willpower” by attempting limited use of substances

How can you avoid a relapse?

Identify and plan for high-risk situations

It’s important for you to identify the high-risk situations that you may experience. Work with your sponsor to create a plan to deal with these situations. Your sponsor might want to interview you to find out about past relapses or episodes where you had difficulty coping with urges to drink or use.

Use coping strategies

Of course you can’t avoid all high-risk situations. It’s your response to the situation that determines whether you will experience a relapse. If you practice and execute coping strategies, such as leaving a “sticky” situation or engaging in positive self-talk, you are much less likely to relapse.

As you gain more and more experience successfully using coping strategies, you’ll gain more and more self-efficacy. This means that you’ll start to see yourself differently. You will see yourself as a confident being who is able to manage these situations powerfully and with intention.

Engage in straight talk

Research has shown that people who relapse often focus on the immediate positive benefits of drinking or using other drugs. When exposed to conflict or stress, you will find it easy to think of how these substances will help you deal with pain, anger, or guilt right now. Instead remember how far you have come in recovery and how powerful your life has become personally and spiritually. Remember the negative consequences of drinking or using. You could lose your family, friends, career, or children. Don’t let the idea of the instant gratification of alcohol or other drugs cause you to compromise all the things you want for your life. Call your sponsor immediately.

How can you deal with a relapse?

Don’t focus on failures

Just because you relapse doesn’t mean you should get down on yourself and consider your recovery a failure. A relapse doesn’t have to lead to a return to use or a life of chronic addiction. It isn’t the end of the world. Focusing on the negative will only cause you to feel guilt, blame, and resentment toward yourself, which is a surefire way to destroy the recovery you’ve built. If you relapse, look at it as a temporary setback. Allow yourself to be human and make mistakes, but get right back to your recovery by getting immediate help from your sponsor or recovery support group. These people will help you get back on track, back to an abundant, liberating life guided by your Higher Power. And if you need additional help from a treatment center or outpatient program, don’t hesitate to call.

Research shows that individuals who view their relapse as a serious mistake that can be turned around with a stronger recovery program and do not fall deep into shame are more likely to restart their sobriety and abstinence sooner.

You can survive a relapse without losing all the ground you’ve gained in your recovery. But remember to stay aware; a relapse is serious territory, so don’t get complacent. Stay away from triggers and high-risk situations, practice coping skills, and continue to work the Steps. These actions will help protect and strengthen your recovery.

Recovery action steps

1. Make a list of the high-risk situations most likely to trigger a relapse for you. These could include any person, place, feeling, or situation connected with using alcohol or other drugs. It could also include anything that causes you stress.
2. Pair each situation with a coping strategy.
3. 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.
4. Ask your sponsor or recovery support group for help and discuss your answers with them.

Write down a personal emergency relapse plan and give copies to your sponsor and family members or friends who support your recovery.

Be sure to include the following:

1. The people or places you can call for help (sponsor, supportive family members and friends, treatment center)
2. The places you can go for help (meetings, sponsor’s house, treatment center, physician’s office)
3. Thoughts that will motivate you to stop the relapse (loss of family, friends, career, health)
4. A “last resort” agreement. For example, if I am unwilling to follow this plan, I agree that I will (check into a treatment center, move out of the house, go to detox, etc.).

How can you deal with a return to use?

Regardless of your best intentions, some of you may return to use. If this happens, set aside any feelings of failure, immediately stop use, and get help from your sponsor or recovery support group. If you have been using for a while, you may need professional help for withdrawal. An unsupervised detoxification could be dangerous. You could experience seizures or hallucinations. Consult a reputable addiction treatment center for help. Never try to handle a relapse or return to use alone.

What is addictive thinking?

“I am absolutely powerless to control my use, maybe.” This is just one example of the addictive thinking, or “stinking thinking,” that can cause you to relapse. Addictive thinking involves a combination of negative attitudes, distorted thinking, and an intense resistance to change. While you were using drugs and/or alcohol, you probably invented all sorts of ways to deny and justify using while trying to avoid negative consequences. These same denying and justifying thoughts can threaten your recovery unless you are prepared to recognize them and replace them with the early recovery lessons you learned from the Twelve Steps: you are powerless against addiction, addiction is a disease that requires a spiritual solution, and you don’t have all the answers.

What are some examples of addictive thinking?

“I can have just one drink and then I’ll stop” is a good example of thinking that, on the surface, may sound quite logical. Additional consideration, however, immediately shows the idea to be completely illogical, given your past history of having “just one.” Telling yourself that you’ll turn over all your resentments except your anger at a particular person is a good example of stinking thinking. “All” means all; it doesn’t mean excluding a person or thing.

After a brief return to use, you might tell yourself that you understand where you got off track. You’ll do it differently next time. You won’t get caught in the same trap. You will find a way to control your drinking. This thinking undermines the lesson you learned in Step One: you are powerless over your addiction.

Other examples of stinking thinking can be found in thoughts such as “People who hang around AA and NA are losers who can’t find friends anywhere else” or “I’m sick of everyone trying to run my life.” When you defy, scoff, belittle, make excuses, or say things to keep people off your back, you are demonstrating a negative attitude. You are showing the world a kind of false pride, or grandiosity, that will only hurt your recovery in the end.

What are the consequences of addictive thinking?

Grandiosity is a natural outgrowth of stinking thinking. You find yourself thinking that the rules don’t apply to you.

You might think that the Twelve Steps are for others who aren’t quite as smart as you are. The truth is that it doesn’t matter how smart you are. People functioning at the highest intellectual levels are just as vulnerable to addictive thinking as anyone else. You may have justified your use by telling yourself that you’re not as bad off as others. Or you may have told yourself that others need to work hard at each Step, but you only need to do enough to get by.

Another consequence of addictive thinking is perfectionism. You set expectations for yourself that you can’t possibly reach and then beat yourself up when you fail. Perfectionism is a form of grandiosity. The addictive thinking goes something like this: “I will do it perfectly because I can, because I really am the exception, and because my intelligence and insight are unique.”

Addictive thinking leads to rigid thinking. You tend to view things in extremes—either black or white. Such thinking causes you to jump on a solution impulsively, leading you to conclusions and solutions that are probably incorrect, inappropriate, or just not helpful. In fact, you might be dead wrong, but distorted thinking will help you hide that reality from yourself.

Eventually your addictive thinking doesn’t make sense even to you. At this point, you stop caring that your thoughts and resulting behaviors are illogical and inappropriate to the situations at hand. You fall back on your substance-using rituals to find comfort. Deep inside you really don’t want to find solutions because chaotic emotions, relationships, and events in your life feed the “ reason” for your continued substance use disorder. The thinking at this point is “If others had it this bad, they’d use or drink too. I deserve some relief from this mess that life has handed to me.”

How can you avoid or overcome addictive thinking?

To avoid the return of addictive thinking, you must be diligent. Remember that the Big Book calls alcohol and other drugs “cunning, baffling, and powerful.” This means that you must work at honesty every minute of every hour of every day. What triggers your addictive thinking? Make a list of the people, places, and situations that may usher in the old distorted thoughts. If being with others who drink or use will lead you to “just one” thinking, you can avoid those people and situations. If you can’t avoid them, have a plan to honor your recovery goals, such as taking a clean and sober friend along. Limit the time and plan on doing something immediately afterward that you especially enjoy. The possibilities for the old thinking to return are endless, but so are the potential solutions.

To overcome addictive thinking, you must clear away distorted thoughts by rooting out lies, denial, rationalization, and minimization. You have to dig deep to find and let go of character defects like grandiosity and perfectionism. Intense isolation and loneliness are an inevitable result of addictive thinking. You become alienated from yourself and others in all areas of your life. You need to re-establish your connections, first with yourself and then with others. The first step to overcoming addictive thinking is to become honest with yourself. Not an easy task, as you know, but that’s exactly what the Twelve Steps will help you accomplish. With time and your best effort in working each of the Steps, you come to know yourself. In the very first Step, you are asked to accept the idea that your life has become unmanageable—your first venture into self-knowledge. Each Step takes you to another level of knowing and accepting yourself. As you develop a healthy relationship with yourself, you prepare yourself to do the same with others. These relationships are the connective tissue that forms your ongoing recovery reality check and support system.

What are the attitudes that will harm your recovery?

In addition to grandiosity, perfectionism, and rigid thinking, blame, shame, control, pessimism, hopelessness, and isolation will interfere with your recovery. Such attitudes involve a kind of negativity that drains your energy, pushes others away, and leaves you without external reality checks. You are left to your own thinking, which, when not examined either by yourself or others who know you, will allow distortions. Distorted thinking leads to a distorted idea of events and distorted solutions. Incorrect thinking paves the way for incorrect conclusions: “Just one won’t hurt,” “I can stop,” “No one will know,” “It’s really not that bad.”

Certain attitudes are a red flag for relapse. Watch for signs of self-pity, impatience, blame, rationalization, resentment, anger, and pessimism. Ask for help if you become overly sensitive to what others say and do, or if you suddenly find yourself full of righteous anger, or if you are laboring under thoughts of “Who cares?” or “None of this matters anyway.” These are the attitudes that lead to a return of addictive thinking, which can lead to relapse.

What are the attitudes that will help your recovery?

An attitude of trust in yourself, other people, and your Higher Power is needed to maintain your healthy recovery. To accept your powerlessness and unmanageability in Step One requires you to abandon your old reality. Although it sounds easy, giving up addictive thinking is hard. Even if it’s “stinking thinking,” it’s old, familiar, and therefore comfortable ground. When you let go of all the defenses and insane thoughts that held your reality together, what’s left? Cultivate an attitude of trust so you can be open and remain open to the perceptions and knowledge of others.

A spiritual openness is another attitude that will aid your recovery. Addiction occurs in a vacuum, when you used chemicals to fill an empty space. That space is a spiritual void that, if filled with addiction, will leave no room—or need—to satisfy your craving for meaning in your life.

Awareness of the moment will help you absorb what is real. Being present in the moment replaces any need to weave a fictional story that only you believe about your life. Work at telling the truth. When difficult feelings arise, take time to understand them. For example, if a vague sense of uneasiness turns out to be shame or guilt, what is causing the feeling? What truths can you tell yourself or another that will dispel the sense that what you’ve done or who you are is somehow deficient?

And finally, humility is an attitude that will allow you to question, listen learn, admit, assert, and clarify—whatever is needed to humbly admit wrongs and ask for help in letting go.

What is perfectionism?

Perfectionism is the inability to make or allow mistakes. Perfectionism is a form of addictive thinking that leads to a negative cycle. You feel bad or inadequate about past mistakes, compensate by setting goals too high, make a mistake, and then feel inadequate once again. It’s a no-win situation and a setup to fail in sobriety. Yet recovering people tend to do this over and over. Perfectionism is another face of insane, or addictive, thinking.

Perfectionism brings much anxiety and stress to your recovery. The tension of trying to be perfect can permeate every act and thought every day. Do you really believe you can attain the goals you set for yourself? Why is it that you feel you must be perfect? Why should others be? What you expect of yourself is almost always transferred to everyone around you. When you feel tension in your day, ask yourself, “What will happen if it’s not done perfectly? Can I do it another way? If I make a mistake, is the consequence serious or minor? Does it really matter that much?”

The Twelve Steps are important in combating perfectionism. Working the Steps helps you cultivate an attitude of humility, which undermines perfectionism. Humble people don’t believe they are perfect. They accept that they can’t control everything and don’t know everything—and they rejoice in that knowledge. A huge weight will slip off your shoulders when you sincerely accept that a power or powers outside of yourself can help. Remember, the Big Book tells you that it’s progress, not perfection, that you seek.

What is a trauma-induced flashback?

Trauma-induced flashbacks often express themselves as mental pictures or feeling states that seem to occur in the present; however, they represent an event or feeling from the past. These flashbacks may occur on a regular basis. When they happen, you may feel “crazy” and “out of control.” If you do not understand the positive purpose of flashbacks, they can be frightening and even life threatening. But if you have an understanding of what causes these flashbacks, they can seem less mysterious, less painful, and more goal directed.

Trauma-induced flashbacks can develop in response to any type of unresolved life trauma, such as a car accident, rape, or sudden death of a family member. These flashbacks may have triggers, such as the anniversary date of the event or particular sounds or smells, but they may also occur without any identifiable trigger.

How can you treat a trauma-induced flashback?

Flashbacks can sometimes provide you with necessary information about the trauma that is not readily available in your conscious mind. To recover from a traumatic event, you must learn and accept the truth of the past. Often this truth was too horrendous to deal with at the time and was blocked from your conscious memory. Flashbacks can help you “unblock” your memories by showing you the truth. Many of those who experience trauma blame themselves. During a flashback, you may see the truth and experience how blameless you are.

When your flashback is over, take some quiet time to reflect on what the flashback may be trying to communicate to you. Write what you learn in your journal to later share with your therapist or self-help group members. If you have neither, share what you learn with a trusted friend. If your symptoms persist, seek help from a licensed mental health counselor.

To find a licensed mental health counselor in your area, visit the American Mental Health Counselors Association.

What is a drug-induced flashback?

Drug-induced flashbacks are an unsettling side effect of drug use that can be experienced in recovery. Drug-induced flashbacks are often described as short experiences of psychedelic symptoms that include visual images, intense feelings, or other experiences similar to those felt during drug use. Visual images may include seeing false motion on the edges of your field of vision, bright or colored flashes, or halos or trails attached to moving objects. These flashbacks can also involve distortions in time, physical sensations, or the reliving of intense emotions, such as anxiety or ecstasy that can last from a few seconds to several minutes.

If you have taken drugs such as hallucinogens or cannabis (marijuana), you may experience these flashbacks. Studies have shown that roughly a quarter of LSD and cannabis users experience some kind of flashback.

Drug-related flashbacks can occur suddenly and often without warning. They may occur within a few days or, in some cases, even within years after drug use has ended. These flashbacks typically occur in people who have used large amounts of drugs during a long period of time, but flashbacks can occur even in people who have used drugs occasionally. People who use hallucinogens such as LSD may experience relatively long-lasting mental disorders, such as schizophrenia or severe depression. The causes of these effects, which in some users occur after a single experience with the drug, are not known.

What causes a drug-induced flashback?

The causes of these flashbacks are not completely understood. Most likely, the use of drugs, such as hallucinogens or cannabis, affect the biochemistry of the brain. It is known that brain chemistry can be altered by drug use. LSD and other hallucinogens affect serotonin and dopamine receptor sites in certain parts of the brain. Even when drug use is ended, the brain may still respond in ways that resemble drug use, which is perceived as a flashback.

How can you treat a drug-induced flashback?

Since flashbacks seem to involve runaway dopamine activity in the brain, the most important thing to do when experiencing a flashback is to relax. Intense fear and panic will only increase the available dopamine and reinforce the intensity of the flashback. If you recognize the flashback as harmless, it probably will be.

Because flashback symptoms may be mistaken for those of other neurological disorders such as a stroke or a brain tumor, sufferers may consult a variety of clinicians before the disorder is accurately diagnosed. There is no established treatment for flashbacks, although some antidepressant drugs may reduce the symptoms. Psychotherapy may help patients relax and adjust to the confusion associated with flashbacks.

Support and understanding can be found in any of the Twelve Step groups, such as Narcotics Anonymous, that deal with drugs other than alcohol. Of course, continued abstinence from the use of illegal drugs is equally important in minimizing flashbacks and preserving peace of mind.

What is the Minnesota Model of treatment?

Imagine for a moment that it is 1949 and you or someone you love is alcoholic. As you struggle with this fact, you quickly learn there are only three outcomes to this situation. One is commitment to a locked ward in a mental hospital, sharing facilities with people diagnosed as schizophrenic. Another is a life of crime, which could mean years in prison. And third is a slow sinking into poverty and helplessness—perhaps life on skid row. In all three cases, you or your loved one’s condition would be denied, ignored, or denounced as evidence of moral weakness.

The year 1949 is significant because it marked Hazelden’s beginning. What started then as a guesthouse for alcoholic men has flowered into the prevailing method of treating addiction: the Minnesota Model. More importantly, this historic innovation offered alcoholics a new alternative to mental wards, jail, or homelessness.

It’s easy to forget that the Minnesota Model represents a social reform movement. The model played a major role in transforming treatment wards from terrible, hopeless places into places where alcoholics and addicts could retain their dignity. Hazelden began with the idea of creating a humane, therapeutic community for alcoholics and addicts. Once this idea was ridiculed; today it is seen as commonplace. The story of how this change has evolved is in large part the story of the Minnesota Model.

The model began humbly. During Hazelden’s first year of operation in Center City, Minnesota, the average daily patient count was seven, and the staff numbered three. The treatment program was just as bare boned, resting on a few expectations of the patients: behave responsibly, attend lectures on the Twelve Steps of Alcoholics Anonymous (AA), talk with other patients, make your bed, and stay sober.

It would be easy to dismiss such a program. Yet behind these simple rules was a wealth of clinical wisdom. All five rules focused on overcoming a common trait of alcoholics—something the founders of AA described as “self-will run riot.” People addicted to alcohol can be secretive, self-centered, and filled with resentment. In response, Hazelden’s founders insisted that patients attend to the details of daily life, tell their stories, and listen to each other. The aim was to help alcoholics shift from a life of isolation to a life of dialogue. This led to a heartening discovery, one that’s become a cornerstone of the Minnesota Model: alcoholics and addicts can help each other.

Throughout the 1950s, Hazelden built on this foundation by adopting some working principles developed at another Minnesota institution, the Willmar State Hospital. Among these were the following:

Addiction exists

This condition is not merely a symptom of some other underlying disorder. It deserves to be treated as a primary condition.

Addiction is a disease

Attempts to chide, shame, or scold an alcoholic or addict into abstinence are essentially useless. Instead, we should view addiction as an involuntary disability— a disease—and treat it as such.

Addiction is a multiphasic illness

This statement echoes an idea from AA—that alcoholics and addicts suffer from a disease affecting them physically, mentally, and spiritually. Therefore treatment for alcoholism or other drug addiction will be more effective when it takes all three aspects into account.

These principles set the stage for a model that expanded greatly during the 1960s, one that has been emulated worldwide and has merged the talents of people in many disciplines, including addiction counselors, physicians, psychologists, social workers, clergy, and other therapists. These people found themselves working on teams, often for the first time. And what united them was the notion of treating the whole person—body, mind, and spirit.

Today, the Hazelden Betty Ford Foundation continues to explore the most cutting-edge research and practices in the addiction field, but still at its core is the Minnesota Model. Fifty years of service have not altered this foundation.

How does addiction affect family relationships?

Addiction is a family disease. One of the toughest aspects of addiction is the chaos you, the addicted person, bring to the family. Like any other illness, addiction elicits a multitude of emotions and behaviors from family and friends. They may become angry or resentful toward you for the hurt they experienced while you were in active addiction. They may have even been fearful that they would lose you to a divorce or that you would die as a result of your addiction. When your family members realized that they could not change your addictive behaviors, they likely felt completely powerless over their own lives.

Often family members feel personally responsible for holding everything together. They fear that if they don’t, the family will fall apart. This intense feeling of being personally responsible for you as well as the family is a huge burden— and it can lead to feeling victimized, angry, and full of blame.

Over time your family members may have adopted caretaking or enabling behaviors that, in the end, allowed you to continue alcohol or other drug use without incurring harsh consequences.

Enabling behaviors include the following:

• lying for the addict to protect his or her reputation with employers or friends
• assuming more responsibility around home or work to make up for the addict’s lack of contribution
• denying that the problem exists
• accepting blame for the addict’s behavior
• withdrawing physically or emotionally because of the stress caused by living with the addict
• continuing to support and be there for the addict, even when this person has become physically, verbally, or emotionally abusive

Many family members have gotten caught up in the dishonesty of trying to keep everything looking good on the surface, while this only allows the situation to continue unchecked.

It’s often true that as an addict you have caused any number of problems and brought harm to others. But family members will not gain anything from remaining stuck in the blame game. Instead, healing and balance will come for you and for your family members when they turn their energies toward think- ing about what they want for themselves, and when they learn to detach with love—to love you but reject your addictive behaviors.

How does addiction affect children?

Children can sense the danger in an addictive family and often know before the parents do that something is terribly wrong. Some children may respond to conflict by withdrawing or emotionally shutting down. Other children may rally to assume additional responsibility in the family to make up for the lack of support from the addicted parent.

How can you regain your children’s trust?

Remember, in early recovery your first job is to stay clean and sober. If you’re not clean and sober, you can’t be the trustworthy, dependable parent your children need.

It may take time for your children to trust you again. Your recovery may stir up lots of different emotions in them. They may react with hope and happiness, resentment and anger, or something in between. Be patient; allow your children to feel, express, and process these emotions.

How can you talk to your children about recovery?

Now that you’re out of treatment, you may not know exactly what to say to your children or how to interact with them. This can be a confusing time for children, and they may deal with hurt emotions by acting as if everything is fine or by being aloof and angry. Like most parents, you really love your children and want only the best for them.

Because you are a recovering addict, you might feel hypocritical talking to your children about the dangers of alcohol and other drugs or about things such as trust. Put those thoughts aside; your job as a parent is to inform and protect your children. If you send them honest, consistent messages, they will listen. One of the first things you can do to repair your relationship with your children is to help them understand what addiction and treatment are all about.

What is your family going through now that you’re sober?

Some family members believe that everything will be fine now that you are out of active addiction and working on recovery. Others may not instantly accept or trust you. They may wonder how long this new “recovery” will last. Either way, just because you are clean and sober right now doesn’t mean that the resent- ments, distrust, loneliness, and hurt are gone from your loved ones. In fact, now that they are not worrying about your use as much as before, they may be more present to the hurt and loss they sustained during years of living your addiction.

What can you do to improve family relationships?

Learn all you can about recovery

The more you and your family know about recovery, the more helpful you will be to each other. Consider attending a program together with family members to learn about addiction and recovery. Although taking time out for such a program is difficult, most people find it time well spent. It may also be helpful for you to attend an Al-Anon meeting and listen to the stories of those families struggling with active addiction in order to empathize better with your family’s side of the situation.

Encourage family members to accept powerlessness over addiction

One of the first tasks for family members is to admit they are powerless over the disease of addiction—they are no more able to control your addiction and its con- sequences with willpower than they would be to cure you from diabetes or any other disease. Admitting powerlessness will help your family members let go of shame, guilt, and resentments. It’s not anyone’s fault that you have the disease of addiction. Your family members could not control your addictive behaviors or make them go away through any amount of love, tenacity, or patience.

To admit to being powerless over anything is a difficult and humbling experience.

Set goals together

Although your family members are not responsible for your recovery, it may be helpful for you to set goals with supportive family members. Commit to participate in events, such as going to meetings, or to take certain actions (for example, calling your sponsor) each week. Ask your loved ones to hold you accountable to these agreements.

Protect your recovery

Protecting your ongoing recovery is one of the greatest things you can do for your family. You can help accomplish this by

• attending Twelve Step meetings on a regular basis
• finding a sponsor who has been in recovery for a while and who can serve as a guide
• seeing a therapist or psychiatrist regularly if you have a co-occurring disorder, such as depression or anxiety
• attending continuing care groups where different recovery topics are discussed

See a family counselor

Marriage and/or family counseling may be of benefit to you if you or your family has experienced difficulties with communication, trouble in balancing the demands of home and work, the loss of a family member, the stress of co-occurring disorders such as depression or anxiety, or childhood traumas. You may also wish to see a counselor to enhance your family relationships by learning such skills as effective communication, conflict resolution, assertive- ness, and time management.

How can you handle family events where alcohol is served or other drugs are present?

Family events, including holidays or other celebrations, can threaten your recovery if you don’t plan for them because they can cause increased stress, heighten emotions, create free time without structure, and cut off or limit your access to your sponsor or recovery support group.

Make it a priority to talk to your sponsor and lay out a plan for coping with family events and celebrations where alcohol or other drugs could be present. It’s easy to become busy or overconfident, taking shortcuts and not making recovery the priority. You forget that without abstinence from alcohol or other drugs you will lose all the things that are valuable in your life.

Recovery action Step

Talk to your sponsor or recovery support group. Make a relapse prevention plan to handle the triggers that you might encounter during family events, such as holiday gatherings.

Let your sponsor know if you may be in a tough situation during a family event. Make sure you have a way to leave the event if you feel your recovery is threatened.

Take another recovering person with you for support during the family event. Having someone there who understands your fears and urges is important. It keeps you accountable.

Web resources

Regular Twelve Step group attendance is another key resource for family members. Al-Anon, Alateen, and Adult Children of Alcoholics groups are available to help family members begin their own recovery process. These groups will help family members come to terms with reality, live in the moment, and take charge of their lives. Rather than react to addictive behavior, they will learn to focus on themselves and make meaningful choices. Below is information on and links to these groups, as well other family resources.

Al-Anon and Alateen

Al-Anon and Alateen members are people who have been affected by someone else’s drinking. The websites for these groups offer an online searchable directory of meetings in the United States and Canada.

Adult Children of Alcoholics

Adult Children of Alcoholics is a nonprofit organization that maintains services for those seeking to arrest the emotional disease of family alcoholism. This website offers a searchable list of meetings worldwide.

Hazelden Betty Ford Foundation

The Hazelden Betty Ford Foundation offers a Family Program where family members can learn how to deal with the recovery of a loved one, while still taking care of themselves.

Talking With Kids About Tough Issues

Talking With Kids About Tough Issues is a national campaign by Children Now and the Kaiser Family Foundation. The website offers tips on discussing topics such as alcohol and other drugs, sex, violence, and HIV/AIDS with children.