Recognizing Triggers, Managing Craving, and Preventing Relapse.
Patients who have gone through the acute withdrawal period (whether on their own or under detoxification treatment) from opiates or alcohol have already completed a major step in their recovery. But it is just one step of many. As with all chronic diseases, acute intermittent treatment–including responding to the crises of relapse, intoxication, or medical consequences–does not typically lead to long-term treatment success. The crucial phase of substance abuse treatment is maintenance of sobriety.
Triggers, triggers, everywhere…
Substance addiction is much more than simply pharmacological dependence that can be broken by detoxification. A cardinal feature of addiction is that the patient’s life progressively centers on the cycle of obtaining, using, and recovering from drugs. Other family, work, and recreational interests fade into the background as the drug use takes center stage. Friendships and places where people spend time together become inextricably linked to drug use. It’s like walking into the bar in “Cheers”- where everybody knows your name. Patients in treatment need the cognitive skills to recognize triggers to drug or alcohol use: associations with people (their drinking buddies), places (the bar), and visual, olfactory, and auditory cues (the look and smell of a beer in a frosty mug)- the sound of a wine cork being pulled, the image of a cocaine pipe or a hypodermic syringe: all of these cues are well established to trigger craving and other behaviors, and one of the bases of cognitive behavioral therapy is to help the patient identify and avoid these high risk episodes.
This module is not designed to go into detail about the more complex “dual diagnosis” patients who have addiction plus another mental health problem, but it is clearly the case that management of the addiction cannot proceed without addressing comorbidities such as depression or generalized anxiety.
And finally, the patient and the providers need to understand that a relapse is more likely than not, just like relapse with heart failure or cancer. When it happens the therapeutic team needs to move quickly to minimize the duration and severity of the relapse and get the patient sober again.
Triggers, Craving, and Relapse…Are you ready to help?