Relapse is all over the news these days, with the one-two punch of Demi Lovato and Ben Affleck relapsing in such close proximity to each other.

Celebrities who struggle with addiction and talk openly about their recovery face a double-edged sword; the media loves to sensationalize active use and/or relapse, and a celebrity thriving in recovery doesn't get much press. The story just isn't "juicy" enough. But every time relapse is spoken about openly - celebrity or not - it's an opportunity to educate everyone on addiction, relapse, and recovery. 

Demi Lovato and Ben Affleck, due to their celebrity status, are a barometer for the way people respond to relapse. There is a LOT of talk in the media about their struggles, what led to their relapse, even speculation about WHY they relapsed. None of this is worthwhile, and it perpetuates the stigma around addiction and relapse.  They did not fail. They are not weaker than others. They are addicts in recovery who need to get help, make adjustments, and continue on in their recovery. And they are STILL IN RECOVERY. Relapse is only an indication that there are still changes they need to make in their program, their self-care, mental health, and/or environment. There is something about the relationship they have to themselves, and their recovery, that needs to change. It's no more and no less than that. 

What Relapse Is, and What It Isn't

A relapse is a spiral into compulsive behavior and maladaptive coping mechanisms. For someone who has abstained from alcohol and/or drugs for a period of time, the primary symptom of relapse is picking up a substance. While relapse is most commonly spoken of in terms of using a substance, relapse materializes in many forms. Any time we seek to escape our reality though unhealthy behaviors, it can be considered a relapse. It can look like falling back into a codependent relationship, an unhealthy relationship with food, gambling, an active eating disorder, self-harm, and many others. Whatever battle we are fighting, any time we revert back to unhealthy, impulsive, and escaping behaviors, we are in relapse.

A relapse never occurs suddenly.  Let me reiterate that: while it make look sudden, and even feel sudden to the addict, there are always warning signs and other identifiable factors that appear in advance of the physical relapse. This is both the good news and the bad news about relapse. It is a teachable experience, and how we deal with it has everything to do with our ability to continue our recovery. 

Here is what relapse is NOT:

• a moral failing
• weakness 
• a negation of the work someone has already done in their recovery

Unlike the first time someone gets sober, relapse can be devastating to an addict (and their loved ones) because there is a feeling that someone "should know better". Addicts themselves can fall victim to this rhetoric, and experience deep shame that they "did it again", despite all their best intentions and despite working some kind of recovery program. This shame prevents people in relapse from reaching for help, and is - quite literally - killing people as a result. There needs to be more open and honest discourse surrounding relapse to counterbalance this feeling of failure.  Many people who relapse and seek recovery again say they feel like "a bad person trying to get good", instead of the reality which is that they are a sick person trying to get well.  There is no room for moral judgement when it comes to relapse. It simply doesn't apply.

Destigmatizing Relapse 

There is a lot of dialogue now, thankfully, around destigmatizing addiction. Slowly, people are being educated on the fact that addiction is a diagnosable disease that needs to be treated like the chronic and potentially fatal condition that it is. 

Understanding around relapse is slower to emerge, likely because it is often as baffling to the relapser as it is to those around them. The common rhetoric most people in recovery hear is "relapse doesn't have to be part of recovery". This is a noble and worthwhile goal for anyone in recovery, but the reality looks very different. We can't battle the stigma surrounding relapse until we take an honest look at the facts.  According to the National Institute of Drug Abuse , between 40-60% of addicts will experience relapse, many more than once. 

Relapse IS a part of recovery for approximately 50% of addicts. The silver lining is that any relapse is a valuable learning experience and an opportunity to make adjustments to one's program of recovery. A program of recovery is no different than a treatment protocol for a cancer or diabetes patient. If a cancer patient has a recurrence of cancer cells, a physician adjusts the treatment protocols: different chemo, more radiation, etc. An addict who relapses needs to do the same. They can look at what worked, and what didn't, with their recovery program and make adjustments accordingly. 

Relapse Response

When an addict relapses, the objective is to shorten the duration and acuity of the relapse. Instead of a "how could you?", "why did you", or "you know better" responses, the questions to ask are "what kind of help do you need right now" and "what needs to change"? 

If someone in relapse feels they will be shamed or shunned for reaching for help, they stay in relapse. If they feel they will be met with support and an action plan to help them, they are much more likely to reach out for help. In some recovery circles, there is a "back to day one" notion, meaning that if you relapse your counter resets to absolute zero. While this may be true in the actual number of days someone has abstained from using, it is NOT true when it comes to the progress they have made in their recovery so far. Everything they learned in recovery - including what didn't work - is of value. 

There is an analogy for this that is poignant: if you were driving to Los Angeles from Boston and you got lost in Chicago, would you drive all the way back to Boston and start over? No. You would reroute, consult people who know how to get to Los Angeles, adjust your path, and continue on. 

The same is true of recovery. If relapse happens we can get help, make adjustments, regroup, and keep moving forward. 

What to Do If You Relapse

• Ask for help: it is very, very difficult to pull yourself out of relapse. Ask a safe person for help, whether it is a friend, recovery coach, loved one, spiritual adviser, or therapist, the first step is TALKING to someone. Getting honest with another person helps you get honest with yourself. 
• Get Honest: Asking for help and getting honest go hand-in-hand, because people can only work with what you tell them. Resist the urge to minimize and/or justify. Simply saying you're in relapse and need help is enough. You have time to figure out what happened and what you need to adjust later. 
• Come Up with a Plan of Action: Do you need a physical detox? Do you need inpatient or outpatient help? Perhaps you need to address something in your life that continues to undermine your recovery, like a stressful job, toxic relationship, and/or other unhealthy behaviors that keep you off balance. The idea is to get support and be safe while you work through what needs to change.
• Tell People What is Helpful, and What Isn't: In other words: advocate for yourself. You may be experiencing shame (due to the judgement, or perceived judgement, of others) but don't let this keep you from speaking up for what you need. If someone isn't being helpful, or is unable to be objective in some way, move on. Your life depends on your ability to get the help you need, so it is fruitless to waste valuable time explaining yourself, trying to make others feel better about your relapse, and/or minimize your pain to placate others. 
• Be Proud of Yourself: You may be shaking your head at this one, thinking "relapse is AWFUL, what is there to be proud of?" Relapse is what it is, and it is treatable. It is hard to ask for help, make changes, and get honest. It takes courage to reach out for help. Dwelling on shame and self-deprecation keeps you stuck. Cultivate pride and self-worth, because you deserve to be healthy, balanced, and whole. 

What To Do If Someone Asks You For Help

• Be Kind: This can be very challenging if you feel angry or disillusioned by a loved one's relapse.  What this person needs right now is your support and a plan of action. There will be time to work through how you feel, and if you need immediate help with your emotions around a loved one's relapse go get help for yourself. Asking the person causing your pain to help you fix it is not helpful for anyone. If you feel you are too angry and/or upset to help, be honest about that. You can help direct them to someone more objective, like a therapist or other loved one, but the immediate wake of a relapse is not the time or the place to subject them to your feelings.
• Listen: Listening without judgement helps the relapser get honest, and allows them to feel safe opening up to you. Even if you aren't sure yet what the plan of action will be, you can simply listen and be there for them. You may not understand, or know what to do, but allowing them a safe space to talk is an important first step. 
• Don't Fix/Ask for Help: Just like the relapser can't fix themselves, you need a support system as well. There are 12-step communities for loved ones of addicts, as well as a multitude of other communities and counselors who can give you the support you need. You can walk alongside someone as they get help after relapse, but you cannot fix them on your own. Marshall the resources you need to take care of yourself, so you are on steady ground to help the ones you love.
• Detach with Love: If you have a loved one who relapses and they are not seeking help, detach with love. Prioritize your own self care without shaming the relapser. Stay neutral and take care of yourself. If and when they are ready for help they may turn to you, but if you shame them or react in anger/resentment, you will make things worse for them AND for you.
• Be Honest: Just like the relapser needs to get honest, so do you.  Be honest with yourself about how you feel, and what you're able to do to help.  As the prior points emphasize, you can't help anyone if you struggle yourself. Talk to people who can understand how you feel, and find a support system of your own which does NOT include the relapser. You are not alone. 

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Significant progress has been made de-stigmatizing substance use disorder, but it remains difficult for many people to ask for help. People often go to great lengths to avoid actually asking another human being for help for a variety of reasons, including the fact that as children we were not taught how, nor is asking for help modeled often in modern-day society. 

Familial and Societal Influences 

If the messages you received as a child, directly or indirectly, taught you that reaching out for help was weak,  unacceptable, futile, or embarrassing, it makes sense that you would avoid doing so whenever possible. It's human nature to fear rejection, and if you have a history of reaching for help - even for simple things - and being ignored or shut down, asking for help will be even more difficult as an adult. 

Society bombards us with images of 'perfection' - in mainstream media, social media, television, and magazines. Everywhere we look, especially as impressionable young adults, we are imprinted with the way things "should" be, and this leads us to compare and not identify with others. 

Human beings are social animals, and there is an evolutionary component to why it's so hard to ask for help. To ensure we will always be welcome in our communities we develop responses, like fear and pain (physical or emotional), that let us know when we risk alienation. When our social standing in the community feels threatened, these responses are triggered. We fear losing status, being treated unfairly, facing uncertainty, and rejection. When we experience all or some of these things, it creates deep distress and our brain signals that we need to modify our behavior to community norms and get back within the fold.

This deep fear of being ostracized is based in our primal longing for connection.  

One of the hallmark symptoms of substance use disorder is that it tells us we are all alone, that we are weak, immoral, or broken, and that we are the only ones struggling the way we do.  As much as we ache to break free from the grip of drinking or drug use, we look around at society and it seems like everything comes so much more easily to other people. Our disease, coupled with our instinctual fear of rejection, can prevent us from reaching out for help.

The Role of Denial 

Denial is also a major obstacle to asking for help. As our drinking or drug use progresses, we justify and minimize our behaviors, making it harder to see the truth of how much trouble we're in. When actively drinking or using drugs, there is also a part of our brain that doesn't want the help - that feels like drinking or drugs is the only thing holding us together (even though the opposite is true) - and wants to cling to our substance of choice like a life-raft. 

Asking for Help is Connection 

The irony is that asking for help is the opposite of alienation; it is a powerful form of human connection. If you are having trouble believing this, think about how you feel when someone asks you for help. Knowing someone loves and trusts you enough to ask you for help feels amazing, doesn't it? Would you ever reject or ignore a loved one asking you for help? Treat yourself with the same kindness you would someone you love. 
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Asking for Help is Brave

If you were raised to believe asking for help is weak or wrong, remind yourself that peoples' inability to ask for help is based in fear. Facing any fear involves courage and bravery, which is the opposite of weakness. Not everyone can understand substance use, but everyone can understand the bravery it takes to reach out to another human being for help. Focus on the ways people are identifying with your strength, as opposed to listening to the narrative in your head that wants to silence you. 

Five Ways to Ask for Help with Substance Use Disorder
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• Find a Real-Life Community Who Understands:  Nobody can provide insight, empathy, and assistance like someone who has been through a struggle similar to yours and has come out the other side. They likely remember what it was like to be where you are, and will do what they can to help. They can talk to you about what they did that helped them, and can introduce you to other people who will also understand. Look for 12-step meetings in your area, as you are assured that everyone at the meeting is there for the same reason you are, and can help. Look online for local resources, groups, and communities and reach out to them. The important first step is connection, and getting out of your own head. 
• Talk to Someone You Trust: Most people have someone in their life that they know they can talk to about anything. If you know someone like this, turn to them. Even if they have no personal experience with substance use disorder, they love you and can help you make sense of what is going on. They can walk side-by-side with you through the next steps so you aren't alone.
• Talk to a Professional and/or Expert: There are counselors, psychologists, recovery coaches, and therapists who specialize in substance use disorder who can help, and who are bound by confidentiality. These professionals are experts in the field of substance use and recovery, and can give you advise on next steps and walk with you through your journey. It's important to be completely honest, too, as they can only be as helpful as you are truthful. 
• Start Online:  While the ultimate goal is to find real-life people who can help, looking online is can be a good start. Sometimes, it’s easier to admit to struggling from the safety of a computer rather than face-to-face with someone. Find addiction/recovery blogs you can identify with, but be careful. It's important to find reliable/legitimate resources when looking online (there are many chat rooms, help lines, and websites that are thinly disguised marketing sites). 
• Write it Down: If you can't bring yourself to talk to another person, at least not yet, start by keeping a journal where you write honestly about how you feel and what you're going through. There is a power to the truth, and it helps break down the difficult obstacle formed by denial. Treat yourself with compassion, and pay attention to the language you use about yourself. Get honest, and speak to yourself like you would someone you love. Shame fuels isolation and fear. Remind yourself that you are strong, brave, and worth it.

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​You may have heard the term 'holding space' for someone, but what does that actually mean? 

We live in an instant gratification world. We are an action-oriented society full of doers. When we encounter our own struggles, or the struggles of others, our natural instinct is usually to jump into action and "help" or "fix". This isn't inherently a bad response (there are no 'bad' responses, really), but sometimes action isn't what's needed. Sometimes what we need is a compassionate shoulder to lean on, a listening ear, and the warmth of companionship. Sometimes what we really need is someone to just be with us. 

Holding space for someone means we are willing to walk alongside another person on whatever journey they’re on without trying to fix them, judge them, make them feel inadequate, or try to impact or control the outcome. When we hold space for other people, we open our hearts, offer unconditional support, and let go of judgement and control.

Sounds straightforward, right? It's simple, but it's not easy. 

Why We Hide Our True Feelings

How many of us have been in some form of emotional pain but when someone asks how we're doing we say "fine"? How often do we plaster a smile on our faces to mask our struggles, instead of allowing our emotions and thoughts to bubble to the surface? in some instances, of course, it's appropriate not to share. But why do we do this even with loved ones or friends who genuinely care? Maybe it is because we don't want to feel like a burden. Perhaps we don't feel emotionally safe being vulnerable. We often justify being closed-up by thinking someone couldn't possibly understand, but most often it's because we're afraid. Afraid that if we open up and don't get a compassionate or understanding response, we will feel hurt and/or rejected. So we play it safe, and keep our true emotions safely under guard.

Part of the reason for this fear is that often well-intentioned people don't allow us to simply experience emotions. They minimize in an effort to make things seem okay, even when they're not. They offer solutions or try to fix us, which can only serve to make us feel more broken. They switch the topic to themselves in an effort to identify - whether they are on-point or not - which makes us feel less-than or like we're 'complaining'.  Perhaps they offer platitudes, or tell us it will all be okay, which makes us feel unheard.

Think of holding space for someone as becoming a safe container for them, where they can feel what they feel in whatever form that takes. We spend so much of our lives performing in some respect. At work, home, with friends and acquaintances, so much of our life requires us to be on.  

6 Ways to Hold Space for Someone

So how does one actually do this? How can you hold space for someone? It can be very difficult to do, especially when you love someone and it hurts your heart to see them in pain. 

• Active Listening: Hearing isn't the same as listening. Active listening, sometimes called deep listening, involves more than sitting quietly and paying attention, it means focusing on what a person needs in that moment - is it holding their hand or rubbing their back? Is it making, or avoiding, eye contact? Listening doesn't always mean someone is talking, either. You can both sit in companionable silence and listen with your heart. When you hold space and listen, it may involve no speaking at all. The important thing is to be compassionately intuitive about what they need, and if you're not sure giving them the space to just be. 
• Practice Non-Judgment: If asked, most of us would likely say we aren't judgmental. If we're being still and paying attention to our own inner narrative, however, we sometimes find small ways we pass judgement whether we know it or not. Maybe we feel impatient, or inadequately equipped to help, or are even slightly distracted. These things wouldn't be described as being judgmental, per se, but they are all distractions from holding space for someone else, which can feel like judgment for the person in pain. When someone is being vulnerable they are highly attuned to any signs of judgment, so practicing total focus and neutrality is a gift to them when holding space.
• Don't Fix: This is one of the hardest aspects of holding space. Letting someone simply feel how they feel is hard. It's a natural instinct to want to offer help and/or offer solutions, but when holding space this isn't always helpful, because it can rob the person of the ability to experience their emotions in their purest form. When we try to fix, we can inadvertently make someone feel more broken, or that they need to make us feel better instead of focusing on themselves. Let someone cry, or speak, or rant, sit quietly - whatever they need to do to get their feelings out. Let those feelings just land where they are, instead of trying to do something about them. 
• Identify, Don't Usurp: It is common, when someone shares their struggles, to try to identify with them by sharing your own experiences. Sometimes, if asked for, this may be helpful. If it's not requested, however, it isn't holding space, because it shifts the focus to you, and requires the person in pain to respond to you instead of the other way around. It also may not be an accurate reflection of how they are feeling, which makes them feel unheard. Instead of offering your own experiences, ask questions. Let the person know you are listening, and that you want to know more about how they feel. Having a similar experience will make you better at holding space, but it isn't necessary to let the person know your own specifics.
• Don't Control: Just like with judgment, many of us would say we don't try to control others. Even those of us who actively work at acceptance and surrender struggle with control, and it can reveal itself in subtle ways. When someone you love is in pain, of course you want them not to be in pain anymore. It's human nature to feel this way. Holding space for someone means we sublimate our wish that they weren't in pain and allow them to experience their feelings exactly as they are. This is much, much harder than it sounds. Even the inner desire that they weren't in pain is a subtle form of control, and it is important not to communicate this, in words or actions,  to someone in pain. Telling someone, even from a place of absolute love and good intention, "I wish you weren't in such pain", may seem like compassion when in fact it can make the person feel like they have to minimize or edit their true feelings so they don't feel like a burden. Holding space means saying "I'm here for you", instead of "I hate that you're going through this". 
• Practice Loving-Kindness: This seems kind of obvious, but practicing loving-kindness is more complex than simply expressing love and kindness. Loving-kindness is a term rooted in Buddhist tradition, and it describes the reverent present-moment cultivation of compassion and love. Loving-kindness is an action, not simply a feeling. It is the difference between telling someone you love them, and showing someone you do. Loving-kindness is an expression of deep compassion, and an acknowledgement of the inter-connectedness of all living things. When holding space for someone, loving-kindness is being in the present moment with them exactly as they are, and showing them they are not alone.

You hear a lot about mindfulness in any kind of recovery, whether it's from substance use, mental health conditions, co-dependency or any other behavior that isn't serving our whole health.

Some think of mindfulness as synonymous with meditation, yoga, or some other structured practice. While it's true that mindfulness can (and often does) include these practices, there are ways to incorporate mindfulness into every day life that can greatly benefit your peace of mind and recovery.  It is particularly useful for people struggling with unhealthy cravings of any kind, whether for alcohol, drugs, food, sex, relationships, shopping or anything that is used to escape, distract, and numb.

What is Mindfulness?

At its essence, mindfulness is the art of being present and aware of any given moment.  The dictionary tells us mindfulness is "a mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations, used as a therapeutic technique."

One critical element of this definition that is easy to miss, and it's at the center of mindfulness, is this: "calmly ...accepting one's feelings".  Mindfulness is more than simply acknowledging thoughts or feelings, it's experiencing them without judgement and with loving kindness.

Sounds simple, right? Simple perhaps, but not easy. It is astonishingly hard to stay in the moment in today's world, with all the information and distractions coming at us from every direction. It's even harder to accept the present moment - exactly as it is - without wrapping our own judgments and reactions around it. We tend to categorize experiences immediately - often imperceptibly - as  "good', "bad", "scary", "uncomfortable", etc.  Being mindful teaches us to distance ourselves from our own interpretations and cultivate gentle acceptance of everything exactly as it is.

But.... It's Not Fair! 

Most unhealthy or maladaptive behaviors stem from our desire to escape and/or numb what we perceive to be undesirable thoughts, feelings and experiences. We seek to gain control - or the perception of control - over things we do not wish to experience. This is why so many of our unhealthy behaviors feel like solutions, at least in the beginning. We believe we are allowing ourselves to avoid unpleasantness of any kind by disappearing ourselves in to our substance of choice or other escaping behavior.  In fact, all we are doing is removing ourselves from the moment, from reality. The problems and feelings aren't better - in fact they are usually getting worse - but we don't have to be emotionally present for them. 

Mindfulness is the opposite of escaping or numbing. Instead of seeking to avoid, we accept.

Let's say you get into trouble at work, and your boss is yelling at you for something you don't believe to be your fault. While experiencing this undesirable situation, your brain will scramble to put up blocks to avoid feeling pain or discomfort. You may deny, or protest. You may make excuses or blame your boss for being unreasonable. These responses are all to avoid accepting the situation exactly as it is.  It is especially challenging to be mindful when you feel unjustly or unfairly treated in some way. 

If you are being mindful about the same situation, you don't judge or avoid. You don't wrap your own thoughts, interpretations or feelings around the experience. You stay in the moment and don't seek to shield, distract or numb. You allow moments to come, and go (and they always go) without altering their reality in any way. 

Mindfulness and Cravings

We all know what a craving feels like; it's a seemingly uncontrollable urge to turn to a substance, person, place or thing for comfort and/or escape. People usually think of cravings in terms of substance use - an urge to use drugs or alcohol - but cravings come in all forms. We can lose ourselves in relationships, chaos, drama, shopping, food .. the list goes on and on.

When we're in the middle of a craving it feels like it will last forever, and that's when we're at the highest risk of relapse from the behavior we are recovering from. In reality, the average craving lasts 7 minutes from beginning to end, and its peak lasts from seconds to a minute. Instead of intensifying the urge to give in to a craving, mindfulness allows you to live with it - and through it - without the need to act on it.

How do you do this, though, when the craving feels like it's got complete control? 

Tips for Using Mindfulness for Cravings: 

Like all things, using mindfulness in the face of such odds takes practice and repetition. Here are some useful tools to use to cultivate mindfulness: 

• Observe: Instead of allowing your thoughts to become your reality, observe them. If your mind is saying to you, "I'll never make it through this, I have to use!", don't try to banish the thought because that will only make it stronger. When someone says "Don't think about polar bears" what do you think about? Polar bears. Almost like looking at subtitles of a movie, or a ticker-tape, step back from your thoughts and observe what they are, not how you feel about them.  Pay attention to how those thoughts feel in your body. Is your throat getting tight? Is your stomach in knots? Cultivate a curiosity about your experience, rather than avoidance. This new response to a craving becomes more natural over time, and can delay acting on it long enough for the craving to pass.

 

• Accept: Remind yourself that you know exactly what this is, and that it will pass. Don't label it; it is a craving, nothing more. It's not "bad" or "wrong". Mindfulness teaches us that everything we experience is naturally occurring, and deserves a place in our whole life experience. Allow the craving to exist, and pass, in its own way.

 

• Stay Open:  While you're observing and a accepting the craving, allow yourself to embrace the fact that all experiences are there for a reason, and if we stay open all experiences are great teachers. Cravings are a natural part of healing as much as they are part of our struggle.  

 

• Be Gentle: Loving kindness is an essential part of mindfulness. This doesn't mean that we create a loving response to all things, or pretty them up in an unrealistic way. Loving kindness is a natural extension of acceptance; it means we give space to all experiences, thoughts, and feelings without labeling or judgement. We can do this with people and relationships, too. Back to the example of your boss yelling at you - if you give him space to exist exactly as he is, instead of labeling him as "wrong" or "mean", for example, you create a loving kindness around the whole experience. Rather than falling into black and white thinking like "he's always so mean" or "he hates me", you leave room for him to be exactly who he is, too.

 

• Be Patient: Patience can be especially challenging in recovery. It can feel sometimes like you take two steps forward, and then take one step back. Our urge to think, "I shouldn't be feeling this way anymore" can be strong. There are no shoulds.  Banish the word from your self-narrative. Replace "should" with "am".  See the difference? Between "I shouldn't feel this way" and "I am feeling this way"? One has judgement and shame wrapped all around it. The other is a statement of fact about what is. 

 

• Be Still:  When in the throes of a craving, even if you can't get to a place of acceptance or loving kindness with it, just be still. Doing nothing, in the face of adversity or discomfort, is doing something.  When all you want to do is run to your drug of choice, toxic relationship, or other escaping/distracting behavior, being in the moment and sitting with things exactly as they are is heroic. Everything passes. Over time you teach yourself that you can sit with a craving, experience it, and allow it to pass without acting on it.