Relapse Prevention & the Meaning of Life
Good judgement is the result of experience;
Experience is the result of bad judgement.
— Fred Brooks
A notorious attribute of Incentive Use Disorders is the high rate of relapse. Ignorant of the results of outcome research, most people who achieve good short-term outcome believe that their initial success means that they have licked this problem. Understand this: Preventing relapse is a task worthy of your attention even after good outcome seems assured.
As the collaborator with a lot of training in psychology and experience accompanying many individuals through a passage similar to the one you are now undertaking, I can warn you of and prepare you for the challenges you will likely face. For example, a first lapse is much more likely and much more destructive than most people realize. I also can help you develop strategies to successfully overcome these challenges and achieve good outcome. Your part is to identify the specific high-risk situations you are likely to encounter, and to make the changes in your social environment and personal coping skills that enable you to successfully cope with them. [Admittedly, yours is the more difficult assignment].
Relapse Prevention Plan
With my generic knowledge about what it takes to follow the path of greatest advantage, and your specific knowledge of your circumstances, history, and Core Motivation, we can prepare for the challenges that are waiting for you.
For example, a predictable challenge is a first lapse. Hopefully, you will not lapse, because they are terrible for you and everyone else. However, if you do have a first lapse, what do you recommend that you do so you get back on track? What do you want your therapist or spouse to do? If you are collaborating with me, what do you want me to do?
Relapse road map
We certainly do not want to wait for a first lapse to engage the challenge. The earlier in the sequence that you begin to respond mindfully the better. Relapses tend to follow predictable paths. When looking back on their relapse, most people can pick out moments when they could have made a different choice and avoided a lot needless pain.
If you have relapsed before, you may be able to identify the critical moments when momentum was lost — see Warning Signals. Typical warning signals of succumbing to the path of least resistance include: decreased use of the exercises and tools of this course, decreased communication with PARTS clinical staff or you personal therapist, lying or withholding information from a collaborator or spouse. Perhaps there are others that you can recognize. The value of being able to predict the future is to prepare yourself in advance to do something that works when the warning signal occurs.
There are two levels of a Relapse Prevention Plan: What you agree to do and what you want your collaborator to do. The thought experiment below is to be used with the Relapse Prevention Plan.
Thought Experiment: Relapse Roadmap & Plan
[For this thought experiment please print out the Sample Relapse Prevention Plan or view it on your screen.]
Review the sequence of events of a relapse in reverse order. Begin with the feeling of remorse a day or two after the first lapse.
- From the perspective of a kindly observer viewing your situation from the disocciative perspective, what do you recommend that you (the person who has recently lapsed) do to maximize the chances for good long-term outcome?
- What do you want your collaborator [spouse, therapist, Dr. Dubin] to do?
Now go further back in time to the sequence of events that preceded the lapse. The goal here is to identify an event that you could have used as a warning signal that you were losing momentum and need to execute some willful action to prevent relapse.
- What was the warning signal?
- Examples: Thinking about using, planning to use, lying to or holding information back from your collaborator, decreased involvment with this course. etc.
- What is the kindly observer's recommendation for what you should do?
- What do you recommend your collaborator do? [Naturally, you will have to inform the collaborator that it is time to act].
Consider other events or signs of loss of momentum that occur earlier in the sequence and make recommendations about what you should do and what your collaborator should do the prevent relapse.
If I stop using this course I will
The Relapse Prevention Plan is stated in Implementation Intention Format: When X [warning signal] then Y [the planned response].
It looks different in hindsight than it feels as you live through the sequence. You may approach the incentive without sensing any conflict. It is only when you become aware of the experience of conflict that you can be warned to do something mindful to interrupt the path of least resistance that leads to relapse.
Once you notice the conflict you will have to do something quickly — when local conditions promote incentive use, time is your enemy. Intentional Trance Formation involves shifting your attention from highly salient stimuli that promote the path of least resistance, to stimuli that more resourceful trances.