relapse

A Five Tool Relapse Recovery Plan – Tool #5 Stalking and Refueling

May 23, 2023 by Ken Wells

Relapse leaves an aftermath of hopeless discouragement and devastating defeat. Ringing in the ears of every addict who relapses is “I know I didn’t have to do it but somehow I just couldn’t stop!” Other addicts in recovery say, “I get it but there’s something about me that can’t! I am destined to fail!” Then there is the tide of thought that tells you to “Just give up!” The voice of shame says “Addicts like you are destined to fail! It’s part of your legacy to be flawed. You will never get it!” And so it goes.

The 5th tool in relapse recovery is well-known but sparingly utilized. Addicts in recovery know about shame. They have heard sponsors and therapists talk about shame reduction. Maybe they have listened to or read some of Brené Brown’s thoughts about shame. I have written about shame many times. Yet, shame continues to dominate addicts in recovery.

Education about shame is important. The more written about shame the greater the insight and instruction about how to manage it. We live in a golden era of enlightenment. However, what is critical to shame management is consistent action. People won’t rid themselves of shame simply through insight and understanding. It requires taking consistent action steps to manage. Shame is a dynamic that every person must regulate. It is not a dynamic that goes away with maturity, recovery, or spiritual growth. It is a life experience to be supervised and maintained with healthy choices.

Addicts who relapse find themselves in a gulf of shame. Negative cognitions pepper their brain like an unrelenting hurricane. Battered by a toxic chatterbox within, the likely choice is to continue the destructive acting-out behavior. At least, you will have some relief from the numbing experience afterward. Yet like the eye of the storm in a hurricane, the backside of the storm of shame is wicked and devastating. It ravages self-esteem while addicts wallow in the mud of misbelief. For some, this blitz of battering has ended in fatality. A category 5 storm of shame is serious business and requires an all-hands-on-deck approach to manage and regulate. Here are my suggestions:

After you have relapsed, practice doing the next right thing no matter how you feel inside. Absolutely, force yourself to get back on track. Make yourself dinner. Finish the project at work. Go to a meeting. Make a phone call. Focus on one thing you can do that represents self-care. Tell on yourself. No matter what or how you feel, take one step in the right direction and then build on that. You will feel phony. There will be a tremendous war inside to wallow in self-pity. Practice taking one step uninspired. When your insides scream at you to quit, just take one more step in the right direction. Stay the course. It will get better. You will feel different in time. There will be no reduction in shame without this process.

Cocoon yourself with affirmation. This is difficult when your inner chatterbox is telling you what a screw-up you are. That said, write out positive affirmations about your being, not so much about what you do. “I am an unrepeatable miracle of the universe”. “I am worthy of love”. “I am doing the next right thing” etc. Your negative chatterbox will want to swat you down when you affirm yourself. There will be a war inside. You must win the war by regularly training your brain with positive affirmations. Most addicts in recovery overlook the value of repetition and visualization of positive affirmations. It takes work. Greatness comes from consistency. This work will bring you back to center. It is the greatest tool I know toward establishing long-term sobriety. Don’t underestimate its power and efficacy.

Practice ignoring your inner negative chatterbox. You can sit in a room full of people and be very lonely. You can sit in a room full of people and be battered by your inner negative chatterbox and no one will ever know. This is your battle. To overcome your chatterbox, it is not necessary to eliminate the negative voices. What you must do is practice and train yourself to ignore its message. Right now I have a hundred different messages screaming hurtful, discouraging messages about my inadequacy, helplessness, and inept ability to create inspiration and positive outcomes in my life. The key is not to escape these negative cognitions. Rather, what is important is to practice ignoring what they have to say to me. There are times that I will need to address each cognition. However, throughout my day-to-day life, I practice ignoring their suggestions. It is similar to an athlete ignoring the negative booing or derisive catcalls that are screamed by fans in the stands. You simply ignore and focus on the task at hand by immersing yourself in the positive belief that comes from inspiring affirmations that you have learned to feed your spirit.

Take time to grieve your loss and refuel your visions. When failure is experienced most of us don’t take time for effective grieving. When you are in the middle of the intersection and a bus is barreling toward you, it is not the time to sit down and grieve. I am always amazed at how many addicts hunker down and let the bus run over them again and again. No, this is the time to get up and move your ass out of harm’s way. However, once you have gotten out of harm’s way, it is important to grieve. Anger, sadness, regret, misgivings, disappointment, and even despair are all hallmark feelings that characterize appropriate grief. Learning to grieve deeply is critical to refueling your dreams. There is a time to act and function and a time to grieve. There is a time to not mix the two together and a time to function while you grieve. Both are important. You don’t have to feel 100% to be 100% committed to necessary action and function. As you grieve, it will be necessary to step back and refuel your visions. Every mistake provides an insight for future destiny. Be gentle with yourself. Be determined that you will extract meaningfulness from every mistake in recovery you make. Transform your fear of abandonment and nagging self-blame to unconditional confidence that comes when you allow yourself to go down and grieve the losses. You will come back up. Trust this process. This is the place shame recedes, and unconditional confidence rules, not in control of outcomes but within your spirit. You will know that no defeat, no disappointment, will be experienced that you cannot come back up from with greater strength.

A 5 Tool Relapse Recovery Plan: Tool #4

May 19, 2023 by Ken Wells

Coroners do autopsies when they think it is important to determine the cause of death. Autopsies can be very sophisticated and detailed. They determine the cause of death, the time the individual died, and a host of other specifics that are important. Sometimes performing an autopsy gives resolution and sanity to love ones while they grapple with the unknown. Answers to questions like “What and why did this happen” are often clarified from the results of a thorough autopsy. Science uses autopsy results to assist in the cure of disease. Healthcare workers utilize autopsy results to create protocols to keep others safe from toxic and high-risk infectious diseases.

Millions of people suffer from the disease of addiction. Admitting that your life is powerless and unmanageable because of your drug of choice is a tough step to take. However, admitting relapse failure after getting into treatment is also difficult. Most addicts who relapse either don’t tell anyone or admit it to support people and try to distance themselves from the painful relapse as quickly as possible.

A lapse autopsy around addictive relapse is crucial to long-term sobriety. Admitting the relapse and moving forward with determination to abstain without insight into the build-up behaviors that triggered relapse is a guarantee to repeating destructive behavior. A lapse autopsy is a powerful tool to identify what happened that created relapse and what needs to change to avoid chronic failure. Consider the following steps toward completing a lapse autopsy.

Write out or tell someone what happened in complete detail. It is important to turn over every stone of your relapse behavior to help you see clearly what happened. When you minimize and gloss over thoughts and behaviors leading to and engaging in relapse behavior, you will miss what is needed to establish a strong intervention.

Identify environmental influences. The environment you live in makes a big difference toward relapse prevention. Think about the relationship conflicts, stress factors, and physical experiences that contributed to your vulnerability to relapse. Unresolved tension in a partner relationship can trigger mistaken beliefs that lead to relapse. Stress build-up from relational, financial, sexual, physical, and parental struggles all influence the possibility of relapse. Take stock of the environment that encompassed you leading up to and including the time you relapsed. Assess the experience of deprivation that fuels entitlement. What were you deprived of? Were there successes that you experienced that were uncomfortable and triggered undeserving thoughts of self-sabotage? You will need to go slow and carefully examine the environment to learn of its influence toward your relapse.

Examine your thoughts leading up to the time you relapsed. What you think about expands. It is critical to examine the mistaken beliefs that marinated in your mind before acting out. If you tell yourself that you are not enough or that you are a failure etc, then in time you will create the data to support that belief, which will convince you to produce more of the same behavior to support your inner thoughts. This is why it is crucial to be aware of negative cognitions so that you can change your thoughts which will help you change your life.

Be aware of the progression of thoughts and behaviors that lead you to acting out. When you anticipate someone rejecting you it triggers a victim-posture attitude. A mask is needed to hide your shameful thoughts and you seek to emotionally isolate to avoid the uncomfortable build-up. Fantasy helps you vacate discomfort which eventually triggers inappropriate addictive fantasy. Optimistically you begin to select a strategy to pursue your addiction while grooming yourself and others in ways that enable you to pursue your secret desires. After you relapse you tell yourself that you need to stop and misplace the responsibility for acting out on some person or force outside of your control. You then reconstitute with behaviors that would indicate to others and yourself that you are not the kind of person who would addictively act out. These steps toward relapse can happen as quickly as the snap of a finger. It is necessary to utilize the lapse autopsy to slow your thinking and to be aware of the negative progression of behaviors that gave birth to relapse.

Map out what you will commit to doing differently to avoid relapse. This includes consideration at every level of activity. Some people think that it is necessary to go back and do all the steps again or to attend 90 meetings in 90 days because of their relapse. Maybe so. However, a lapse autopsy will help you clarify where you got off track so that you can specifically target interventions that will help you return to the space of relapse prevention.

After you complete your lapse autopsy it is helpful to sit down and review each misstep with your sponsor or support friend and clarify what you will commit to do differently with each misstep.

The lapse autopsy is necessary to create clarity in the presence of chaotic relapse behavior. It helps to create grounding and bring you back to center to continue your recovery journey.

Essentially, a lapse autopsy is what every sports team does when they study film from a previous game. This is the way they learn and improve. It is true for businesses that take time for quarterly and yearly reviews. The lapse autopsy has proven to be an excellent tool for long-term sobriety.

A Five Tool Relapse Recovery Plan: Tool #1

May 9, 2023 by Ken Wells

In baseball, a 5-tool player is one who excels in hitting, fielding, speed, hitting for power, and average. There are not many major league players who demonstrate all these skills during any given season. In 2022, Paul Goldschmidt of the St. Louis Cardinals was such a player. It is even more rare for a player to demonstrate these skills throughout a long career. Willie Mays, Hank Aaron, Mickey Mantle, and Barry Bonds are all iconic players who demonstrated these five tools throughout their careers.

Long-term recovery from any destructive behavior requires a commitment to change and new behaviors must be incorporated to replace old destructive conduct. There are five tools necessary to achieve long-term sobriety in addiction recovery. Today, I will discuss one of the tools and follow up with subsequent blogs to cover the other four.

Failure is a reality in almost all aspects of life. Everyone desires to relate to short-term accomplishment and success. But long-term achievement requires more, including the ability to manage failure. People highlight spectacular victory but longevity teaches how to handle human shortcomings.

It is a common response to lower your expectations when encountered with failure. Sometimes it is helpful like when you attempt to achieve unrealistic expectations. However, in many cases lowering expectations is an attempt to soothe yourself from the sting of failure. Addicts tend to scale down expectations for sobriety after they announce their successes in a 12-step meeting but then slip into old destructive patterns of behavior. It is easier to lower expectations than to learn from the disappointment of failed behavior.

Relapse vs lapse are often confusing terms. Relapse behavior for an addict is a reconstitution of old destructive patterns in behavior that engages acting out with a drug of choice. Lapse behavior includes indications of failure in attitude and action around addiction management. It involves behaviors that are short of addictive acting out but engage high-risk patterns of thoughts and behaviors that inevitably do lead to actions of relapse.

There are very few addicts who do not relapse after engaging recovery, no matter the program. All addicts and everyone else fail with lapse behavior. This is simply a human element that touches everybody.

Addicts must learn how to extract the fruit of meaningful lessons and then throw away the rind of failed experiences. This treatment of failed behavior is absolutely critical to anyone who has successfully created long-term sobriety.

Tool #1 is about how to address times when you fail and stumble into old destructive patterns of addictive behavior. You learn what to do when you determine to quit destructive conduct but after your best efforts find yourself back to where you started. You learn how to manage times when you feel defeated with a strong urge to give up. Here are a few considerations to think about:

Tool #1: Engage in a Relapse Litmus Test

Geoff Hewitt wrote a poem about a sailor who was lost at sea and somehow made his way to the shore. Exhausted he fell asleep on the shore only to have the tide come in and sweep him back to sea. This is the story of many addicts in recovery. Managing recovery failure embraces the following components that comprise tool #1.

(a) A beginner’s attitude: The challenge of showing up every day hungry for one thing that will keep you sober and growing. This becomes more difficult the longer you are sober. The tendency is to lose urgency and back off from cultivating personal growth. On a scale of 1 to 10, how would you rate your beginner’s attitude toward recovery? Will you take the initiative to examine where you got off track from your recovery program? Are you willing to do what you need to do to get back to where you need to be? These are the questions required about the humility needed to engage a beginner’s attitude.

(b) Honesty: Recovery requires honesty. Deep emotional honesty is difficult to achieve. Few people achieve this level of honesty. Face the questions: Where am I dishonest with myself? Who have I been dishonest with? Am I willing to make amends and restitution for my dishonesty? Who will I be willing to be accountable to? These are important litmus test questions to guide you through failure.

(c) A willingness to do something different: Albert Einstein’s famous quote “you can’t solve a problem with the same mindset that created it”. Twelve-step communities like to croon “Insanity is doing the same thing over and again, expecting different results”. Ponder what it is that you would be willing to do differently to accomplish the level of sobriety you desire. When you don’t know what to do, brainstorm with your 12-step community for solutions that make sense. Are you willing to go to any length? What would you do differently in the next 24 hours/week/month?

(d) Do whatever it takes to stop the slide of acting out: When skiing on a steep slope and you fall and uncontrollably cascade down the mountain, you do whatever it takes regardless of how it looks to get stopped! Even if you look like the abominable snowman coming down the mountain, one thing matters and that is to stop the fall. It takes the same urgency and burning desire to stop the slide toward addictive behavior. There must be a burning desire within your heart. Although determination alone will never keep you sober, you cannot recover without it.

What Happened? And How Do I Stop the Bleed?

March 31, 2023 by Ken Wells

Alex has never been able to establish more than 30 days of sobriety. It’s not for a lack of effort. He goes to meetings, has a sponsor, completed the Steps, does service work and just got out of rehab for the second time. Still he is stuck with chronic relapse. He’s confused wondering what other steps must he consider to stop his use of cocaine.

John’s not much different. Just a different vice. Johnny Walker Red has been his constant companion through thick and thin . . . lots of pressure as a commodity stock broker. Adrenaline flows every day at work which creates a ton of volatility. Over time his only constant friend has been his Johnny Walker Red. After losing his family, he entered rehab wondering what will it take to stop the crazymaking. He feels the junkie worm crawling up his spine for just one more drink after completing Step 4 with his sponsor. He’s wondering what more can he do?

Kerry got caught ogling and flirting with another waitress by his beleaguered wife, who is going insane from his disrespect. Even though he attends 12-step meetings, has a sponsor, and does therapy, he secretly returned to old destructive behaviors, after being sober for a long period of time. He began accessing porn on a secret burner phone. He has been strongly entertaining and engaging a hooker. He wonders why he abandoned his established sobriety and doesn’t come clean to his recovery support and wife.

Recovery requires an understanding of lapse and relapse behaviors. Relapse occurs when an addict re-engages the old lifestyle of destructive addictive behaviors. Some think of a single act out with a drug of choice as a “slip”. The difference between a “slip” and relapse is that relapse involves a consistent pursuit of old behaviors and not a mere single use. The vernacular is controversial. However you choose to reference a return to old destructive behavior it is against bottom lines and must be addressed.

A lapse in behavior is not a relapse. Lapses involved high-risk situations with people and places. They include mind states, powerful emotions, and behaviors that lead up to a relapse with a drug of choice if ignored.

Addicts in recovery often refer to their behavioral contract around their drug of choice as a sobriety contract. During 12-step meetings they will talk about inner, middle, and outer circles. Sometimes it is referred to as red, yellow, and green circles. Inner/red circles focus on behaviors that define acting out addictive behaviors. Middle/yellow circles define high-risk zones and outer/green circles identify positive, healthy behaviors designed to replace old destructive behaviors.

Lapse behavior is focused around the middle circle and imbalanced outer circle behaviors. Frequently, when an addict relapses, there is a significant focus on recovery tasks that were neglected and an emphasis on getting back to the basics that establish sobriety. Usually, this includes consistent attendance to 12-step meetings, regular contact with your sponsor, working the steps and picking up the phone, and reaching out to other addicts during craving for your drug of choice.

In general, these are important first steps to “getting back on the horse” and addressing your addiction when you engage in either lapse or relapse behaviors. That said, if you primarily focus on outside program intervention, you are likely to overlook what is critically missing on the inside.

During addiction recovery, when relapse occurs most addicts look to outside interventions that trigger an inside collapse of values and commitment to sobriety. But many addicts fail to look inside. Generally, it makes sense to examine tools from inside that were either not used or misused which opened the door to backsliding.

Here are some examples.

Alex: While Alex was sincere in prioritizing therapy, meetings, steps, and service work, he failed to address self-sabotage inside. Enmeshed with his mother as a teenager he felt responsible to be her emotional support when his dad abandoned the family for another woman. Overwhelmed and depressed, Alex learned to depend on speedballs to get thru the rigors of academia in college. He likely won’t experience consistent sobriety without addressing his enmeshment with mom no matter how many meetings or rehab stints he engages. Unpacking destructive enmeshment and discovering his own self-identity (inside work) will be necessary for him to establish distance from his drug of choice and provide an inner healthy resource.

John: While 12-step work is critical for John’s healing, he likely will not put a cork in the bottle until he addresses unresolved issues with his family of origin. Mom and dad were both alcoholics. Dad was a successful high-volume gastroenterologist who worked long hours during the week, and he drank and fought with his wife during the weekend. John learned to pretend his family was All American and that what was really important was to figure out how to be productive in his professional life. Without addressing the trauma of neglect and abandonment inside, it is unlikely that John will find a better friend than his Johnny Walker Red. He might learn to switch to another addiction but the craving that dominates within will remain until he addresses his trauma.

Kerry: While he knows what to do to bring himself in balance with his recovery program, he hesitates because he is fearful to face the anger of his wife and the accountability from his recovery group, so he deepens isolation. He minimizes his behavior when discovered by his wife and paints a biased picture to his recovery support about his wife being over-controlling and making him the identified patient. The truth is that Kerry, who had been the face of a well-known corporation, was pushed out the door because of his high salary. Experts assessed that they can do better by repurposing his job and paying Kerry to retire. Well-compensated with a healthy retirement income, Kerry struggles with resentment of being forced into retirement, a loss of identity, and what to do to find significance. He turns to porn and flirtation to salve his wounded ego and soul. Until he learns to deeply grieve his transition, he probably will not stabilize his recovery program.

Recovery is about grieving. Most of us don’t want to practice grieving. Doing recovery is more an inside than an outside job. It is one thing to do outer program work—meetings/calls/written step-work, etc and another to go deep and heal inside wounds. Confidence in recovery is not dependent upon controlling outside results but knowing that you can go deep inside to embrace painful reality and rise again. Craving for your drug of choice is like sitting in the middle of a busy intersection in a major city. You must remove yourself to avoid getting run over by the bus barreling toward you (your addiction). This is the outer program intervention. Yet, inwardly, it is important to recognize the legitimate emotional need that must be met in a healthy way. This requires recognizing the effect and deepening self-parenting skills.

To All the Rock Bottoms I Have Yet to Hit

January 28, 2019 by Sean Paul Mahoney

My favorite thing about getting a new doctor is when they ask me about my drug history. No, seriously. It’s my favorite because I get to rattle off a seemingly endless list of narcotics that I’ve tossed into the chemical dumpster that is my body. Granted, just talking about drugs and alcohol and my relationship with them was really uncomfortable in early sobriety. Confessing my chemical sins to a doctor was humiliating but 10 years of sobriety later, I really enjoy it. “Yes but not in 10 years” was what I answered to nearly every substance my new physician dove into the drug topic.

“Alcohol?” she asked.

“Yes but not in 10 years.”

“Marijuana?”

“Yes but not in 10 years.”

“Cocaine?”

“Uh hell yes but not in 10 years.”

I really hope my doctor was playing a game of drug bingo with her medical pals because I’m pretty sure I helped her win. When you put my drug and alcohol use into the context of time—from age 14 to age 36—there’s no wonder I had a lot of time to check a lot of boxes. Twenty-two years in the biz meant I had years to make lots of things really unmanageable. It was also the perfect time to retire, as it were. With every substance known to man put in nearly every orifice I have, you would think that I wouldn’t feel the urge to explore new drunken, drugged out avenues after 10 years of sobriety. But you would be wrong.

Listen, I’m not saying I’m “planning a relapse” or even in danger of slipping (which is, let’s face it kind of a cute word for something really devastating). I’m just saying I have the brain of an addict and sometimes that brain gets really loud and says stuff like, “Maybe you should try smoking crack again? I don’t feel like we ever gave crack a fair chance! Maybe crack would work out for us!”

The truth is even though I’ve tried as many drugs as most people with the last name Sheen, there are still a list of “yets” that are a mile long. For example, I got sober before “Rosé All Day” was a thing. This is a real tragedy for a gay man like myself who loves the color pink and getting shithoused on wine during the day. Back in my era, pink wine usually only came from the fine folks at Franzia and it was served out of a box. But now the kids are all about it and I, alas, am not of one the kids, in more ways than one.

I also completely missed crafts beers, boozy seltzer waters and Moscow mules. I also never had a moment with opioids which is odd considering I’m an accomplished drug addict who loves to do things that are popular. I mean it’s an epidemic so I shouldn’t feel FOMO for not being effected by an epidemic. But that’s just how I’m wired. Like I was horrified a few years ago when I heard people were shooting up elephant tranquilizers. Horrified but also had a moment of thinking, “Ooh. I wonder what that’s like!” And don’t get it twisted, even though I never, ever shot up when I was actively using, there’s still a part of my mind that can go there and think that’s a good idea to try some day. Just the other day, someone at the hospital where I work was brought in because they had overdosed on something called “nope.” From what I gathered it’s this mega remixed drug featuring your favorite artists like meth, heroin and ecstasy. Sounds pretty dangerous and let’s be honest something I would have tried with zero hesitation in a different time and place.

The important word in all of this is “yet.” Like: I haven’t tried all of those things yet, I haven’t had my life devastated by them—yet. I haven’t relapsed yet. Beyond the substance I haven’t tried there’s the darker yets that haven’t happened too. Like I haven’t served time in jail for drugs and alcohol—yet. I haven’t wound up in a mental hospital—yet. I haven’t gotten a DUI or attempted suicide or wound up living on the streets—yet. Because what I know about my own journey with drugs and alcohol is that there’s nowhere left to go but even further down. There isn’t a right combination of vaping weed (something else I haven’t ever done yet) and Negroni in existence that will make me a functional and successful drug addict. I’m not going start drinking rosé next week and magically become this normal person who can handle his booze. Knowing this 100% is an incredible gift and one I don’t take lightly. The only places left are even more awful than the garbage rock bottom I already hit in 2009.

“Jails, institutions and death” are the yets that 12-step programs tell us are the inevitable end if people like us continue to drink and use. Sounds dramatic but just from my own Irish and Swedish family, I can confirm this. Recently, I was lucky enough to work with a patient who celebrated 30 days clean and sober. After multiple stints in the hospital, this patient had nearly died during his last stay. His body was no longer able to keep up with his addiction. It was an intense reality: either keep using or die. The room for negotiating on possible ways to make addiction work for him was closed. Remarkably, he got the message, which is why that month sober really meant something to him. I say “remarkably” because I see tons of jaw dropping cases of addiction at their absolute worst—people who should not under any circumstance go back to using but somehow do. It’s the nature of the beast.

The romance of the new highs and even lower lows quickly passes for me these days. It’s a thought. It’s a blip on my radar. It’s a minute and then it passes. I know that whatever is out there in the world of active drinking and using can stay out there. I’m just happy that I haven’t felt the real urge to go find out (yet).

3 Questions for People in Rehab to Ask Themselves (AKA Hard-Learned Lessons from my Relapses)

January 7, 2019 by Emily Redondo

Twelve days after getting out of my second stint in a 30-day inpatient rehab facility, I woke up on the concrete floor in a jail cell. With echoes of screams and cries from the back seat of the car still ringing in my ears, I sat there trying to piece together that DUI debacle—how I picked my daughter up from preschool in a blackout, how I pulled the car over to “rest” a minute, how I tried desperately to come out of that alcoholic fog and make everything go back to being okay. But mainly I just couldn’t understand why in the hell I decided to drink again. Jesus, I had just crawled my way out of that nightmare and now there I was again…only worse.

I’m certainly not the smartest person in the room, but I know a thing or two about rehabs. In the course of my sobriety journey, I’ve been to seven of them, ranging from the fancy to the basic, from one side of the country to the other. And now, with a couple years of good quality recovery under my belt, I’m putting the pieces together.

The first time I got sober in 2002, I just walked into a meeting and that was it. I was done. But addiction is progressive and chronic, and soon I slipped into a space filled with 24-hour drinking that was jeopardizing the safety of my children. And I was incapable of figuring out how to stay away from alcohol long enough to even collect a decent number of days. Believe me, I tried every time. The damage I was causing to my family and to myself had grown so out of control that even my recovery community had lost hope in me. I had to get out in order to see what I was even doing.

What have I learned from my experience? Enough to compile these questions for anyone currently in a 12-step-based rehab to ask themselves:

What’s Your Expectation?

I walked into the doors of rehab the first couple times thinking I was going to “find myself” in there. Ha! On my best days, I found the guts to look at what a mess I was and had the courage to be honest about it—to cry about it or get pissed off about it. I had a thousand pounds of bricks built up around me to keep everyone from looking at myself. Hell, we all did. Most of the things we found out about ourselves and each other were the exact same things that sent us running for a drink or a drug.

But rehabs don’t offer cures. Ever. It’s best for everyone involved to keep expectations realistic and that includes the family at home. If you think you’ll walk out with answers to all your problems, trust rebuilt in relationships and a guarantee you’ll never drink or drug again, good luck with that.

What’s Your Goal?

Rehabs are not a quick fix, and good gracious, they are full of distractions. It’s easy to get sucked into the gossip circle-jerk out at the smoking hut or hunt down the most eligible hottie of the opposite sex if you’re desperate enough. It happens everywhere. And even if you’re not participating, you have to sit and listen to the dramatic bullshit that unfolds in the aftermath. Here’s the deal: you are likely not going to meet your lifelong friend circle in rehab, so my recommendation is not to going into it trying to win popularity. At one of my stays, a counselor said to the entire group of us, “Look at the person on your left and introduce yourself. Now do the same to the one on the right. Then say you are sorry. Because only one of you will stay sober.”

Of course, none of us thought it would be us.

So make a goal to set a foundation. Do what you can to remember why you are there. Strange as it sounds, it’s easy to forget some days. Time will drag by slowly but before long, if you’re doing it right, your time will be up. Supposedly, you are ready to go back to the scene of the crime, to walk right back to where you came from…except this time you’re choosing to do it clean and sober. Make sure that rehab has done everything in its power to help you in that transition.

Are You Ready for Anything?

Any good quality rehab is going to tell you that you need more help—that 30 days just isn’t going to cut it. And at that point you will have some choices to make. By the time I got to my seventh rehab, I knew this would be coming, but I still stood out in the parking lot defiantly smoking one last cigarette before half-assing an agreement with my husband that I was willing to do whatever was suggested. I was ready, but I didn’t like it.

I’ve tried different plans upon leaving—I’ve gone home after 30 days with a plan. I’ve stayed at a facility for extended treatment for an extra six weeks, and I’ve gone afterwards to a more intensive treatment across the country for an extra 10 weeks. Every choice was a gut-wrenching, learning experience.

So I say don’t be afraid to make a commitment, but for God’s sake, stick it out. You will probably get incredibly uncomfortable. Any time I saw someone throwing an all-out blood curdling meltdown, I got really excited because I knew they were onto something. It was the bottled-up people-pleasers that scared me—probably because I saw too much of myself.

I used to have a sticker on my mirror that said, “You’re looking at the problem” but my kids didn’t get it so I took it down. Obviously, the ultimate answer here is that I am responsible for my sobriety. No one was pouring the drinks down my throat. But good God, can treatment centers learn anything from people like me? I promise you, I am not the only one who’s had to go back or who’s relapsed after treatment.

Being a mother of four kids put me in a minority at rehabs. I had a breast pump at one of them, so an aftercare program filled with messages of sober living homes was out of the question. I always understood the importance of a 12-step program, but rarely felt anyone was listening when I spoke about the reality of the newborn, the toddler, the preschooler, the daughter in elementary school, and the overworked and exhausted husband all waiting for me to get home. My treatment teams continued to preach nightly AA meetings, counseling sessions, an intensive outpatient program during the weekdays. Oh, and self-care. Meanwhile my poor kids just wanted their mom back and my heartstrings always broke at the sight of them.

Treatment centers can only do so much. They are limited by insurance demands, faculty qualifications, industry standards and patient participation. But if your aftercare advisor is searching Google for a therapist recommendation for you, there’s a problem. If your meds are way out of whack and you can’t see a doctor for a week, there is a problem. And if your small group looks and sounds like an out-of-control dysfunctional family reunion, your counselor sucks.

Not every issue is going to get addressed, but you still have the right to be your own advocate. Make an appointment to talk to the top dog if necessary. I did. But don’t forget that you don’t make the rules (I hated that part).

What a collection of knowledge I got from all that failure. Out of all of it, the one thing I’d pass on above everything else, the best gem I ever got, was from my very last rehab. It was this: No matter what else you do on your first day out, if it’s a 12-step based rehab and they recommend 12-step meetings, just go to a meeting. No exception. Leave your rehab and go straight there. I finally did that, this last time. And I certainly haven’t regretted it.

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