If you are one of the ten percent of people with substance use disorder who has sought and undergone treatment, first of all, congratulations. Seeking help for such a complicated and socially loaded health issue is a brave and hard choice. Sobriety is both the hardest and most rewarding journey that many people take in their lifetime.
“ Addiction is just a way of trying to get at something else. Something bigger. Call it transcendence if you want, but it’s like a rat in a maze. We all want the same thing. We all have this hole. The thing you want offers relief, but it’s a trap” – Tess Callahan
For a newly sober person, the thought of relapse can be anxiety-provoking. After all the hard work you have done to achieve sobriety, (plus the money you’ve spent and time you’ve invested), you are motivated to stay sober. After treatment, a person has the best odds of maintaining sobriety if they remain actively involved in a treatment program for at least one year. This might mean you see your healthcare provider, attend therapy, and support groups every day after you return home, and reduce the frequency of your visits slowly throughout the year.
Most people who are successfully sober for decades will tell you that even after their treatment plan is officially concluded, sobriety is a daily task that requires intentional work.
Staying Sober After Rehab
Addiction treatment centers take you out of your typical environment for a reason – it’s easier to start new habits and shed negative beliefs when you aren’t exposed to your normal stressors. Returning home after addiction treatment is the biggest hurdle many people face in maintaining their hard-earned sobriety. People and places in your home environment can trigger your urge to use substances and put you at risk for relapse.
Returning home after rehab is the time to use all the tools you gained while in treatment. Many people find that a strict daily routine helps manage triggers by providing predictability. Waking at the same time each day, attending a meeting, therapy or support group, meeting with sober friends and including a physical activity like a walk, run or yoga class each day can help you stay on track.
Avoiding Relapse After Rehab
Many people believe that relapse happens when alcohol or drugs are put into the body following a period of sobriety. The truth is that relapse begins long before the first drink or drug is taken.
A person starts sliding into a relapse when they begin skipping meetings and therapy appointments. Isolating from support systems and neglecting important self-care pushes a person further into relapse. After giving yourself permission to stray away from your sobriety in these small ways, visiting a bar or hanging out with friends who use drugs or alcohol isn’t a huge leap.
Because relapse is progressive, sobriety requires daily, hourly, and minute-to-minute commitment. Relapse prevention is an intentional process that involves activating a sobriety plan that helps you face situations that challenge your sobriety.
Stress Can Make or Break Sobriety
Stress is the most common reason that sober people return to using drugs and alcohol. Many people find that reducing stress is the key to sobriety, whether that is leaving a stressful job or relationship. However, not all stress are avoidable because stress is simply a part of life. One thing that people with long periods of sobriety have in common is that they find positive ways of handling the stress that doesn’t involve drugs or alcohol.
Using alcohol and drugs over long periods changes the way the human brain responds to stress, which makes it harder for a person with a history of substance abuse to respond to stress. Over time, small changes take place in the brain that makes it reliant on the substance. A neurotransmitter called dopamine (sometimes called “the happiness chemical”) is released when a person uses drugs or alcohol.
With repeated use, the brain begins to rely on the substance to produce dopamine, and a person may no longer feel happiness when they aren’t drinking or using drugs. Stressful events and situations begin to feel more intense, and a person’s ability to regulate their own emotions decreases.
Because of these changes in the brain, a person in recovery needs to be more aware of stress and proactive in its management. Staying consistent with your treatment plan, finding non-substance tools to manage your stress levels and asking for help when you need it can help manage the stress that puts you at risk for relapse.
Mental Illness and Sobriety
People with mental illnesses face more challenges when working to maintain sobriety. Mental illness is a risk factor for addiction — one-third of people who abuse alcohol and half of the people who abuse drugs live with mental illness. If you have been diagnosed with depression, anxiety, or another mental illness, you cannot maintain sobriety without paying your mental illness the attention it needs and deserves. A plan including regular psychotherapy, medication, and self-help or support groups is necessary to maintain sobriety.
Aftercare for Sobriety
Total healing after rehab involves thorough aftercare. This type of care after rehab helps build a bridge from your sober life in rehab to your sober life out in the world and helps ease the shock of leaving a safe environment. Transitioning to your life at home safely involves consistent interaction with your healthcare team, therapists, and support system. Without this regular and predictable interaction and support, you are at risk for relapse.
Aftercare following rehab might include:
1. Cognitive-Behavioral Therapy
Cognitive-behavioral therapy or CBT is a type of therapy that is designed to modify unhelpful thought processes to change behavior that can promote sobriety. This type of therapy can help a person better understand why they use drugs or alcohol and use more effective coping mechanisms when they are triggered to drink or use drugs. CBT can address specific situations that may lead to relapses like cravings, stress, anger, depression, relationship issues, and exposure to substances.
It’s common for people who become addicted to alcohol or drugs to feel powerless in situations. Feeling unable to prevent or control the behavior of other people or feeling powerless in a work environment are risk factors for relapse. CBT can help a person feel more confident in their ability to address problems positively and effectively.
2. Support Systems
Most people who have maintained sobriety for decades will tell you that it wouldn’t have been possible without a reliable and accessible support system. Support takes a different form for each individual, but for many people, it is a combination of therapists, family, and friends and peer support groups. Twelve-step programs like Alcoholics Anonymous and Narcotics Anonymous are a source of daily support for many people in recovery.
3. Community Reinforcement Approach
Community Reinforcement Approach is a simple part of sobriety aftercare that is often overlooked. The approach focuses on rearranging a person’s life to reduce the motivation to use drugs or alcohol and increase the motivation to engage in other activities. A therapist and your support group can all work together to provide incentives to change your lifestyle so that sobriety is more rewarding than the potential of drinking or using drugs again. High-risk situations that put you at risk for relapse are identified, and you are encouraged to pursue other enjoyable hobbies and activities that can help you maintain sobriety.
4. Cravings Management
After treatment for addiction, many people wonder how they will handle those rough moments when they have an intense craving for drugs or alcohol. It’s normal to have cravings after rehab, and it’s not a sign of weakness. The temptation to drink or use drugs is predictable and controllable, and not an emergency when you know how to manage the cravings.
The first step is to recognize what triggered the craving. It may be a place or person that reminds you of alcohol or drug use or an internal feeling like stress or even happiness. Learning to recognize these triggers can help you predict when you might have cravings in the future. Tracking your cravings in a notebook and discussing them with a therapist or friend can help you learn even more about why you have cravings.
Many people find it helpful to carry a piece of paper or notecard with them that lists the reasons you became sober and want to stay sober. In moments of craving, you can read the list and be reminded why you shouldn’t give in to the craving. You can also carry a list of alternate activities you can do instead of giving in to the craving. The activities might be as simple as watching television or going for a walk, but having a written reminder can help distract you from the craving so you can walk away from it.
5. Building Self-Efficacy
Self-efficacy is simply the belief that you have within yourself that you can make changes to your behavior that will positively impact your life. Many people who get treatment for alcohol or drug addiction have very poor self-efficacy when they begin treatment. If a person’s self-efficacy can improve, they have a higher chance of achieving and maintaining sobriety.
A person in recovery is encouraged to view their sobriety and history of drug and alcohol use objectively, as an outsider. This view can help a person see that they can accept responsibility for the behavior as well as the potential to change it. Building self-efficacy teaches a person that maintaining sobriety isn’t about willpower, but rather a process of changing habits. The method helps breakdown the overwhelming task of maintaining sobriety for a lifetime into smaller, more achievable tasks that promote coping. 12
Self-Care is the Key to Sobriety
Self-care during sobriety isn’t about bubble baths and massages; it’s about the little things that help you maintain your mental wellness. For most people, mental wellness relies on a regular sleep schedule, adequate nutrition, and daily physical activity. As a newly sober person, these three aspects of self-care may be the most important for you to focus on initially after treatment.
It might sound obvious, but keeping appointments with healthcare providers, making time to engage with support systems and taking your medications are all critical parts of self-care. You cannot be well or maintain your sobriety if you fall into a pattern of avoiding these sobriety maintenance activities. Basic grooming is another form of self-care. A daily shower or bath, brushing your teeth and hair, and wearing clean, weather-appropriate clothing are all dignities that you owe yourself.
Beyond the basics, being enthusiastically kind to yourself is the ultimate in self-care. This doesn’t mean giving in to cravings or substance-related indulgences, but being kind to and present for the person you ignored while you were lost in your addiction to drugs or alcohol. Re-engage with the things that used to make you happy, and if you aren’t sure what those things are, try every hobby you can think of until you find one you love.
It might be something more labor-intensive like pottery, or something simple like visiting a library and reading a book. Many people find that journaling or writing, in general, helps them get in touch with their inner voice — one that may have been silenced for years by drugs and alcohol.
You Can Stay Sober
Again, congratulations on your newly found sobriety. Your interest in avoiding relapse shows your commitment to staying sober. You know well that a part of leaving behind drugs and alcohol is being honest with yourself in ways that you weren’t when you were caught up in your addiction.
Sobriety is a continuation of that uncomfortable honesty. The moment you begin making excuses for your behavior, you open the door and let risks of relapse slip in. What are your motivations to stay sober? Remind yourself every day. Don’t forget the strength it required to leave behind drugs and alcohol while you were in treatment. That strength is still inside you, and you can stay sober.