Category Archives: Relapse

Melissa Killeen

[This is the second in a series of short posts about my interactions with recovery coaching clients. I want to share what happens during a recovery coaching engagement, the discussions that take place, what usually comes up for the client and how as a recovery coach I respond.]

In this post, I am still working with the gentleman who had relapsed. One of the consequences of his relapse is that he was discharged from his Intensive Outpatient Program (IOP). We spent time during one of the afternoon appointments I had with him using Google search to find another therapist, and an outpatient program he could attend.

Getting psychological help when needed is important. With many of my clients, their addiction is a symptom of an underlying mental health issue; this is often called a co-occurring symptom or disorder. Seeking and getting the necessary psychological help for this client, and medication for suspected psychiatric illnesses, was crucial. It is important that he learns better ways of coping with life events than drinking and drugging.

Treatment options for addiction are not limited to psychotherapy or support groups. In our research for a new psychiatrist, my client commented that he wanted to consider medication-assisted recovery options. I provided him printouts describing the many medications that are available for the recovering person. We reviewed these printouts and discussed what he thought about each medication, while further discussing the perception of medication-assisted recovery as a positive sign. People in this client’s 12-step meetings consider taking medication to assist in recovery another form of addiction. We talked further about this prevailing 12-step-group attitude and I made it clear that it was never a mark of failure or inadequacy to take medication as prescribed and needed. I assumed the role of an educator, pointing out the possible side effects and interactions, asking him to keep in mind that it is important for him to complete a full psychiatric and medical evaluation before considering these medications. He expressed a willingness to look at medications like Disulfiram (Antabuse®), Naltrexone (ReVia®), or Acamprosate (Campral®).

As a result of our investigations into finding a new psychiatrist and doctor, my client scheduled two appointments the following week to interview prospective doctors. Both physicians use medication-assisted therapy as part of their treatment plan. And my client scheduled at the end of the month an evaluation for a new outpatient program, as well.

Melissa Killeen

Over the next few months I would like to share with you a series of short posts about my interactions with recovery coaching clients. I would like to share what happens during a recovery coaching engagement, the discussions that take place, what usually comes up for the client and how as a recovery coach I respond.

In previous blog posts, I have described working with a client who has relapsed. That the severity of the consequences of his relapse far exceeded any expectations he might have had really hit him hard. His girlfriend left him. He was discharged from his Intensive Outpatient Program. His Employee Assistance professional reported the relapse to his employer. And his mother will not answer his phone calls. He was sure that I would leave him, as well.

This is the time a client most needs a recovery coach to hold out their hand as that client slowly climbs out of the hole. Portia Nelson describes this process in her book, There’s a Hole in My Sidewalk: The Romance of Self-Discovery.

“I walk down the street.
There is a deep hole in the sidewalk.
I fall in.
I am lost . . . I am helpless.
It isn’t my fault.
It takes forever to find a way out.

I walk down the same street.
There is a deep hole in the sidewalk.
I pretend I don’t see it.
I fall in again.
I can’t believe I am in the same place.
But, it isn’t my fault.
It still takes me a long time to get out.

I walk down the same street.
There is a deep hole in the sidewalk.
I see it is there.
I still fall in. It’s a habit.
My eyes are open.
I know where I am.
It is my fault. I get out immediately.

I walk down the same street.
There is a deep hole in the sidewalk.
I walk around it, looking at the hole.

Today, I walk down another street.”

I give this poem to my clients, if and, when they relapse and on each occasion of any future relapses. One of my clients received from me fifteen copies of this poem! Sometimes, often, a recovery coach has to sit back and watch their clients fall into that hole, until those clients decide to walk down another street.

Melissa Killeen

Sometimes a relapse is so severe, detox and residential treatment is advised. After a stay in a residential treatment center, maybe even for a second time, many clients don’t like the idea of going back to the very beginning of their recovery journey. In fact, going back into treatment can feel a bit like retracing their steps or “repeating a grade” as in elementary school.

The tendency is to think that they’ve already been there and done that. So what else is there to learn from a repeat visit to a treatment center? The answer is that your client will always pick up new pieces of information. They will learn new strategies for coping, how to deal with recurring issues and problems, how to incorporate healthier behavior patterns into their life and not allow stress to get them down. They will even learn how to communicate better. Research shows that people in long-term recovery may have visited a treatment center four to five times in the course of their life in recovery.

Relapses, severe and frequent, tell me there may be co-occurring elements that have not been discussed during the previous stay at a treatment center. I will suggest to the current facility (and the client) a referral to a center that features a co-occurring disorders program. A number of treatment centers offer this type of program as part of their addiction-treatment plan. If drugs and alcohol have been used as self-medication to disguise a mental health condition, a treatment facility with expertise in co-occurring disorders will recognize that both mental health and addiction problems should be treated during this client’s stay.

If the client has relapsed, gone back into treatment, relapsed again and continued with several additional stays in residential treatment, I will suggest the client go to a long-term residential facility. Such a facility offers the client a stay between 6 and 12 months, so they can re-learn how to live without drinking or drugging. Hand-in-hand with the long-term residential programs are psychiatric services to address any co-occurring disorders.

After a stay in a long-term residential program, a focus on assistance in entering back into “real life” is important and necessary and many recovery coaches are employed for this purpose. After 12 months in a residential program the client will often need to be reacquainted with such day-to-day tasks as driving a car or using an ATM. Just shopping in a Wal-Mart can be over stimulating. To ensure continued sobriety with support, a stay at a halfway house is the next logical step for a client leaving long-term residential treatment.

More and more halfway houses are popping up to cater to the older, more affluent recovering client. Some upscale halfway houses (or transitional housing environments) feature private rooms, live-in chefs, gym memberships and charge upwards of $10,000 a month. Others feature a more middle-class suburban environment and will charge $3,000 per month. The Oxford Houses, a nationwide not-for-profit organization, charges in the vicinity of $500-$700 a month. All of these halfway houses offer an environment where staying sober is seen as a requirement of living in the house and sobriety is monitored by frequent toxicology tests. The client must find a job or attend school within thirty days and frequent attendance at 12-step meetings is usually required. The length of stay in a halfway house varies, but it can be as long as one year.