My recovery journey
task 3: coping skills
❝ You never know how strong you are, until being strong is your only choice ❞ Bob Marley
Why coping skills?
Coping skills are commonly understood to be the way that you respond to high risk situations for drinking or drug use…
Can you refuse drink or drugs when they are available?
Can you expect and plan for high risk situations?
Whether your goal is abstinence or cutting down there will be situations where the temptation to drink or use drugs is strong, whether during a period of abstinence or if a slip or relapse occurs. Coping skills can be explored using the problem solving approach and then rehearsed.
Here you have all that you need to know about creating and rehearsing coping skills.
Coping skills
In this task you will…
Identify high risk situations for drinking or drug taking
Decide how to cope in each situation
Rehearse your coping skill in imagination or with a trusted person
Try out suitable coping skills in real life
Make a list of topics to address coping with craving and refusal skills
Using worksheets
We encourage you to use worksheets - they are not an end in themselves but they do...
help you and your network remember your plans
show how you are doing
highlight success and difficulties
There are examples of two commonly used tools in this task: the risky situations and five areas worksheets.
You will find worksheets to complete if you go on to make an action plan at the end - for now they are just examples.
Example of a high risk situations worksheet
Notice in the example that the first step is to identify a high risk situation and see how it scores on the likelihood of leading to drinking or taking drugs. The next step is to brainstorm possible alternative responses to the situation - only take up ideas that have a good chance of working and see if the risk is now scored lower. You might rehearse the plan a few times to build confidence in it being done and working. Check again later how well it actually worked.
Write down the high risk situation. The act of writing is itself important as it strengthens your awareness of the risk.
Give a rating to the risk from 0-10 of drinking or drug taking when the high risk situation happens.
Write down one or more realistic ways to deal with it.
Rate likelihood of success of each suggestion.
Repeat the exercise for more high risk situations until all major risks are planned for.
Be sure to check out if the plans worked in the real world and rate their effectiveness.
High risk situations are usually accompanied by a strong craving to drink or take drugs. Here are 10 coping strategies for craving...
1. Talk about your cravings
What are your options for talking to someone when you are experiencing a strong craving?
2. Distract yourself
Think of things to do which will distract you from the craving. This needs to be something you can do instantly, for example, some quick exercise, meditation or talking to a support person or other friend.
Who will you be able to call if you are feeling at a loose end, or if you meet someone who is going to tempt you to drink/take drugs?
3. Escape the situation
Remove yourself from the situation as soon as a craving is developing. For example leave the area, find a safe place or a safe person. Then use another skill to bring the urge down.
4. Change thoughts about drinking or drug taking
Challenge your thoughts. For example say to yourself:
“I can’t have just one drink/one hit and then stop” or “If I give in I’ll have to start all over again.”
Cravings usually subside fairly quickly anyway, so think about saying:
"this will pass" or “the craving won’t last long…. I can deal with it.”
Try not to make catastrophic predictions about cravings, like:
“there’s no way I can stand this, so I might as well just drink/take drugs and get it over with”, “I keep having cravings, so I must be an alcoholic/addict, I can’t beat this…”
5. Using imagery
Close your eyes and run through an imagery exercise:
Command the craving to STOP (e.g. see a big stop sign), then refocus on a favourite relaxing and peaceful spot. Imagine somebody has asked you: “tell me what you can see?” “what do you find relaxing about that?” “describe the place” - now pretend you are describing it to them.
If the craving is associated with good times when you were drinking, replace that image with the bad times, your lowest ebb when you felt ashamed or disgusted. Imagine somebody has asked you: “do you want to end up back there?” - now pretend you are describing how it was to them.
If it’s negative, depressing images that are giving you cravings, then imagine an optimistic view of the near future, with friends or family, having fun without a drink.
If there is a high risk event coming up then imagine the situation and how you deal with it successfully. Run through the feelings you’ll have so you are not caught off-guard by them.
6. Coping flashcards
When you are in the grip of a strong craving, it can be hard to think rationally and remember all the things you are supposed to, so writing some instructions on a phone alert can be useful. Here are a few examples of things you might write:
Things are going well right now, I don’t want to mess it up
This craving will pass if I do something else
Recite a poem or count backwards from 100
I’m not helpless here, what action can I take?
What are the pros and cons right now?
Name of person to phone
7. Relaxation
Anxiety, anger, frustration and stress are amongst the biggest triggers for cravings. Learning some relaxation techniques can be helpful. Options include breathing exercises, progressive muscle relaxation, taking a hot bath, listening to relaxing music, listening to a relaxation app or a podcast, taking a walk.
8. Plan ahead to prevent avoidable triggers
Plan ahead to avoid places and people likely to cause craving. Introduce a fifteen minute rule so that when craving is experienced, the rule is not to act on the craving for fifteen minutes, using distraction, escape, talking about it to someone or any of the above strategies. The idea is that after 15 minutes the craving will have passed, especially if a good strategy is used.
9. Activity
When trying to stop drinking or taking drugs, boredom can be the biggest hurdle and result in craving. Plan activities for the times that cravings are likely to be highest - for example when you would be going to the pub, or getting your first fix of the day, or meeting friends to take drugs.
10. Reminders of important things
Keep a photograph of a loved one, or favourite activity in something that you usually carry with you. This can help to refocus on why you do not want a drink or drugs. Keeping photographs of important others, for example in a prominent place such as the fridge door, may also provide good visual imagery to protect against relapse.
Emotionally high-risk situations
There may be high-risk situations that are more emotive than others and need more than common sense to be understood. The Five Areas approach has typically been used for finding coping strategies to use where there are unhelpful thinking responses to situations.
The Five Areas model aims to explain and identify the connections between thoughts, feelings, behaviours and physical reactions – in this case looking at relapse triggers.
The example illustrates how a common situation can lead to thoughts and feelings that then lead to drinking or drug taking. Often the situation is unexpected.
Now go through the same sequence of thoughts and feelings but see what happens when the situation has been expected so that the thoughts and feelings do not lead to drinking or drug taking.
Use the Five Areas worksheet to…
i) identify situations that are a high risk for triggering drinking or drug taking; these will be situations causing an emotional and physical feeling
ii) develop a plan to use coping strategies in these situations.
There are two more situations that you might need to think about…
Mental health problems
Mental health problems are very commonly associated with substance misuse. What appears to be a mental illness may be confused with symptoms caused by the substance use itself, may be a result of substance use and therefore expected to resolve if the substance use is stopped, or may be independent of substance use but made worse by it. The interplay between substance use and mental health must be taken into consideration when goal setting.
It is important to understand the relationship between mental illness symptoms and substance use effects. You might ask...
“How does drinking/drug taking affect my mood in the short term? And what about later?"
If you have experienced psychotic symptoms, you might ask…
“How does drinking/taking drugs affect my mental health?”
“How does drinking interfere with taking my medication?” “When I was abstinent how was my mental health?”
Pregnancy and parenting
Pregnancy or parenting will raise concerns about the risk of relapse. It is a risk to set a goal other than abstinence.
Think about the potential impact of drinking or taking drugs on the unborn child, or on your capacity adequately to care for and protect your children. You might ask…
“What do I understand about the way alcohol/(specified)drugs can affect my pregnancy?” “What have I heard about this”
“What does my child know about my drinking?”
“How do I see things working out in the future?”
“How are my children affected by my drinking/taking drugs”
“What effect does my drinking/drug taking have on the way I am with my child?”
Think about whether there are any special measures you need to take because of either mental health problems, pregnancy or parenting. You might want to discuss this with a trusted person.