Identify high risk situations and rehearse coping strategies
Aim
Identify high risk situations for drinking or drug taking
Agree a coping strategy for each situation
To do
Provide information about the nature of high-risk situations
Create a network based coping strategy
Practise coping in high-risk situations
Select topics to address eg coping with craving and refusal skills
My recovery journey #3
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 anticipate high risk situations and deal with them?
Whether your goal is abstinence or moderation 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.
❝ You never know how strong you are, until being strong is your only choice ❞ Bob Marley
Why coping skills?
You will be able to complete this task digitally and download a PDF of your responses at the end of these notes - if you want to respond as you go then that is fine too
Using worksheets
We encourage you to use worksheets - they are not an end in themselves but they do...
provide a framework for discussing a topic
facilitate monitoring and evidence of progress when repeated several times
bring important issues to the attention of service users
Here are examples of two commonly used tools: the high risk situations and five areas worksheets...
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 implemented and working. Check again later how well it worked in the real wor
Write down the high risk situation. The act of writing (or typing) is itself important as it strengthens the FP's awareness of the risk.
Give a rating to the risk of drinking or drug taking if the high risk situation is encountered. This is a measure of self-efficacy ("how likely am I to resist this temptation?")
Write down one or more plausible (likely to happen) coping strategies.
Rate self-efficacy again but this time in expectation of the plan being actioned.
Repeat the exercise for more high risk situations until all major risks are dealt with.
Be sure to check out if the plans worked in the real world and rate its 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 the NM 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:
“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. Guided imagery
Use guided 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 they 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 stimulate 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 to complement this rule. The idea is that after 15 minutes the craving will have passed, especially if another 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 (such as children), 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 psychological 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 a sequence of thoughts and feelings that lead to drinking or drug taking. Often the situation is unexpected.
The aim of the Five Areas worksheet is to…
i) identify situations that are a high risk for triggering drinking or drug taking; these will be situations causing an emotional and physical response
ii) to develop a plan to use coping strategies in these situations.
Explain the five areas model as described on the previous page.
Complete a five areas worksheet (below). This is a measure of self-efficacy (how likely am I to resist this temptation?)
Write down a plausible (likely to happen) change in thinking and follow through how that might prevent drinking or drug taking.
Rehearse the situation with a role-play or accompany the FP in the real world situation.
Repeat the exercise for more high risk situations until all major risks are dealt with.
Now go through the same sequence of thoughts and feelings but see what happens when the situation has been anticipated so that the thoughts and feelings do not lead to drinking or drug taking.
There are two more situations that you 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 misuse itself, may be a consequence of substance misuse and therefore expected to resolve if the substance misuse is stopped, or may be independent of substance use but exacerbated by it. The interplay between substance misuse 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 you 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?”
Are there any special measures you need to take because of either mental health problems or pregnancy or parenting? You might want to discuss this with a trusted person.