Dr. Jacob Adal Stresses Relapse Prevention Therapy

dr jacob adal inside addiction

dr jacob adal inside addiction


Dr. Jacob Adal Stresses Relapse Prevention Therapy

Registered addiction therapist, Jacob Adal, Psy.D., highlights the important role Relapse Prevention Therapy plays in staying sober and why it’s necessary to continually practice the techniques learned.

Regardless of what your addiction is, regardless of how bad your usage is, regardless if you’re using multiple substances or how long or how old or whatever the situation is, it is possible to recover, and it’s possible to stay sober.

Highlights from the Podcast

What is Relapse Prevention Therapy?

Well, I think you’re just going to have to define it. Relapse prevention therapy, or RPT for short, is defined as a behavioral self-control program that is designed to educate clients who are suffering from some sort of substance abuse, whether it be alcohol or some sort of drug on how to recognize, plan for and pretty manage the high-risk situations that real life offers them post-treatment. It helps them manage high-risk situations.  This is pretty much why it is vital for them to continue to work on their recovery.  Recovery, like you were talking about earlier, doesn’t end the second you leave treatment.  Recovery is a day-by-day, hour-by-hour process.

The Life Long Care Plan

I don’t want people out there who are either in-depth in their addiction or are listening or family members who are worried about their significant others or children to think that there’s no hope.  The message is not it’s not so much it’s a sense of no hope.  Recovery isn’t something that is a hopeless feat, but, in my opinion, it’s one of those things where you have to keep yourself aware of potential cravings because there’s a difference between being physically addicted and then being mentally addicted.

During detox, while they’re in treatment, the body is getting rid of the physical aspect of the addiction, whatever the addiction is, but the mental addiction is what makes a recovery tricky, and that’s where I feel, having to go with what Dr. Mohammad was talking about, if you don’t have a life-long aftercare plan, there’s a high risk of relapse because you’re pretty much battling your internal mind.  You’re battling your addicted side with the sober side.  You want to stay sober.  That’s the goal of treatment is you’re coming in because you want to be sober, but your addicted mind is a very powerful adversary where it will try to trick you into trying to use.

What are some triggers that can cause relapse?

You know, life in itself can be a stressor.

We always tell our clients, especially those who come in here with high-profile jobs or high-stressful jobs, you know, you’ve got to watch out for things that pretty much started the addiction.  We were talking about this the other day, and no one is born an addict.  There is a biological factor with a family history of addiction, just like you have a family history of some sort of physical illness, you know, high blood pressure, diabetes, cancer.  You have a high risk of it, but life stressors, work stress, school stress, family stress,  trauma, and childhood trauma it can play a huge role in getting the person to use maladaptive coping skills, just like substance abuse, because that’s what substance abuse is, it’s a maladaptive coping skill, and that’s where the addiction kind of starts.

In order for you to recover from that, you’ve got to gain kind of insight into what started the addiction for me.  What was going on during that period of time that kind of got me kind of hooked on alcohol or drugs and then by working on that, you can gain insight, and that’s where the recovery starts is through insight.

With relapse prevention, we highly emphasize cognitive behavioral therapy or CBT because a lot of the time the trigger isn’t so much seeing the substance. It is possible, I mean, it’s going to increase the likelihood of you using if the substance is in front of you, but most of the time it’s a thought or a feeling.  Such thoughts like, and we’ll talk about this a  little bit later, but thoughts like, I deserve this.  You know, I got a  promotion yesterday at work, I’ve been sober for ten years, and I think I can handle it.  I deserve at least one drink, and I can handle it, you know, I’ve been sober for 20 years, I can handle it.

Other therapies used in conduction with RPT

CBT is primarily the one used because in CBT you learn that thoughts and feelings and behaviors are correlated. It’s in one of those cycles, one affects the other. If you’re able to learn how to thought stop thoughts like I can handle this or I need this, whatever it is for the individual, then you’re going to have a very powerful coping skill in preventing yourself from actually relapsing.


Coping Skills

Mind you these skills are not something that you’re going to learn right off the bat.  It takes time.  Any kind of coping skill takes time, but one of the things we kind of, in at least my groups, we teach for RPT is, to play that tape through.  I’m sure people have heard that kind of saying where, you know, okay I deserve this, okay, so I’ll take one drink, but where does that one drink lead me to?  It leads me to two drinks, three drinks. Now I’m binging, so now I’m binging now I lost that promotion because I’m not being effective at work, losing the job at work would entail family consequences, so being able to play that tape through and seeing the consequences at the other end of it.  Thought stopping too is very important as well realizing who is really talking now.  Is it the addicted mind talking or is it me talking?

How many treatment centers use Relapse Prevention Therapy?

I personally don’t have the answer to that, but I can say this in my opinion, at least, it is important to have it.  If you’re going into treatment and not preparing for recovery after treatment, it’s not going to be beneficial for you in the long term.  You can come in detox, and you’ll be sober the 30 days, 60 days, and 90 days you’re there, but the goal of treatment is to stay sober long term, so if you’re not in a program that offers a form of relapse prevention therapy, it’s going to be something that isn’t going to be beneficial for the client.

Dealing with Relapse

Yeah, the most common ones that are here are for people who either lapsed with a kind of slip or full-blown relapse, is that either they were unable to utilize the coping skills in an effective time.  By the time they realized how bad the craving was, by the time they realized that they were already driving to the liquor store, it was kind of too late. Another one is motivation as well.  People start to lose motivation because they start seeing recovery as a long-term thing they don’t have the motivation to maintain that sobriety.  It’s important to realize if you’re focused too much on the future, you’re not really focusing on the here and now.  A lot of clients tend to catastrophize the fact that now I  have to completely worry about my recovery 10, 30, 40 years from now, and they kind of get overwhelmed by that.

Another factor with relapse is it just … It is an addiction.  The best way I can probably identify this is for those who aren’t addicted to substances is for those who smoke cigarettes. Personally, in my family, I have people who smoke cigarettes and are trying to quit.  They quit for a few months, and they come back to it.  The question is, what is it that’s so hard for people that quit cigarettes?  Is it so much nicotine as it is the ritual, the routine, the oral fixation of the cigarette?  For those who aren’t aware of how addiction is,  I mean, I’ve heard people say, “Well, why don’t you just quit?  Just quit.  Just get over it.”  It’s not as easy as that.  I know that people who are listening to this might have an addiction of some sort, and they understand that, but for those who are listening to this podcast who aren’t familiar with addiction, it is not something that can just be shut off.

Anyone, any human here, can be addicted to something.  No one is above addiction.  It can take the right storm, and the right life circumstances to create an addiction in someone, but it doesn’t make that person less than the person next to them.

What to Look for in a Relapse Prevention Therapy Program

I think the biggest thing here at Inspire Malibu is the fact that we’re not a telescope program.  All our groups here are science and evidence-based.  We talked about earlier the CBC, cognitive behavioral therapy, DBT, dialectical behavioral therapy, MET, motivational enhancement therapy as well as relapse prevention therapy, to name a few, are all evidence-based.  There’s science behind their proven fact to help people in recovery.

30, 60 or 90 days of treatment?

For myself, and research actually indicates this too, 90 days is considered the most effective for treatment.

It takes that long.  The first time, the first 30  days you’re here, half of it’s spent in detox for a lot of people.  You’re physically getting the substance out of your body.  You’re not really absorbing anything mentally.  You’re there in the physical being, but you’re not there mentally.  Thirty days is a detox-type era.  Mind you, the detox doesn’t only last a whole month, but half the time spent is mostly getting the substance out of your body.

Sixty days, and we started seeing a change in a lot of people.  Somewhere around the 50-day mark, we start seeing a lot of change.  By 90 days, a lot of our clients start to not only understand what CBT, DBT, MET and RPT are, but they start to implement it in their recovery.  Even if you’ve been in the treatment center for 90 days, and this is something that I advise and tell my clients, cravings are going to happen.

You’re not cured of addiction.  You’re going to have cravings. There are some things in life that are going to cause various cravings, stress, depression, anxiety, and boredom, which is number one for a lot of people in here.  If you don’t learn how to cope with those cravings, you’re bound to be in a high-risk situation for a potential relapse, so by sitting here for 90 days, you’re going to experience cravings. You’re going to experience what cravings feel like without a substance, and being in a safety bubble in treatment, you learn to not only cope with the fact that you’re having cravings but learn how to actually fight against them using the CBT, DBT, MET, different type of training that we give you to develop coping skills because it’s going to happen once you learn how to cope with it.

After Treatment

Just because you leave a treatment center, especially here in Inspire Malibu, doesn’t mean the doors are closed.  Just because you physically leave here doesn’t mean you’re gone in that sense.  If for what reason you’re at a point where you’re struggling with your recovery, regardless of how long you’ve been sober for.  You could have been sober for five, six, seven years or six months, the door’s always open.

Part of that is part of your relapse prevention plan.  People to call.  With most of  my clients, I design a relapse prevention plan, people you can call when you’re feeling cravings.  People that you feel comfortable talking to who are sober, who are a good support system that you feel comfortable calling when you’re having moments of high intense cravings.

Make the Decision to Recover

Recovery isn’t something that you or I can give.  It’s not something that I can prescribe and say you’re recovered.  It’s something that the client needs to work on, as we talked about earlier, but it’s important to know that you’re capable of action by being sober.  It’s not the sense of hopelessness.  I know for those clients who may be listening to us who are in the depth of their addiction who feel like there’s no hope for them. There is hope.

Once you make the mental decision that you no longer want to use, pick up the phone, call us.  Regardless of where you’re at in the state or in the country, we’re open.  This is where that stigma, what we were talking about earlier about addicts, kind of comes in because people are afraid, and it’s okay to be afraid.  Eventually, we want to give you your power back.  Not so much your power back in various aspects of your life but at least the power over your addiction because each one of us has the capability, we need that spark under us sometimes.

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