The Relapse Prevention No One Talks About

Until I sat down to write this, I didn’t realize that my ultimate goal with everything I do is to prevent my relapse. As I was thinking of all of the ways and times that I have intentionally worked to prevent a relapse in my life, I came to see that it’s always what I’m doing. Sometimes I downplay how much work I put into my recovery. When I say “work”, I mean changing my brain chemistry, behaviors, and even my personality traits. Actively analyzing every perception, every response and every afterthought. Constantly aware of all of my thoughts and actions. It’s exhausting at times, but always necessary to continue my success. The biggest change has been learning when to just keep my mouth shut and to choose my battles.

I’ve always been a fighter. Always. When I was a teenager, I didn’t know how to express my emotions in a healthy way. I didn’t know how to just calm down, talk it out and de-escalate a situation – usually caused by me. What I had learned to do was to respond in the biggest way to make the hardest impact. I’d scream, fight and kick. I’d use intimidation or scare tactics, threats, to get my way. If I felt disrespected, I didn’t rise above and walk away. No, not me. I would walk right up to that person, man or woman, big or small and punch them in the face. Without any regard for mine or others safety or of getting into trouble. I had no skills to use to stop myself from reacting with rage and anger. I didn’t know how to be different. I didn’t want to behave like that, but it was as if that is who I created myself to be. If I changed, I was somehow betraying myself. But I had to change. Because if nothing changes, then nothing changes.

The day that I decided to get help and detox from Heroin, I had to fight. I had to physically fight my ex husband to be able to go to the hospital. I couldn’t get into a substance use treatment center because I had no insurance. But I knew that I could go to an Emergency Department and convince them that I had a plan to kill myself. By doing that, the ED admitted me into their Dual Diagnosis unit for Mental Health and Substance Use Disorder. It was there that I was given Buprenorphine,  commonly known as a brand name of Suboxone. The medication quickly took away my withdrawal symptoms and was able to get me through the withdrawal of Heroin. I only took the medication for about ten days. But that was all I needed. I just needed to get through the sickness. I knew that because I didn’t have health insurance, I was going to be on my own for continuing my recovery. I tried an NA meeting and aside from the abusive relationship I was in not allowing me to go back to NA, I felt very triggered at the meeting. I wasn’t ready to be around a group of people like me. I knew that I would have linked up with someone at the meeting and go use Heroin. Not to discourage anyone from 12 step support, because it saves thousands of lives every day. But, realize, it’s not for everyone either. I didn’t know it then but I was preventing my relapse by not going back to NA. I placed a barrier between me and Heroin.

Over the next couple of years I would continue to fight. The person I was fighting was the same person that I could see in the mirror. I mean, let’s be real here. I was my own worst enemy for at least eighteen years.

After about a year of not using heroin, I stopped having urges for Opiates specifically. But it took me a few years to stop having urges to escape, which is when drug use would usually happen. Every time the urge to escape or numb presented itself to me, I fought it. I can specifically remember the last time I had the urge to escape and be numb. For some reason it was alcohol that I was actually craving. I was on my way home from a long day at work and it was a rough day. I wanted to unwind and escape just a little bit. But I knew that if I chose to unwind and escape with alcohol, I was setting myself up. Instead of buying a beer, I bought a milkshake. I needed something to satisfy that urge to just give myself a treat, so I gave myself a strawberry shake. I remember how it tasted. I remember how after I took the first drink, I sat back in my seat and let out a sigh. Just as I would have after using drugs or drinking, to escape. I did something pretty clever, on my own. I replaced the behavior. I prevented a relapse by not giving in that one time. Buying that milkshake for myself meant, it’s okay to have a bad day. It’s okay to have a bad day and even want to burn bad days to the ground. Just don’t light the match.

In 2017, in recovery for five years, I had two surgeries. There was nerve damage in both of my arms from  my IV drug use. My hands had been numb for weeks. I was slowly losing the use of my hands. Within six weeks of each other, I had two Ulnar Nerve Release procedures. When I first met my surgeon, Dr. Safi Faruqui, I immediately told him that I am in recovery from heroin addiction and he needed to know that. We instantly clicked. He was so supportive and respectful of my background and needs. We often shared stories of how we view things related to the Opioid crisis. I could trust him. It was very difficult for me to trust doctors. Over so many years, Doctors were the ones to overprescribe to me and start it all. Doctors were the ones that would feed my addiction when I surfed through emergency departments. Doctors were the ones who would meet me with judgement when they saw my drug seeking behavior, and never once offering resources or hope. But I knew that I could trust Dr. Faruqui, 100%. I knew that he had my best interest in mind, as a whole patient. Not just my injury for which his medical specialty is his interest. But also for my long term effects of the damage, surgery and medications.

When we discovered that surgery would be needed for both of my arms at the elbows, the conversation of pain medication came up. I had thought about this for weeks. I couldn’t decide if I should remain completely abstinent from opiate medication or if I would be okay with taking it. I spoke to my husband and my support system. I did some research on my own.  I decided that I was going to have only three days worth of Vicodin. I spoke with Dr. Faruqui and I said, I believe that I’m going to be okay and I understand the difference between taking medication as prescribed and abusing the medication. I have a lot of self awareness and accountability to be able to recognize if my intentions change. If I wake up from the surgery and I’m not in any pain, I won’t have a need to take any pain medication. But if I am in pain, I’m going to take the medication correctly. I had a plan. I had put so much thought and planning into this, all as a form of preventing my relapse.

On the day of surgery, when the nurse came to speak with me, I learned that Fentanyl is used during surgery as a sedative, in addition to anesthesia. I was taken aback by this. Fentanyl had recently hit the streets of Cincinnati and was killing dozens of people every day. But I also knew that when used in the appropriate setting, Fentanyl during surgery is long lasting to assist with pain management without taking more after surgery. I told the nurse to wait until I’m asleep from the anesthesia to administer the Fentanyl, so that I don’t feel the effects or the rush of the drug. When having this discussion with a few different members of my medical team, they were all clear on supporting my choices. It felt as if I was in control of my care. It felt that I was being respected and being given dignity to be heard and understood. Just before it was time to roll into the surgery suite, Dr. Faruqui came in and spoke with me. He made sure I was comfortable, prepared and knew what to expect. My level of fear was very minimal. By keeping consistent communication with my medical team, there were no other surprises. I used communication as a way to prevent my relapse.

This experience was healthy for me but it was something that was so much bigger than only me. Throughout this time, Dr. Faruqui changed the way he prescribed pain medication. He already understood addiction and potential addiction in a medical fashion. But through meeting and caring for me, he was able to see the long term and even psychological effects. He began having conversations with his patients about risks involved with Opiates and potential abuse. He set boundaries and guidelines up front that he would not prescribe a large amount of Opiates. He also started asking the patient directly, how much pain medicine they thought they would need for surgery. He facilitated for the patients to verbally communicate their expectations and understanding of being responsible with pain medication. One of the biggest compliments a doctor has ever given me was that I was his most responsible patient. Me?!! I used to be the one that was doctor shopping and emergency room hopping. Manipulating doctors for more pills. Here I was, asking for less.  I was able to create a huge ripple effect, without any intention. I always hope to touch someone and change perspective for people when I meet them. I hope to open their minds and always to solve any stigma, through my story. Occasionally, I get to hear or see how my story has directly helped someone. People will reach out to me and tell me about their specific story and how I was able to be part of that. I’m always blown away, humbled and get emotional with the fact that I’m able to help others through my story.

These are only a few examples of how I’ve prevented my relapse throughout the past six years. Every single day, multiple times I am actively preventing my relapse. By writing this right now, I’m preventing a relapse. I have a very steady routine that I stick to. I have a healthy home life. My husband and I never argue. We communicate and we laugh. We support each other. We respect each other so we intentionally don’t push each other’s buttons. We value the rare and easy love that we have with each other. Without going on and on and on some more, here are a few more ways.

  • Accountability

  • Awareness

  • Playing the tape forward

  • Finding the silver lining

  • Always being positive

  • Responding instead of reacting

  • Choosing my battles   

  • Ability to say “no”

  • Healthy balance

  • Don’t over do it

  • Stay busy but know when to rest

  • Self care

  • Stay away from toxic people

  • Meditation, healthy eating, yoga

Preventing my relapse is sometimes exhausting. I’ll be honest with you. Sometimes it’s down right exhausting. I am always, always on duty. Always fighting to be better. But the thing is, it’s so worth it. My life is what it is today because of how hard I fight every day. I value every part of my life so much, I could cry about how grateful I am. I lived for so many years, lost and broken. I had nothing. I felt like I was nothing. I wished I would die every day for sixteen years. But when I woke up and realized that I have a chance to do something amazing, I never looked back. I’m a fighter. I have always been a fighter and I will always be a fighter. Just like changing all other part of my life, I changed the way that I fight. Instead of fighting with people in my life who talk badly about me, judge me and criticize me, I pray for them. I rise above them and I tell myself, it’s their problem, not mine. Instead of fighting people who say that “addicts are a waste”, I show them exactly how that’s not true. I know how to fight in healthy ways now. I also know when not to fight. I don’t have to fight my demons anymore. I don’t have to fight myself. That is true relapse prevention, for me. I hope that by reading this, you’ll see that recovery isn’t as easy as just not using drugs. I will spend the rest of my life actively and intentionally preventing a relapse, so that I can be healthy for myself, my children, husband, family and community.

The Manager and The Mess

Relapse. Redo. Reset: Part 1