“If we keep doing what we're doing, we're going to keep getting what we're getting.” — Stephen Covey

It is a pure joy to be in the profession of addiction medicine. Every day brings opportunities to learn, challenges to unravel, and patients who inspire our staff, validating the years of collective experience the Coleman Institute for Addiction Medicine brings to the table.

The success stories are abundant. When people do "the next right thing," moment-by-moment, amazing changes unfold. Just ask anyone in long-term recovery to share his/her story with you.

But—especially in early recovery—it is not uncommon for people to make choices while the brain is still healing that can herald a relapse. Alcohol and opioids (Percocet®, Vicodin®, oxycodone, fentanyl, heroin, Dilaudid®, methadone, hydrocodone, etc.) can wreak havoc on one’s ability to make good decisions.

Beware of falling into traps that may jeopardize your sobriety! Based on many years in the field, these are the Top Ten Ways I have witnessed people sabotage their recovery:

1. Try to do it on their own.

If you haven’t heard it yet, embrace this insight: the opposite of addiction is connection. Watch Johann Hari’s TED talk here to see what I’m talking about. Then, go be with someone who supports your most important endeavor: staying sober.

2. Blame parents for their current predicament.

In the setting of our clinic, as patients embark upon their detox, we frequently witness severe lashing out and blaming directed at parents, for why the patient finds himself in his current situation.

Remaining a victim to one’s past is an excellent way to sabotage recovery. Not taking responsibility for one’s own life, and having some oft-told tales about how hurtful one’s parents have been, is a handy reason to start using again. Be assured, there will always be someone around ready to play that sympathy card and agree with all the injustices visited upon you. He may even treat you to your next hit. *

*By the way, it is important to get help if you’ve had trauma. I am not in any way diminishing the idea of getting help or denying the fact that a lot of parents really.

3. Believe "I got this."

Complacency kills.

Occasionally after a patient in recovery gets a couple of clean months under her belt, she will call us to cancel her next naltrexone implant or Vivitrol appointment. The brain will heal, but it’s a slow process, and after the pink bubble of early recovery wears off and real life, unembellished by mind-altering substances settle in, the patient who has not cultivated substantial coping skills is at increased risk for relapse.

4. Skip treatment.

See Number three.

5. Believe everything you think.

Although we see most patients in long-term recovery regain an executive functioning capacity, growing evidence suggests there may be deterioration of the brain’s white matter due to heroin use.

This makes it all the more imperative that the person with Substance Use Disorder (SUD), especially on opioids, work closely with professionals who can be guides as they navigate early life without drugs. Twelve-step recovery programs often refer to Stinkin’ Thinkin’. Having a sober group to test hypotheses that are drawn from a damaged brain is a really good idea.

6. Be judgy about recovery meetings.

I meet a lot of people who are really judge-y about Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). Patients tell me they don’t want to hear people “whining” and telling war stories and glorifying their drug use.

Fair enough.

However, after so many years of working with people in this setting, I see the most success when a person is able to drop their defenses and be willing to try anything and everything to stay in recovery.

I recall a man I met early on in my career with the Coleman Institute. He didn’t love AA meetings, but he didn’t have insurance or any resources to go to alternative counseling or therapies. He had made up his mind to do 90 in 90; that is, to attend 90 meetings in 90 days.

I truly admired his determination and dedication to his sobriety; his willingness to do whatever it took.

For patients who dismiss recovery meetings as gripe sessions, I encourage them to attend a meeting with this intention: listen for that one helpful thing they can use today. A good friend of mine texts me the One Thing from her weekly AA meetings.

This mindset drops resistance and dials up willingness.

7. Don’t use medication.

Patients seeking treatment for a Substance Use Disorder have usually tried to quit before they ever get to the Coleman Institute. They are motivated and determined to stay clean. Many insist they don’t need medication, whether it is naltrexone, methadone or buprenorphine to treat opioid dependence.

Their argument actually makes a lot of sense. They tell me that medication is not going to keep them sober, that they have made the choice to stay sober. Sadly, the statistics just don’t bear this out.

“Medication-assisted treatment of opioid use disorder with physiological dependence at least doubles rates of opioid-abstinence outcomes in randomized, controlled trials comparing the psychosocial treatment of opioid use disorder with medication versus with placebo or no medication."

And now we have data showing long-acting naltrexone is equally effective at helping people maintain abstinence.

The Coleman Institute has specialized in the use of long-acting naltrexone for over 25 years, and many of our offices offer buprenorphine treatment options as well.

8. Stay super busy.

I have lots of patients who believe that filling every moment in their day is the ticket to remaining sober. Food prep, long workouts, multiple meetings, committee work, children’s activities, day jobs, etc.…anything they can do to avoid being plagued by their thoughts.

But consider this: everything you have ever read about mindfulness and meditation is true. Unless you can be at home with your own mind, you will never know true peace. And if you don’t know peace, it will be oh so easy to relapse.

I urge you to take a mindfulness class. Mindfulness-Based Stress Reduction (MBSR) is one of the original programs. Grounded in evidence-based research, MBSR teaches the techniques and benefits of mindfulness. Classes are available online and live, often in beautiful locations such as the Omega Institute in upstate New York.

The gift of mindfulness is learning to see all your thoughts as visitors whom you can choose to acknowledge seriously or dismiss with a wink and a nod, and that it is truly your choice to make the distinction.

Not only will cultivating the skill of a mindfulness/meditation practice help you from de-railing your sobriety, but it will also provide perpetual entertainment as you become aware of the mundane, ridiculous, and brilliant thoughts that come and go perpetually between your ears.

9. Slip into the past.

Many of my patients use drugs or alcohol, at least partly, to deal with things that happened in their past. Things that were done to them, or things they did to themselves or to others. With the shield of unreality removed, staring into the past, dwelling in shame and remorse, can quickly steer even the most determined user to resume his habit.

This is like walking into a field of landmines.

And it’s is why we emphasize over and over again the importance of working with knowledgeable and compassionate addiction professionals. They are the explosive ordnance disposal (EOD) experts of the damaged human psyche. As a US Army EOD expert “defeats and exploits unexploded ordnance, improvised explosive devices and weapons of mass destruction” that’s what addiction therapy specialists do for our patients.

10. Slip into the future.

As Byron Katie so aptly puts it: If you want a life of fear and terror, get a future. I think the fear of whatever that void looks like to a person confronted with stopping addictive substances is one of the strongest powers around.

What lies on the other side of quitting drugs or booze? And how could it possibly ever compete with the sensation an opioid delivers?

This is not to discourage one from making plans and setting goals, but to be aware of how quickly the mind will depart from the present moment and into the future. It’s why I think starting the morning with an intention-filled ritual is so powerful. Wake early, pray or meditate, journal, express gratitude. Set the stage for your day to encounter each of your present moments with the clarity you have earned through sobriety.

As I come to the conclusion of my list, I recognize I could easily double it. Suffice it to say, when you choose Recovery, choose long and choose well. Call us to learn about the treatments we offer to help you or a loved one get off opioids or alcohol. We too are in the long game.