Early recovery -the first few weeks of sobriety, usually in the context of an inpatient or outpatient treatment program- is a vulnerable time.  There’s a lot of ambivalence about recovery, and it’s easy to lose focus and get off track.  Here’s twelve things that often derail the effectiveness of treatment, and result in leaving treatment uncompleted and/or relapse.

In an inpatient program, counselors have more opportunity to help you keep an eye out for these problems. If you’re in an outpatient program (or someone you love is in such a program,) there may be periods of several days where you don’t have an individual appointment with your counselor.

If you notice any of these signs, it’s a good idea to make an appointment right away, talk to your group leader before/after a group session, or bring them up in your support or step group.

1. Not following directions

Red flags: Feeling that the treatment program demands too much time and energy; missing sessions with or without excuses; overt resistance to being in treatment; failure to participate or complete assignments.

2. Lack of self-diagnosis

Red flags: Comparing out; failure to identify with others in treatment; rationalizing, externalizing, or minimizing symptoms; conditional thinking; recurrent problems with motivation

3. Experiments with control

Red flags: Persistent euphoric memories of use; comparing out with respect to loss of control; thoughts about possibility of future return to use; emphasis on personal willpower or self-discipline; erratic behavior/missed sessions.

4. Maintaining a high-risk lifestyle

Red flags: Continued contact with using associates or environments; emphasis on personal willpower or discipline; failure to establish recovery-oriented support or activities; blasé attitude about risks of relapse; ‘self-testing’

5. Stress accumulation

Red flags: Feeling a lot of emotional augmentation; crisis lifestyle; constant or severe fear or worry about future; inability to tolerate frustration; perfectionism, resentment; mistrust of others; inability to let go of problems even for brief periods; loss of emotional control

6. Complacency

Red flags: Excessive self-confidence about recovery; ‘pink cloud’ thinking; desire to ‘put this all behind me’; avoiding making a realistic recovery plan

7. Medical problems

Red flags: Poorly controlled or managed medical symptoms; preoccupation with pain or other symptoms; physician enabler; feeling as though recovery depends upon relief of symptoms.

8. Psychiatric problems

Red flags: Poorly controlled or managed psychiatric disorder(s); preoccupation with psychiatric symptoms; excessive fear of depression or anxiety.

9. Complications of normal recovery

Red flags: Persistent insomnia, craving, sexual dysfunction, or somatic discomfort not explained by medical or psychiatric disorder; significant anxiety over symptoms; lack of methods to cope with above.

10. Substitution of other drugs

Red flags: History of polysubstance use, thinking some drugs are ‘safe’ or not problems; insistence on need for ‘something’ to relieve symptoms; lack of faith in possibility of longterm recovery or drug-free lifestyle.

11. Relapse by intent

Red flags: Thinking about times or circumstances that would make relapses ‘okay’; presence of enablers who reduce negative impact of relapses; collecting resentments or justifications for relapse.

12. Family feud

Red flags: Extensive enabling or provoking behavior in family; externalizing behavior onto family dysfunction; preoccupation with family status; inability to let go of resentments stemming from family life, recent or remote.