Monday, June 20, 2011

Fighting Our Evil Twin

The PMS - Relapse Connection

For many women, the days prior to the start of their period are marked by an increase in unpleasant symptoms, ranging from the physical to the emotional.  We may become irritable, moody, and listless while our bodies put on weight, cramp, or otherwise put us through physical discomfort.  For some, this monthly roller-coaster becomes overwhelming.  Research has shown a correlation between the luteal phase of the menstrual cycle (days 14-28) and increased alcohol consumption in women.  For those with dependency issues, this is of particular concern as it raises the real issue of relapse during this period of emotional distress.

In early sobriety especially, PMS can be a major trigger in relapse.  It could even be suggested that the difficulties so many women face in obtaining 30 days of continuous sobriety are tied to the hormonal cycle.  For those who suffer more serious symptoms immediately prior to their periods, having these symptoms occur during the initial withdrawal phase of recovery can be devastating.  Those with longer sobriety can similarly find their recovery faltering when their “evil twin” makes an appearance.  This hormonal sabotage even finds its way into menopause, causing some women to relapse after years of sobriety.

Relapse doesn’t have to be the end result of a particularly fierce case of PMS, however.  As with all other aspects of recovery, the more attention we pay to our behavior and thoughts the stronger we become and the less likely we are to resort to addictive methods of handling emotional stress.  We can think of PMR (pre-menstrual relapse) prevention as a focused effort within our overall plan.  There are several aspects for us to consider in constructing this plan, which I will discuss below.

Determining Your Cycle (charting)

The most important aspect of preventing a Pre-Menstrual Relapse is knowing when to heighten our awareness.  Maintaining a cycle chart can help us discover when during our cycles we begin to experience problems.  You may incorporate this charting into your daily journaling activities or choose another method.  You want to list when you are feeling certain symptoms associated with PMS.  These break down into a few areas:

Emotional – Moodiness, irritability, anxiety, sadness, tension, crying spells, difficulty concentrating
Physical – Bloating, breast tenderness &/or swelling, cramps, headaches/migraines, joint pain, backache
Sleep – Fatigue, increased sleep, insomnia
Cravings – Food binging, alcohol cravings

This list is not exhaustive.  You may have other symptoms which you generally recognize as happening just prior to your period, including changes in libido and bowel/bladder function.  Your charting entry for each day should include the date and any symptoms you are experiencing, along with their severity.  You should keep this chart for a couple of months, until you can see where in your cycle you begin to see your symptoms reaching a critical mass.

If you are new to sobriety, don’t assume you will have to suffer through relapses for months until you fill out your chart.  Recognizing the immediate symptoms can help to short-circuit the relapse process even the first month of recovery.

Nutritional Support & Exercise

Good nutrition is important throughout recovery, but even more so during the PMS phase.  B Vitamins, thiamine, niacin, calcium, Vitamin D, riboflavin, folate, magnesium, and zinc are all important as they are excreted at a higher rate when estrogen levels are high.  High levels of estrogen also appear to contribute to sugar/carbohydrate cravings.  Taking a good multi-vitamin is an important part of your daily nutritional regimen.

It is also suggested that women limit their intake of caffeine, salt, and refined sugar during this phase.  Eating smaller meals more frequently may help maintain blood sugar levels and even mood.  Don’t go too long without eating.  Snack suggestions include plain yogurt, unsalted nuts or popcorn, whole wheat bread with peanut butter, oatmeal or bran muffins, apple slices, raisins, dates, fresh vegetables, and fruits.

Exercise remains important during the PMS phase.  Exercise, such as walking or swimming, has been shown to reduce PMS symptoms which can also reduce the risk of a pre-menstrual stress-related relapse. 

You may also wish to consider yoga, meditation, relaxation therapy or massage.   Being gentle with yourself is more important during this time as your thoughts and feelings may seem outrageous or overboard.  

Meetings & Other Support

From the point of view of relapse prevention, this is an extremely important area to consider.  If you do not regularly attend chats or meetings, you should plan to do so during the period of greatest risk in your cycle.  Formal online chats are available through the Women for Sobriety site twice per day most days, and other programs certainly offer online chats as well.  Even if you do not feel like talking during a formal chat, making the effort to be present will help keep your mind focused on the importance of your sobriety.

Friends can be a valuable asset during your “cranky” phase.  Having someone you can talk to helps alleviate the pressure you can feel when you are out of sorts with yourself.  Don’t be afraid of expressing negative thoughts during this time; recognize that they are coming from a part of yourself that is transient and that they do not have any more power than you give them.

Talking to Your Doctor

If you suffer from severe PMS and/or severe cravings for alcohol during the days just prior to your period, you should talk to your doctor about medical options.  Certain anti-depressants and birth control pills have shown success in leveling moods during PMS and reducing symptoms.  There are other medications which may be successful as well.  Psychotherapy has also shown promise in preventing relapse during the PMS phase.  It is important to take your thoughts seriously if they involve harm to yourself or others or if you find you cannot weather the emotional storm without drinking month after month.  Speaking to a doctor or healthcare professional is a sign of strength, not weakness.  Do not feel that you have to “do it alone”.

Conclusion

PMS can be an emotional roller-coaster that makes drinking look like a sane treatment option.   The physical and emotional symptoms may seem unmanageable without losing our sobriety, but by recognizing the biological processes at work and formulating – and following – a plan to counter the monthly blues, we can weather the visit from our “evil twin” with our recovery intact.

#4. Problems bother me only to the degree I permit them to.
I now better understand my problems and do not permit problems to overwhelm me.

Even More Summer Refreshment

Here are two more iced tea recipes for you to try!

Boston Iced Tea

Ingredients:
  • 4 quarts water
  • 1 cup sugar
  • 15 tea bags
  • 12 oz frozen cranberry juice concentrate
Preparation:

Heat water to boiling, and add sugar. Stir until the sugar dissolves. Add tea bags, remove from heat and let steep for 4 to 5 minutes. Remove tea bags, and add cranberry juice concentrate. Stir until melted and mixed, then allow to cool to room temperate before refrigerating. Serve over ice.
Serves 14

Orange Mint Tea

Ingredients:
  • 2 cups water
  • 2 tea bags
  • 3 tablespoons fresh mint leaves
  • 2 tablespoons sugar
  • 4 cups orange juice
  • 2 tablespoons fresh lemon juice
Preparation:

In a large saucepan, bring water to a boil; remove from heat. Add tea bags, mint leaves, and sugar; let stand 10 minutes. Remove tea bags. Transfer to a large pitcher; stir in orange juice and lemon juice. Chill thoroughly before serving.
Makes 4 to 6 servings.

Thursday, June 9, 2011

Book Review: Staying Sober by Terence T. Gorski

A relapse is a return to addictive use of a substance following a period of sobriety.   Relapse Prevention is a cognitive-behavioral approach to the identification and prevention of high-risk situations such as substance abuse.  Put simply, Relapse Prevention focuses on changing our beliefs, images, and thoughts to prevent a return to self-destructive behavior.  It encourages us to be active participants in our recovery and has been shown to be highly effective.

One of the biggest myths in recovery is that thinking about a relapse will bring one on.  It is the failure to learn the warning signs and to preplan ways of handling them that causes relapse.  If we approach the idea of relapse as “forbidden thinking”, we block ourselves from taking action to prevent a relapse from happening and may in fact hasten the occurrence of one.

Terence T. Gorski is an internationally recognized expert in the Relapse Prevention field.  His years of research, much with Merlene Miller, has resulted in a greater understanding of what causes relapse and what ways work best to prevent it.  His findings are available in an easy to understand book, Staying Sober, with an accompanying workbook.  I cannot recommend these two books highly enough for those who are serious about preventing a relapse in their own recovery.


Staying Sober Workbook: A Serious Solution for the Problems of RelapseStaying Sober: A Guide for Relapse Prevention

The book itself is 227 pages, divided into ten sections.  It covers topics such as addictive disease and relapse, PAWS, stages of recovery, and relapse prevention planning.

The workbook, hefty at 291 pages, offers 37 exercises (many with up to five parts) designed to help the user create a detailed understand of their particular dangers and to come up with a plan to combat relapse symptoms.

An excerpt from the book is as follows:

Recovery from addiction is like walking up a down an escalator.  It is impossible to stand still.  When you stop moving forward, you find yourself moving backwards.  You do not have to do anything in particular to develop symptoms that lead to relapse.  All you need to do is fail to take appropriate recovery steps.  The symptoms develop spontaneously in the absence of o strong recovery program. (p. 129)

This book/workbook combination is a great tool and I use these books as reference in many of my writings.  They are a very helpful addition to any library.

Staying Sober: A Guide for Relapse Prevention
Staying Sober Workbook: A Serious Solution for the Problems of Relapse

Tuesday, June 7, 2011

Going Video

I am going video!  Here is my first offering, a video version of my essay, "You Can't Direct the Wind."

Thursday, June 2, 2011

More Summer Refreshment

Here are two more iced tea recipes to add to your sober cookbook!

Thai Iced Tea

A creamy iced tea, with some spicy hints. An iced tea recipe for all chai fans. Only a couple of spices, but enough to make a delicious impact.

Ingredients:
  • 6 cups water
  • 8 tea bags, black
  • 1 cup evaporated milk
  • 4 tbs sugar
  • 4 tsp cinnamon
  • 4 tsp cardamom
  • Ice, crushed

Preparation:

Boil the water and steep tea bags with cardamom for 5 minutes. Strain out teabags and let cool. Put ice into 4 glasses, and add tea. Leave about a quarter of the glass empty. To each glass add, 1 tbs sugar, 1 tsp cinnamon and 1/4 cup of milk.
Serves 4


Peach Iced Tea

Peach juice is so nice in the heat of the summer. Lemon is nice, but you can only drink so much lemon iced tea. Try something different.

Ingredients:
  • 3 12-oz cans of peach juice
  • 2 quarts tea
  • 1 cup sugar
  • 1/4 cup lemon juice

Preparation:

Combine everything and chill. Serve over ice.

Danger Zone: Planning to Drink

Summer is bearing down upon us with great rapidity, and the weekends can be a dangerous time for those in recovery, especially early on. Of particular danger is "planning to drink", where we start talking ourselves into breaking our sobriety.  It may be a thought that if we drink at a certain time and place, we will be sober before returning home to those who might know, or a justification, such as trying to give ourselves permission for those fruity tropical drinks on vacation.

These thoughts may be fleeting, or they may start to become obsessive; if you find yourself going into detail in imagining a drinking situation you have definitely crossed into a danger zone and will want to bring all your recovery forces to bear to shut off those thoughts.  This doesn't happen automatically when you are new to sobriety, it requires conscious effort.

The important thing to do when you catch yourself wanting to drink is to admit it - to yourself especially.  There is a difference between having the thought and incorporating the ramifications into your consciousness.  Once you admit to yourself that you are thinking about drinking, you are taking that thought from the reactive part of your brain to the active part, where you can counteract it.  Here are some suggested steps to use in redirecting your energy away from a drinking plan and towards reinforcement of your sober path.

Step One - Admit to yourself that you are in danger.

Step Two - Make a safety plan.  Gather phone numbers together.  Put the wallet card with the statements in your purse (if it isn't already there).  Verbalize the thoughts to someone close and supportive.  Plan for what else to do besides drink.

Step Three - If there is a specific event associated with the urge, decide whether you really need to go; sometimes it's best to beg off rather than face the threat head on

Step Four - DON'T DRINK

Step Five - Afterwards, analyze why the Imp reared his head.  Look for clues that will help you change your thinking to prevent a recurrence.

These short steps can make the difference between moving forward on your path to a New Life or stepping back toward the shadows of addiction.  Recognizing this danger zone will become easier with time and before you know it, these thoughts will flit past without even trying to worm their way into your plans!