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(p. 158) Awareness of High-Risk Thoughts 

(p. 158) Awareness of High-Risk Thoughts
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date: 16 January 2021

It’s normal to have thoughts about using alcohol or drugs during recovery. You may feel guilty about the thoughts (even though you have not acted on them), and you may try to deny or ignore them. The problem is not so much thinking about using, but whether or not you act on those thoughts.

Sometimes the thoughts are obvious, but most of the time they are not. These thoughts can be very sneaky and can creep up on you almost without being noticed.

With practice you can train your mind to identify high-risk thoughts (i.e., thoughts that increase the likelihood that you might use alcohol or drugs) and replace them with healthier thoughts. Over time, you will have fewer thoughts about using, and they will be less intense when they do occur.

Here are 10 common high-risk patterns of thinking associated with alcohol and drug use:

  1. 1. Escape. Individuals may want to escape discomfort caused by unpleasant situations, conflicts, or painful memories. They just want to get away from it all and numb out. People with PTSD may wish to block out their trauma memories and try to forget what happened. In these instances, people may use alcohol or drugs as a way to “escape.”

  2. 2. Relaxation. Individuals look for a “quick fix” and an immediate way to relax from a stressful day or situation. People with PTSD, in particular, often feel physically and mentally “on edge” and jumpy or irritable, and may turn to alcohol or drugs in an attempt to relax or sleep. People with PTSD may also use alcohol or drugs to help “self-medicate” stress.

  3. 3. Socialization. Many individuals who are shy or uncomfortable in social settings may feel a need for a “social lubricant” to feel more at ease and decrease the awkwardness and inhibitions they feel around others. People with PTSD who have withdrawn from others or who feel disconnected and cut off from others may feel particularly uncomfortable and lonely in social situations, and may be prone to using alcohol or drugs to feel more socially at ease.

  4. 4. Nostalgia. Some people think about alcohol/drugs as if they were their long-lost friend. For example, “I remember the good old days when I’d have a few drinks.” These thoughts are one-sided and do not take into account all the negative consequences of using.

  5. 5. Testing control. Sometimes after a period of successful abstinence, people become overconfident and want to “test” their control—for example, “I wonder if I am strong enough to leave some alcohol in the house, just for friends who come over?” or “I bet I can have just one drink; no one will ever know.”

  6. (p. 159) 6. Crisis. During stressful situations or crises, people may say, “I need a drink to get through this,” or “Once this is all over, I’ll be able to stop using but not right now.” They don’t feel like they have other options to effectively cope with stress, and they underestimate the harm and additional stress that using will bring.

  7. 7. Improved self-image. When people become unhappy with themselves, feel inferior to others, or feel unattractive or deficient, they may begin to think of alcohol/drugs again. In the past, they experienced immediate and temporary relief from these negative feelings with alcohol or drugs. People with PTSD may be particularly susceptible to this if the traumatic experience has left them feeling inadequate, weak, damaged, like a “bad person” or a failure, responsible for what happened, or irreparably flawed in some way.

  8. 8. Feeling uncomfortable when sober/clean. Some people find that new problems arise after they become clean; for example: “I’m being very short-tempered and irritable around my family—maybe it’s more important for me to be a good-natured parent and spouse than it is for me to stop using drugs right now,” or “I’m no fun to be around when I’m not high.”

  9. 9. Romance. Some people associate sexual intimacy with using alcohol/drugs. They may feel uncomfortable engaging in intimacy without substances. For people with PTSD, especially those who have suffered sexual abuse, they may use alcohol or drugs because they believe it is the only way they can get through it, to “zone out” during intimacy or, alternatively, to “feel” emotions.

  10. 10. To-hell-with-it. At times, people may think that nothing matters to them or that they simply don’t care anymore. It’s important to realize, however, that even though they may not care in that moment, at some point they will care. Their future does matter, and saying “to hell with it” is an unhealthy, unproductive way of thinking that puts people at risk of using alcohol or drugs.