Advice for Clinicians: How to Help Clients Avoid a Holiday Relapse

For those battling addiction, the holidays are laden, even in the best of times, with pitfalls that could trigger a relapse. It’s the time of year when people tend to eat more, drink more, idle more. Routines get disrupted. Expectations go unrealized.

Then there are those for whom the holidays also mean toxic family dynamics, unsafe living conditions, or intense isolation and loneliness.

In 2020, add to that the stress of a global pandemic and rising social unrest.

With all of this going on, self-care routines can fall by the wayside, said Margaret Giles, coordinator for the Alcohol and Drug Education and Psychology Training (ADEPT) Center at William James College. Giles asked five clinicians to offer useful tips and strategies that mental health professionals could use to help clients with substance abuse issues approach this season in a healthy way.

Write a Breakup Letter to Alcohol

A client will be attending a family event where people will want to enjoy an alcoholic beverage with their meal. She feels that not attending is not an option, but fears that her troubles with alcohol misuse will tempt her to drink. How can a clinician help her manage the situation?

Ask her to write a breakup letter to alcohol, said Gayl Crump Swaby, director of the clinical mental health program at Springfield College.

Think about a bad relationship with a former romantic partner, Crump Swaby advised. Then think of alcohol as a bad relationship. “Say to alcohol: We’re broken up. The relationship is over. We will see each other at events, but we won’t be engaging with each other.”

The client can even keep the letter with them. When at a family function where alcohol is being served, she can consult the letter and even share it with others. This strategy may be useful in communities of color, she said, where sustaining family bonds is so important that absence can be akin to insult.

Spend the Holidays Without Family

Families have traditions and longstanding dynamics. Triggers abound, but in many cases stepping away for talks with a sponsor or time alone won’t be received well. People will feel offended. As a result, clients may miss a meeting, stop self-care routines and drop healthy habits. It could be the start of relapse.

So why not consider skipping the family reunion altogether?

“What’s best for the family system and the homeostasis of the family system isn’t always what’s best for the individual in recovery,” said Miriam Ervin, a mental health counselor who specializes in treating adolescents and young adults with substance addiction.

Coach clients on how to have that straightforward call with family members, said Ervin. Roleplay that conversation. The good news is that keeping healthy boundaries with family means they can hold healthy boundaries with anyone.

Self-Efficacy, Harm Reduction and Self-Awareness

“There’s a lot of fear with holidays approaching. It can feel to them that relapse just magically sneaked up on them,” said Danielle L. Owen, an alcohol and drug counselor. Drawing on the work of Terence Gorski, she has clients stay in front of relapse by working on self-efficacy, harm reduction and self-awareness.

Help clients understand that they can handle the pressure, and that you believe they have the skills to get through it, said Owens. They may hit a wall if that confidence isn’t there. Point out the times where you recognized them setting and achieving goals. Build on small victories.

Limit the opportunities for relapse by defining what relapse would be for them, she said. Get their definition; don’t impose one on them. Remember: This is their recovery journey.

One quick and easy technique for clients to use is the acronym HALT (hungry, angry, lonely, tired). By identifying that a common mental or physiological state leaves them more vulnerable to cravings, they can more easily spot the seeds of relapse before it happens.

Let’s Be Together: Help, but Don’t Enable

What if the client isn’t the person with a substance use disorder, but rather a mother or father worried about what to expect when a son or daughter who has been struggling with misuse of alcohol comes home? He or she may be asking: Should drinking be present at all?

It’s important to distinguish between what’s helpful and what’s enabling. “Enabling is essentially love that looks like fear,” said Felice Lopez, a mental health counselor in Framingham, Mass. Trying to control someone’s access to alcohol can be enabling. Listening and being attentive is helping. “Be the person that she can turn to,” she advises. Foster mutual respect and trust that she’ll move to recovery in her own time.

As for whether to serve or hide alcohol, according to Lopez, the question for the client is really: What do you want the holiday to look like? Once the role of alcohol has been decided, clear and realistic house rules should be established for all guests to follow, so the client won’t feel singled out and controlled. Family members should be notified and told they’re welcome to join on those terms.

Spend the Holidays with a New Type of Family

Healing is about change and seeing things from different perspectives. The holidays are an opportunity to start developing those skills, said John Meigs, director of the substance use and addictions counseling concentration at William James.

Perhaps that new perspective comes from spending the holidays with a recovery community instead of family. In the spirit of seeing things differently, reframe your client’s coming absence in a positive light, as an act of giving rather than loss.

“What a gift you can give to your family, letting them know that you’re safe, that you’re taking care of yourself,” said Meigs. “And you are kind of giving them peace in some ways.”

These tips were originally shared in a longer, recorded discussion that is now available on the William James College YouTube channel.

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