The holidays can present difficult challenges for people in recovery from drug or alcohol use disorder. Even in the best of times, people may experience anxiety and stress related to the holiday season whether due to increased family time, travel fatigue, or unrealistic expectations of holiday happiness.
2020 has not been the best of times. And, of course, the uncertainties surrounding the COVID-19 pandemic have added to the usual litany of holiday stressors. Some individuals in recovery may even opt out of seasonal festivities to avoid relapse triggers that can lead to feelings of loneliness and isolation.
While there is no one-size-fits-all plan to ease holiday anxiety for those in recovery, below are a few helpful tips that I offer my patients during this time.
Remember, you are not alone
Individuals can often feel a sense of shame about their addiction. Also, they may be reluctant to share their thoughts and feelings with friends and family over the holidays. This can further increase feelings of isolation
Remember, nearly 21 million Americans struggle with alcohol or substance use issues. So this is not a struggle that you are facing alone. People all over the world are trying to cope with the same challenges you are.
Know your triggers
If any situation was designed to trigger a relapse, visiting family and friends in a setting of celebration is potentially at the top of the list. Although the holidays may look different for you this year.
Seeing family or friends in-person or even virtually may prompt emotional memories, even traumatic ones. This can elicit a desire to use drugs or alcohol.
If you are celebrating the holidays alone this year, loneliness can also be a potential trigger. It is important to mentally prepare yourself by identifying likely triggers that will test your sobriety during the holiday season.
Develop an “emergency plan” before there is an emergency
Once you have written down your triggers, visualize how you would respond when confronted with each triggering situation, such as an emotionally fraught discussion with a family member.
It is important to develop an emergency plan in advance, so you are ready to navigate uncomfortable situations that place you at a high risk of relapsing.
You don’t want to have to figure it out on the fly. For example, you may want to bookend a therapy session or support group meeting both before and after a social engagement you suspect will be difficult.
Stick with a friend
Identify a sober friend you can check in with over the holidays. It should be someone who can help you with your emergency plan. Your friend can attend socially distant events with you or even check in with you virtually. This can help ensure that you are able to properly assess the situation and leave if any events seem too high of a risk.
You should always have an exit strategy. Your friend can help, or he or she can simply be available to talk during or after a challenging situation.
Ensure you are engaged in your treatment
This past year has caused a lot of uncertainty for everyone. Many individuals in recovery have had to adjust their recovery journey to adapt to this unprecedented time.
It is important that you maintain your normal schedule as much as possible. If you usually attend in-person peer support meetings, but no longer have the option to do so, it is important that you take advantage of the many virtual meeting options available right now.
Further, it might be important to schedule a meeting before and after holiday celebrations to keep you on track. In addition to meetings, it is important to attend all scheduled therapy and medical visits (whether virtual or in-person).
The most comprehensive treatment for addiction combines two approaches:
- Medication to help reduce cravings and prevent relapse
- psychosocial support to help manage the social and emotional aspects of addiction.
If you currently take medication as part of your treatment regimen, it is important that you stay on track and take your medications as prescribed.
Focus on others
Holidays are a time for giving, and great thinkers over the centuries have reminded us that our acts of kindness benefit us as well as those we help. Science has now shown that reward processing  in the brain kicks into a higher gear when we perform altruistic acts.
Finding an activity that contributes positively to your family, friends, community, or a group that you are passionate about can help you refocus on the meaning of the season. It can also keep you preoccupied and away from potentially triggering situations.
Sometimes those in recovery look back on their previous days of substance use and find themselves romanticizing the situation. They may only remember the fun while forgetting the challenges and difficulties associated with using.
This year try redefining what “fun” means to you. Instead of getting together for drinks, perhaps have a cookie bake-off (virtual or in-person), play board games, or host a holiday movie trivia night.
Have fun during the holidays: 10 Smart Ways to Enjoy a Healthy Holiday Season
HALT! Pay attention to your internal cues
The acronym HALT stands for
- lonely, and
These are states in which someone in recovery is particularly vulnerable to relapsing.
More fundamentally, the concept of HALT is a reminder for you to stop for a minute and think about whether you are truly caring for yourself. Are you getting too little sleep or feeling isolated? Now might be a good time to try some meditation techniques, eat a healthy meal, or call a friend.
If you are heading into a situation that is high risk, take a minute to do a quick self-check to see if you are hungry, angry, lonely, or tired and decide if you really want to attend. Or if you might want to eat, calm down, or rest before going.
Exercise, exercise, exercise
Exercise increases the production of endorphins. These are “feel good” chemicals in the brain that reward us when we do the right thing. As I noted before, this is the same reward center that comes under attack with substance use.
One study  in morphine-addicted rats found that rats who underwent swimming exercises voluntarily reduced their consumption of morphine compared with sedentary rats. Studies  in humans  have also shown that people who participate in exercise programs reduce their drug use.
The Final Takeaway on Holiday Challenges in Recovery
This year has been a challenging time for everyone, but if you are experiencing difficulties in your recovery, or are just getting started, don’t hesitate to reach out to a healthcare professional to get support. With these tips, people in recovery can set themselves up for success as we head into the new year.
- Santi J. The Secret to Happiness is Helping Others. Time Magazine (undated), https://time.com/collection/guide-to-happiness/4070299/secret-to-happiness/ Accessed 12/18/20.
- Filkowski M, Cochran R, Haas B. Altruistic behavior: mapping responses in the brain. 2017 Jun 2. Published in final edited form as: Neurosci Neuroecon. 2016; 5: 65–75.Published online 2016 Nov https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5456281. Accessed 12/18/20.
- Gorji H, Hosseini S. Swimming reduces the severity of physical and psychological dependence and voluntary morphine consumption in morphine-dependent rats. https://pubmed.ncbi.nlm.nih.gov/25498794/Accessed 12/17/20
- Roessler K. Exercise treatment for drug abuse–a Danish pilot study, Scand J Public Health, 2010 Aug;38(6):664-9, doi: 10.1177/1403494810371249. Epub 2010 Jun 7. https://pubmed.ncbi.nlm.nih.gov/20529968/ Accessed 12/18/20.
- Brown R. Abrantes A, Read, J et al. A Pilot Study of Aerobic Exercise as an Adjunctive Treatment for Drug Dependence. Ment Health Phys Act 2010 Jun 1; 3(1): 27–34 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2889694/ Accessed 12/18/20
Sarah Church, Ph.D.
Sarah Church, Ph.D. completed a predoctoral fellowship in addiction at the Yale University School of Medicine and a postdoctoral year at the Substance Treatment and Research Service (STARS) at Columbia University Medical Center after graduating from Fordham University with a doctorate in clinical psychology and from Columbia University with an AB in psychology.
Dr. Church is a clinical psychologist who has more than 20 years of experience in research, program development, and treatment of patients with substance use and co-occurring mental health disorders. She is an expert in Cognitive Behavioral Therapy (CBT), Community Reinforcement Approach (CRA), and Contingency Management. She is the founder and executive director of Wholeview Wellness®.
Before starting Wholeview Wellness®, Dr. Church served as the Executive Director of the Division of Substance Abuse at Montefiore Medical Center and as an Assistant Professor in the Department of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine for 16 years.
Dr. Church was appointed by Mayors Bloomberg and De Blasio to the NYC-DOHMH Community Services Board and serves on the Board of the Coalition of Medication-Assisted Treatment Providers and Advocates (COMPA).
She is the President-Elect for the Division of Substance Abuse at the New York State Psychological Association (NYSPA). Internationally, she has provided consultation to the United Nations Office of Drugs and Crime (UNODC) for both Vietnam and Afghanistan as they develop medication-assisted treatment centers in their countries.