I’m Sober. Now what?

Mary started drinking and using pills when she was 15. She is now 28 and has a year of sobriety. She works in the field of finance and has her own apartment. Most of her time is spent at work and going to 3-4 AA meetings a week. She has thought about joining a gym but just hasn’t done it yet. Getting to sleep has been difficult. When she does get to sleep, she doesn’t want to get up. She feels tired all day and is losing interest in doing anything.

One of the reasons Mary liked drinking was how it made her feel more relaxed and able to talk with others. She especially liked how drinking kept the critical voice in her head quieter. Now that she is not drinking, the mental chatter in her head is back and loud as ever. When she is at work talking with co-workers, clients, and even when she is with family and friends, the critical tape plays over and over. It is telling her things like, “don’t bother, you know you’re not good enough for that position”; “Don’t bother talking with them, you know they don’t think you’re interesting”. There are a million other negative things Mary’s critical voice tells her throughout the day ranging from things she “can’t do”, “shouldn’t do”; and “shouldn’t have done”. These negative thoughts have fueled her sense of self-doubt, lack of confidence, and poor self-esteem. Such thoughts are what Mary used alcohol to drown out and forget and stop feeling so anxious and bad about herself. These constant negative thoughts are making it harder and harder for Mary to get through the day at work. When she gets home its even worse. At home, it’s just Mary and the critical voice in her head. She is becoming more withdrawn and starting to not want to go to work. Her anxiety and depression symptoms are getting stronger.

After two rehab programs, three Intensive Outpatient Programs, countless AA meetings, two sponsors and working the 12 steps, Mary has finally learned how to stay sober. Now what? How can Mary get clean from depression and or anxiety?

Often times underneath addiction lies the struggle to manage or overcome depression and anxiety symptoms. The symptoms of poor self-esteem, constant self-criticism, not feeling like you ever measure up and unwanted thoughts, to name a few, are often what the recovering addict used substances to numb out, forget, and try to stop feeling bad about. Once you get sober the struggle to manage and overcome such symptoms resurface leaving you vulnerable for relapse. So what can you do?

One of the first things a person learns when they get sober is to avoid certain people, places and things that would prompt an urge to drink or use drugs. These are often referred to as relapse triggers to addiction. With regards to depression, they are often referred to as red flags. The same strategy of identifying triggers to using can be applied to being depressed or anxious. Certain people, places and things can trigger or be a red flag to someone to feel depressed or anxious. Identifying a list can empower a person. I know for some people, being with certain family members leads to conflicts or put downs. Certain places trigger memories of abuse. Certain songs on the radio remind you of someone you are no longer with. One way to handle such triggers or red flags is by limiting your time and frequency of being with certain individuals. You can also avoid certain places and change the channel on the radio.

Unstructured free time is often a trigger to relapse. This is also true for those struggling with depression and anxiety. A helpful strategy is developing a daily activity plan or schedule. Incorporate activities you like or used to like. Be sure the schedule includes activities with others once or twice a week. Getting out of the house often helps us get out of our head. Physical activity reduces the stress hormone cortisol and stimulates endorphins, which are the hormones that make us feel good.

Sometimes we can’t get outside or do something. That’s when our thoughts can really play with our heads. Those negative thoughts seem stuck and it’s tough to interrupt them or stop them from playing. Try to write out those thoughts that are running through your head. Look at them on paper to create some distance from them. See them as words in a sentence rather than thoughts that you can’t turn off. Evaluate them and challenge them.

• How else can you think about things?
• Are the thoughts accurate?
• Ask yourself, Is it true?
• Is there another way to view it?

Worry thoughts often revolve around things you “have to do”. In these cases, try writing out your plan with target dates as to when these things “have to” or need to get done. Making a plan often generates a sense of control and helps us feel more grounded.

Changing and challenging unwanted thoughts takes practice. Try listing some unwanted thoughts on the left side of a page and replace them with alternative statements on the right side. For example,

Unwanted Thoughts                                  Alternative Thoughts

“I can’t make it without using.”                  “I’m stronger than I think. I’m going to call a support to help me.”

“Life is too much.”                                     “I can break things down into smaller chunks and focus on what I can do today”

“I can’t get out of my head.”                      “I can talk with others or write my thoughts out in a journal.”

Add some of your own unwanted thoughts and alternative thoughts. The more you practice, the better and easier it becomes.

Sometimes you need support. It’s okay to ask for help. You don’t have to go it alone. The addiction community is famous for support. Attending AA, NA, or other 12-step meetings is a key building block to sobriety. The same is true for overcoming depression and anxiety. Find a support group of people who have had or who have depression or anxiety. If you are in therapy, ask your therapist for a list of such groups in the area. If there aren’t any, perhaps your therapist would be willing to start one. Being part of group helps decrease the isolation and also helps facilitate learning to share your thoughts and feelings with others. When people get sober they often lack or struggle with this ability. Talking with other sober people or others struggling with depression and anxiety can help you develop this skill.

For more ideas for overcoming depression you can also pick up a copy of my latest book, “When you can’t snap out of it: Finding your way through depression”. Throughout the book I use client accounts of what it is like to experience the primary symptoms of depression. Using cognitive therapy, I offer practical suggestions and strategies for each symptom. You can purchase a copy from www.amazon.com or www.barnesandnoble.com

Best Regards,

Dr. Lou