By Niki A. Miller, MS, CPS, Senior Program Manager, Advocates for Human Potential, Inc.
This article is the third in a four-part series that discusses some of the benefits a Wellness Recovery Action Plan can offer people with addictions, summarizes the components of my plan, and shares examples of ways I have applied them to my recovery.
Read Part 1. Read Part 2. Read Part 4.
The consequences of a relapse into active addiction have always had the potential to devastate the lives of recovering individuals. But in recent years, the risk of overdose fatality has increased exponentially and is higher among people initiating recovery from opioid use who have abstained for a period of time due to changes in their tolerance. WRAP can help meet an urgent need for integrating harm reduction into treatment discharge planning and recovery support services. This article outlines the components of crisis planning covered in sections five and six of the WRAP for Addictions book. (Read about the first four sections of a WRAP for addictions in Part 2 of this series.) It includes examples from my personal recovery experience and explores ways WRAP can be used to reduce the dangers associated with a return to drug and alcohol use.
The Crisis Plan should be formulated before a crisis occurs—during a period of stable recovery. However, it can take a significant amount of time to complete, especially if the implementation of this plan is meant to give your instructions legal standing. It can involve coordinating information with health care providers and supporters, making copies of the Crisis Plan for everyone involved, and ensuring there is a process in place for activating it.
Several states now have advance directive forms available for individuals who do not wish to be prescribed opioid medications, and the WRAP for Addictions book has information on health care advance directives and creating a durable power of attorney for health care. Once a Crisis Plan is complete, according to the instructions in the following section, it can be formalized to whatever degree the individual desires.
Crisis Plan or Advance Directive
This section of my WRAP begins with a profile of who I am when I’m in recovery that I created as part of my Daily Maintenance Plan, mainly for the benefit of anyone who may be involved who has never known me when I’m clean and sober. Next is a clear list of behaviors that only occur when I am using or drinking and indicate the plan should be put into action.
Following that, there’s a list of designated support people who should be involved in the event of a crisis (including health care providers) and descriptions of their responsibilities. People who are recovering from an opioid use disorder should indicate which people on their support team are trained to administer Narcan to reverse an overdose and are willing to have it on hand if this is part of your plan.
The next part pertains to medications: what I am currently taking, the ones I need to avoid, the ones that have helped me in the past, and the medications I am willing to take if necessary. This section should include all medications, including over-the-counter medications and supplements. This component is important for me whether I am hospitalized for a medical or a behavioral health issue. I avoid opioid medications, but they can be difficult to eliminate in cases of severe injury or extensive surgery.
If I am administered opioids for a significant period, I have specified that I will require medically managed detoxification supervised by a physician with addiction medicine experience. If I return to the illicit use of opioid drugs, I’ve specified that I’m willing to be treated with certain medications used for maintenance therapy, but not everyone wants that. This is the section to address medications that you’re okay with and any that are not acceptable for you.
Personally, I wish to avoid antipsychotics and certain types of tranquilizers, but some antidepressant medications have helped me in the past. Having these individual preferences clearly laid out can help people maintain a degree of choice, receive the appropriate care, and prevent them from being prescribed something for a mental health problem that makes it more difficult to manage their addiction recovery.
The next entries pertain to preferred treatment approaches, including any that are unacceptable, and a list of preferred facilities, hospitals, and/or providers. I have stipulated that an addiction professional should be part of my treatment team if I enter a psychiatric hospital and that I require a provider experienced in both addiction and pain management for chronic pain issues. The final Crisis Plan components include a list of things my support team can do to help during a crisis, as well as a section on my preferences regarding outpatient care, respite care, and peer support. The last item is a description of specific conditions that indicate the plan is no longer needed. These can be predetermined lengths of clean time or specific recovery milestones.
Post-Crisis Plan
My Post-Crisis Plan details how to climb back up on the horse after I’ve fallen off. This section can be extensive, but how much of it is required depends on the severity and duration of the relapse. You can complete some parts in advance; others are useful for discharge planning in cases where time is spent in residential treatment. Some sections are best completed during the initial weeks and months that follow a crisis.
This section, for me, begins with a description of what I want to feel like once the crisis has passed and a list of people I can turn to for support as I regain my footing. There’s a section on arriving home after time away: the preparations that others can make, what should be in place, priorities I’ll need to attend to, and things that can wait. This is the place for you to revisit overdose prevention plans and information on community providers of emergency overdose prevention services.
Then there are the ongoing components of a Post-Crisis Plan: what I must do daily to support my healing process, my continuing care providers and plans, and the additional steps I can take when I feel shaky. It is important for me to compile a list of what I need to avoid and for how long. For example, I generally do not have a problem going to bars, clubs, or restaurants where liquor is served, but that’s something I should eliminate temporarily when I’m recovering from a crisis.
There’s a section on issues to consider that includes steps I can take to limit repercussions that result from a relapse, such as making arrangements with my job to reduce my workload or taking care of pressing bills. It has a place to list people I would want to thank and amends I may need to make. There is a planning section for resolving medical, legal, or financial issues and a timetable for gradually reassuming my responsibilities. The final element is where I apply the lessons learned from the relapse and list the changes I will make as a result.
All this may seem like a lot of work to create something you may never use, but it is a worthwhile endeavor for several reasons. We are living in a high-stakes relapse environment. People are dying every day from relapse, and many of them are people who had periods of good recovery. The process of developing a Crisis Plan and Post-Crisis Plan has taught me to be more compassionate toward myself and prepared me to help others facing similar challenges.
Niki A. Miller, MS, CPS, is a Senior Research Associate at Advocates for Human Potential, Inc.
