Safety Barriers Address Vulnerabilities in Recovery

How can an individual in recovery stay sober when the areas of his or her brain that process decisions aren’t functioning properly, Kevin McCauley, MD, senior fellow with Meadows Behavioral Healthcare, asked NCAD attendees in his Saturday session. In other words: How can a person protect themselves from relapse when their ability to assess relapse is, in itself, impaired?

McCauley, who is in recovery after developing an addiction to prescription painkillers after surgery when he was a flight surgeon for the U.S. Navy in the 1990s, discussed the need for a recovery management plan and developing a safety culture to solve common problems early in recovery.

McCauley drew parallels between aviation safety checklists used during his time in the Navy and recovery plans. Much like no single safety barrier can prevent mishaps, no single element of a recovery plan can entirely prevent a relapse, McCauley said. He made the analogy that the parts of safety checklists and recovery plans are similar to a stack of slices of Swiss cheese—each has holes, but when you put enough together, they form a solid block of cheese, or a safety checklist/recovery plan that accounts for all potential problems.

“If I try to consciously process this risk, I’m going to fail,” he said. “But if I put enough safety barriers in my life, it doesn’t matter if I’m craving. It doesn’t matter if I am offered the chance to get high. Those safety barriers should protect me. … At some point, consciousness will break down. You have to have other factors in place.”

A solid recovery management plan should include the following elements, McCauley said:

• Treatment, either residential or intensive outpatient
• Work with a therapist, counselor, coach or advocate
• A recovery residence, noting studies have shown housing is a critical social determinant of health
• Participation in mutual support groups
• A plan for how to respond when relapse occurs
• Frequent testing. McCauley said that while relapses happen, it is clandestine relapses that create a greater potential for bigger problems.
• Active employment or education
• Work with an addiction medicine specialist
• Medication-assisted treatment
• Hedonic rehabilitation, i.e., relearning to engage in healthy pleasurable activities

“You don’t know which one is working at any one time, but when you put them all together, that’s when you get these high prognosis rates,” McCauley said. “That’s what the pilots do. That’s what the doctors and nurses do. That’s what people in collegiate recovery programs do. And that’s why they’re successful.”