Fair Warning: this is a long but good & useful one- there are resources and an entire planning form at the bottom.

This week, although we are right at the start of the holidays it is still a good time to review the joys and stresses of the holidays. To start I would like to take a moment to note that I’m feeling like the holidays have crept up very quickly and every year they seem to mishmash closer together. Christmas decorations were in stores before Halloween and I have even seen New Years’ decorations already. My neighbors have Christmas lights up and all the stores are blaring repetitive Christmas music, “last Christmas, I gave you my heart… the very next day…. you gave it away…” George Michael* ( I hope you enjoy that one stuck in your head- your welcome). Can’t we just take them one at a time?! But as always, I like many others enjoy the holidays and winter either way.

In all seriousness, although the holidays can be awesome, they can be really hard for people sometimes. My husband told me a bittersweet story about Christmas one time.  He said that when he was a kid he had a classmate that had an old, thin jacket for winter. My husband’s family was poor too, but he managed to finagle a coat for the classmate. My husband said when he presented the coat to the classmate he was very happy, grateful and excited. He said, “when that family went coat shopping they could only go to the thrift store and what was there is what he got.” That is what the holidays are meant for, to remind us of all the good things we can do for others. In some of our programs, we see that same stuff. Kids not having coats, food or even heat in the winter, it is really heart-wrenching when you think about it. A long time ago I remember a staff member saying that a kid wanted to stay for dinner while attending our outpatient day program because he/she didn’t have food at home. Of course, they were allowed to stay and eat!

Working as a clinician I have had the privilege to hear people’s stories and when discussing holidays the sad stories usually pertain to abuse, co-dependency, alcoholism, lacking money for presents or food for the holidays. Another common struggle that people have during the holidays is having to go see family members who may have been abusive or mean. The more a person is exposed to dangerous, physically or emotionally traumatic relationships/ situations, the more they struggle to find stability. The holidays are a big-time for relapse, depression and for major mood disorders to flare up.

With those things in mind, I thought it would be good to put together a list of warning signs for kids, parents, and adults who have a history of chemical use, mental health disorders or are in recovery. These are things to pay attention to when the holidays hit. Also to assist in some safety planning to help when things become problematic or even traumatizing again.

Common Warning Signs For Relapse Or An Increased Instability

Common Warning Signs For Relapse Or An Increased Instability

I want to note that these signs do not need to occur at once and they do not need to be present for an entire week – they can come and go. Everyone is different. But if you see many of these it’s probably a good idea to reach out for help.

  • Feeling fatigued, lethargic
  • Feeling like you can’t slow down your thoughts
  • Self-care begins to lack (no activity or overeating)
  • Poor sleep quality (waking up in the middle of the night, not being able to fall asleep, trouble staying asleep)
  • Too much sleep- wanting to sleep all the time, or sleeping excessive amounts and still feeling tired
  • Sadness, Hopelessness
  • Irritability
  • Isolating: Physically and emotionally- Feeling like you can’t say what you are thinking, hiding your thoughts and feelings
  • Fearfulness, chronic worry. Being unable to slow or manage the worry – Anxiety symptoms (sweaty palms, fast heart rate, rapid thoughts)
  • Urges to use, drink or engage in some destructive behavior: self-harm, gambling, sex
  • Apathetic- not interested in anything, often bored, feeling like you have nothing to do or are interested in doing
  • Decrease or increase in appetite
  •  Spending lots of money- aside from Christmas or gift shopping- or even going overboard
  • Feeling like you have to give in to people, their needs and wants are more important than your own
  • Missing work or school due to illness or lethargy often/ increased
  • Memory issues- forgetting things that would normally be obvious or in the front or your mind
  • Avoiding feedback or supportive advice
  • Distancing yourself from people who are healthy
  • Change in season – we just moved into cold and dark weather!
  • Poor hygiene, not showering, wearing dirty clothes over and over
  • Not wanting to do hobbies anymore

Signs of Teen Substance Abuse During the Holidays

Signs Of Teen Substance Abuse During The Holidays

More can be found on our website, but here are a few that happen often over the holidays.

  • Parties with friends
  • Wanting to avoid the family get together- would rather be with friends instead
  • Extra money
  • The present you bought for them goes missing (usually sold)
  • Frequent lies, chronic lies
  • Wanting to stay out every night for school break
  • Sudden sleepovers & begging
  • Anger/ reactivity when they are not able to leave the house or a limit is set

Creating a Safety Plan

Creating A Safety Plan

Here is a format that can be used to assist people in creating a safety plan for holidays or difficult times.  And parents, if you are worried about your son or daughter you can have them do this stuff too.

  • Looking at the above warning signs; pick your top 3 that indicate you are at risk for relapse or mental health relapse.
  • Make a list of potentially difficult situations that could come up around the holidays (being with a certain friend, place or around people drinking at holiday parties)
  • Make a list of potential triggers that could set off a mental health relapse or substance use relapse (people, places, situations, songs, memories)
  • Maintain taking medication! Do not quit meds without the supervision of an MD. (This can also include keeping up with medical needs or health in general)
  • Is there anyone I should talk to BEFORE things get out of hand or I develop a major resentment? Do I need to air out fear or problem before it gets bigger?
  • Create a list of limits that you might want to set. For example, do you often want to take on other people’s projects or easily get pulled into things that you do not want to do? Set these boundaries in advance, in the moment it can be hard to set a limit – the pressure gets strong. Things like, “gee mom, I guess I was thinking that I didn’t want to bake 12 sheets of cookies, but I will help you with setting up decorations later.” Or, “I have somewhere else to be later so I won’t be able to give you a ride to the party, I have to get up in the morning, or I want to spend time with my family” Or, ” I don’t think I will go to Aunt Katie’s house this year for the whole family thing, I have had some pretty bad experiences in the past.” Obviously, this sounds like a therapist talking, but you get the point!
  • And most of all avoid getting high or drunk, and if you do, call your sponsor, friend, get to a meeting, or call your therapist!
  • It is also a good idea to create an “if I relapse, I will do…” plan. That could be calling your therapist, returning to treatment, telling your parents, increasing meetings, returning to your old curfew from when you were 8, no phone, etc.. anything really.
  • Action plan for when those signs are present: 
    • Name 3 people that you know you can rely on when you are distressed.
    • Create a list of support groups that you can find to attend if you are having a difficult time.
    • Create a schedule to follow when you are down: Go to work, school etc, hang out with or talk to a specific person on a certain day or regular time, make activities for self- engage in a hobby daily instead of TV. (make a list of hobbies or things you like to do before you get upset).
    • Plan to remove self from a situation that is emotionally difficult or unsafe
      • Who will I call? Do I have access to transportation? Can I go to a different room until I am okay? Is this an emergency should I call 911?
    • Create a list of things you can do in the moment to assist with anger (deep breathing, walking, pacing, leaving the situation into a different room or place altogether).
    • Keep a consistent schedule, do not stay up late, sleep in too much, eat unhealthy foods, stop activity- keep your body going in the same activities and patterns.
    • If you get depressed or anxious, use the DBT Skill: Self soothe with 5 senses: vision, taste, touch, smell, hearing.
    • Create and obtain a list of emergency behavioral health crisis numbers: here in MN, we have the crisis connection (612) 379-6363. We also have a few behavioral health hospitals (U of M Health, Prairie Care, Regions Hospital, Abbott NW Hospital, Unity Hospital).
    • Engage in Mindfulness as much as possible. I often tell people to read the book Buddhism Plain and Simple– one of the best books I have ever read on meditation and the whole point behind it. It doesn’t have direct meditation in it, but it is meant to change the way our mind works and “wake up.” The UCLA Mindful Awareness Research Center provides online guided meditation, its awesome and not cheesy. They have short ones and long ones.

So there it is. Quick safety planning in a flash. I hope that this was helpful and I know I missed some things. PLEASE FEEL FREE TO ADD ANY OTHER THINGS IN THE COMMENT SECTION. I like having some collaborative stuff. That way I can re-post, change and add the stuff that other people think of too!!!

Oh! and PS, that story about my husband was before he was tough (he would want to make sure that I said that).