By Dr. Stephen F. Grinstead

Dr. Stephen F. Grinstead
Relapse Prevention Expert and Author

I first saw the need to develop a relapse prevention protocol for compulsive overeaters, food addicts and binge eaters in the mid-1990s. These terms describe people who use eating and food to manage feelings and cope with life. Many of my patients also had chronic pain conditions with coexisting disorders and when both of those conditions were stabilized I noticed a pattern that many of them started using food to cope instead of for fuel and that sabotaged their pain management and addiction recovery.

In early 2008 I decided that the focus and name of the original relapse prevention protocol developed in 2001 for the Food Addiction Workbook I developed in collaboration with Terence T. Gorski the founder and president of the CENAPS® Corporation needed to be changed. I asked a colleague, Dr. Shari Stillman-Corbitt who was then the Clinical Director of Sierra Tucson, to collaborate with me on a new project—The Eating Addiction Relapse Prevention Workbook—that was published in the Fall of 2008. If you would like to see that or the companion Eating Addiction High Risk Situation Pamphlet please go to www.relapse.org to order.

Although the primary purpose of this new Eating Addiction Relapse Prevention Workbook is to help this population develop a recovery and relapse prevention plan and create a schedule of activities to assist that goal, Dr. Corbitt and I believe that patients must first develop a definition of abstinence that can work for them. It is also critical to develop an effective recovery plan or what we call a Healthy Living Plan, which is life enhancing. Therefore, The Eating Addiction Relapse Prevention Workbook is designed to increase patients’ knowledge and understanding of the nature of eating addiction.

The remainder of this article is copied from the Goals section of The Eating Addiction Relapse Prevention Workbook.

• Exercise 1: Looking at the principles of a Healthy Living Plan from a Biopsychosocialspiritual perspective, then listing your personal triggers in each of those categories and creating your own Healthy Living Plan.
• Exercise 2: Learning how to develop your personalized definition of abstinence as an important component of your recovery and Healthy Living Plan.
• Exercise 3: Completing the Eating Addiction Problem Checklist to help determine your level of problem (past and/or present) with compulsive use of eating.
• Exercise 4: Looking at the pros and cons concerning the way you have used eating in the past and making a decision to stop using eating as a coping tool.
• Exercise 5: Creating a craving management plan and an early relapse intervention plan designed to help you avoid relapse in the early stages of your recovery.
• Exercise 6: Looking at your presenting problems with eating and personalizing your own Healthy Living Contract.

The last five exercises in this book help you identify and manage high risk situations that could set you up for relapse despite your commitment to your Healthy Living Plan (recovery) and develop an effective recovery plan designed to help you manage those high risk situations.

• Exercise 7: Defining high risk situations and picking your own personal high risk situation that you would like to learn to manage.
• Exercise 8: Mapping (exploring) past ineffectively managed and effectively managed high risk situations, then using that information to project and explore a future high risk situation.
• Exercise 9: Learning to identify and manage personal reactions to high risk situations by exploring your automatic thinking, feelings, urges, actions, and social reactions that drive the relapse process and are triggered when you encounter a high risk situation.
• Exercise 10: Developing a personalized recovery plan by selecting and scheduling recovery activities that will help you identify and manage future high risk situations.
• Exercise 11: Completing a final evaluation process that asks you to complete a check list to determine how well you believe you did completing this workbook.

In Eating Addiction recovery, many have found it is critically important to abstain from addictive behaviors around eating. This means changing basic eating behaviors or eating patterns that support compulsive overeating, such as abstaining from gobbling, eating all the time rather than only at meal times, eating while driving, standing, etc. This is similar to alcoholics in recovery being told to stay away from drinking juice in a wineglass or non-alcoholic beers in a bar to avoid being ‘triggered’ to drink alcohol. Likewise, some alcoholics in recovery have found the tinkling of ice in a glass can bring on urges for alcohol and are encouraged not to use ice in drinks to distract themselves from their recovery.

These suggestions help addicts avoid the triggering of cravings and possible relapse. Addictive behaviors around eating can also trigger relapse. This is why compulsive overeaters find it helpful to be mindful of not just what they eat (a healthy meal plan), but also how they eat (healthy eating patterns); when they eat (a healthy meal schedule); and how much they eat (healthy portion control). Getting clear on what, how, how much, and how often you eat will make your recovery process smoother with less cravings. It will also reduce your incidences of and length of relapse.

This workbook is not another “diet book.” Knowing what to eat and how to eat can be learned through your medical provider, a nutritionist or registered dietician, or any of the many books available. Likewise, we do not want to discuss biochemistry (though we know it is important) or differences in metabolism and nutritional needs.

This workbook is designed to assist you in discovering and understanding your personal relapse triggers whether they are in response to specific foods, particular experiences, or certain feelings. We call these high risk situations (HRS). By not recognizing or ignoring them puts you at greater risk for relapse. You will create a definition of abstinence for yourself – your “sober” pattern of eating that will support you in avoiding random or spontaneous eating behaviors.

Finally, you will also create a Healthy Living Plan which will outline the necessary ingredients for your recovery. Because this plan is individualized, you will develop a personalized Craving Management Plan and Relapse Intervention Plan. This will require you to involve trusted others, who have been told (by you) what to look for and how to intervene, should they see behaviors that you have described as high risk.

It is possible to do the exercises in this workbook as a group process, with a qualified facilitator. As long as everyone is committed to individual exploration and discovery, it works very well. We suggest you avoid those who have an absolute idea of what your program SHOULD look like. Rather, it is important that the person you choose to share your journey with be someone who can respect your ability to develop, over time, a workable program for YOU. This will be a program that you can live with, not follow for brief time (like a diet) and then abandon. Things we suggest you look for in a person are:

1. Eating disorder knowledge and experience, especially in compulsive/binge/addictive eating
2. Relapse Prevention training and experience
3. A trustworthy person with whom you are willing to be absolutely honest
4. A person who can be honest, direct, and compassionate with you

REMEMBER:

• COMPASSION WITHOUT HONESTY IS ENABLING
• HONESTY WITHOUT COMPASSION IS BRUTALITY