Once you’ve emerged from any alcohol or drug treatment program, the real works begins: staying clean and sober. People in recovery and those who support them all agree that the first year is the most difficult, a bewildering time when relapse is most likely to occur. Here are some tips for beginners or those trying again:

Blood sugar: Hypoglycemia is common among active alcoholics, but instead of burning sugar they're burning alcohol. For people in recovery, the body's craving for sugar often gets mixed up with a craving for alcohol — that's why there's always lots of candy around Alcoholics Anonymous (AA) and other self-help meetings. Find a substitute for alcohol to deal with the biological cravings caused by fluctuating blood sugar; consider a hypoglycemic diet, with six meals a day to avoid those wide swings.
Emotional reminder: One stress management acronym widely used in the recovery community is H-A-L-T, which is a reminder to avoid becoming hungry, angry, lonely or tired.

Avoid triggers: Stay away from people, places and things that are going to remind you of drinking or using drugs.

Supplements: In addition to eating healthy, consider taking B complex vitamins. Thiamine, in particular, helps prevent delirium and tremors in alcoholics. Also L glutamine, an amino acid available in health food stores, has a unique function in the brain and is said to offer a natural way to help the body fight off cravings.

Exercise: Develop a regular exercise routine, even if it’s only walking on a daily basis. During a good workout, the brain releases endorphins that create a “natural high,” one that is certainly less potent than what you’re used to, but still a mood elevator.

Seek support: Regularly attend a supportive group, such as AA, Narcotics Anonymous (NA) or one of the alternatives to 12-Step programs, to help deal with depression, which is common among alcoholics, particularly women. Meeting with others in recovery can help you understand the scope of the disease and prevent you from becoming bitter or angry.

Plan ahead: Make a list of dangerous situations and how to deal with them. Let’s say you’re invited to a wedding. Be prepared to leave early or make sure in advance that a non-alcoholic beverage will be at the table if you’re going to be called upon to make a toast.

Analyze your patterns: Examine your drinking or drugging life carefully to decide what situations might have stimulated you to use. If you realize that every time you visited your mother there was an argument and you started to drink, then it’s probably a good idea to stop seeing mom in early sobriety or until you’ve worked with a therapist through the issues that cause the arguments.

Educate yourself: Read everything you can, attend public lectures and watch TV specials to try to understand what your addiction does to your body and mind. It will equip you to treat addiction like the progressive disease it is and provide insight into yourself as well as your new friends in recovery.

Clear out the clutter: Make it massively inconvenient to use your substance of choice. Get rid of alcohol, binge foods, cigarettes and drugs. Also dump the barware, wine glasses and beer mugs. Remove suggestive items, such as powdered sugar or baking soda (which looks like cocaine), sage (which smells like dope), flavoring extracts (which contain a remarkable amount of alcohol) and paraphernalia like handheld mirrors, ashtrays and even the music or incense you used to create a mood or cover up your using.

Choose your friends: Keep in contact with people who are in good recovery.

Avoid new addictions: If your recovery isn’t going well, chances are you may have additional addictions. It’s very common for recovering addicts to simply switch addictions.

Rely on rituals: Establish new routines and rituals, which can provide meaning, connection and even future promise. These can range from morning prayers and meditation or simply reciting the same encouraging words each morning to daily journal writing or a regular exercise routine.
Resist romance: Striking up a new relationship in the first year can be dangerous because if it fails, the potential for relapse is greater. Don’t use a romantic relationship as an excuse to get clean; in AA and NA parlance, this is called “13th stepping.” Get clean for yourself – not somebody else.

Try again: Cycling more than once through treatment, recovery and relapse is not uncommon, so continue seeking help. The good news is that the cycles often are a precursor to stable recovery.

(Sources: “Staying Sober: Tips for Working a Twelve Step Program of Recovery,” by Meredith Gould (Hazelden, $15.95); Dr. Nicholas A. Pace, a life member of the National Council on Alcoholism and Drug Dependence board of directors; AddictionZ in Canada; Alcoholics Anonymous.)

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