Relapse Warning Signs in Addiction Recovery

Relapse triggersLearning to recognize relapse triggers and relapse warning signs in addiction recovery is critical. Triggers are sights, sounds, people, smells, places and things in general that remind the person in recovery of their drug of choice. Some cocaine addicts in recovery can see powder of any kind and begin craving cocaine. A recovering alcoholic can pass the wine section in a super market and think about the good times years ago when drinking was still pleasurable, even glamorous at times. A heroin addict can see an insulin needle and feel the rush of heroin in her veins. There are ways to deal with triggers. The craving they produce doesn’t  last, if the person in recovery takes action to deal with the craving.

It’s suggested in treatment to have someone who’s in recovery to call when the compulsion of addiction is triggered. Just calling someone and talking about it often changes the feeling. Some people immediately leave the environment, go for a walk, think about the end-result consequences from using or drinking, exercise and burn up the energy — usually any kind of counter action will work — the main thing is to not let the craving linger, fantasizing about using or drinking. 

Then there are warning signs of relapse. Sometimes the warning signs are more subtle than a trigger. The trigger is immediate and powerful, but the relapse warning signs might be difficult to recognize and understand — but it’s usually the unrecognized relapse warning signs that create triggers. Below is a list from Project Know: Understanding Addiction of warning signs that can lead to relapse:

  • Frequenting old using grounds or hanging around drug-using friends
  • Keeping drugs in your home for any reason
  • Isolating yourself from friends or support groups
  • Constantly thinking about using drugs
  • Quitting therapy, skipping scheduled appointments, or veering away from your addiction treatment program
  • Overconfidence or feeling as though you no longer need support
  • Relationship conflicts
  • Being too hard on yourself or setting impossible goals
  • Abrupt or sudden changes in eating or sleeping habits, personal hygiene, or energy levels
  • Feelings of confusion, depression, uselessness, anxiety, stress, or being overwhelmed
  • Boredom or irritability, usually stemming from a lack of structure
  • Refusing to deal with personal problems related to daily life events
  • Replacing drugs with other obsessive behaviors such as gambling
  • Major life changes that cause intense emotion such as grief, trauma, or extreme elation
  • Thinking that “just one time” won’t hurt
  • Physical illness or pain

Some of these changes in attitude and behavior are rationalized in recovery so that the person normalizes isolation, or blames others for conflict, or medicates feelings before trying counseling. If a person doesn’t understand the warning signs and doesn’t take actions to avoid relapse, the odds are the person will eventually use or drink again. It’s important to have a Recovery Management Plan, so that when the person in recovery or someone else recognizes the warning signs, action is taken. Its not a sign of failure when warnings appear — they happen to everyone. What’s important is taking action and doing something about them — avoiding relapse is the goal. Every time a person recognizes relapse warning signs and takes action to deal with the problem, they grow and become stronger in recovery.

Addiction Treatment: Lapse and Re-Lapse

Lapse and relapseIn addiction treatment and recovery, we talk about lapse and relapse. Lapse is when someone is just beginning addiction treatment and starts using again shortly after. Lapsing is common. Think about dieting and how easy it is in the beginning to eat a candy bar when the urge gets strong. The alcoholic or other-drug addict, cocaine addict, opiate addict, etc, in early recovery hasn’t learned how to control the compulsion to drink/use, so, unless they’re following all directions in recovery, they’ll likely give in to the compulsion. It will seem to the person as if they have no control whatsoever over the compulsion that drives them to drink/use. I’ve heard it described by alcoholics as if they went on autopilot, and zombie-like walked into the liquor store, bought the bottle, and before they knew they were drinking. 

If the person returns quickly to recovery to start again and learn why they drank alcohol or used some other drug, then it can be a learning experience. There was a lapse in recovery, the person started back in recovery and went forward. No one has to have a lapse, but it happens. The person will usually feel guilty and beat themselves up, but this shouldn’t last long — the person has to get over it, talk with someone who understands and start again. Addiction recovery is tough in the beginning– lapses happen. I don’t want to make light of a lapse. Some people drink/use again and bad things happen, like a DUI, a fight where someone is seriously injured, the final straw for a spouse who leaves — then the person loses hope and the return to drinking/using turns into the continuance of addiction and down-hill slide. There are much easier ways to learn how to stay sober than going back to alcohol, cocaine, opiates, and suffering consequences. There’s an old saying in recovery communities – it’s easier to stay in recovery than to leave and come back.

A re-lapse is when someone has recovered, then gets away from the things that got the person straight and sober to start with, and they return to active addiction. This can happen after a year in abstinence, 10 years of abstinence or 40 years of abstinence. Re-lapse is usually more severe, because the person becomes more confused, guilt-ridden, filled with shame and anger at themselves. It takes quite a lot for someone who relapses after years of recovery to come back into recovery. Many people don’t make it back. The worse thing the person can do is give in to the shame and guilt and wallow in it.

Just remember, if you’re in recovery, it’s much easier to stay in recovery and continue to maintain recovery – however, if you lapse in early treatment or relapse after years of abstinence, quickly get back and learn from the experience. Remember that’s it’s a disease and you’re human – humans don’t always do what’s best for them. We can start feeling healthy and start believing we never really had a real problem after all, then start drinking or using again only to find that we again lose control. Learn about addiction, and once you know the truth believe that the truth doesn’t change, no matter how long you’ve been abstinent or how healthy and powerful you feel.

 

Addiction Relapse Prevention

Addiction relapse prevention plan

Relapse prevention plan

What is relapse? It’s not drinking or using again after a short break to catch your breath. Most people misuse the word relapse. If a person stops using drugs for a short period then starts again with no recovery efforts or improvement in between – that’s just a continuation of addiction. All people with an alcohol or other drug addiction stop for short periods of time — the human body breaks down with uninterrupted use, so there are brief intervals in which the alcoholic or drug addict has to stop for a short period. Relapse is using drugs or drinking again after a period of improvement.

Addiction relapse is also considered a return to heavy, destructive, addictive use. If a person has had a period of improvement and drinks one beer, then realizes that this is crazy, calls someone and gets back into a recovery program, this is a lapse. This is from Everyday Health:

Addiction relapse is generally considered to be the return to substance use after a period of abstinence. However, according to James Garbutt, MD, professor of psychiatry at the University of North Carolina in Chapel Hill and a researcher at the Bowles Center for Alcohol Studies, “Relapse has different definitions. Some would say that it is a return to any amount of substance use, while others would say it is a return to heavy use. The medical profession states that a relapse is a return to destructive or heavier use.”

It’s an important distinction: If you drink one beer on one occasion, you have had a lapse. But if you are abusing regularly or your alcohol or drug abuse is causing negative consequences in any area of your life, you are having a relapse and need professional help.

I would only nitpick the word “abstinence” and substitute “a period of recovery and improvement”. I’m sure the author meant a period of improvement when writing abstinence. In treatment we focus on addiction relapse prevention through Recovery Management. Relapse triggers must be identified and dealt with. It’s not the end of the world if a person in recovery has a lapse or a relapse, but if the person relapses, there’s no guarantee that a return to recovery in imminent. Many people in recovery who relapse never make it back to recovery. It’s best to stay in recovery if you’re in recovery.

Terence Gorski has been one of the foremost authorities on relapse prevention. Go here to learn how to develop a relapse prevention plan – http://www.tgorski.com/gorski_articles/developing_a_relapse_prevention_plan.htm.

 

Outpatient Addiction Treatment

relapse preventionSo, what’s the purpose of outpatient addiction treatment? There are several aspects to addiction treatment, and it’s important to understand the transitional phases. In the beginning, the main goal of treatment is to assess and stabilize. If the assessment shows outpatient treatment is appropriate, then the person is medically assessed to make sure there are no physical complications. Addiction presents itself as an acute, immediate problem, characterized by loss of control, legal problems, relationship problems, financial problems, employment problems, physical problems, emotional problems, etc. Not everyone coming into treatment is dealing with problems in all these areas, but they have problems associated with drug use. When I write “drug use”, I also mean alcohol, which is simply a legal drug, even though it causes more problems, collectively, than any other drug.

Although treatment professionals are presented with symptoms of addiction in the beginning, after a period of assessment and stabilization, treatment shifts to a different client/therapist relationship, an educational/therapy phase. Outpatient treatment doesn’t have the luxury of inpatient treatment where the patients are a captured audience. Outpatient clients go home after group, so it’s important to educate the client on abstinence skills from the beginning. Relapse prevention education should start immediately in outpatient. Once the client enters group, there’s a dual approach of group therapy and education. The client is taught that they are responsible for their recovery, although they don’t have to do it alone — there’s support available. Recovery support can come from different sources: family, employer, 12 Step groups, churches, etc. Clients in addiction outpatient treatment are encouraged to develop relapse prevention plans that best suit them and their situations. Not everyone has a supportive boss, or a job, and not everyone goes to church, and not everyone has a supportive family — so the individual works with the counselor to develop a realistic recovery plan.

As outpatient treatment comes to an end, the client should understand by this point that recovery is a long term process. When the client came into treatment, they presented with an acute, emergency situation with lots of symptoms, but the client learned addiction is a chronic and progressive condition that will only get worse if they don’t manage their recovery long term. Treatment is the difference between dealing with symptomatic problems with symptomatic solutions and dealing with fundamental problems with fundamental solutions. Although outpatient addiction treatment programs deal with symptoms in the stabilization phase, treatment is about applying fundamental solutions to fundamental problems. Too many people deal with the symptoms of addiction and never address the fundamental problems.