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.

 

Alcoholism and Holidays

Alcoholism and holidaysI could have titled this recovery and holidays rather that alcoholism and holidays, but I believe we all need to come to terms with the word “alcoholism”and “alcoholic”. Alcoholism is perceived as a harsh word that some prefer to soften with terms like Alcohol Use Disorder (AUD). Regardless what we call it, the reality’s the same. I’m okay really with using a different term as long as it doesn’t change the way people perceive the seriousness of the disease. Yes, alcoholism, or AUD, is a serious, debilitating. progressive and deadly brain disease. Recovering alcoholics have to make adjustments, and one adjustment in early recovery is how to deal with holidays and all the attendant festivities.

It seems like a downer when a newly recovering alcoholic comes up on a holiday like Christmas and invitations to parties arrive. What to do? Go and drink a soda that looks like a mixed drink? Tell the host that you aren’t drinking? Don’t go? Make a pledge to yourself or your spouse, partner or friend who might be going with you to leave if you get uncomfortable? Each individual has to make their own choices, of course, but it’s much better to get advice from someone in long term recovery who’s dealt with alcoholism and holidays a few times, or many times.

If the recovering alcoholic is going to AA, they suggest that newcomers get a sponsor, someone who’s been in recovery for awhile and knows the pitfalls. No one has to recover alone. There are many people who can and will support you in recovery — the recovering alcoholic has to seek them out and ask for advice and support. It’s difficult for most people to admit they have such a serious problem they have to ask for help, but there’s no shame in asking for help. If you don’t know anything about real estate, you find someone who does. If you want to learn a new language, you seek out people and methods to teach that language.

Alcoholism and holidays are tricky. There’s unnecessary stress during the holiday season — it doesn’t have to be that way. If a person in early recovery chooses to avoid parties with heavy drinking, then that’s probably a good choice. There will be other holidays, and when that person is strong in recovery and the desire to drink has gone away, a recovered alcoholic can do anything others can do, except drink alcohol without consequences.

Motivation in Addiction Treatment

Motivation in addiction recoveryThere are basically three types of motivation in addiction treatment. One is to avoid unpleasant consequences through compliance. These clients are usually pushed hard to get into treatment, and they’re the most likely to return to their drug of choice. Another form of motivation is calculation — a person has calculated the costs and benefits of drinking and using drugs and has concluded that stopping will be a better choice. The third form of motivation is existential — the person has committed to addiction treatment because life in addiction has become miserable, hopeless and precarious. These last two forms of motivation are stronger than the first with the last being the strongest.

Although addicts who’re forced into treatment by the courts, family, spouse, etc., can and do recover, they usually have to go through more trouble before the desire to change is deep and meaningful. I’ve seen clients who’re forced kicking and screaming into treatment turn around and realize they have a problem. Most of us working in the field for a lengthy period of time have come to realize that it’s almost impossible to tell who’ll recover and who won’t, but the odds are not favorable for the person who’s in treatment just because someone holds leverage over the person. You’ll often hear people say about addiction treatment and recovery that the person has to want to stop drinking or using some other drug in order to recover. A desire to stop is not necessary in the beginning. I’ve seen people forced into treatment with no intentions of stopping have an epiphany and recover long term, and I’ve seen people who desperately wanted to recover never stop for any long length of time and eventually die from their addiction. Nothing has hurt the addict more than for people to tell him/her that they aren’t trying hard enough, and that if they just put their mind to it, they could stop drinking alcohol or using cocaine or shooting up heroin.

The person who rationally looks at their addiction and decides the costs of using drugs outweigh any benefits are at least motivated, but if addiction recovery were as simple as calculation, most people would stop long before the late stages of addiction. Calculation can be strong enough to get a person into recovery, but there usually has to be something stronger keeping a person in recovery or they go back to the drug of choice after the bad memories fade and the calculation changes. Perhaps the person has bad fortune in recovery and loses their job in a bad economy — the person who’s only calculating the costs and benefits might say that recovery is not “paying off”.

The point is that a desire to stop is a good motivator, but not necessary to start the treatment process. Having a desire to stop, though, doesn’t guarantee recovery, especially if the person is quitting with the expectations that life will be trouble free without addiction. Addicts forced into treatment can and do recover, and addicts who initially decide to deal with addiction and recover can and do die from their addiction. What usually determines if a person recovers or not is their level of ongoing commitment to the long term process of recovery. The main form of motivation in addiction treatment that enhances long term recovery is internal commitment. When a person has truthfully admitted that addiction is a life-threatening problem and has committed to taking steps to achieve and maintain recovery, regardless of external circumstances or obstacles, then the motivation is real enough to sustain long term change and growth.

Virtuous Cycle in Addiction Recovery

recovery management

Upward and onward

In his book The Fifth Discipline, Peter Senge wrote about a virtuous cycle. Senge was writing about learning organizations, but the same principles apply to individuals and a virtuous cycle in addiction recovery. We’ve all heard about the vicious cycle — addiction is a prime example of a vicious cycle. A person becomes addicted to a drug, things get bad, the person tries to quit, the withdrawals are painful and life is just too hard without the drug, so the person says just one to take the edge off, then the cycle begins, over and over, with no apparent escape. This type of cycle is a downward spiral that ends in institutionalization, jail or death.

So, what is a virtuous cycle? A virtuous cycle would be when the addict actually breaks out of the cycle to create a new cycle that generates personal growth. The virtuous cycle is upward — it’s a good, reinforcing loop. The virtuous cycle is when a person applies recovery principles, things improve, the person reaches a plateau, then the person finds a new challenge, a new opportunity for personal growth which creates another cycle, over and over, upward and upward.

The path to the virtuous cycle is not easy, but it’s infinitely rewarding. In treatment, we attempt to guide clients to this virtuous cycle, to identify the old ideas that keep them trapped in the vicious cycle, to inspire actions necessary to get out of the vicious cycle and to teach recovery management tools necessary to start a virtuous cycle. The online Macmillan Dictionary defines a virtuous cycle this way:

a process in which a good action or event produces a good result that also causes the process to continue so that more good results happen

When the addicted person first tries to quit drinking alcohol or doing some other drug, they’re spending a lot of energy just staying away from the drug – if this is all the person does, no treatment, no counseling, no support, just white-knuckling it, then this will wear a person down mentally and emotionally, so that the person will most likely return to drug use. The virtuous cycle creates positive results — these improvements in the person’s life are inspirational. After improvement happens, the person’s drawn toward recovery rather than just trying to stay away from the drug(s) of choice. This makes all the difference in recovery.

When a person is pulled toward recovery because they want more growth and improvement, then great things can happen.

Relapse

realpse and lapse

relapse prevention

Why do so many who receive treatment for an addiction problem relapse? That’s a question I often hear. First, let’s distinguish between relapse and a continuation of the addiction after a short break. Most people who start drinking or using drugs shortly after treatment call this a relapse, but there was really no recovery. There has to be some significant level of recovery in order to say someone relapsed when they return to drinking or using drugs. Those who take a break from using drugs in order to receive treatment for a month or so, perhaps because they were forced by the court or a family member, then continue drinking and using shortly after treatment haven’t relapsed — they just stopped drinking alcohol or using their drug of choice for a short period to get out of trouble for a minute. Alcoholics and drug addicts stop using from time to time for short periods for one reason or another, but this doesn’t mean they’ve recovered from addiction.

So, relapse is when a person has had a significant period of recovery and is actively making changes to remain abstinent and put things back together. People sometimes relapse after a year of recovery, three years, 30 years, although if someone stays sober and clean for a year and is managing a recovery program, the chances of them maintaining long term, permanent recovery is very high. I also need to distinguish between a relapse and a lapse. A relapse is a full return to addiction, while a lapse might be a one time slip that the recovering person quickly does something about and returns to the recovery program.  Those who do relapse usually stop doing the things that got them into recovery to start with. They stop utilizing their support, like AA or NA or a church group if they are part of a church — the family thinks they are cured, and their friends see them as past all that unpleasantness for good. Most often the person takes being clean and sober for granted and thinks they have power over their addiction disorder. Once the recovering person believes they have power over alcohol or some other drug, they might start thinking they can take a drink or smoke a joint periodically without consequences. Their minds start playing tricks.

When the alcoholic or drug addict experiences a period of recovery, they are healthier, think more clearly, have better relationships, are able to hold down a good job, make more money, etc., so they might start thinking they are as capable as anyone else of drinking sociably or using drugs recreationally, especially if they remove themselves from their support structure which served as a reminder of how bad it was before. The pain they experienced years before fades in their memory — they start thinking problem with alcohol or some other drug might have been because they were immature, or it was just a wild period, but now that they’ve put their lives together and have become responsible, it’ll be different. When the recovering alcoholic or addict drifts away from their long term recovery program, they put themselves at risk for relapse, even if they never intended to when they first started drifting.

Relapse is not inevitable

relapse is not inevitable

Relapse Prevention

Addiction has been called a disease of relapse, mainly because relapse is common. First, though, we need to distinguish between the up and down process of addiction, in which a person might struggle for awhile after deciding to stop drinking or using drugs. Someone addicted to alcohol, opiates or other drugs might go through many experiences of trying to stop but never getting into recovery. When a person decides to do something about the problem, they might stay straight for a short while then drink or use drugs, and this can go on for months. This is just the process of addiction — recovery hasn’t happened yet. There is no recovery, so there is no relapse, just many attempts to deal with the problem. All the attempts can move someone closer and closer to recovery, but they can’t be considered to have recovered then relapsed during all these attempts.

Relapse is when a person has some significant time in recovery and has moved past the irrational compulsion to drink or use drugs, then starts drinking and using drugs again. It’s actually more complicated than that. If a person has been in recovery, utilizing support resources and relapse prevention tools, and has changed his/her thinking and behavior regarding alcohol and other drug use, then the person begins drifting away from the support and stops using the relapse prevention tools, it can be said that the person has relapsed in their mind before taking the first drink or using the first drug again.

It’s the mindset and behavioral changes that constitute the relapse — the actual return to active addiction is merely the end consequence of the mental, emotional and behavioral relapse. It’s like someone who’s lost 60 pounds and has a bright outlook on life and feels healthy again — then the person stops doing the things they did to lose weight and feel good about themselves — then they go on an eating binge, all after a long time of feeling good and keeping the weight off. This process can be called a relapse.

Relapse is not inevitable. Recovery management is about understanding that relapse is possible, thus, managing recovery for the long term. If a person in recovery has no plan for the times when it gets hard to continue in recovery, or has no plan to deal with the down times in life, then the person will put themselves at risk for relapse. If, however, a person in recovery has plans for those tough times, then, when they get to a cross roads in recovery, they’re more likely to know what steps to take to protect their recovery. There are many people in recovery who don’t relapse once they recover from what AA calls the “seemingly hopeless state of mind and body” that is addiction. Relapse is not inevitable.