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.

Addiction Recovery — Relapse Triggers

value-judgments

Stop and think

In treatment clients identify their relapse triggers and develop plans to deal with these triggers. What is a relapse trigger? Here’s a definition from Psychology Today:

A trigger can be thought of as anything that brings back thoughts, feelings, and memories that have to do with addiction (like a computer reminding a sex addict (link is external) of porn). In addiction research, these are often simply called cues. The word comes from learning research in which a reward (or punishment) is paired with something (the cue). For instance, in Pavlov (link is external)‘s classic experiment, a dog heard a bell ring right before it would get served its daily portion of meat. The dog quickly learned to associate the bell with food, and would begin salivating as soon as the bell would ring, even before the food was presented. In this case, the bell was the cue, and food the reward it was paired with. The story in drug addiction is similar. I’m sure many of you can relate to the overwhelming memories and emotions that seem to come out of nowhere when you hear music you used to get high to or pass a street where you used to buy drugs (or sex). Each of those examples is a trigger that is simply bringing about a similar reaction to Pavlov’s dog’s salivation. Seeing these things, or hearing them, creates an immediate response to the reward that it was paired with, the drug!

As we go through life we develop value-judgments. When I first tasted ice cream, I developed a value-judgment that ice cream is good. If I see a commercial for ice cream, I immediately think about how good ice cream tastes. This response to the ice cream commercial seems to be automatic, as if I saw the ice cream then automatically had a pleasurable feeling, but actually there was another step. My mind went back to the first impression I developed regarding ice cream, the value-judgment that ice cream is good. In recovery, the process must be slowed down so that when there is a trigger that causes craving for the drug, the recovering person thinks it through and re-evaluates.

Most alcoholics once had enjoyable experiences with alcohol, especially in the beginning, so they developed a value judgment that alcohol is good. With alcohol the value-judgment is even stronger because alcohol affects the pleasure center in the brain. We might like ice cream, but we really crave sex and food (in general), and drugs in some brains when drugs, including alcohol, are introduced.

In treatment, clients have to re-evaluate their relationship to alcohol and other drugs. The process of treatment is a way to change the value-judgment to meet the new reality of addiction and consequences from drug use. This can be a long process — ask anyone who goes on a diet, or decides to start an exercise program  rather than lying around watching TV. It’s difficult to change value-judgments we’ve held deeply for years, sometimes decades. In recovery, though, these value-judgments must be changed or the triggers will lead to relapse and more consequences.