Relapse -- It won't be what we want it to be

[Lia~~]

I find this article, although a little old, one of the best on the topics of relapse.

Relapse is more than just using alcohol or drugs. It is the progressive process of becoming so dysfunctional in recovery that self-medication with alcohol or drugs seems like a reasonable choice.
The relapse process is a lot like knocking over a line of dominoes. The first domino hits the second, which hits the third, and soon a progressive chain reaction has started. The sequence of problems that lead from stable sobriety to relapse are similar to those dominoes. There are two differences. First, each domino in the line (i.e. each problem that brings us closer to substance use) gets a little bit bigger and heavier until the last domino in the sequence is ten feet tall, four feet wide, and a foot thick. As this 10,000 pound domino begins to fall on us, it is too heavy for us to handle alone. The second difference is that the dominoes circle around behind us. So when the last domino falls, it hits us from behind when we're not looking.
So here we are, moving along in recovery. We tip over one small domino. No big deal! That domino hits the next, and then the next. A chain reactions gets started. The first dominoes are so small that we can easily convince ourselves that it's no big deal. We look the other way and start doing other things. All of a sudden a huge domino falls on us from behind, crushing us to floor, causing serious pain and injury in the process. We need to make the pain go away and we reach for old reliable - the magically substances that always helped us with out pain in the past. We've now started drinking and drugging.
The answer to avoiding relapse is not to take up weight training so you will be strong enough to lift that last domino off of your now crippled body. Part of the answer is to learn how not to tip over the first domino. Another part of the answer is to develop an emergency plan for stopping the chain reaction quickly, before the dominoes start getting so big and heavy that they become unmanageable.
The Relapse Process
The progression of problems that lead to relapse is called the relapse process. Each individual problem in the sequence is called a relapse warning sign. The entire sequence of problems is called a relapse warning sign list. The situations that we put ourselves in that cause or complicate the problems are caused high risk situations.
It's important to remember that we don’t start drinking and drugging because of the last problem in the sequence. We start drinking and drugging because the entire sequence of problems got out of control. Let's look at the steps of this process in more detail.
Step 1: Getting Stuck In Recovery
Many of us decide that alcohol or drugs is a problem, stop using, and put together some kind of a recovery plan to help us stay sober. Initially we do fine. At some point, however, we hit a problem that we are unwilling or unable to deal with. We stop dead in our tracks. We are stuck in recovery and don’t know what to do.
Step 2: Denying That We're Stuck
Instead of recognizing that we're stuck and asking for help, we use denial to convince ourselves that everything is OK. Denial makes it seem like the problem is gone, but it really isn't. The problem is still there. It just goes under ground where we can’t see it. At some level we know that the problem is there, but we keep investing time and energy in denying it. This results in a buildup of pain and stress.
Step 3: Using Other Compulsions
To cope with this pain and stress, we begin to use other compulsive behaviors We can start overworking, over-eating, dieting, or over-exercising. We can get involved in addictive relationships and distract outrselves by trying to experience the orgasm that shook New York City. These behaviors make us feel good in the short run by distracting us from our problems. But since they do nothing to solve the problem, the stress and pain comes back. We feel good now, but we hurt latter. This is a hallmark of all addictive behaviors.
Step 4: Experiencing A Trigger Event
Then something happens. It's usually not a big thing. Its something we could normally handle without getting upset. But this time something snaps inside. One person described it this way: "It feels like a trigger fires off in my gut and I go out of control."
Step 5: Becoming Dysfunctional On The Inside:
When the trigger goes off, our stress jumps up, and our emotions take control of of our minds. To stay sober we have to keep intellect over emotion. We have to remember who we are (an addicted person), what we can’t do (use alcohol ore drugs), and what we must do (stayed focused upon working a recovery program). When emotion gets control of the intellect we abandon everything we know, and start trying to feel good now at all costs.
Relapse almost always grows from the inside out. The trigger event makes our pain so severe that we can't function normally. We have difficulty thinking clearly. We swing between emotional overreaction and emotional numbness. We can't remember things. It's impossible to sleep restfully and we get clumsy and start having accidents.
Step 6: Becoming Dysfunctional On The Outside:
At first this internal dysfunction comes and goes. It's annoying, but it's not a real problem so we learn how to ignore it. On some level, we know something is wrong so we keep it a secret. Eventually we get so bad that the problems on the inside create problems on the outside. We start making mistakes at work, creating problems with our friends, families, and coworkers. We start neglecting our recovery programs. And things keep getting worse.
Step 7: Loosing Control:
We handle each problem as it comes along but look at the the growing pattern of problems. We never really solve anything, we just put a band-aides on the deep gushing cuts, put first-aide cream on seriously infected wounds, and tell ourselves the problem is solved. Then we look the other way and try to forget about the problems by getting involved in compulsive activities that will somehow magically fix us.
This approach works for awhile, but eventually things start getting out of control. As soon as we solve one problem, two new ones pop up to replace it. Life becomes one problem after another in an apparantly endless sequence of crisis. One person put it like this: "I feel like I'm standing chest deep in a swimming pool trying to hold three beach balls underwater at once. I get the first one down, then the second, but as I reach for the third, the first one pops back up again."
We finally recognize that we're out of control. We get scared and angry. "I'm sober! I'm not drinking! I'm working a program! Yet I'm out of control. If this is what sobriety is like - who needs it?"
Step 8: Using Addictive Thinking
Now we go back to using addictive thinking. We begin thinking along these lines: " Sobriety is bad for me, look at how miserable I am. Sober people don’t understand me. Look at how critical they are. Maybe things would get better if I could talk to some of my old friends. I don’t plan to drink or use drugs, I just want to get away from things for awhile and have a little fun. People who supported my drinking and drugging were my friends. They knew how to have a good time. These new people who want me to stay sober are my enemies. Maybe I was never addicted in the first place. Maybe my problems were caused by something else. I just need to get away from it all for awhile! Then I'll be able to figure it all out."
Step 9: Going Back To Addictive People, Places, And Things
Now we start going back to addictive people (our old friends), addictive places (our old hangouts), and addictive things (mind polluting compulsive activities). We convince ourselves that we're not going to drink or use drugs. We just want to relax.
A client in one of my groups said he wanted to go to a bar so he could listen to music and relax while drinking soft drinks. And old timer in the group asked: "If you told me you were going to a whore house to say prayers, do you think I'd believe you? Well, when you tell me you're going to a bar to drink cokes I have about the same reaction!"
Step 9: Using Addictive Substances:
Eventually things get so bad that we come to believe that we only have three choices - collapse, suicide, or self-medication. We can collapse physically or emotionally from the stress of all our problems. We can end it all by committing suicide. Or we medicate the pain with alcohol or drugs. If these were your only three choices, which one sounds like the best way out?
At this stage the stress and pain is so bad that it seems reasonable to use alcohol or drugs as a medicine to make the pain go away. The 10,000 pound domino just struck the back of our head, breaking our bones, and crushing us to the ground. We're dazed, hurt, and in tremendous pain. So we reach out for something, anything, that will kill the pain. We start using alcohol and drugs in the misguided hope it will make our pain go away.
Step 9: Loosing Control Over Use
Once addicted people start using alcohol or drugs, they tend follow one of two paths. Some have a short term and low consequence relapse. They recognize that they are in serious trouble, see that they are loosing control, and manage to reach out for help and get back into recovery. Others start to use alcohol or drugs and feel such extreme shame and guilt that they refuse to seek help. They eventually develop progressive health and life problems and either get back into recovery, commit suicide, or die from medical complications, accidents, or drug-related violence.
Other Outcomes Of The Relapse Process
Some relapse prone people don't drink. They may say "I'd rather be dead than drunk" and they either attempt or commit suicide. Others just hang in there until they have a stress collapse, develop a stress related illness, or have a nervous breakdown. Still others use half measures to temporarily pull themselves together for a little while only to have the problems come back later. This is called partial recovery and many people stay in it for years. They never get really well, but they never get drunk either.
What I have just described is called the relapse process and it's not rare. Most recovering people periodically experience some of these warning signs. About half can stop the process BEFORE they start using substances or collapse from stress. The other half revert to using alcohol or other drugs, collapse from stress related illness, or kill themselves.
It's not a pretty picture. No wonder we don't want to think or talk about relapse. It's depressing. The problem is that refusing to think or talk about it doesn't stop it from happening. As a matter of fact ignoring the early warning sing makes us more likely to relapse.
.
References
Gorski, Terence T., Relapse - Relapse Prevention - A New Recovery Tool, Alcoholism & Addiction Magazine;; By Terence T. Gorski September 25, 1989

[Lia~~]

How To Prevent a Relapse (From SoberRecovery.com)
(I added a few comments from what I learned from my own relapse).

Relapse Prevention Planning

Proper action on the part of the alcoholic and key persons in his or her life can prevent or interrupt relapse before the consequences become tragic. Planning for relapse minimizes its destructive potential. Alcoholics can utilize intervention skills at any time before drinking becomes out of control if they are prepared to recognize and understand the relapse process.

The alcoholic is ultimately responsible for all behaviour and decisions that accompany relapse. The alcoholic pays most heavily for relapse. Many alcoholics relapse because they don't understand the process and don't know what types of behaviour change are necessary to prevent it. Most relapse in alcoholism is unnecessary. It stems from lack of knowledge.

Alcoholism is a disease prone to relapse. If you had heart disease your family would know the warning signs and what to do in case of heart attacks. The same would be true if you were diabetic or epileptic. Any condition with high relapse potential should be treated with respect. The relapse pattern should be systematically explored and prevention tactics individually designed.

Proper relapse prevention plans can give you and the concerned people in your life a deep-seated sense of security. All involved can know that they are doing everything that is necessary to prevent relapse. They can develop a plan and a checklist of warning signs. As long as you follow that plan and watch for warning signs, you can be confident that recovery is following a successful course.

An essential part of the recovery process is the establishment of a relapse prevention plan. The plan should include the individuals in your life. Each person should be informed of the potential for relapse and their responsibility and appropriate action if you demonstrate early signs of relapse. The steps of relapse prevention planning are:

1. Stabilization: The first step in preventing relapse is stabilizing from the relapse that has just occurred or, if this is your first time quit, stabilizing your sobriety.

2. Assessment: If this is your first time quit, you need to assess whether you are ready for relapse prevention planning. Do you believe that you are really alcoholic and that you need to change your lifestyle? If you are not sure, you need to work on these issues before you are ready to develop a relapse prevention plan. You have to believe that you have a disease that is subject to relapse before you can do what is necessary to prevent that relapse. If you have relapsed previously, then you need to cooperate with your therapist/support network to assess that relapse and other relapses you may have experienced to determine what contributed to the relapse process and what could have prevented it.

3. Education About the Relapse Process: You need to learn about recovery and relapse. You need to understand the sobriety-based symptoms and what it takes to manage those symptoms. You should review the 37 warning signs of relapse and learn to describe examples of the general process and specific symptoms.

4. Warning Sign Identification: Develop a list of warning signs or indications that you may be in risk of drinking. The warning list should be developed from past experiences with relapse warning signs. Try to identify at least ten specific and clear indicators that you are moving away from productive and comfortable living and beginning to set yourself up for relapse.

5. Review of Recovery Program: Recovery and relapse are opposite sides of the same coin. If you are not in the process of recovering, you are in the process of relapsing. A good recovery program is necessary to prevent relapse. Has your previous recovery program been working for you? How can it be improved? Develop a new recovery program based on what has worked for you and what has not worked for you in the past.

6. Inventory Training: Any successful recovery program involves daily inventory. AA Step 10 says, “Continued to take personal inventory and when we were wrong promptly admitted it." The alcoholic must learn to challenge himself in his day-to-day living patterns. "Am I living up to my own standards and values? Are those standards and values realistic? Am I acknowledging my alcoholism and managing its symptoms? Am I attending to my overall health needs?" For a relapse prevention plan you should design a special inventory system that monitors the warning signs of potential relapse. Develop a way to incorporate this inventory system into the fabric of day-to-day living. The key issue is this: You now know the personal warning signs. How are you going to determine if any of these symptoms have been activated in your life?

7. Interruption of the Relapse Warning Signs: It is now important to establish new responses to the identified warning signs of relapse. Determine what you are going to do about each symptom when you are able to recognize that it is working in your life. And practice each new response until it becomes a habit. The response must be available in times of stress. Only habits are dependable in times of stress. You must practice in times of low stress until the response becomes a habit.

8. Involvement of Significant Others: Make a list of all the people with whom you have daily contact. Select from that list those people that you think would be important in helping you stay sober and avoid a relapse. Determine how each person has interacted with you in the past when you have shown symptoms of relapse. Has it been helpful or harmful to your sobriety? What could they have done that would have been more helpful to your staying sober? Now determine what you would like each of these people to do the next time symptoms of relapse are recognized. Bring the key people in your life together for a meeting. Explain to them your list of personal warning signs and form a contract with each support person as to what they will do when relapse symptoms are recognized and what they will do if you begin drinking.

9. Follow-up and Reinforcement: Recovery from alcoholism is a way of life. Since relapse prevention planning is part of the recovery, it too must become a way of life. Relapse prevention must be practiced until it becomes a habit. We are all enslaved by our habits. The only freedom we can find is to choose carefully the habits to which we allow ourselves to become enslaved.

For the recovering alcoholic, it is especially true that there is freedom in structure. It is only in the habit and structure of a daily sobriety program that the alcoholic can find freedom from enslavement to alcohol.

Relapse is a process. A process is different from an event. When an event has taken place, it is unchangeable. A process can be changed or interrupted at any time. It is ongoing; it is occurring; it is not fixed in time. To see a process as an event blocks change. Death is an event; grief is a process. To experience grief as an event locks you into grief as though it were the event of death.

Relapse is not an event; it is subject to change or interruption. Relapse begins long before the first drink. There are warning signs and symptoms that pave the way. These symptoms can act as early warning signals to alcoholics and their families. By understanding the process, unnecessary pain can be avoided. Proper action by alcoholics and the key people in their lives can prevent relapse or interrupt the relapse before the consequences become tragic.

Points to Remember:

1. Most people do not make it after the first attempt at sobriety (don't use this as an excuse to relapse-- this is probably NOT your first attempt at sobriety. Every failed attempt is playing with a loaded gun for an alcoholic).

2. People get drunk because they fail to do what is necessary to stay sober. (Whatever it takes. Plan your quit and stick to your plan-- no excuses).

3. There are a variety of behavioural setups which make a return to drinking an alternative in spite of known consequences. (So identify and avoid them-- there's always a reason to drink. But never one that is good enough to throw away your hard earned days of sobriety or your life).

4. Relapse begins long before the first drink. There are 37 warning signs of relapse. (Write them down. I use a daily inventory -- at this point it is mental-- but every morning and every evening, I do a "recovery check"-- it's just as much a part of my life as looking in the rearview mirror while driving. It doesn't mean I'm not enjoying the ride-- I'm just staying safe).

5. Proper action by you and the key people in your life can prevent or interrupt relapse before the consequences become tragic. (If we keep signs of impending relapse secret, we're planning our relapse).

6. A relapse prevention plan is an important part of recovery. (in my opinion it is second only to not drinking-- having a plan and a commitment to stick to it, no matter what, is the common denominator in long term sobriety, from what I have read and learned from talking to people with long term sobriety (> 10 years).

[DW]

There are 37 warning signs of relapse.

could you post these please, or a link?
thanks.

[Lia~~]

Sorry DW. Here they are:

37 Relapse Warning Signs
1. Apprehension About Well-Being
2. Denial
3. Adamant Commitment to Sobriety
4. Compulsive Attempts To Impose Sobriety on Others
5. Defensiveness
6. Compulsive Behavior
7. Impulsive Behavior
8. Tendencies Towards Loneliness
9. Tunnel Vision
10. Minor Depression
11. Loss of Constructive Planning
12. Plans Begin to Fail
13. Idle Daydreaming And Wishful thinking
14. Feeling That Nothing Can Be Solved
15. Immature Wish To Be Happy
16. Periods Of Confusion
17. Irritation With Friends
18. Easily Angered
19. Irregular Eating Habits
20. Listlessness
21. Irregular Sleeping Habits
22. Progressive Loss Of Daily Structure
23. Periods of Deep Depression
24. Irregular Attendance At Treatment Meetings
25. Development of An “I Don’t Care” Attitude
26. Open Rejection Of Help
27. Dissatisfaction With Life
28. Feelings Of Powerlessness And Helplessness
29. Self-Pity
30. Thoughts Of Social Drinking
31. Conscious Lying
32. Complete Loss Of Self-Confidence
33. Unreasonable Resentments
34. Discontinuing All Treatment
35. Overwhelming Loneliness, Frustration, Anger, Tension
36. Start of Controlled Drinking
37.Loss of Control

Here's the source.

[miffy]

This is an incredible thread. Thank you so much. I am inspired now to write out my own plan. I will post it when it is completed. I too love structure and can see where this will help.

I had a question about #3 on the 37 warning signs of relapse.

Is it really adamant commitment to sobriety?? I don't understand. Does that mean that you should be more humble about it and take it day by day?

[Lia~~]

The way I interpret #3 is to mean "I KNOW I will never drink again and there is no question about it" (I call it getting cocky")

I think #37 means-- we loose control and start drinking.

I can't wait to see your plan, Miffy-- it will help me to see other peoples'--- mine is trial and error and I don't want the error part.

[jujubee]

Wow...lots of great info here. I agree w/ t-bone that this place is still an important part of my recovery process. I still learn here, I am reminded by visiting of my past and the dangers of relapse and have a rare opportunity to help others as I travel my own path to sobriety.

I have been thinking a lot about this. I wonder, I guess as I am coming on my year am I doing enough? There have been relapses of several people with extended sobriety and I wonder could that be me someday? These posts have really helped me evaluate things and I will continue to do so to ensure I am heading he right way. Thanks for posting them Lia.

[Time to Change]

Excellent thread -- thank you Lia.

I have not yet relapsed but am very, very aware that it occurs very frequently. Here is how I focus on my sobriety every day:

1. Thank God every morning and night for how good I feel. I think how great it is to go to bed sober and how amazingly wonderful it is to wake up without a hangover.

2. I remind myself many times a day of how much better I am doing now that I'm sober -- this includes things like, "I take a shower almost everyday, I care about my appearance, I make my bed everyday, I love the taste of grapefruit juice again, I look great, I am building stronger relationships, I am reaching out to my neighbors more, etc." These thoughts pop into my mind through out the day and it always takes me by surprise. For example, I was stuck in some bad traffic on the way home from work tonight and I thought, "if I were drinking, I would be so incredibly angry right now that the traffic was stopping me from getting to my bottle of wine. I can now really enjoy the clouds in the sky."

3. I recognize my other compulsive tendencies more easily and for what they are. I ask myself, "why do I really want to buy this blouse? Do I need this?" The fact that I've removed the alcoholism allows me to drill down to the other addictions I have (shopaholic, chocoholic). These may sound innocent but there is that certain "fervor" that appears when I think about missing my dose of dark chocolate for the day. More recently, I've become very sensitive to taking over-the-counter pain relievers -- not because I think they are harmful, more because I wonder why I want to rush to take them when I feel a small headache coming on.

4. This website and the AA meetings are also what help keep me grounded. Watching people who I've seen change for the better and who choose to go back to drinking (and their subsequent realization that it never works out the way they want) is what has the biggest impact on me. I have a huge sense of "fear" -- I guess that is the best way to put it -- when someone relapses at AA or here. My heart literally freezes and I realize what a fine line it is. I remind myself of Audrey Kishline. Her life story, and the tragedy she caused by choosing to deny/not take control over her alcoholism is always the biggest wake-up call to me.

That's it for me. I'm going to really review these posts more though to get more insight/ideas on having a plan.

[Bridgit]

I like this one;
My addiction is out in the hall doing pushups

[peace4u]

I had a slip and just admitted to it in my journal. The warning signs are accurate, and need to be taken seriously. I spent yesterday sleeping off a hangover, and feeling completely shitty, emotionally and physically. There could not have been any other outcome.......................poison causes one to feel sick, and it is poison in our bodies. If one thinks that one last time can be fun, it CAN'T. Fun is not feeling like shit, it is waking up refreshed, healthy and clear, able to do what ever it is the day requires or what one wants to do. Like being with friends, family, going for a drive, enjoying the outdoors, seeing a movie, cheering someone up, feeling alive and excited about the day, knowing you have another day sober and appreciating that..........
I am soooooooo disappointed, there is just no other outcome possable. Don't slip, don't relapse, the day's of fun drinking are LONG gone. Peace4u.