Addictions 104 – Relapse
Too often, people believe if you fall off the wagon then there is no hope. I do not believe that to be true. With the right effort, knowledge and support people can and do make a full recovery, but there are many hills and valleys on that road. By better understanding relapse you can encourage and support yourself and others. Realism and hope are two necessary medicines for recovery and relapse prevention.
In my previous 3 blogs, I discussed the realities of addiction, its impact on relationships and recovery. Recovery is a gradual process towards a healthy, balanced and satisfying life. If you return to using after beginning recovery, relapse is a reality that can be managed through planning and ongoing treatment.
Recovery has several stages. First is moving from active addiction/abuse/misuse to seeing the truth and seeking help. Second, in early and mid-recovery you are trying to stabilize your life through regaining self-control, setting limits, and changing your lifestyle. You know you are well on your way when you experience growth and development and can maintain the positive changes you have made.
According to Gorski, a major researcher and educator on relapse and recovery, the following are some principles of relapse prevention: Relapse is a process not an event because there are identifiable warning signs that precede relapse (thoughts, feelings and triggers) and most people who relapse are not aware of their warning signs.
Here are some typical signs of potential relapse.
Denial that there was a problem, unwilling to change, cravings, withdrawal, exaggeration – of the pain of recovery or the benefits of using substances or activities.
Unmanaged stress as life problems occur, often compounded by poor eating, and sleeping, over-working and/or no exercise.
Return to problematic thinking, feeling, behaviors or situations – trying to avoid facing consequences.
Failure to repair lifestyle damage or address unresolved issues like mental illness or trauma.
Return to self-defeating behaviors like over-confidence, complacency, exit recovery activities or stop doing what was working.
Based on a person’s place in the world as top or under-dog there are different relapse warning signs which are mirror images of each other. Top-dogs exaggerate their strength and deny their weakness. They focus on themselves and try to control, use or drive others away as they become isolated and angry. Under-dogs exaggerate their weakness, deny their strength, focus on others, assume the victim role, drive others away by excessive clinging, and become isolated and depressed. Isolation has been found to have a very negative impact on addiction and mental illness.
With good relapse prevention planning the duration and severity of relapse can be limited. When I do relapse prevention planning with people we first identify why they have decided to stop using or abusing substances or activities. Next, we identify all the ways they recognize they are experiencing any of the above signs preceding relapse. For most people there are thoughts, feelings, situations or issues that likely arise before relapse. I educate them about realities of recovery, like post-acute withdrawal (depression, difficulty thinking, physical pain); cognitive distortions; and self-defeating behaviors. For every potential trigger identified we develop actions, thoughts, or people that the person in recovery can employ to avoid or make the relapse less severe.
It is very important that any relapse prevention plan is based on what the person with the problem is willing and able to do (not what everyone else tells them to do). If there is a relapse, the plan to see what we missed or didn’t work and develop alternate options.