What is Relapse?
Typically, like any other chronic condition, a relapse refers to the recurrence of any disease that has already gone into recovery. Relapse in substance use is the movement away from recovery. It happens when we stop being mindful or paying attention to our sobriety, and not doing things that contribute to the process of recovery. Urges and cravings can occur at any time, even if we are actively involved in a program of recovery. Relapse is not uncommon during recovery for people who are attempting to overcome an addiction. It may happen once or even more than once during different stages of recovery. In fact, relapse can be a positive and valuable learning experience for persons who undergo multiple relapses in their attempts at achieving long term recovery.
Relapse and recovery move together. During the process of recovery, it is important to be aware and recognize that the progression of the disease of addiction is always in lock step as well. The craving for alcohol or drugs does not always completely disappear and is known to be challenging for individuals in early sobriety, especially during periods of stress. Relapse occurs within the mind, and patterns are formed by our attitudes and thought processes. Family, friends, and others can notice our thought processes through changes of behavior, actions, reactions, and responses. This is referred to as “dry drunk syndrome” where the alcoholic and addict is not actively using, but the attitudes and behaviors seem the same as those exhibited during episodes of drinking or using drugs. This shows we are heading towards alcohol and drug use again.
Relapse is preventable once we learn to recognize and manage the early warning signs. We can stop the process and prevent a return to alcohol or drugs. Remember that we deal with the disease of addiction – cunning, baffling, and powerful. The progression never gets better, but always worse; and without help it is too much for us.
Common Relapse Triggers
An important part of recovery from any addictive behavior is to be able to recognize our triggers and how cravings and urges manifest in the body. Whether our addictions have to do with drugs, food, sex, shopping, gambling or alcohol, the addictive behavior is usually preceded by some triggering event that usually sets off a number of uncomfortable emotions and stressful situations that can lead to cravings and urges to engage in the addictive behavior. These events or feelings that can bring back thoughts, feelings and memories that have to do with addiction are referred to as “triggers”. Both urges and cravings often feel like they strike without warning; therefore, one must be mindful and develop and practice coping skills that have worked before.
Some examples of internal and external triggers are:
- Association with people we use to drink with
- Returning to familiar places where we use to get high (bars, clubs, casinos etc.)
- Doing things that involve drinking or using (parties, concerts carnival festivities, sporting events)
- Sight and smell of alcohol, marijuana, crack cocaine, meth, nicotine
- Depression and anxiety
- Feelings of shame and guilt or regret
- Experiencing loss of relationship (grief, death of loved one, friend or pet
- Experiencing extreme emotions (stress, worry, anger, fear, resentment, frustration)
Since it is impossible to avoid most triggers completely, it is crucial that addicts learn how to cope with inevitable stressors while in their treatment program.
Warning Signs of Relapse
- Depression/Anxiety: experiencing unreasonable or unexplained despair and fear, hopelessness, feeling overwhelmed or dwelling on problems
- Impatience: feeling that things are not happening fast enough, the need for instant gratification (I want it now)
- Argumentativeness: arguing small or unimportant issues, always needing to be right
- Self-pity: feeling sorry for self, worrying about unfairness, refusing to accept what is
- Cockiness/Arrogance: believing we have it all figured out, all in control, ego
- Dishonesty: keeping secrets, telling lies, omitting some of the truth
- Complacency: believing everything is okay, forgetting about recovery, not taking steps to make recovery our number one priority
- Exhaustion: allowing ourselves to become overly tired, poor diet and health habits, HALT (hungry, angry, lonely, tired)
- Unrealistic expectations: setting goals that are too high, expecting sobriety to be easy, expecting too much from self and others
- Forgetting to cultivate gratitude: being preoccupied with problems, forgetting to acknowledge what is good in life and sobriety
- Difficulty managing emotions: over-and under-reacting to events, being moody or irritable, anger, harboring intense feelings, resentments
- Difficulty managing stress: not staying in awareness of stressors, not taking time to relax, to stop, to breathe, and to engage in stress reducing activities on a daily basis
Ten Tips to Prevent Relapse
- Pray. Use the Serenity Prayer for the strength to stay away from a drink or drug. This too will pass
- Stop, pause. Step out of automatic mode of reactivity, observe thoughts, beliefs, perceptions, and emotions. Breathe. Don’t believe everything that you think
- Play the tape through. Choose not to drink or use drugs despite what your mind is telling you
- Physically move away from the situation you are in and engage in some meaningful activity
- Pick up the telephone and call your sponsor. Talk about your urges or cravings and discuss the high-risk situation you are in
- Go immediately to a self-help group meeting such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Co-Dependency Anonymous (CoDa), Gamblers Anonymous (GA) or Sex Addiction Anonymous (SAA)
- Speak with someone who is supportive such as a therapist, sober support, family member or friend
- Exercise. Go for a brisk walk or run, swim, workout, or engage in aerobic activities that require physical exertion
- Eat a meal, snack, or drink a non-alcoholic beverage. Make a smoothie or cook your favorite dish
- Practice mindfulness. Sit quietly with awareness of the five senses. Change your perspective with positive self-talk and cognitive behaviors techniques
The practice of mindfulness-based relapse prevention can bring a deeper awareness of thoughts, beliefs, sensations, emotions, and behaviors. This technique teaches ways to respond to challenging emotions and stressors with wiser choices aligned with what is important in your life and can be an effective relapse prevention tool.
Remember, easy does it. Take your recovery one day at a time. Stay in the moment.
Colin Hodge, RAS