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.
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
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.
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.
to remember that we donít 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.
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 donít know what to do.
Denying That We're Stuck
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 canít 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.
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.
Experiencing A Trigger Event
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."
Becoming Dysfunctional On The Inside:
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 canít 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.
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.
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.
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.
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."
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?"
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 donít understand me.
Look at how critical they are. Maybe
things would get better if I could talk to some of my old friends.
I donít 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."
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!"
Using Addictive Substances:
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.
Loosing Control Over Use
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
Outcomes Of The Relapse Process
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
But there is
hope. There is a method called Relapse
Prevention that can teach us to recognize early warning signs of relapse and
stop them before we use alcohol and drugs or collapse.
That's what my next article is about.
There's also a process called Relapse
Early Intervention that helps us set up an emergency plan to stop relapse
quickly should it occur. We'll
cover that in our third article.
Gorski, Terence T.,
Relapse - Relapse Prevention - A New Recovery Tool, Alcoholism &
Addiction Magazine;; By Terence T. Gorski September 25, 1989