What Leads To Relapse
Over the 40 years I’ve been sober I’ve witnessed many people relapse. Some return to recovery and many don’t. Some relapse after a short time of sobriety and some relapse after thirty years. Knowing what is contributing to an unconscious drive to use drugs and alcohol again is critical to succeed in long term recovery. The reason I say ‘unconscious drive’ is because often people who relapse don’t have any clue as to why it happened.
When I first got sober there was a term the professionals used called “Budding.” This term stood for Building Up to Drink or Drug. The other popular saying was “The relapse happens way before the relapse happens” Often our friends would know we were heading towards a relapse way before we did. The list of symptoms included agitation, irritability, isolation, euphoria, depression, avoidance, pulling away from supports, overconfidence, having all the answers, blaming others, romanticizing the drink, negative feeling states and many more. Suddenly you are bored or want some excitement or just want to escape. We are relief seeking missiles. We do not like discomfort.
The biggest skill in recovery to avoid relapse is to learn how to tolerate what’s happening in our minds and bodies. There was a reason we checked out and didn’t want to face reality. Life can be uncomfortable. In recovery we need to address the things that have been unresolved from the past, but also learn to deal with present life situations. We spent so much time checking out, numbing ourselves, denying or moving away from what was happening inside us, that it takes time to become familiar with our inner landscape. Learning how to tolerate even sitting quietly for 5 minutes can be a big deal when we first enter sobriety or even for people in long term recovery. Beginning to allow for the vicissitudes of our emotions and to be more comfortable with uncomfortable or negative thoughts is critical to embracing the ongoing shifts of the human experience.
I know many people over the years who just went from one addiction to another so they didn’t have to face what was percolating underneath the surface. This is called substitution. An addict can pick up food, gambling, shopping, technology, video games, a relationship, sex, or anything to deny feelings of the past, stress in the present or fear of the future. A friend of mine had fifteen years of recovery and started gambling. When she looks back at when that started, she told me she just wanted to escape. But escape what? Usually, it is an internal pressure to escape from underlying feeling states. The truth is she was lonely, bored and enraged while remembering past abuse.
To avoid these feelings, our minds will begin to rationalize, minimize or deny the seriousness of the addictive behavior. Thoughts like, “I deserve to escape” or “It’s not that bad, at least I’m not drinking” or “Who am I really harming by ordering from Amazon all day?” Our cognitive processes work hard to make the behavior acceptable so we can continue to act out with other addictions. Obviously, all these behaviors are on a spectrum but if you have an addiction issue, we will often choose any distraction to avoid experiencing feelings.
When I was in graduate school, the craving to drink returned briefly at the end of each semester when I completed the last exam. My body remained all wound up from months of stress and I wanted relief. My brain would immediately go to thoughts of alcohol, even though I hadn’t drank in years. This is the power of addiction. A patient of mine also had a pattern of craving but she would relapse every six months. It eventually became clear that by month six, she couldn’t distract herself from all the anger churned up in her abusive relationship. Instead of dealing with her underlying rage, she just drank again. Many external circumstances can trigger the desire to drink- a loss of relationship, loss of a job, a new job, a new baby, getting married, basically any change in the status quo.
When I list all those possibilities contributing to a relapse, it is not about the event itself, but our internal resistance to experiencing our feeling states about the event. At 20 years of sobriety my mother passed away and the day of her funeral I wanted to drink badly. It came upon me like a sharp slap to the face, suddenly the magic taste of the old way to soothe myself was right on my tongue. The immediate desire to go to what I had always gone to in the past, suddenly was overwhelming. But losing my mom was a huge deal. We had a complicated, conflictual relationship that never got off the ground due to the combination of both of our addictions. It was a huge loss of that relationship never happening. I needed to grieve the loss of her physical self but also the fact that I would never have a close relationship with a mother. This was devastating.
10 ways to Avoid a relapse
- Stay connected. Community, friends or a support group are essential to a successful recovery
- Practice sitting with yourself quietly a few times each day so you can start to recognize your feeling states and thought patterns
- Address the grief/anger/fear/shame and unresolved/leftover pain from the past with ongoing support
- Staying sober is a delicate dance of taking time to dive in and time to stabilize. Figure out what is too much and know how to take care of yourself when overwhelmed
- Learn to identify what/who/when your triggers are: for example: notice if every time you visit your mother you feel like drinking, look at what the underlying feeling states are that get churned up
- Take care of basic needs like sleep, eating, exercising, not overworking or overfunctioning. Stress can lead to the desire to relapse
- Be aware of what I call the residuals. Often times we can get through a stressful event like a wedding, the holidays, a weekend around drinking people, a funeral but its the day or few days after that we let our guard down and the desire to use can be intense
- Figure out ways to identify and address your anger. Anger and/or the repression of anger can be a huge trigger to relapse.
- When you have a loss, get support. Loss of a relationship is frequently a trigger to relapse because we don’t want to experience grief
- Identify ways to calm your nervous system, settle and reduce anxiety. Anxiety and fear can be uncomfortable so looking at its underlying causes, and having tools to stay centered is important.
Some experts say “Relapse is part of Recovery.’ It can be but it also doesn’t have to be. Unfortunately if you have a serious enough substance abuse issue, you may not come back from a relapse. Our minds can trick us into believing it will be ok. That is the danger of the mind of an addict. The most important thing is to begin to get to know yourself. Take small steps to move inward, rather than outward. Acceptance of who we are, what we have done and where we are headed is quintessential to a successful sobriety. Get to know the awesome person who is here now.
9 Comments
Thank you
thanks doc sober since 3-6-87
Awesome my friend! Keep up the great work!
Excellent article. I learned alot and related with the whole message here. As a gambling addict, many times I would be clean for a long time and wonder why my urges seemingly came out of nowhere. It validates my theory, that when I have any changes in my life good or bad, is a dangerous time for and addict. Looking forward to reading and hearing more of your material, it is very well explained. Thank you for taking the time to write this.
Glad it was helpful…addiction is such a tricky illness because it is one of the few that has as its main component…DENIAL..which tells us We don’t have it!… And yes…stress can come in all kinds of packages..good and bad!…Marriage can be great..and be extremely stressful, having a baby, change of job, moving.etc. etc..Great insight..
Always a pleasure to hear from other addicts..
I drank in progressive non-moderation for 27 years. I attended 5 alcohol treatment programs. The first was at Farmington State Hospital, MO, in 1968, a 30-day inpatient stay. The last two were at the VA in Temple, TX—two simultaneous 30-day inpatient programs. The other two were the Audie Murphy hospital in San Antonio, TX. 1978 & Austin State Hospital inpatient each 30 days. I attended 100s of AA meetings + & quit going 1 1/2 years ago. I didn’t go for my 40-year chip last year with the support of my psychiatrist. I don’t support the first & many other steps. I have had a cough for 2 years & started taking daily shots of cough ‘10% alcohol meds. I was a low-bottom drinker for 20 years. Now I am certain that the cause of addiction is not immorality.Could you recomend an online non-AA discusion group, will gladly read your book !
Wow, sounds like you have gone through a lot to get sober!…Not sure where the cough syrup is leading you..wasnt sure how you were presenting it..like a problem or not? Hope you are ok. The steps can be tricky for anyone, especially if your beliefs are different…You are right, Addiction is NOT a moral issue, it is a serious disease…Many many people die from it everyday…Its really about our minds more than our bodies..we can clear up the body with stopping drinking, but the mental part is much harder…I need to know that my brain is the brain of an addict that tells me I’m ok and I can figure this out, when really I need to surrender. There are soooo many non AA discussion groups these days, i’m not an expert on that but I would google it. Good luck
Struggling with slipping in and out. I will get a thought and that’s all it takes and I don’t even think I just act. Any recommendations for that. I have been going to meetings. I truly don’t understand where the thought will come from. It can happen literally at a meeting.
Liz,
sorry you are struggling, yes, the thinking is a killer!..It is One Day at a Time…Just think about not drinking for one day…Have some spaciousness with your thinking..your disease.WILL want you to drink, yes..so just notice the thoughts…This is a mental illness that will tell you its ok to use…That is the nature of it..Thoughts usually come from an unconscious feeling …you may be angry, scared, irritated, sad..literally anything…our minds will tell us that drinking is the way to cope..but it is a lie…Just know that the most normal thing for an addict to think about is the substance..the key is being able to tolerate your feelings and know drinking NEVER HELPS..If you choose the drink…you give up everything for one thing..If you pick up recovery…you give up one thing, to get Everything..hang in there.