Guarding Against Relapse

guarding against relapseRecovering addicts and alcoholics know relapse happens… We just hate to talk about it.

We prefer to think that as long as we keep going to meetings, talking with our sponsors, working with others… we are somehow immune, inoculated against that particular soul-sickness. We love to quote the section in the tenth step where it talks about us being “safe and secure,” about being placed in a “position of neutrality” about “not fighting anything or anyone, not even alcohol.” We might notice that directly AFTER the tenth step promises, the writers of the Big Book add the caveat “as long as we stay in fit spiritual condition,” but we tell one another THAT warning has to do with us having AA’s permission to go clubbing (not avoiding a relapse).

To make matters more confusing, when we’re painstaking about the program of recovery from start to finish – for the most part and in most cases – we ARE immune! “How could anyone give up the recovery life?” we ask one another after attending yet another funeral. “That friend or loved one who relapsed MUST have been doing it wrong!”

This is where we must fetch ourselves up sharply.

All of us, even the best AA and NA members in the whole damn world WILL go through at least one dangerous period in recovery. None of us can claim that we’ve been ‘re truly painstaking from start to finish. Every member finds themselves in a dangerous spot from time-to-time. All of us.

Bill W wrote that:

Of course all A.A.’s, even the best, fall far short of such achievements as a consistent thing. Without necessarily taking that first drink, we often get quite far off the beam. Our troubles sometimes begin with indifference. We are sober and happy in our A.A. work. Things go well at home and office. We naturally congratulate ourselves on what later proves to be a far too easy and superficial point of view. We temporarily cease to grow because we feel satisfied that there is no need for all of A.A.’s Twelve Steps for us. We are doing fine on a few of them. Maybe we are doing fine on only two: the First Step and that part of the Twelfth where we “carry the message.” In A.A. slang, that blissful state is known as “two-stepping.” And it can go on for years.

The best-intentioned of us can fall for the “two-step” illusion. Sooner or later the pink cloud stage wears off and things go disappointingly dull. We begin to think that A.A. doesn’t pay off after all. We become puzzled and discouraged.

Then perhaps life, as it has a way of doing, suddenly hands us a great big lump that we can’t begin to swallow, let alone digest. We fail to get a worked-for promotion. We lose that good job. Maybe there are serious domestic or romantic difficulties, or perhaps that boy we thought God was looking after becomes a military casualty. (Twelve and Twelve, 112)

While “falling off the AA beam” does not necessarily result in picking up a drink or drug, it is important to realize that every slip from active engagement with the program is the start of a dangerous progression.

To add a third layer of complication to an already confused topic, counselors at rehab centers tap about “relapse prevention.” What the hell is that supposed to mean? I thought we were without defense against the first drink! Then we hear people in the rooms of AA and NA talk about being in “relapse mode” or slipping into “relapse thinking.” These phrases suggest that relapse is a vaguely mysterious event and that certain “bad” behaviors or “bad” thinking patterns immediately precipitate a return to active use. While this is a fair start at comprehension, it misses a key ingredient: by focusing on the thoughts directly leading to picking up that drink or taking a hit, it fails to recognize that relapse is a process, not a single, tragic moment in time. Worse, it leaves the power of a God of our understanding out of the equation entirely.

Relapse is more than just returning to alcohol or drugs after a period of abstinence.

Relapse is the progressive process of becoming so dysfunctional in recovery as a direct result of failing to enlarge our spiritual life that self-medication with alcohol or drugs seems like a reasonable choice. Indeed, for many people at the moment of relapse, self-medication seems the ONLY choice.

Think of relapse this way: it’s like knocking over a line of dominoes. The first domino hits the second, which hits the third, and soon a progressive chain reaction begins.  The sequence of problems leading from stable sobriety to relapse are similar to those dominoes. Please note: relapse is not EXACTLY like a string of 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. When the last domino falls, it hits us from behind when we’re not looking.

Relapse should never come as a shock.  Sadly, it often does.

orlando recovery family on relapse preventionRelapse: The Unpleasant Surprise

So here we are, moving along in recovery. We tip over one small domino. Maybe we wake up one morning and realize we haven’t started a day with prayer in a long time. Maybe we realize we never gave meditation a serious trial. Whatever. “No big deal!” we tell ourselves. “We’ll get around to that stuff later on.”

That domino hits the next, and then the next. We’re not being entirely honest. Then we’re actively lying. A chain reactions is started.  The first dominoes are so small we convince ourselves 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 our old reliable — the magically substances that have always helped us with pain in the past.

And before we even know what is happening, we’re high or drunk.

The answer to avoiding relapse is not to take up weight training so you will be strong enough to lift that last domino off your crippled body.  Nor is it to spend every waking moment in a twelve step meeting. It’s not identifying lists of “triggers” nor is it “thinking through the drink.”

Thinking has never been our strong suit.

We must learn how to NOT tip over the first domino.  We must become aware through the application of the tenth step of HOW WE ARE DOING and develop an emergency plan for stopping the chain reaction as soon as it begins; of stopping the progression before the dominoes are so big and heavy that they become unmanageable.

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. In the final analysis, we start drinking because God became an afterthought – because recovery transformed into the great things I AM DOING rather than the service I am providing others.

Let’s look at how it happens in more detail.

Step 1: Getting Stuck In Recovery

Many of us decide that alcohol or drugs is a problem, stop using, and slowly put together some kind of spiritual experience. We are excited and work steps rapidly. We follow suggestions without much complaint or argument. We have some sort of spiritual awakening. For the first time in a long time, life is good and we are doing 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 underground 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, overeating, dieting, or overexercising. We get involved in addictive relationships and distract ourselves by trying to experience the orgasm that shook Orlando.  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 later.

This is a hallmark of all addictive behaviors.

Step 4: Experiencing A Trigger Event

Then something happens.  It’s usually not a big thing.  It’s something we could normally handle without getting upset.  But this time something snaps inside.  One person described it this way: “It feels like a spring got wound tighter and tighter in my gut, making me edgy and jittery. The spring is pulled, a trigger goes off in my gut, and my emotions and behavior swing 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 or drugs), and what we must do (stay focused on working a recovery program).  When emotion gets control of the intellect we abandon everything we know, and start trying to feel good at all costs.

Relapse 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. 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, things get so bad 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 apparently 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: Addictive, Alcoholic Thinking

Now we go back to our old ways of thinking.  Our self-talk starts sounding like this: “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’m not going to drink or use drugs, I just want to get away from things for awhile and have a little fun.  I should never have cut ties with my old friends; they’re the ones who REALLY supported me.  These new “AA” people are dicks. They’re my REAL 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 for awhile!  Then I’ll be able to figure all these things 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 sponsee said he wanted to go to a bar so he could listen to music and relax while drinking diet cokes and energy drinks.  I said:  “If I told you I was going to Rachel’s Strip Club because I like the steak sandwiches, would you believe me?  When you say you’re going to a bar to have a soda I have the same reaction.”

Step 10: Using Addictive Substances:

Eventually things get so bad that we come to believe that we only have three choices — collapse, suicide, or self-medication.

  1. We can collapse physically or emotionally from the stress of all our problems (or)
  2. We can end it all by committing suicide (or)
  3. 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 it seems reasonable to use alcohol or drugs 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 11: 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 successfully 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’ve described is called the relapse process. 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.  Ignoring the early warning sing makes us more likely to relapse.

There is Hope

We can become familiar with the The Phases and Warnings Signs of Relapse.

We can read the the research. A good place to begin is an article like Relapse Prevention: An examination of relapse issues includes consideration of the relevance of this issue, an historical perspective, a survey of existing knowledge on the subject, and ideas counter to disease concept beliefs.

We can learn to recognize early indicators as described in this post. Most importantly, we can follow the program of recovery outlined in the steps with great vigor, pushing more and more of our energy and determination into attaining and nurturing the kind of spiritual life that can sustain us regardless of our circumstances.

We may not be able to do these things alone… But we can usually do them with one another’s help.

We can ALWAYS do them with the power of the God who watches over us all.

Grace and Peace

CPB

picking-yourself-back-up-after-a-relapse-compressed-1

Note: most relapse prevention models in the US and Europe are based on the work of Terence Gorski, author, researcher, and recovery advocate. This particular blog post was inspired by Gorski’s first national article targeting the issue: Relapse Prevention – A New Recovery Tool published in Alcoholism & Addiction Magazine; 25 September 1989.

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