People in recovery learn to identify the warning signs that may lead to a lapse in their abstinence and take positive steps to stay clean and sober. At the same time, they follow a practical plan that addresses their emotional or psychiatric illness in a positive and constructive way. The quicker they learn to spot these signs and signals the sooner they can take positive action for their own wellbeing and dual recovery.
Many factors can lead to a relapse or flare-up to one or both of our no-fault illnesses. A flare-up of psychiatric symptoms can leave us more vulnerable to relapsing on drugs or alcohol. Drinking and drugging can lead to a flare-up of our psychiatric illness. Alcohol and drugs can also change the effects of psychiatric medications with unpredictable results. Maintaining abstinence allows us the freedom to grow as individuals and manage our no fault illnesses in the healthiest possible way.
In chemical dependency, relapse is the act of taking that first drink or drug after being deliberately clean and sober for a time. It helps though to view relapse as a process that begins well in advance of that act. People who have relapsed can usually point back to certain things that they thought and did long before they actually drank or used that eventually caused the relapse. They may have become complacent in their program of recovery in some way or refused to ask for help when they needed it. Each person’s relapse factors are unique to them, their diagnosis, and personal plan of recovery.
Relapse is usually caused by a combination of factors. Some possible factors and warning signs might be:
• Stopping medications on one’s own or against the advice of medical professionals
• Hanging around old drinking haunts and drug using friends – slippery places
• Isolating – not attending meetings – not using the telephone for support
• Keeping alcohol, drugs, and paraphernalia around the house for any reason
• Obsessive thinking about using drugs or drinking
• Failing to follow ones treatment plan – quitting therapy – skipping doctors’ appointments
• Feeling overconfident – that you no longer need support
• Relationship difficulties – ongoing serious conflicts – a spouse who still uses
• Setting unrealistic goals – perfectionism – being too hard on ourselves
• Changes in eating and sleeping patterns, personal hygiene, or energy levels
• Feeling overwhelmed – confused – useless – stressed out
• Constant boredom – irritability – lack of routine and structure in life
• Sudden changes in psychiatric symptoms
• Dwelling on resentments and past hurts – anger – unresolved conflicts
• Avoidance – refusing to deal with personal issues and other problems of daily living
• Engaging in obsessive behaviors – workaholism – gambling – sexual excess and acting out
• Major life changes – loss – grief – trauma – painful emotions – winning the lottery
• Ignoring relapse warning signs and triggers
Almost everyone in recovery has times when compelling thoughts of drinking or using drugs resurface. In early recovery, drinking or drugging dreams are not uncommon. It helps to remind ourselves that the reality of drinking and using has caused many problems in our lives. That no matter how bad things get, the benefits of staying abstinent will far outweigh any short term relief that might be found in drugs or alcohol. Recovery takes time. Eventually the cravings, relapse dreams, and uncertainties of early recovery fade. When we are committed to dual recovery we slowly but surely develop a new confidence in our new way of life without drugs and alcohol.
Staying clean and sober and managing ones psychiatric symptoms constructively is an ongoing process.
Staying clean and sober and managing ones psychiatric symptoms constructively is an ongoing process. Abstinence and dealing positively with a dual disorder go hand in hand. DRA members build a personal inventory of recovery tools that help them meet these goals by staying involved in the process of dual recovery.
An individual is in dual recovery when they are actively following a program that focuses on the recovery needs for both their chemical dependency and their psychiatric illness. People in dual recovery make sure to use some of their recovery tools each and every day. Their personal recovery tool kit serves as the best protection against a relapse.
By identifying things that put us at risk for relapse and using the various recovery tools on an ongoing basis, we try to prevent a relapse before it happens. We can periodically review our relapse prevention plans with our doctors, treatment professionals and sponsors and modify them as needed.
By becoming familiar with our triggers and warning signs, utilizing the various recovery tools, and having a practical plan of action, we greatly minimize the tendency to lapse back into our addictions. If and when lapses do happen, we do not judge or blame–we are not bad people. We seek progress not perfection. We simply learn what we can from the situation and move on with our program of dual recovery. Sharing our relapse experience with our sponsor, group, and helping professionals is an important way to figure out what went wrong. Our experience may also help others in recovery.
Relapse Signs and Symptoms
Experiencing Post Acute Withdrawal: I start having problems with one or more of the following; thinking difficulties, emotional overreaction problems, sleep disturbances, memory difficulties, becoming accident prone, and/or starting to experience a serious
sensitivity to stress.
Return to Denial: I stop telling others what I’m thinking/feeling and start trying to convince myself or others that everything is all right, when in fact it is not.
Avoidance and Defensive Behavior: I start avoiding people who will give me honest feedback and/or I start becoming irritable and angry with them.
Starting To Crisis Build: I start to notice that ordinary everyday problems become overwhelming and no matter how hard I try, I can’t solve my problems.
Feeling Immobilized (Stuck): I start believing that there is nowhere to turn and no way to solve my problems. I feel trapped and start to use magical thinking.
Becoming Depressed: I start feeling down-in-the dumps and have very low energy. I may even become so depressed that I start thinking of suicide.
Compulsive And/or Impulsive Behaviors (Loss Of Control): I start using one or more of the following- food, sex, caffeine, nicotine, work, gambling, etc. often in an out of control fashion.
And/or I may react without thinking of the consequences of my behavior on myself and others.
Urges And Cravings (Thinking about Drinking/Using): I begin to think that alcohol/drug use is the only way to feel better. I start thinking about justifications to drink/use and convince myself that using is the logical thing to do.
Chemical Loss of Control (Drinking/Using): I find myself drinking/using again to solve my problems. I start to believe that “it’s all over ‘till I hit bottom, so I may as well enjoy this relapse while it’s good.” My problems continue to get worse.
THE TEN MOST COMMON RELAPSE DANGERS
1. Being in the presence of drugs or alcohol, drug or alcohol users, or places where you used or bought chemicals
2. Feelings we perceive as negative, particularly anger; also sadness, loneliness, guilt, fear, and anxiety
3. Positive feelings that make you want to celebrate
4. Boredom
5. Getting high on any drug
6. Physical pain
7. Listening to war stories and just dwelling on getting high
8. Suddenly having a lot of cash
9. Using prescription drugs that can get you high even if you use them properly
10. Believing that you no longer have to worry (complacent). That is, that you are no longer stimulated to crave drugs/alcohol by any of the above situations or by anything else – and therefore maybe it’s safe for you to use occasionally
RELAPSE ATTITUDES
• Sobriety Is Boring
• I’ll Never Drink/Use Again
• I Can Do It Myself
• I’m Not As Bad As …..
• I Owe This One To Me
• My Problems Can’t Be Solved
• I Wish I Was Happy
• I Don’t Care
• If Nobody Else Cares, Why Should I?
• Things Have Changed
• I Can Substitute
• They Don’t Know What They Are Talking About
• There’s Got To Be A Better Way
• I Can’t Change The Way I Think
• If I Move, Everything Will Change
• I Like My Old Friends
• I Can Do Things Differently
• Nobody Needs To Know How I Feel
• I’m Depressed
• I See Things My Way Only
• I Feel Hopeless
• I Can Handle It
• If I Hide Behind Everyone Else’s Problems,
I Won’t Have To Face My Own
• I Can’t Do It
• Why Try
THE EVENT: A Return To The Use Of Alcohol And/Or Drugs.01
Mr. Foster is the Clinical Director at the Beachcomber Intensive Outpatient Treatment Center, operating locations in Boynton Beach and Ft. Lauderdale. Additionally, he is a doctoral candidate at Florida Atlantic University, specializing in alcoholism and addiction. He has a dual-track Master’s degree from FAU in Mental Health and Rehab Counseling. He is a Certified Addiction Professional, a Certified Rehabilitation Counselor, an SAP, and an ICADC.
