Relapse is more than just not 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.
The relapse process is a lot like knocking over a circle of dominoes. The first domino hits the second, which hits the third, and soon a progressive chain reaction starts. The progressive problems that lead from stable recovery to relapse are similar to those dominoes. There are three differences.
• First, each domino in the line gets a little bit bigger and heavier;
• Second, the last domino in the sequence is ten feet tall, four feet wide, and a foot thick, and weighs 10,000 pounds.
• Third, the dominoes are not in a straight line. They circle around behind us. So when the last domino falls, it hits us from behind when we’re not looking.
We are moving along in recovery and tip over one small domino. No big deal! That domino hits the next, and then the next. A chain reaction starts. The first dominoes are so small that we can easily convince ourselves that it’s no big deal. We look the other way. 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 magical substances that always helped us with our pain in the past. We’ve now started drinking and drugging.
Relapse Prevention Therapy (RPT) is not about taking up weight training so that we will be strong enough to lift that last domino off of our now crippled body but it’s about these three things:
• Learning to avoid knocking over the first domino.
• Learning how to recognize and stop the chain reaction quickly, before the dominoes start get too big and heavy to stop.
• Developing an emergency plan for stopping the relapse quickly should it occur.
The Relapse Process
The progression 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.
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. Let’s look at the relapse process in more detail.
Step 1: Getting Stuck In Recovery
We start using a recovery plan to help us stay sober. Then we hit a problem that we can’t, won’t, or don’t know how to manage. This problem stops us dead in our tracks and we are stuck in recovery. Instead of asking for help, we use denial to convince ourselves that
everything is okay. 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 can’t see it.
Step 2: Increased Stress
At some level we know that the problem is still there, but we keep investing time and energy trying to deny it. This results in a buildup of pain and stress.
Step 3: Using Other Compulsions
We begin to use other compulsive behaviors to manage the stress and pain. We can start overworking, over-eating, over-dieting, or over-exercising. We can get involved in addictive relationships and distract ourselves by trying to have the orgasm that shook New York City. All of these behaviors have one thing in common – they make us feel good now, but cause us to hurt later.
Step 4: Experiencing a Trigger Event
Then something happens! We overreact and something snaps inside. It feels like a trigger firing off in our gut, our stress jumps up, and our emotions take control of our minds.
Step 5: Becoming Dysfunctional On The Inside
Relapse almost always grows from the inside out. The trigger event increases our pain and stress. We can’t function normally. We can’t think clearly, we swing between emotional overreaction and emotional numbness, we can’t sleep restfully, and we start having memory problems. We lose touch with the fact that we are addicted and can’t use alcohol or other drugs. When our emotions start to get control over our intellect, we abandon everything we know. We start trying to feel good, right now, at all costs. We feel “cured” and stop working a recovery program.
Step 6: Becoming Dysfunctional On The Outside
At first, this internal dysfunction comes and goes. It’s annoying, but we learn how to ignore it. The first small dominoes are starting to fall! On some level, we know that something is wrong, but we keep it a secret. Eventually we get so dysfunctional on the inside that we
start creating problems on the outside. We start making mistakes that increase our pain and problems. We push away our friends, families, and coworkers. We start neglecting our recovery program and things keep getting worse.
Step 7: Losing Control
We handle each problem as it comes along, but never look at the growing pattern of problems. We never really solve anything; we just put band-aides on deep cuts that are gushing arterial blood. We put first-aid cream on our seriously infected wounds. Then
we tell ourselves that our problems are solved. We look the other way and get busy doing other things. We try to forget about the problems and start to believe these other compulsive behaviors will somehow magically fix us. Things start getting out of control.
As soon as we solve one problem, two new problems pop up to replace it. It feels like we’re 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 we reach for the third, the first one pops back up again.”
Step 8: Using Addictive Thinking
We go back to using addictive thinking. It goes something 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.”
Step 9: Going Back To Addictive People, Places, and Things
We mistakenly believe that the people who supported our drinking and drugging were our friends and the people who want us to stay sober are our enemies. We start going back to addictive people (our old friends), addictive places (our old hangouts), and addictive things (mind polluting compulsive activities). We convince ourselvesthat we’re not going to drink or use drugs. We just want to relax and visit old friends.
Step 10: Using Addictive Substances and Losing Control
Eventually things get so bad that we come to believe that we only have three choices:
• Collapse physically or emotionally from the stress of all our
• End it all by committing suicide, or
• Self-medicate with alcohol or other drugs. If these are the only three choices, which one sounds like the best way out?
If these are our only three choices, self-medicating with alcohol or other drugs seems the best choice. 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.
We lose control and develop progressive life and health problems. We either get back into recovery, or we die as a result of alcohol and drug-related accidents, illness, or suicide.
This is the relapse process. It’s not a pretty picture, but there is hope. We can learn to identify and manage the early warning signs of relapse. The process is called Relapse Prevention Therapy. That’s what my next article will be about.
Terence T. Gorski is the Founder and President of The CENAPS Corporation. He is an internationally recognized expert on substance abuse, mental health, violence, and crime. He is best known for his contributions to relapse prevention, managing chemically dependent offenders and developing community-based teams for managing the problems of alcohol, drugs, violence, and crime. He is a prolific author and has published numerous books and articles.