UNDERSTANDING Relapse Signs and Symptoms

Relapse is a process, not an event.

What?  Me?  Relapse?  Maybe.  Maybe not.  Still, it is a good idea to spend some quality time thinking about relapse and what we can do to strengthen our recovery.

Relapse is not unusual in recovery.  In fact, any one of us is at risk for relapse.  Hence we need to pay attention to the warning signs, especially when things are going well, because most of us relapse when things are going well than when things are not.  When we recognise the warning signs described in this pamphlet, and when we can avoid complacency about the value of Alcoholics Anonymous and aftercare, our chances of a relapse-free recovery are much improved.

When we think of relapse, some of us might picture a cliff.  Once we step over the edge of that cliff, we may think there’s no turning back – there are no lifesaving vines to grab.  But that’s simply not the case.

relapse prevention
CSOM Training Curriculum: An Overview of Sex Offender Treatment for a Non-Clinical Audience. Long Version: Section 3.

Relapse is not unusual in recovery from chemical dependency, and any one of us is at risk for relapse.  In fact, some experts think the tendency to relapse is part of the disease.  If it is, then we need to pay attention to the warning signs.  This pamphlet will help us not only identify the warning signs of relapse, but also to be more aware of the value of participation in Alcoholics Anonymous groups and other aftercare activities.  And if we do relapse, we’ll know the consequences and how to get back into a strong and lasting recovery.

Before we read on, we should realise that we don’t have to recover alone.  Through the Twelve Steps and with the help and encouragement of our peers, our attitudes can change.  We learn recovery is more than just staying off alcohol and other drugs; it is becoming aware of a whole new way of life.  The Big Book of Alcoholics Anonymous describes this new way of life well:  “We became less and less interested in ourselves, our little plans and designs.  More and more we became interested in seeing what we could contribute to life.”*

When we were chemically dependent, we responded in an unhealthy way to life’s problems.  Recovery helps us develop healthy responses and attitudes.  We learn to deal with life on life’s terms, not on the unhealthy terms dictated by our disease.

Recovery is not a single event, but a long and often difficult process.  It takes discipline – day in and day out – to hold on to the attitudes and actions that lead to a new life.  It often feels as though the old ways and the new ways are in a fight to the death.  Sometimes the old ways win out for a time – we take the drink or use the drug we swore we would never touch again.  When that happens we relapse.

Why Do People Relapse?

Relapse as we teach at our alcohol addiction centre often happens when we let down our guard.  Things are going well.  We’re feeling better than we have for a long time.  Our problems seem fewer – or more manageable.  And we begin to think we don’t need to go to another Twelve Step meeting or to call our sponsor.  We’re doing just fine, thank you.  Then it happens and we can’t believe it:

  • “Why, drinking never even entered my mind!”
  • “Things were going great. How could smoking one joint have hurt so much?”

Relapse can also happen when we begin to feel the emotions that had been numbed with alcohol or other drugs.  Alcoholics and other addicts aren’t comfortable with feelings.  When emotions arise – whether positive or negative – our first reaction is fear.  We think: “Something’s wrong!  I must not be working this programme right if I’m having such strong feelings.”  Or we think:  “If this is the way I’m going to feel, to hell with it.  I’ll use again.  It was a lot easier before I quit”.

*              From Alcoholics Anonymous [The Big Book], 3d ed. (New York:  Alcoholics Anonymous World Services, Inc, 1973), 63, by permission of AA World Services, Inc.

The Consequences of Relapse

A relapse can devastate the recovering person emotionally.  We feel like complete failures.  The good feelings of self-esteem and self-confidence leave us.  The bad feelings of remorse, guilt and shame suffocate us.  Sometimes we feel so bad we consider giving up on recovery altogether.  Remember, though, that relapse is not the end of the world – it’s a part of our illness.

Relapse does not happen on the spur of the moment.  It often happens after our overwhelming urge to drink or use is gone.  A relapse usually follows a period of irrational thinking that may last days, weeks, months, or even years before the actual fall.  The old advice ‘Call a member before you take that drink’, usually doesn’t work.  Why?  Because it’s often already too late.

In my thirty years in AA, no one ever called me and said:  “Stop me.  I’m about to take a drink.”  I too never called for help at the threshold of relapse.  At that point I did not want to be stopped.  The time to prevent a relapse is long before the irrational thinking has reached the final insanity of taking that first drink or pill or getting that fix.

A Checklist of Danger Signs on the Path to Relapse

Many danger signs warn us of a possible relapse.  If we do a weekly inventory of the danger signs listed in this section, we may be able to prevent some relapses.

 Resentment:    The Big Book refers to resentment as the ‘number one offender’ because ‘it destroys more alcoholics than anything else’.*  Holding on to the past hurts or slights (real and imagined) can trigger a relapse.  It may be that we need to do another Fourth or Fifth Step with a sponsor, a clergy person or someone in our recovery programme whom we respect and trust.

relapse prevention
Doing work like this at the end of everyday can help you to keep your mind freer from worry and stress

 Exhaustion:      When we are well rested and in good health, our thinking is clearer.  When we are overtired and in poor health, our thinking is more muddled.  If we feel bad enough, we begin to think drinking or using couldn’t make it worse.

Dishonesty:      We begin with a pattern of unnecessary little lies we tell to fellow workers, friends and family.  Then we lie to ourselves.  This is called ‘rationalising’ – making excuses for doing what we know we should not do.

Impatience:     We feel impatient when it seems things aren’t happening fast enough or others aren’t doing what they should be doing fast enough.

Argumentativeness:    Are we arguing small and ridiculous points?  Do we always need to be right?  We may be looking for an excuse to drink or use.

Anger: When we stop drinking or doing other drugs, many emotions come flooding in.  We may get angry at ourselves that we have a problem called ‘addiction’; we may get angry with others who are not addicted and seem to have it so easy.  We may become angry because our lives haven’t improved despite our sobriety.  Such anger – when not discussed at meetings, with a sponsor, or with the person you’re angry at – can lead to relapse.

Depression:     Unreasonable and unaccountable despair comes in cycles.  When it does, deal with it.  Talk about it at meetings, with a sponsor or with a counsellor.  Don’t bottle it up.

Frustration:     Things aren’t going our way.  We’re agitated.  But when this happens we can remember that recovery gives us the tools we need to handle life on life’s terms.  One of life’s terms is:  ‘Things will not go our way at times’.  Another is: ‘People will not behave the way we want them to behave’.

 

Self-Pity:          Beware of thoughts such as these:  “Why do these things happen to me?  Why must I be an alcoholic?  People don’t appreciate all I am doing for them.

Cockiness:       We feel as if we’ve got it made.  We no longer fear alcoholism or other drug addiction.  We go into drinking and using situations to prove to others that we have no problem.  If we do this often enough, it will wear down our defences.  A favourite saying of old-timers in AA is:  “If you hang around the barbershop long enough, you’re going to get a haircut”.

Complacency: If drinking is the furthest thing from our minds, then not drinking is no longer a conscious thought either.  It’s dangerous to let up on discipline because everything is going so well.  A little fear is a good thing.  More relapses occur when things are going well than when they’re not.

Unrealistic Expectations:        When we think:  “I’ve changed, why hasn’t everyone else?” we’re in trouble.  If people change, great.  If they don’t, we can’t force them.  We cannot expect other to change their lifestyles just because we have.  The world is not obligated to pay us respect because we have sobered up.

Lack of Discipline:       When we stop prayer, meditation, daily inventory and AA attendance, we slip into complacency and boredom.  But we cannot afford to be bored with our programme.  The cost of relapse is too great.

Mind-games:   As dependent people, we can play mind games.  Perhaps we think: “As long as I’ve quit using alcohol, a little marijuana wouldn’t hurt”.  Or:  “What’s wrong with a prescription form my doctor to calm me down when I’m nervous?”  Those of us who have used this kind of thinking know how often it leads us back to our old addiction while introducing us to a new one.

Greed: We should not set goals we cannot reach through normal effort.  We’ll get what we’re entitled to as long as we do our best, but it may not come as soon as we like.  When we find ourselves wanting too much, we can remember the adage: ‘Happiness is not having what you want, but wanting what you have’.

Lack of Gratitude:       Don’t concentrate on life’s problems.  Although we’re not trying to be Pollyannas, it’s good to remember (often) where we started and how much better life is now.

Dangerous Thinking:   We begin to think that it can’t happen to us.  When we do, almost anything can happen, especially if we’re careless.  Remember, ours is a progressive disease.  If we relapse, we’ll simply pick up the disease where we left off when we came to recovery.

Omnipotence: When we think we have all the answers for ourselves and for others, when no one can tell us anything, when we ignore suggestions or advice from others, relapse may be imminent.  A simple remedy is to ask our sponsor and other people form our recovery group to give us a firm yet gentle reminders when we act omnipotent.  It works.

Guilt and Shame:        When we’ve been sober for a while, strong feelings of worthlessness may surface.  We remember all the bad things we’ve done (guilt).  Gradually, we may come to believe that we are bad at our core (shame).  We think:  “My life is beyond repair, so why bother?  This faulty thinking can lead to relapse.  We need to rework Steps Four and Five to reach a more honest assessment of ourselves.  If the shame is rooted in early childhood, we may need to see a counsellor to help us sort things out.

Avoiding Relapse

Now we have a good blueprint for avoiding relapse – a weekly inventory.  But we need more to keep the good life we have found in recovery.  How do we gain the strength we need to stay sober?  How can we increase our odds of avoiding relapse?  What do we have to give to get the rewards we know are possible in recovery?  Many of our answers can be found in AA and aftercare.

The Importance of Twelve Step Programmes

For three years I was a counsellor for groups of repeat patients in a special rehabilitation unit at Hazelden.  Of the five hundred repeat patients who participated, 80 – 90 percent reported one of the following:  no attendance at Twelve Step meetings, brief attendance only or dropping participation at some point prior to relapse.  Most admitted to some complacency or neglect that resulted in their not taking the steps necessary to ensure continued abstinence.

Some people have enjoyed successful sobriety without the help of the Twelve Steps.  But the vast majority of us cannot do it alone.  We need the mutual support and encouragement of a Twelve Step programme.  Otherwise we put ourselves at great risk.  Besides, as much as we need AA, AA needs us.  As recovering persons, we have much to give those who will come along after us.  And by giving to others – our stories, our wisdom, our mistakes and our successes – we gain the strength to stay sober.  By giving, we receive the good life that we seek. Call 0824424779 for more information on drug recovery programs or visit www.markllockwood.com for courses in recovery.

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