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Understanding The Relapse Process

Relapse refers to the process of returning to the use of alcohol or drugs after a period of abstinence. Relapse is a possibility for you regardless of how much time you have been sober. Part of your recovery plan should include learning about the relapse process and devising a plan to help prevent you from relapsing should warning signs occur.

You can be in a relapse before you actually use alcohol or drugs. It is possible to build up to a relapse over a period of hours, days, weeks, or even months. Many alcoholics and drug-dependent persons have reviewed their relapse experiences and identified clues that preceded the relapse, and which indicated they were headed back to using alcohol or drugs.

Relapse clues, or warning signs, may relate to changes in your behaviour, attitudes, feelings, thoughts, or a combination of these. This does not necessarily mean that the changes you experience are an indication that you may be in a relapse. It simply means that you should be on the alert when changes occur with you and examine whether or not these do in fact indicate that you may be headed for a relapse. The following are examples of “relapse clues” preceding relapses of other alcoholics and drug-dependent persons:

  1. Behaviour Changes; increased episodes of arguing with others, for no apparent reason; decreasing or stopping meetings; stopping in a bar to socialise and drink soda; increased stress symptoms such as smoking more cigarettes or eating more food than usual.
  2. Attitude Changes; not caring about sobriety; not caring what happened; becoming too negative about life and how things were going.
  3. Changes In Feelings Or Moods; increased moodiness or depression; strong feelings of anger at oneself or another; increased feelings of boredom; or sudden feelings of euphoria.
  4. Changes In Thoughts; thinking alcohol or drugs were “deserved” due to being sober for six months; thinking it wouldn’t be harmful to substitute one drug for another (e.g. giving up cocaine, but continuing to smoke marijuana; abstaining from alcohol but continuing to use uppers); thinking the alcohol or drug problem was “cured” because no substances were used for a period of weeks or months.

These are just a few examples which may or may not relate to you. The important point to remember is that changes in your behaviours, attitudes, feelings, thoughts, or a combination of these could indicate that your relapse process is set in motion.

 

Case Example:

John is a 45-year-old alcoholic with a history of heavy drinking and related problems for the past fifteen years. He has been in three detoxification wards, two rehabilitation programmes and has participated in meetings on and off for the past nine years. In reviewing his relapse history, he states he usually builds up to a drink over a period of about five weeks. His relapse clues include:

  • Decreased interest in taking care of his nutritional needs – evident in skipping breakfast and not eating regular dinners.
  • Increased thoughts of drinking – evident in thoughts such as “no one will know if I have a few beers,” or “What does it really matter if I drink again?”
  • Stopping in the bar where he used to drink in order to “see old buddies.”

 

The following relapse prevention plan was devised by John:

  1. When he notices that his nutritional habits are changing he will ask himself why this is happening now, and whether or not something is bothering him which needs him immediate attention.
  2. He will initiate a discussion in his next meetings or to his sponsor to review his current feelings and what is happening in his life.
  3. John will also write on a sheet of paper why stopping in bars to see old buddies is not in his best interest.
  4. When he has the impulse to stop in a bar, he will instead contact a sober friend and make plans to do something that is not threatening to his sobriety, or he will review his meeting list and choose a meeting to attend that day.
  5. John will review the “benefits of sobriety” journal he has been keeping in order to reinforce the importance and payoffs of his sobriety.

 

Identifying and handling urges or cravings to use alcohol or drugs

During recovery, particularly the early months, it is common to experience urges or cravings to use alcohol or drugs. An urge or craving may occur at any time even if you are actively involved in a recovery program and may differ in frequency and intensity with each person.

Urges or cravings can be triggered by things you see in the environment which may remind you of using alcohol or drugs or getting high; internal discomfort such as anxiety or anger; or, by things that you don’t seem to be able to identify. Physical signs may include tightness in your stomach, and feeling nervous throughout your body; psychological signs may include increased thoughts of how good you would like to feel from using alcohol or drugs, or feeling you “need” alcohol or drugs.

 

Other recovering alcoholics and drug-dependent persons have used a number of practical methods to help them survive urges or cravings to use alcohol or drugs:

  1. Talking With Others. Talk with someone face-to-face or on the telephone such as a friend, family member, sponsor, etc. Attend meetings. Keep names and phone numbers in your wallet
  2. Redirecting Your Activity. Get involved in an activity such as going for a drive, working around your home, going to a movie, or working out in some physical manner. Occupy yourself with reading. Write your thoughts and feelings in a journal. Get something to eat. These activities may take your mind off your urge or craving and physical activities may also help you relax.
  3. Changing Your Thoughts. Think of all the bad things which have happened to you as a result of your alcohol or drug use. Think of how good you will feel if you do not use it. Think of all the benefits to your sobriety, both now and in the future; write these down on paper if needed. Think positively: “I’m not going to use” or “I will get through this urge or craving without using.” Repeat some of the recovery slogans such as “one day at a time,” “easy does it,” or “this too will pass.”
  4. Avoiding Threatening Situations. Don’t go to bars, parties, or clubs where you think it will be even more difficult to handle your urge or craving. Avoid socialising with others whom you feel may influence you to use alcohol or drugs.

 

In early recovery, many social pressures to use alcohol or drugs may be avoided simply by planning your day-to-day activities around non-chemical events and environments. Staying out of bars or not attending parties where others are getting high are examples of how you may avoid some of these pressures. However, there is no way you can avoid all social pressures to use alcohol or drugs so you may want to rehearse ways of handling these situations. For example:

  1. State straight out that you have a problem with alcohol or drugs.
  2. Simply refuse the offer without giving an explanation.
  3. State that you are not using today.
  4. Offer an alternative activity if you would like to spend time with the person “Lets go get a cup of coffee.”

 

If you begin to feel increasingly anxious in a social pressure situation then it is advisable to physically leave the situation if possible. This is especially important if the people who may be present have the ability to influence you to use alcohol or drugs.

 

Case Example:

Bill is 28 years old, single, and employed who entered into a rehabilitation programme because of a problem with alcohol and multiple drug abuse. About a month after completing the program, four of Bill’s friends stopped over to see him. After several minutes of discussion, one of these friends suggested they all go down to the local pub and have a few beers. Although Bill wanted to go he thought it was not in his best interest to do so and stated “I’m not drinking” and suggested his friends stay at his place and watch the game on TV. Bill seemed fairly comfortable with this action. However, about a half-hour later, one of his friends brought out his marijuana and suggested they get high. Bill felt extremely uncomfortable and with great difficulty, he refused this offer. In later discussing this situation with his sponsor, Bill developed the following relapse prevention plan:

  1. He will decide with which friends he can socialise, without the constant threat of being offered drugs; he will purposefully cut ties with several old friends whose relationships with him were based primarily on getting high.
  2. He will not socialise at the local pub where he would often drink with others.
  3. He will begin to develop relationships with others who do not misuse alcohol and drugs by contacting an old school friend who he knows does not misuse alcohol or drugs.
  4. He will inform other friends that he has an addiction problem, cannot safely use any substance and that he would appreciate it if he is not offered alcohol or drugs.
  5. He will invite a small group of sober friends over to his home each week for social and recreational activities that do not evolve around getting high.

 

What to do if a relapse occurs

The first thing you want to do should you use alcohol or drugs following a period of abstinence is to tell yourself you must stop using immediately. Tell yourself it is important to get back on the sober track. Discuss your return to alcohol or drug use immediately with some other concerned person such as a family member, sponsor, or friend.

If you have returned to use after quitting or reducing treatment activities, decide if you need to return to these or increase your participation. You can anticipate feeling guilty and disappointed in yourself after using drugs or alcohol again. But it is important not to allow these feelings to give you permission to continue using.

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