People Places Things

People, Places And Things

Many of the folks who attend the groups at Sunrise Detox wonder about “people, places and things,” and question how merely seeing someone, or being in a particular place, can trigger a powerful desire to drink or use other drugs.

Maybe the best way of understanding this is to consider a number of recent experiments that studied the brain activity of subjects while they were exposed to certain stimuli. Rats, rabbits, and non-human primates will seek the same drugs that we humans abuse, and will begin seeking them again — even after months of deprivation — when exposed to the drugs themselves or to visual cues that they have associated with drugs in the past. Along with these, brain-imaging studies on human addicts indicate that visual cues can cause the addict to recall the pleasure of drug* use, and can cause enhanced activity in areas of the brain that are associated with cravings.

This research shows scientifically what people in the rooms have known for a long time, often demonstrated in sayings like “If you don’t want to slip, stay out of slippery places.” It doesn’t take a rocket scientist to figure out that if you want to stay sober you don’t go into a bar, order a drink, and sit and look at it. There’s a technical term for folks who test themselves that way: relapsers.

It shouldn’t take a lot more thought to see how less obvious things can have similar effects. Ordering a club soda and hanging with our drinking friends, seeing our dealer in a crowded club, passing the shop where we purchased our wine, even sitting in front of the TV with our buddies watching a game — all of these thing can trigger a desire to use, the “just one won't hurt” thought that has killed so many of us .

Stress

Consider that stress is one of the greatest causes of relapse, because it was one of our biggest excuses for using. Family arguments, the presence of people whom we believe disapprove of us, being around other people who are behaving the way we used to, animosity from people we harmed during our addictions — all of these things are powerful stressors, along with financial, legal and romantic complications. Some of these things are going to be parts of our early recovery, but it certainly makes sense not to complicate the problem with temptations and stressors that can be avoided. Of course these things are part of live, and of course we’ll have to deal with them eventually, but that doesn’t mean we should try when our brains are still in early recovery and the likelihood of relapse is at its greatest.

Thus, to the extent possible, we need to avoid the old people, places and things until we have enough sobriety under our belts to deal with the stress and temptation. Even then, smart addicts moderate periods of tension by attending extra meetings, calling people in the program, and generally stepping up their involvement in recovery.

Many sensible strategies, such as living in halfway houses, staying out of home areas, putting off jobs, relationships and other potential stressors can seem counter to the idea of recovery. After all, isn’t it about carrying on with life? That it is, but carrying on with life means doing so effectively, which means clean and sober, with some good recovery under our belts. Recovery is difficult enough without standing at the plate begging for curve balls. Trying to “make up for lost time” is an excellent way to lose even more of it, and perhaps our jobs, families, or even our lives along with it.

*When the writer uses the term “drug” he includes alcohol, which is simply a legal drug.

Relapse Triggers — They Don’t Keep Cat Food In The Beer Cooler

Speaking of relapse triggers, it happened that two or three days after I got out of treatment back in 1989, I went to the supermarket to buy some cat food. I was walking through the store, and just for the heck of it I turned down the beer aisle. (That's what folks who work in the field call “testing yourself.”  It's considered to be pretty dumb.) After my stroll down memory lane, I was pleased to note that I hadn’t had even a twinge of a desire for my drug of choice. I was pretty proud.  Yesiree.

The next day, at “day care,” I bragged about it to Ron, my counselor. He looked at me with disgust, and shouted, “You stupid shit! They don’t keep cat food in the beer cooler!

Oops.

I knew enough to understand immediately what he meant, and I never consciously did anything like that again. Some years later, after having worked with Ron at a different treatment center, I had the sad honor of telling that story at his memorial service. Everyone laughed and nodded their heads; they knew Ron, just like Ron knew me.

A big mistake that we alcoholics and other addicts make is believing that we are different; that only we know what’s best for us. In the rooms, we call this terminal uniqueness. The fact is that when it comes to addiction, our similarities are far more important than our differences. That’s because, in all of us, addiction works the same way: it causes certain changes in our brains that alter our priorities and put our drugs of choice first in every part of our lives, and every part of our lives that have to do with obtaining or using those substances become of paramount importance.

Recent studies involving addicts who viewed selected images while being scanned in an MRI revealed that certain stimuli can activate the portion of the primitive brain that controls cravings for alcohol and other drugs.  We relate certain situations and places, along with certain smells, visual and audible cues, to obtaining and using drugs and alcohol. These associations take place in a part of our brain that we cannot directly control, any more than we can control our tendency to flinch at unexpected loud noises.

Walking down the beer aisle won’t always trigger cravings, just as driving past the corner where we used to cop drugs won’t always trigger them. But in all addicts, the wrong combination of trigger, mood, hunger, distress with life and a million other things can cause those synapses to go “click.” Then all of a sudden we’re handing the guy a twenty and he’s dropping a little baggie into our hand, or we’re walking out of the corner store with a bottle of Smirnoff's.

That’s why one of the ideas that we pound into clients’ heads (or try to) is stay away from the old people, places and things until you have some sobriety — preferably, a lot of it — under your belt.  Our families hard-wired our buttons for us, and we can play each other like a cheap barroom piano. Our drinking buddies make us think of those good times (we rarely remember the bad ones), and may themselves not have our best interest at heart. They (and our families) may find that they prefer the old us to the newly-sober variety. And it should hardly need to be said (if it does, we’re in trouble already) that we don’t keep a six-pack or a baggie of blow around “for guests,” or hang around the corner bar because we like to shoot pool.

Simple ideas.  A little rough on the “Me, me, me…I want, I want, I want” part of our addict brains, but really not complicated.  Relapse triggers: If you want to stay on your feet, stay off the slippery places.

Next to People, Places, and Things, relationships and physical stress are the greatest relapse triggers. More about them to come.

Relapse Triggers — People, Places and Things

Knowing and avoiding relapse triggers is essential for folks in recovery from alcoholism and other addictions.

We addicts are accustomed to making things better right away. In our addictions, relief of our discomfort was only as far away as the next pill, the next drink, the next trip to see the guy down on the corner, the next shopping trip, the next snack, the next sexual encounter. You get the idea.

So it’s not surprising that we tend to think of recovery that way. We think we’re detoxed when we aren’t; we think it takes too long for our bodies and minds to repair themselves after we stop using; we think we don't need treatment, or AA, or other support.  We think we’re recovered, when we’re going to be recovering for a long time yet. In short, we look for the quick fix, the quick answer, and we misjudge our ability to deal with issues in early recovery. We make these mistakes because we are accustomed to living our lives in the short term, to making snap decisions, and to doing things without thinking them through, all in the service of immediate gratification, because we want what we want when we want it –NOW!

Far too often, after having demonstrated for years that we have no idea what's in our best interest, we decide after a few days or weeks clean that we know what’s best in the face of massive evidence to the contrary. We’re used to that quick fix that the drugs and booze used to give us, and we have no concept of the truth that “time takes time.” We think that our brains and bodies ought to straighten up and fly right, just because we want them to. We think that the damage and changes wrought by months and years of drinking and drugging should go away immediately — just because we’ve stopped using.

Nowhere is this more obvious than in the case of alcoholics and other addicts who decide that it’s time to go home and make up for all the time we’ve lost. We want to jump back into our lives, re-establish our relationships with spouse, kids, family, employers, friends (and often our old buddies with whom we used), and set the world right again.

All this, when we have no idea of how to have a healthy relationship with ourselves.

The experiences of thousands of recovering people, along with many decades of observation by professionals, indicate that this is rarely the sensible thing to do. Recent scientific studies have shown that even a photograph of a person buying drugs, having a drink, shooting up — even a photo of a liquor store or an ad for beer — can be relapse triggers that stimulate responses in the portion of the brain that controls cravings. We can’t control that part of the brain by thinking. It’s part of the sub-cortical brain, inaccessible by conscious thought, and we can’t think our way out of those feelings. All we can do is fight, and often the feelings and cravings win.

It's better to avoid the battle.  We're not “strong.”  Strength comes with recovery, not when we want it.

Of course, as addicts we’re sure we have things under control, that we know what we did wrong, and that we know The Way Things Ought To Be. So we go back home, where we learned and perfected our skills at addiction, and where we are sure to run across the old relapse triggers — People, Places and Things — long before we’re ready emotionally, physically or spiritually.

Next: “They Don't Keep Cat Food In The Beer Cooler”