relapse

Change Is The Key To Recovery

Yesterday I was at the new Sunrise facility in Ft. Lauderdale, helping prepare for an accreditation inspection. I was working with client records, and noted once again how many addicts relapse and return to detox. This isn't surprising; one of the symptoms of addiction is relapse, and virtually all addicts do it at least once. Noticing it just brought the fact back to mind. It’s a good thing for us addicts to keep in mind, whether we are in recovery or just think we are. Alcoholics and other addicts relapse. All the time. So can we all, even us old-timers. I’ve seen it way too many times.

I found myself wondering how many of those folks who returned multiple times for detox actually went on to primary treatment or the 12-step groups (hopefully both), versus how many went back out to The World with the same old ideas and habits.

Detox is certainly the first step in the direction of recovery, but it's not the whole answer.  If it were, our repeat business would be zip.  Recovery is about willingness to change: to change how we think, how we relate to others, how we look at our lives, our approaches to problems, and how we solve them (or don’t).  It's about deciding how badly we want to have a life free of drugs.

Woodrow Wilson once said, “If you want to make enemies, try to change something.” We don’t like change. Hardly anyone does. Humans like predictability. We’re like the musician who said he was going to get his guitar tuned and have it welded. We want to get everything in our lives just the way we want it, and then weld it in place.

Welcome to the real world. The only thing that’s certain is change, and if you don’t want to keep on being miserable — regardless of the cause — you have to do what you can to make the changes reasonably predictable. As addicts, alcoholics, or whatever we call ourselves, if we don’t change all the things I mentioned above, and learn the skills to move forward afterward, then we’re going to see detoxes, jails and other institutions, over and over again. Until we die.

Detox is about getting alcohol and other drugs out of our systems, so that we have a shot at making good decisions about the rest of our lives. The secret's not in quitting — it’s in  learning to live in a way so that we can stay quit. We don’t learn that overnight. We don’t learn it from gurus, or New Age books (no matter how many we read) or preachers, or well-meaning friends.  We learn from other addicts and drunks, and we practice.

Staying sober is about practicing the skills of recovery until they become second nature, just like being an addict was second nature. Until that happens, we’re at risk. And if we forget how to live sober lives, slipping instead back into our old ways of thinking and behaving, we’re at risk again.

Some kinds of welding are worth the effort.

Take Especially Good Care of Yourself After the Storm

Winter Storm Athena has again slammed the Northeast with snow, ice, power outages, freezing temperatures and the hardships that go with them. Coming so soon on the heels of Sandy, this added stress will be hard on people in recovery, especially on folks just out of detox or treatment.

Experts tell us that Sandy and similar disasters rank extremely high on the stress scale, even for people whe are not themselves severely affected. Stress is one of the primary relapse triggers. People in recovery need to make extra efforts in their programs during such times, and travel and communications difficulties may make this hard.

Sunrise suggests that folks faced with these additional pressures on their recovery should avail themselves of whatever resources they can. For those completely cut off from contact with other recovering people, we recommend not isolating. Try to remain in the company of others. Distract yourself with chores or reading — especially reading about recovery. If you have recovery tapes or MP3's, listen to a few. Journal. Write down your feelings about what you are experiencing, and things that you are learning about yourself.

If you have Internet access (as you almost certainly do if you're reading this), search for “online recovery groups” and reach out to them. Someone on the other end may need support, too, and there is nothing like another recovering person to help us weather storms, of whatever kind. If you are able, reach out by phone to members of your own support group, especially sponsors. If possible, get to a meeting. Perhaps an impromptu meeting could be arranged among a few recovering friends. You don't need a meeting hall.

Those close to recovering people need to understand that the stress could be dangerous to their loved one or friend. Without clinging or being annoying, try to include them in anything that may be going on to distract them. Helping with cooking, playing cards, board games, sing-alongs and other communal activities can raise the spirits of all involved.  Many have found that periods without distractions, such as TV and the other factors of our busy lives, have brought them closer to their loved ones and neighbors.

We also recommend that you get to a meeting as soon as you can. The other folks who have been impacted by the storm need your support just as much as you need theirs. Take care of yourself. Nothing…nothing…is worth adding the tragedy of relapse onto problems caused by the weather.

Why I Don’t Say I’m “Recovered”

Every so often around the 12-step rooms you’ll hear someone say something like, “My name’s (…), and I’m a grateful recovered (alcoholic, addict, codependent, etc.)”

“Recovered” is meant to remind us that there is more to life than meetings and hanging around with people from the rooms — that recovery is learning to live the way “normal” people do and moving back into the mainstream of life. Healthy people who work a good program have nothing to fear from this return to the world outside, and much to gain: continued renewal of self respect; new associations with people whose main focus is life in the world rather than just the Steps; business advantages; broader horizons, and myriad other things.  

I get that.  So a few years ago I decided to try “recovered” on for size. I began referring to myself that way: as a recovered person. I stopped after a bit, though, because it made me uncomfortable.  Also, I thought it made me seem like an attention-seeker in the rooms, where most people still refer to themselves as “recovering.”   It seemed presumptuous, and maybe even a little arrogant.

I came to recovery a physical, emotional and spiritual wreck, with just enough brain power left to recognize the reasons for my troubles and the way out of them. I am one of those people who has had the good fortune not to “relapse.” When I tell my story, I say that with tongue in cheek and then explain that while it’s technically true that I haven’t had a drink or drug since 1989, it isn’t strictly true that I haven’t relapsed.

Relapse begins when we begin to fall back into the old behavior and ways of thinking, whether or not we go so far as to pick up our drug of choice (or a different addiction). Given that more realistic definition, I’ve relapsed several times.  I didn't have to use.

One of the things that leads to the old behavior and ways of thinking and living is getting too big for our  britches. That’s why “recovered” feels uncomfortable. I know that my continued recovery depends on staying mentally, emotionally, and physically healthy, and especially on remaining humble.

My gut tells me that — for me — “recovered” is the wrong way of looking at what is really a process, not an event.  One of the most valuable things I was told early on was “trust your gut.”  

If it feels icky, it probably is.

Your recovering friend,

Bill

How is addiction a disease, and why does it come and go?

The Merriam-Webster Online Dictionary defines disease as “a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.”

Let’s take a quick look at addiction based on those criteria.  First of all, it is definitely a condition of the body or one of its parts.  It creates changes in the brain and some other portions of the body that impair normal functioning and that in some cases fail to return to normal, even after the disease is arrested by abstinence.

It is manifested by signs such as abnormal behavior (often including psychosis), an unhealthy fascination with drugs, including alcohol, behavior outside accepted limits of society, and symptoms such as tolerance to the drugs’ effects, deterioration of organs and systems, and in most cases a withdrawal effect when the drugs are withheld.

The question of coming and going is almost a contradiction in terms.  The disease can be arrested.  That is, the signs and symptoms will eventually subside when the drugs are completely out of the system, but the disease is still there.  Some immediate relief is accomplished as soon as withdrawal is over — a few days for alcohol and some drugs, up to two to three weeks for some others.

During the period while the brain and other organs are recovering from exposure, there will be occasional periods of discomfort that are interspersed with times when the symptoms are slight or non-existent.  This period of post-acute withdrawal can last for months, but the progression is always toward feeling better, as long as drugs are not put back in the system.

However, “arrested” is not “cured.”  If drugs (and not just the drug of choice) are re-introduced, the changes in the brain that comprise the physical part of addiction will return quickly and the addiction will again become active.

When we combine that with an addict’s instinct to use drugs whenever he or she doesn’t feel good, it means that stress, poor health, failure to maintain a healthy frame of mind, over-response to post-acute withdrawal symptoms, and just plain depression can lead to using, and thus to the re-activation of the disease.  It is rather like diabetes, which can be arrested with exercise, diet and medication, but is still in the wings, ready to pounce, if we get sloppy about taking care of ourselves.

So you can see that alcoholism and other addictions meet the criteria of a disease (as both the American Medical Association and American Psychological Association declared more than half a century ago).  There are identifiable changes in the body, and identifiable impaired function, both physical and psychological.  Furthermore, the progression of the disease, unless arrested, is always “downhill” and almost invariably results in death, unless something else kills us first — often physical deterioration aggravated by the disease.

As regards the coming and going: barring mental illness, we either choose to relapse, or to remain abstinent.  Relapse occurs long before we pick up, and is the result of either a lack of commitment to sobriety, and/or failure to maintain our physical and emotional health and do for ourselves the things that only we can do: make use of our supports and follow “to any lengths” the suggestion of a proven program of recovery.

When You Relapse, Do You Lose All Your Sobriety?

I get letters in another venue from people in early recovery, asking for information about the variety of symptoms and problems common to all of us when we were newcomers.  I was quite taken with the following letter, because it illustrates an extremely common issue — family members who don't understand what we need, or who passively try to sabotage our recovery.  I thought I'd share the letter and my response with you here.  It has been redacted to remove some unrelated information, and to protect the identity of the writer.

I have abused opiates on and off for four years. Went through detox two times when I had insurance, just from being so afraid of withdrawal. Went to counceling once. Of course my abuse continued to grow. I got to the point of being just sick of it. I quit and used a recipe I found online using vitamins an amino acids. I went to get change from my husbands “spare change cup” and found eight pills there (he takes them because he needs hip replacement). By the end of the night I had taken eight to ten pills out and took the pills over the next 24 hour period. This was on the 101st day of being clean. I am so disappointed in myself and feel miserable, but I am determined to pick up the pieces and move on. …[Your] article was very helpful to me. I realize I need to be in a program and will look in to it. I guess my question is, Have I lost the time of 100 days I put into sobriety, after a one day binge? Have I lost all recovery ? I so want to be rid of this deamon and your article has helped.

Thanks,

“Jenny”

Dear Jen,

Quite the contrary: that 100 day investment may turn out to have been one of the most valuable experiences in your quest for sobriety. You now know that you cannot trust your disease. It is going to be with you — in spirit, as it were — for a long time. Recovery is about learning that, and learning to live without drugs.  Addiction is a disease of relapse.  Those who have done so one or more times are far more common than those lucky ones who made it on the first try.

Your picking up should have taught you three things:

  • You must speak with your husband about keeping strict control of his medication so that you will not be tempted “accidentally” again;
  • You need a support group that you trust enough to call and talk through urges to use, and that will help you learn to cope with life — comfortably — without using;
  • Life goes on. Beating ourselves to death for being human and giving in to temptation is not productive. Learning from our mistakes is, however, imperative.

Relapse occurs long before we pick up; using simply makes it official. If we keep ourselves in a healthy state of mind and body, follow suggestions and generally live our lives as someone who is IN recovery, as opposed to someone who is thinking about being in recovery, we do not reach the state of mind that will make it easy for us to pick up the random pill laying around the house.

As the song would have it, “Pick yourself up, dust yourself off, start all over again,” using the very important lessons you've learned to help avoid further slips.  Addicts have to be extremely careful about falling down to begin with, because sometimes we find ourselves unable to get up. The good news is, as long as we learn not to make the same mistake again (and, hopefully, none similar as well) we can profit from them.

I’m seeing some wishy-washy thinking here: “I realize I need to be in a program and will look in to it” needs to be “I will call and find the location of a meeting immediately and get to it as soon as possible.” Please get to some meetings! You cannot do it alone. Your best thinking got you where you are, and you need some fresh input. The lifelong friends you will make in the process are a bonus.

Remember one other truism: Anything that you place ahead of your recovery, you will eventually lose.

Keep on keepin’ on,

Bill