relapse triggers

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”

No Holiday Secrets

Relapse is a symptom of addiction, just as much as the craving, obsession and withdrawal.  Most addicts relapse one or more times.  That isn't to imply that it's a good idea, but it is a fact.  (This may seem like an odd subject for Thanksgiving Day, but bear with me here.)

Holidays provide two things that are dangerous for addicts: plenty of different kinds of stress, and ample opportunities both to think about using and to actually do so.  Some of us are going to start some additional research over the next day or so.  Some of us have already started.  Those who do will discover that it's not working any better this time than it did before.  Most will find that things are even worse.  Some will die.  Some will make it back into the rooms of recovery.

It is vital that those who make it back share about it — at meetings, after the meeting, and especially with their sponsors.  (If you don't have a sponsor, perhaps you might take your relapse as a sign that you need one, eh?)  There's a saying that we're as sick as our secrets.  It's true.  Secrets lead to lies, and they lead to more secrets, and the first thing we know we're so tangled up and emotionally exhausted that a drink or other drug seems like the only way out.  Once again.

So no holiday secrets.  They lead to the wrong sorts of celebrations for us — and sometimes for our survivors.

What about “non-alcoholic” beer in recovery?

Q. I quit drinking about 6 months ago. Things are most certainly getting better but I was wondering what effects if any have you seen in regards to non-alcoholic beer?

Beverages may be called non-alcoholic if they contain no more than 0.5% alcohol (one-half of one percent). That is roughly one 1/10th the percentage in a can of regular beer. That’s not much, but we don’t know how much it takes to keep the brain from recovering as it should, nor how much having low levels of blood alcohol for hours at a time (assuming that you drink more than one) has an effect. It seems to me that it is a danger that can be avoided, and thus undesirable.

Just as important, however, is the psychology. I’m telling myself that I can’t drink, but that I can keep on pretending that I can. I can hang with my troops and do the stuff we used to do, I’ll just drink O’Doul’s® or whatever. That shows reservations about our disease, regardless of what excuses we adopt, and indicates a definite ambivalence about remaining clean and sober.

I suspect that you may not be attending enough meetings, and that you didn't discuss this issue with your sponsor (if you have one).  If you aren't going to meetings, then I'd start. You can cheat on some things, but cheating on sobriety — whether physically or mentally — eventually lands you off the wagon and back in the muddy rut. It seems to me that knowingly drinking alcohol, even in small quantities, comes extremely close to just plain old drinking.

Some folks might disagree about this, but I know people who relapsed after thinking they could drink the stuff. I can’t say whether or not that was the cause, or just an expression of the “easier, softer way,” but I certainly wouldn’t take the chance myself, even after all this time.

We Don’t Have To Give In To “Stinkin’ Thinkin'”

Everyone in recovery knows someone who tried to go back to “occasionally” using alcohol or other drugs — with predictable results. Many of us have personal experience. It often starts out with being sober for a few months, but it can happen in a program that has gone smoothly for years. We begin to think that we've been feeling so good lately that maybe we aren't an addict after all. Maybe we can “handle it.” Of course, now that we know all about addiction, we won't let it get the best of us.

Sometimes we try it, sometimes not, merely teetering on the edge for a bit. Those of us who did try tend to have the most interesting stories, and they all center around the idea that we convinced ourselves that we didn’t need to remain abstinent, or that we concentrated on some terrible thing that someone had done to us, dwelling on that instead of the good things in our lives.  Or perhaps we simply forgot to look for the good and concentrated on the bad, so that drinking or using drugs seemed like a reasonable alternative to the way we were feeling. Professionals call these ideas “reservations.”  But call it that, or a “dry drunk, “stinkin’ thinkin’” or whatever you will, it is the main component of relapse. (Remember, we relapse before we use.)  And it causes a lot of misery, even though we may technically remain clean and sober.

But it doesn't have to work that way.

Photo: DigitalZen

When we are active in our addictions, we dwell on our problems.  After all, they give us a marvelous excuse to use.  And, as we progress in our addiction, we learn to project our feelings about ourselves onto others.  It is much easier for me to resent the fact that my spouse spends all her time at work than it is to admit that if I got off my butt and found a job, she wouldn't have to work so hard.  Thinking like that would threaten my drinking and drugging, and I need to avoid that at all costs.  This way of thinking rapidly becomes a habit, because it allows us to feel more comfortable despite evidence that we shouldn't be. Eventually it affects our entire view of the world.

But after we're clean and sober, we no longer need to protect ourselves that way. One of the things I’ve learned through years of meditation is that I actually do have a reasonable amount of control over what I think. When we meditate, we try to concentrate on something without intellectual content — our breathing, say — to the exclusion of outside thoughts. This allows our subconscious to percolate uninterrupted, and we begin to gain some insight about ourselves.

To begin with, it’s hard. Thoughts about all sorts of things come along. We get really pissed off at our inability to do anything about it. Then someone tells us that it's a normal part of meditation. The idea is not to fight the stray thoughts, but to just let them arise, and then bring our mind back to the breathing, mantra, rosary, or whatever we’re using as a meditation tool. The key is that I can’t stop thoughts from coming to my mind, but I can control whether or not I concentrate on them, even if they come back over and over again.

Instead of drinking the poison of resentment and then waiting for the other guy to die, I can choose to turn my mind to something else. I can do it over and over again, until eventually I’ve distracted myself into thinking about other things entirely. The same is true of obsessions like drinking, or unsatisfied sexual urges, or the new toy that I think I need. It is entirely within my power to control those thoughts — not to pretend that they don’t exist, or fail to acknowledge them, but to choose not to dwell on them. In doing so, I rob them of their power, instead of giving them mine.

Newly Sober? PAWS Still Has You In Its Claws!

We all know that most relapses occur in the first few months after we get clean and sober.  Many of them are related to Post-acute Withdrawal Syndrome.  We talked about PAWS in a previous post, but I wanted to go into it more specifically here.

Although there are differences in the way they act, all addictive drugs function by either stimulating or imitating the chemicals of the brain's reward system — giving us too much of a good thing.

In an attempt to return our brain chemistry to normal (homeostasis), the brain builds more receptor sites for those particular neurotransmitters.  This allows it to deal with the higher-than-normal levels, leading to tolerance: the need for more drugs to fill up the additional receptors so that we can continue to get high.

When we get clean and sober, those extra receptors clamoring to be filled up are what causes withdrawal: acute withdrawal while the drug is clearing out of our system, and post-acute withdrawal during the period when the brain is deactivating the extra receptor sites and returning to normal.  Some authorities believe that it never normalizes entirely, which may be why any use usually leads back to full-blown addiction.

There is a double-whammy effect, too. When the drug is removed, there is a “rebound.” We begin to experience many feelings and physical symptoms that are the opposite of the way the drugs made us feel.  Removal of the drugs' stimulation causes the production of the reward chemicals to drop to below normal, and they return to their pre-addiction levels slowly. During this period we may be antsy, anxious, depressed, manic, or combinations of those feelings. We may feel as though our recovery is hopeless, and that we might as well use.

That's PAWS.  The duration  varies depending on the drug(s) used and individual physical differences.  It can — but usually does not — last for up to two years.  Ordinarily it will peak and then slowly subside within the first few months.  During that period (and in most cases for the rest of our lives), use of addictive drugs can put us back on the merry-go-round quickly.  It will also prolong the period of PAWS.  It can even set us back completely, because it interferes with the brain's repairs.

So, in early recovery we need to be prepared for a prolonged period of slowly feeling better, with setbacks when our bodies need that additional bit of natural feel-good and don't get enough, usually when we are under stress.  Stress aggravates PAWS symptoms because the natural “drugs” that help us to cope aren't back to full strength yet.

The good news: it always gets better, slowly but surely.

The best medicine for Post-acute Withdrawal Syndrome is time, aided by mild exercise, good nutrition, rest, stress avoidance, and distractions.  We need to have some fun.  We need the support of people who know where we're coming from, and who know how to deal with people in early recovery.

That's why we recommend meetings, fellowship, halfway houses, long-term treatment, and some time away from the old grind and the old stresses.  They help us deal with PAWS, while we're getting into the habits that lead to long-term recovery.

As George Carlin used to say, “Just because the monkey is off your back, it doesn't mean the circus has left town.”

If you've had your own experiences with PAWS, how about sharing in the comments?  Questions?  Feel free!

How Do I Deal With Old Relationships In Recovery?

The question of dealing with old friends, drinking buddies and family once we’re in recovery is one of the most vexing (and sometimes complicated) things about getting clean and sober.  How we handle it can be critical to our ability to avoid relapse.

Until we have learned new ways of dealing with pressure and old feelings, we need to keep them minimized.  That’s why professionals recommend treatment and halfway houses that are well away from our home turf.  Too many times they have seen what happens when people in early recovery try to deal with old relationships too soon.  Our continued sobriety is essential to our being able to deal with those issues and get our lives straightened out.  If we relapse, we will only make things worse and we’ll still have to deal with the mess when we get sober again, if we don’t die first.  So it comes down to common sense.

Old buddies who still use or booze — we just stay away from them.  Chances are we no longer have much in common anyway.  Later on — much, much later — maybe we can hang out if they aren’t drinking or using while they’re with us.  Otherwise, it needs to be sayonara.

Family members must understand that recovery comes first.  If they can’t understand that, get a little knowledge about recovery under their belts, and support our program, then we need to stay away until we have the skills to cope with them.

This is especially true of those people we perceive as having the most  power over us: parents, siblings, wives and children.  When it comes to family, we’re with the people who hard-wired our buttons and who can push them without even intending to.  These are the people who can arouse the old feelings, resentments, insecurities and emotions with a word or a look.  Those are powerful triggers, until we’ve learned to handle our own emotions and impulses.

Because we’re addicts, accustomed to short-term solutions to our difficulties (oblivion, after all, was always just a few minutes or drinks away), it’s hard for us to realize that the solution for some of our problems is time.  In the case of relationships, that sometimes includes time away from the problem.

This is not only hard for us to swallow, but often goes against the plans and expectations of the others involved.  Nonetheless, our recovery is paramount.  We have no chance of resolving old issues and improving relationships if we can’t stay clean and sober.  Getting back on the horse too soon, in this case, makes getting bucked off again a pretty sure thing.

Holidays Can Be Hazardous for Alcoholics And Other Addicts

Last week I posted a couple of articles about sobriety during the holidays. We talked about ways to be safer at holiday parties, and mentioned some ways that people with recovering guests can make things easier for them by observing some simple guidelines. In this third article, I’d like to discuss some of the hazards of holidays in general.

Holidays, especially the Winter holidays, are times when our emotions are near the surface. For those of us in early recovery, it sometimes seems imperative to get to family gatherings and let everyone know how we’re doing, make up for some bad behavior in the past, see loved ones, and generally try to fit in again. There’s nothing wrong with that on the surface, and yet there are several major hazards That we need to keep in mind. [Read more…]