triggers

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.

What About People, Places and Things?

Q. How can you stay away from people, places and things when they are family or significant others?

Q. If my boyfriend drinks and does coke occasionally, what should I do about it?

These really translate into the same question: How much do I value my sobriety?

Let's first ask ourselves, why did we get sober? Why did we go to AA, NA, treatment, detox or whatever? Was it because we were having fun while we were using? Was it because our lives were completely under control? Was it because we could pick up a drink or a drug and then stop whenever we wanted to? Could we go into a bar, or to a party, hang with our friends, and choose whether or not we were going to get high?

If any of those answers were yes, then there's no need to worry about it. Why should we? Everything's great!

But if we got  clean because our life was in the toilet; if we were afraid we were going to die, or hurt someone else; if we got clean and sober because we couldn't stand the idea of continuing in the direction we were going, then if we want to remain clean we have to put that idea ahead of everything else in our life.  That doesn't mean we have to live in meetings forever, or that we can't ever have fun again, but it does mean that we may have to change the ways we deal with others, in order to protect our sobriety.

Those people who are able to do so will normally take pains to avoid things that might cause us problems. If they are unable to do that, or won't, the reasons don't matter. We can't change them; we can only make changes in ourselves, and the only sensible thing for us to do is to put our welfare first, and stay away from them.

There are family situations that are so uncomfortable for us, even if alcohol or other drugs are not involved, that we are emotionally unprepared to handle them in early sobriety. If our family drinks or uses drugs, if our friends hang out in bars or hit the restroom five times an evening, if our significant other drinks (and does coke occasionally), it's no business of ours. Our business is taking care of us, and if we believe there's a danger in those people, places and things, then we need to distance ourselves until the conditions change.  We can't take the chance unless we're willing to do the detox and treatment thing all over again — if we survive.

Even if we have children, we may need to stay away for a while. Those kids may need us, but if we can't remain clean they may never have us. Let's face it, we were absent even when we were with them. Isn't it worth a bit more time to help insure that we won't be leaving them again?

Stress is a primary cause of relapse. We need to avoid stressful situations until we are able to handle them.  We also know that just the sight of (or merely thinking about) drugs or alcohol can cause changes in our brain chemistry that cause cravings.  The sight of a guy standing on the corner where we used to cop, a bar where we used to drink — even the recliner where we used to collapse — can do the same thing.

The very fact of wondering about it is a pretty good indication that we aren't ready yet. As much treatment as we can afford, a stay in a halfway house or sober living facility, working at a low-stress job for a while — along with a lot of support from our peers — can better prepare us to go back to the “real world.”

If going home right now worries you — or even if it doesn't — it probably should.

Home Groups, Sponsors, Reservations, and Families That Use

This time we’re combining four questions that don’t require long answers into one post.

How soon should I find a home group?

You need to find a group where you feel reasonably at home.  This may change over time, but you need to look for one where you aren't totally uncomfortable.  Don't look for perfection, because it doesn't exist.  Groups are made up of people — all kinds of people.  Again, reasonable comfort is the key.

There’s no set limit.  Generally, it is suggested that we spend a few meetings in each of several groups, then stick with the one that feels best for a while.  When we’ve made that much of a commitment, making a home group decision shouldn’t be difficult.

How long should I wait to get a sponsor?

Generally speaking, the same rule applies to sponsors.  Listen to what people say.  Look for people who are happy in sobriety, and sound like it — consistently.  Look for people who sound honest.  Avoid people who quote the literature constantly, and look for people who make sense when they’re thinking for themselves.  Don’t wait too long, but try to choose based on those ideas.

There is no set rule, but since a sponsor is your guide through the program and the steps, it’s not good to wait too long.  If you’re doing a meeting a day, you should have a pretty good list of candidates in a couple of weeks.  Then ask them to go for a cup of coffee, and spend some time one-one-one.  If that feels good, then ask.  You're not getting married, but you don't want a one-night stand, either.

What is a reservation?

A reservation is an excuse to use that we make in advance.  Here are some examples:

  • I’m an alcoholic and can’t drink, but a little pot can’t hurt.
  • I’m a painkiller addict, but it’s OK to have an occasional drink.
  • I’ll go to meetings and do as I’m told, but it’s hard for me to trust people so I’m not getting a sponsor.
  • I’ll go to meetings, work the steps, and do as I’m told, but I’m sure that after I’ve been clean and sober for a while it will be OK for me to have a drink now and then.
  • I’ll go to meetings and work the steps, but to heck with that one-year thing.  I’m going to have a relationship if one comes along.

To put it another way, a reservation is a recipe for failure.

How often should I see my family members that still use drugs?

How often do you want to be tempted to use drugs yourself?

Talk about pushing buttons!  Our families hard-wired our buttons for us.  They can push them without even meaning to.  In any case, people who are using around you clearly don’t have your best interests on their mind.  Add to that the fact that seeing you clean and sober may make them uncomfortable enough to actively encourage you to use, and the answer is simple: very seldom, and always in the company of a sober companion. (See “reservations.”)

That's it for this time.  Keep on keepin' on!