“And the greatest difficulty is that it’s not the elbow that becomes addicted, but the brain. The very origin that likes alcohol is trying to determine whether to change the behavior. Guess what it will always decide?” ~Bert Pluymen, The Thinking Person’s Guide to Sobriety There’s an old saying in recovery – “Relapse happens“. Taken out of context, that is a very dangerous statement because once you have achieved sobriety, it is NEVER okay to go back to drinking again. The very real way, your next drunk or high may be your last. But at the same time, it’s important to understand that relapse CAN happen at any time, to anyone, and any stage of recovery. Statistics quoted in the Journal of the American Medical Association show that between 40%-60% of drug addicts will relapse. That means that relapse is not only possible, it’s actually LIKELY. But with that knowledge comes power. If you practice vigilance and reject complacency, you CAN maximize your chances of successful, uninterrupted sobriety.
First Things First – What’s the Difference between a “Relapse” and a “Slip”?
Both of the terms indicate a return to drinking/using after a period of sobriety, but they are NOT interchangeable. The difference is in the duration.
- A “slip” is when someone briefly resumes alcohol or drug use – for a single night, for example – but almost immediately realizes that they’ve made a mistake. They pick themselves up, dust themselves off, and resume their sobriety. The damage to the rest of their life is minimal.
- A “relapse” is when someone completely abandoned the recovery efforts and returns to their addiction. What may have started off as a slip becomes far more serious. In this case, the damage can be severe, because they just might never return to sobriety.
Does a Relapse Mean That Recovery Has Failed?
Of course not. Remember the 40%-60% relapse rate? While that may sound like a lot, it’s actually in line with or even lower than the relapse rate for other chronic diseases:
- Type I Diabetes – 30%-50%
- Hypertension – 50%-70%
- Asthma – 50%-70%
No one would ever suggest that a diabetic who has veered off of their diet and nutrition plan is completely doomed. Neither is an alcoholic or addict who has resumed their substance abuse. But it DOES mean that there was something missing in the recovery plan – vigilance, preparation, a specific treatment protocol, medication, support, etc. This is where a Relapse Prevention Plan comes in handy.
Three Important Things You Need to Know About Relapse
We already know two important things about relapse – (1) it’s entirely possible – even probable, and (2) it’s preventable. The way we know that a relapse is preventable is because of the third important thing about relapse – it’s predictable. A relapse doesn’t happen in a vacuum – there are recognizable signs and symptoms that, if noticed early, can serve as an early warning system that something needs to change immediately. As a general rule, people who have been addicted to drugs or alcohol will relapse because of:
- Emotional/Physical pain
- Stress
- Anxiety
- Fear
- Anger
- Frustration
- Depression
- Conflict
- Peer/Social pressure
Remember H.A.L.T. If You Want to Stay Sober
If you are in recovery and you want to stop yourself from backsliding, there is an apt acronym that you need to remember –HALT. What this means is you should never let yourself get too:
- Hungry – It is easy to confuse normal hunger pains with cravings for alcohol or drugs.
- Solution? Eat regular meals and keep a supply of healthy snacks – peanuts, trail mix, fruit, etc. – close at hand.
- Angry – Negative emotions lead to frustration (emotional pain) which leads to fantasizing about relieving that pain which leads to old habits of chemical relief (relapse) – all parts of the cycle of addiction.
- Solution? Work hard at acquiring new, healthier coping mechanisms, distractions, and stress reduction techniques.
- Solution? Practice honesty and better communication – when someone does something to bother you, tell them and try to talk it out, rather than internalizing your anger.
- Lonely – Humans are social animals – we actually need interactions with others in order for our central nervous system to function properly. There is a theory that addicts and alcoholics have trouble making emotional connections, and it is this isolation that partially drives addiction.
- Solution? Attend 12-Step fellowship support groups. Not only is this an excellent place for you to make friends with people who completely understand what you’re going through, but it is also a way to build a support system that you can call upon when you are feeling tempted or overwhelmed.
- Solution? Work on reconnecting with family members and friends who you may have alienated during active addiction.
- Tired –When you exhaust yourself mentally and physically, it’s far too easy to get frustrated (see above) or to let yourself have a lapse in judgment. When you let yourself get too tired to continue working hard, you’re actually giving yourself permission to drink or use.
- Solution? Get plenty of rest, especially during early recovery. Your body is trying to heal from the damage that active addiction did to it.
- Solution? Practice relaxation techniques that can help improve your sleep – exercise, yoga, meditation, etc. Remember, addicts and sleeping pills don’t mix.
When You Fail to Plan, You Plan to Fail
It’s not enough to practice HALT and use your willpower. Your Relapse Prevention Plan should be just that – a well-thought-out, written-down, step-by-step set of instructions to yourself that will keep you vigilant and will tell you what to do when you are tempted to resume drinking and using. Crafting a Relapse Prevention Plan requires honest introspection on your part. You’ll have to ask – and honestly answer – yourself a number of questions that will help you recognize the warning signs of a possible impending relapse.
- Step One – Establish a relationship with a sponsor who will hold you accountable and help guide you on your sober journey. When you are feeling like you want to return to drinking or drugging, this should be the FIRST person you call – anytime, day or night.
- Step Two – Make a list of sober friends and family members that you can call upon whenever you need help.
- Step Three – Actively participate in your counseling sessions. The more work you put in, the more the message of recovery will stay with you and serve you.
- Step Four – Regularly attend 12-Step fellowship support groups. These are your peers who will hold you accountable, answer whenever you call, sit with you when you’re feeling overwhelmed, and give you their strength when you need it.
- Step Five – This is where your introspection comes in – you have to know and be able to identify those triggers that have in the past preceded an episode of drinking or using. While making your plan, make a list of potentially-dangerous:
- Emotions – insecurity, isolation, anxiety, anger, frustration, etc.
- Thoughts – constant worry, negative thoughts about yourself, suspicion, etc.
- Behaviors – dishonesty, missing meetings/counseling appointments, driving by the liquor store, etc.
- Physical symptoms – insomnia, achiness, headaches, shaking
- Risky situations – arguments, holidays, court dates, etc.
It is up to YOU to be cognizant of each of these relapse risk factors and be constantly vigilant against their impact upon your continued sobriety.
- Step Six – Be proactive with an Action Plan to know what to do and what not to do when a risk factor arises. Some examples might include:
- DO call your sponsor and discuss how you feeling
- DO get together with a sober friend and distract yourself with healthy activity
- DO keep a journal of how you’re feeling
- DO go to extra support meetings
- DON’T skip meals
- DON’T stop taking your medications
- DON’T keep your emotions bottled up
- DON’T isolate yourself
As part of your plan, make a list of activities you can do instead of drinking or using. Referred to this list whenever a risk factor presents itself. It IS possible to keep yourself so distracted and so busy that you will not have time to relapse.
- Step Seven – After the risk has temporarily passed, give yourself a short review. This will enable you to do even better the next time. Ask yourself questions like:
- How did _____ make me feel?
- What were my thoughts?
- What could I have told myself?
- What else could I have done?
- What emotions could I’ve pushed myself into the feeling?
- How do I feel about my response to the situation?
- What, if anything, am I going to do differently next time?
There is another, the more positive old saying in recovery – “It works if you work it”, and in this case, it can refer to writing and utilizing your Relapse Prevention Plan. The temptations and stresses and risks are ALWAYS going to arise – but if you plan beforehand how you are going to respond, you maximize your chances of uninterrupted sobriety and long-lasting successful recovery.