fbpx
RSA +27 82 775 5973 | UK +44 (0)20 3318 1144 12 Cherry Ave, Belle Constantia, Cape Town enquiries@cherrywoodhouse.com

Intervention Guidelines

If a loved one is suffering from an addiction and you judge that they might be responsive to an appeal from family members and close friends to address their problem, an intervention might be a good course of action. 

By “intervention” we mean a deliberate, planned discussion initiated by those closest to the addicted person with the intention of encouraging him or her to recognise the problem and take action. 

The immediate objective of an intervention is to induce the addicted person to see clearly the impact of the addiction on themselves and others, without provoking defensiveness on the part of the addicted person or allowing the conversation to escalate into a conflict. 

In General, The Best Outcome Will Be Achieved By Adhering To The Following Guidelines

DO’S:

  • Ideally the intervention should involve a small group of people that are close to and care about the addicted person.
  • It is often helpful to write letters in advance, detailing the impact that the addiction has had on the writer. These can be read to the addicted person on the day.
  • You should educate yourself beforehand on relevant aspects such as the nature of the particular addiction, detoxification and treatment programmes – particularly those which suit the personality and needs of the addicted person.
  • The participants should plan in advance precisely how the conversation will unfold and should rehearse beforehand.
  • Each participant should be willing to offer concrete help to the addicted person in some or other way, within their respective means – e.g. attending family therapy sessions, financial support, care of children while the addicted person is in treatment.
  • The participants should be prepared to implement and act upon boundaries if the addicted person is not receptive to the request for intervention. Relationships will need to change. Everyone present must commit to cease enabling and codependent behaviour and be clear that there will be consequences for the addicted person if they refuse help.

DON’TS:

  • The tone of the discussion should not be one of blame.
  • The discussion should not occur spontaneously when the addicted person is drunk or high.
  • The participants should not be overly prescriptive or authoritarian in the solutions presented.
  • Do not despair if the intervention ends badly. A seed has been planted.

Signs of an Addiction

Addiction is an insidious illness.  It usually develops gradually over time, making it easy for the severity of the problem to escape the notice of immediate family members.  On top of this, the natural inclination for close family is to deny and diminish the problem in order to retain some sense of normality. 

If you suspect that a family member may be addicted to alcohol or substances, but you are unsure of the severity of the problem, consider whether any of the following apply to the person:

  • An inability to stop using. The individual has made at least one serious but unsuccessful attempt to give up the substance or behaviour.
  • Use and abuse of substances continue despite health problems. The individual continues regularly taking the substance, even though they have developed related illnesses.
  • Dealing with problems. The substance or behaviour is resorted to in order to (or as an alternative to) dealing with problems.
  • Obsession. The individual has become obsessed with the substance or behaviour, spending more and more time and energy finding ways of getting access to it.
  • Taking risks. The individual takes risks to obtain the substance or engage in the behaviour.
  • Taking a large initial dose. This is common with alcoholics. The individual may rapidly consume large quantities of alcohol in order to feel its effects as soon as possible.
  • Sacrifices. The individual is willing to give up activities that they used to enjoy in order to carry on taking or having access to the substance.
  • Maintaining a good supply. The individual will ensure that they have a good supply of the substance of choice even if they cannot afford it or are put to serious inconvenience.
  • Secrecy and solitude. The individual uses the substance alone or in secret.
  • Disregard for safety. The individual consumes the substance in amounts which are unsafe (particularly in the case of alcohol and heroin).
  • Maintaining stashes. The individual maintains small hidden stashes of the substance in unlikely places (such as the car or the office).
  • Withdrawal. The individual experiences physical discomfort when their ingested levels of the substance drop below a certain level. Depending on the substance they may experience symptoms such as cravings, constipation, diarrhea, trembling, seizures, sweats, insomnia and uncharacteristic behaviours such as violence.
  • Appetite changes. Some substances alter a person’s appetite. Marijuana consumption, for example, might greatly increase their appetite while cocaine may reduce it.
  • Sleeplessness. While insomnia is a common symptom of withdrawal, the use of illicit stimulants such as speed or ecstacy might also result in a disrupted sleep cycle.
  • A change in appearance. A person may begin to appear more disheveled, tired, and haggard, as using the substance or carrying out the addictive behavior replaces key parts of the day, including washing clothes and attending to personal hygiene.
  • Increasing tolerance. The individual needs to take more and more of the substance to achieve the same effect.

A person might experience a few of these symptoms or many of them. Substance use disorders manifest differently in different individuals.  In general, the greater the number of symptoms displayed, the greater is the severity of the situation. 

Most of the above symptoms apply equally (with the necessary changes) to process disorders (i.e. an addiction to a behaviour such as gambling or shopping). 

Helpful Information for Families

If you love someone who is battling an addiction and you are wondering what to do, please keep the following in mind:

  • Treating an addiction is about more than just about breaking the addict’s physical dependence on the substance – It is a common misconception that curing an addiction simply means abstinence from the substance or behaviour for a long enough period that it is eliminated from the addicted person’s system. This assumption fundamentally misunderstands the nature of addiction and the neurological processes that keep it alive.   As an addiction develops, new and distinct neural pathways are formed in the addicted person’s brain, establishing powerful linkages between the pleasure and relief provided by the substance or behaviour and the routines and triggers of everyday life.  This process might be compared to the formation of a well-trodden hiking trail.  The more we use the path, the faster, easier, and more familiar it becomes.  As we travel it more and more, it becomes wider, smoother, and easier to use.  It becomes a preferred route. The same is true of neural pathways. Over time, the brain forms familiar neural pathways, and these become habitual routes.   Recovery from addiction is about laying new paths and equipping the addicted person with sufficient coping mechanisms and motivation to tread them for a long enough period that they become the preferred route.
  • Sometimes medication is necessary – When treating addictions to opioids (prescription pain relievers or drugs like heroin or fentanyl), medication should be the first line of treatment, followed by some form of behavioural therapy or counseling. Medications are also available to help treat addiction to alcohol and nicotine. Medications are also used to help people detoxify from drugs, although detoxification is not the same as treatment and is not sufficient to help a person recover. Detoxification alone without subsequent behavioural therapy or counseling generally leads to resumption of drug use.
  • Be optimistic – If the addiction is acknowledged and decisive action taken, there is good reason to be optimistic about the future.  The last two decades have seen great strides in the development of effective evidence-based treatment methods and research shows that most people who consciously pursue recovery do ultimately succeed.   A substance use disorder is considered “a good prognosis disorder”. 
  • Be realistic – Expect recovery but be prepared for relapse. Although some people achieve recovery on their first attempt, for others it requires multiple attempts over multiple years.  Family members should also maintain realistic expectations in their interactions with the addicted person.   Your loved one is going to lie to you, and you will want to believe them. They might actually believe themselves. But what they are doing is protecting their illness, because the addictive behaviour or substance has come to seem as vital to them as air. This isn’t to say that you should excuse lying, only that you should understand where it’s coming from so you can take it a little less personally and avoid getting sidetracked by pain and resentment. Instead, keep the lines of communication open, but set clear boundaries that protect you and them, and that encourage a turn toward treatment.
  • You are not to blame – It is not unusual for the immediate family members of a person in active addiction to feel guilt or responsibility for the way that the situation has developed. This is not productive, and it is almost certainly not a true reflection of reality. No matter what you did, how you parented or whether you argued, you did not wish this life for your loved one and you did not cause the condition.  Whatever the circumstances were that led your loved to start using drugs or alcohol, you need to know that addiction is a complicated condition influenced by many factors, including genetics.  It is more than just an emotional or psychological phenomenon.  The structural changes that occur in the addicted brain exert an extremely powerful influence on that person’s behaviour – crowding out reason, common sense and even love. 
  • Educate yourself about treatment options and seek out support networks – A vital first step in moving towards a permanent solution for your loved one and your family is shining a light on the problem.  AlcoholicsNarcotics  Anonymous,  Sex Addicts Anonymous and Gamblers Anonymous are well-established non-profit organisations with a robust global network of support for family members of people suffering from addiction.   If your family member is willing to undergo an assessment, Cherrywood House offers this service for free

RELATIONSHIPS AND MANAGING EXPECTATIONS IN EARLY RECOVERY.

So often we hear people sayingBut why don’t they trust me? I’ve been clean for a few months now, I’ve done 3 months of rehab, surely, they should trust me already.

Firstly, I think we need to look at what a relationship looks like with an addict before we start expecting anything from anyone. If we take a moment and reverse our roles, we might start to see things a little differently.

In Addiction: The Hostage

It has been said that addicts and alcoholics don’t have relationships, they take hostages.

This might sound extreme but if we look a bit closer, this statement has many areas that ring true.

People in relationships with us are often held or controlled by our behaviour, they feel frightened, they are often manipulated, cheated on and lied too. When they threaten the connection between us by saying things like “if you don’t stop using, I will leave you” we take it a step further. 

Here’s the thing, we don’t even need to say anything, even though addicts often do. Things like “well then I’ll drink myself to death” are often used as emotional blackmail to keep people around. 

But we don’t even have to say anything because the people around us know that addiction is fatal, they know that the way we use or drink will one day kill us and their belief is that if they are not around, that process will be accelerated. The fear is gripping; they love us, they don’t want this life for us. They stay because they think they can help.

All of this sounds like a hostage situation, the problem is, it’s their loved one who is holding the gun.

Broken Promises, Broken trust

“I SWEAR THIS TIME I WILL STOP, I PROMISE YOU!“

The saddest thing about this statement is that at the time we meant it. It was a real promise we made, we feel that promise in ourselves. We promise ourselves often that this will be the last time. 

Just one last time”. What our loved ones don’t know is just how out of control we really are, they don’t know that addiction hijacks the brain, they don’t know that its main control center is where our survival instincts live. Just like the need for food and water, our brain tells us we need to use/drink in order to survive. 

If you want to test out your survival instincts, find a very dry place with no water and hang around there for a while, then put yourself in a place with lots of shade and water and see if you can control yourself not to drink the water when your life depends on it. It will reach a point where will power alone will not be enough and you will drink the water. 

The same is said for drugs and alcohol. The primitive brain once hijacked will make sure we use or drink regardless of feelings, relationships or promises.

So we do mean the promise, we ourselves don’t want this life. For every promise, we break to someone we have already broken hundreds to ourselves.

Above are two of the many, many different reasons why people have a hard time trusting us. It’s not hard to understand if we take an honest look at ourselves. We have done some major damage, people are left with trauma after being with us while in addiction.

Time is the best healer here, we have to prove ourselves worthy of trust again. Our behaviour and actions are in line with our words and people will start to see the new you that is starting to shine through.

Finally, be gentle with yourself, but also be gentle with others.

Their love for you has hurt them in the past, they need to do the healing in THEIR own time, not yours.

If you fear yourself or a loved one is addicted to substances if you want yourself/them to stop using and sabotaging relationships, feel free to contact us. We’re here to help. Admitting there is a problem is the first step on your road to recovery

Compliance VS Surrender

There are a few ways we can talk about the battle of compliance versus surrender. The first part relates to clients in treatment.

Some people believe that because they say the right things and do “what’s required” of them in treatment that they are working in the program. We find that these people never actually change their behaviour; nearing the end of their treatment they begin to act the same as or similar to when they first came in. The recovery mask drops and we see the person for who they really are. Compliance is a dangerous dynamic, as most of the time, the person doesn’t really know that they are being compliant. We have often heard people saying “but I don’t understand what the problem is, I’m doing all the right things, getting all my assignments done, participating in group and really dealing with all my issues. So what’s the problem?”

It’s a good question.

The problem is that without surrender you won’t change. So where does the surrender come from and how can we make it happen?

The birth of surrender comes from the acceptance we experience in step one. Surrender to most people implies that they have lost, they are giving up, the fight is over. Addicts are not the easiest people to deal with when it comes to losing or letting go so the concept is foreign. But it is a must; we need to surrender to the fact that within us we don’t have the power or ability to stop using substances. That left to our own devices we will use or abuse substances till it kills us. The second part of that surrender is accepting that we need help from external sources in order to get into recovery.

Counterproductive belief systems in recovery sound like this.

  • I’ve got this.
  • Now I can handle this on my own.
  • I hear what you’re saying but…
  • Yes I know, I know…

There are many signs to people who are compliant; as mentioned before we won’t see any real personal change with their behavior, and when pushed they will revert back to old behavior as a default coping mechanism.

The second part of the battle between compliance VS Surrender is once the client has left treatment.

This type of challenge really does separate the complaint from the surrendered.

Some people say the right things, do all the work and planning for when they leave, and when they do actually leave they take the reins back. They tell the people around them all the new lingo they have learned. They actually start using recovery info as a weapon against their own recovery. They throw around this new info to convince people that they are in recovery, but the moment it is time to act on this new information, they don’t or can’t because it isn’t a subjective reality to them, its objective. Its something outside of themselves. Everything is a farce because the majority of their recovery is not real. The honesty and integrity of the program is only used in front of people and not behind closed doors. This alone is enough to completely undermine everything recovery stands for, relapse will follow shortly after, followed by statements like; “but I don’t understand why this happened. I was doing everything required of me.”

So why does relapse happen? Where does the Compliant falter?

I think part of the problem is people don’t know how to make the real changes, they are not completely willing to make the needed sacrifices or dedicate the needed time to their new way of life. The first year of recovery is very taxing as it takes a monstrous amount of your time to focus on your recovery at that level and I believe that people don’t see recovery for what it actually is.

Recovery isn’t easy, especially in the first few months. Feelings are hard to deal with, we are reminded on a daily basis of the destruction we have caused, no one around us really trusts our change, people are broken because of our past behaviour and it takes time for the relationship to heal. There are a lot of exterior influences that push us to react the way we used to, throwing up a middle finger and destructing.

Another trap that people who are compliant fall into is trying to separate their lives from their recovery. Like doing recovery on the side while still trying to reap the benefits of this new life. Anyone, including myself, that I’ve seen really embrace recovery has made their recovery their life. It’s hard to tell the two apart. People who are compliant often have severely different lives. One side going to meetings and sharing about recovery, then the same night going to a club and pretending to be normal. Like trying to mix oil and water. The addiction culture and recovery culture won’t and don’t mix, one of them will win. Unfortunately, it’s usually the addiction culture that pulls people in because it’s familiar and comfortable.

The majority of people who have long term recovery will tell you that recovery comes, came and will always come first in their lives.

This is the recipe for the surrender I’m talking about.

  • I can’t do this on my own.
  • I need as much help as I can get.
  • I don’t really know much about recovery but I’m willing and open to learning.
  • Recovery is difficult but I’m prepared to embrace the struggle.
  • Please tell me what to do next.
  • I’m accountable for my decisions.
  • I’m responsible for my actions.
  • I can’t, He can. So let him.

Recovery isn’t just about stopping the using

Many people come into treatment  and think this is recovery, if I could just stop using/drinking/acting out my life would be fine, it would go back to “normal”. Here’s the thing, what’s normal?
Is normal that life you had before you started using/drinking? Is normal the way your life was as a child?

Here are the facts, if you walk into our treatment centre it tells us several things.

  1. Your life is no longer working.
  2. You are slowly or quickly dying.
  3. Your family and or loved ones around you are sick and tired of your behaviour.
  4. You, at some stage needed drugs/alcohol to cope with life.
  5. If you could have stopped on your own, you would have by now.
  6. Lastly you are not here by mistake.

Take note of point number 4, your normal didn’t work for you in the past why would it work now?
We understand that using and or drinking had become the major coping mechanism in your life. The question is not why the drugs/ alcohol, the question is why the need for mood and behaviour altering substance? What has happened in your life that made it okay to cope with such a self-destructive behaviour pattern?
Right here things start to get real for our clients. We go into the past and the present and work with them on as many of the “what’s” and “whys” as we can find in our limited amount of time with them.

We address the denial. Without fully conceding that there is a problem, the clients cannot fully concede that they need help. The need for support and help in early recovery is paramount to the ongoing process.

Recovery starts to take on another form. The old ideas and false expectations fall away. We instil the drive that recovery is not a side-line job and it isn’t an event but rather a program of continual action. We delve into the spirit and hope that clients come out the other side refreshed and with a new lease for life. We are in the life changing business and we might not always reach someone, but there is that one, two or three that get it and make the necessary changes and adjustments to live a full and happy life. This by no means is easy, but we suggest struggle, through the hardships come the growth, through the growth comes the freedom.

The freedom is there, waiting for you to grasp it and make it your reality !

Outgrowing Early Recovery

How to outgrow early recovery

 I’m taken back into those first few months of early recovery, some fond memories, some hard battles. Some lost and some won, one thing was certain from the start, recovery needed to be more than just not using. I wanted a new life, I’ve so often heard people say, ‘I want my life to go back to normal’ the way it was before I started using. The truth of that matter is the life you used to have, you needed drugs to cope, so I knew straight away I wasn’t interested in what life used to be like. It was time to outgrow that old life but also, I had to keep growing.
You see one thing I didn’t realise before was the change had to be continual. I wanted more than what the steps had to offer, I wanted more than what the rooms of Narcotics Anonymous had to offer. I was so comfortable in those rooms, surrounded by dysfunction. Yet when I was around “normal” people I felt uncomfortable and out of place. That dynamic had to change for me, I wanted nothing more than to be a productive person. It’s not that I wanted to be normal, I just wanted to feel like a human being. I was so sick of feeling like I was evil, I was sick of lying and hurting everyone I cared about.

So, the process started, I wanted to know why I was an addict or what made me behave in this strange way. I started writing and reading a lot about different theories because the disease theory on its own didn’t make sense to me, I remember a lecture at the treatment centre where I cleaned up, where they said if addiction is a disease then I don’t have it. That statement made a lot more sense to me than some victim angle, blaming disease as the culprit for my disastrous behaviour. So, what then was left to answer the question, why am I an addict?

This question bothered me for months, I read books, researched and watched YouTube till I was blue in the face. I really liked the direction Dr Marc Lewis was going. The neurological side of addiction was very fascinating to me, I wanted to understand what happened in the brain that caused me to go back and back for more “pleasure” at the expense of everything around me.
I found the harder I looked, the less I understood. The less I understood the more questions I asked. Eventually leading to a place where all those questions became irrelevant.
I wasn’t going to solve the mystery of addiction, I was an addict, full stop. It started there and it ended there. Something new surfaced, how did I stay clean this time and what was different to all the other times I had tried to clean up in rehab?
There are a few important points to make here.

  1. Knowledge within itself is useless. For many years I knew all there was to know about what I believed was recovery. I still couldn’t get through a day without using. If knowledge equalled recovery most of us would have got clean a long time ago. Knowledge becomes useful when it is backed by action, dreams, ideas and goals are nothing without applying yourself and making the necessary changes. This is a program of action after all.
  2. Understanding the fundamental basis for recovery became everything. Here is what it means to me. Within myself I did not have nor would I ever possess the power to control my addiction. Once I start the ball rolling, I use over and over again until it kills me, it was that simple. Powerlessness.
  3. I needed to able to stay clean and sober and most importantly sane without NA and AA before I could walk into those rooms and carry any sort of message of hope. I was sick of always having to depend on something. I had always heard throughout every rehab that it was NA or die, I didn’t want to live that life. What if I find myself in a situation where the rooms are not accessible? I would eventually relapse because my recovery depended on being able to get to meetings. There must be a way to apply the same principals in a different environment.
  4. I was not the man of my ideas and intentions. If I was I would never have been an addict or broken all those promises to the people I loved. I would have stayed clean the first attempt and lived a successful life. It was and still is too some extent easy to live in that fantasy, it’s easier to see myself as what I project I want to be rather than the recovering addict in early recovery. Staying present and accountable helped me see myself for what I was, the ideas were important but I was not that person, yet.
  5. I gained an understanding of myself more than anything else, I learnt where I fall short, where my weaknesses are, I also learnt where my strength lies and how to ask for help. Understanding those few points is what keeps me in recovery. I don’t over-estimate my importance any more than I under-estimate it. I believe I have a realistic view of myself and my abilities. I’m not scared to try new things or admit that I’m struggling.

On concluding I feel that it’s important to say that we are not and never will be perfect, we as humans are fallible, we as addicts are hyper-sensitive and critical. Finding the balance between easy and firm on yourself is the key.

Recovery Actions have Expiry Dates

Expiry Dates during recovery:

Many people come through our treatment centre and believe that the work they put in here is enough and that the work they put in here is going to carry them for the rest of their lives. This is a dangerous myth and one that could lead many to relapse.
Like the title states, Actions in recovery have expiry dates and what we mean by this is that the last counselling session you had, has a “half-life” of about a day. That Just for Today reading you did this morning can set you on the right path for the day but still, it’s not enough to keep you clean and sober for the rest of your life.

If you understand the fundamentals of early recovery you’d understand that to convince yourself that using or drinking is a clever idea and won’t hurt anyone is a simple task. “no-one will know”, “just this one time” and then my personal favourite, “this time will be different” are all slogans addicts in early recovery on the road to relapse use. There is no neighbourhood more dangerous than an addict in early recovery left to his/her own devices for extended periods of time.
Another fundamental principle of early recovery is powerlessness, just because I’ve written out the theory of step one does not necessarily mean I grasp the principle of what that step should offer.
If you find yourself alone with the means to use your drug of choice and you are bargaining ‘should I use or should I not use’ you are in a seriously dangerous situation that in my opinion will end in your power of choice diminishing and eventually lead to relapse. The solution here is to remember the principle we are talking about, powerlessness. Asking for help is imperative in this situation, remembering that reaching out means that you care enough about yourself and your recovery to make the right decisions.

I believe what most people get wrong in these early days sounds like this, they don’t view recovery as a lifestyle, a new culture to take part in. They keep life and recovery separate, eventually allowing the “life” side to take priority, smothering out any hope of recovery surviving, this might take a year or 3 weeks but eventually, people lose sight of what’s truly important.
The actions we put in daily last for that day, maybe more. But one thing I feel sure about is that without recovery becoming a lifestyle, the chances of living in long term recovery get smaller. Time and life become the enemy, we can only deal with what we are willing to face and being able to see these simple but powerful facts could be the deciding factor in your process.

Next Steps

We hope that you found this article helpful. If you are struggling with an Addiction or know someone who is. Please feel free to contact us and we can help you with your next steps.

Cherrywood House is a rehabilitation centre for people suffering from substance and other addictive disorders. It is situated in the tranquil, semi-rural environments of Constantia, Cape Town, South Africa. We offer  Residential Programmes, Aftercare Support Services, Outpatient Programme, Family Support Groups. For more information. Visit our Website Here.

Triggers | Associations

What are Triggers?

Triggers and associations are strong reminders of the past. For people in early recovery, a trigger or association can be the influencing factor which leads to a relapse. A few triggers are easier to see than others, for example, the bar you used to drink at is a blatant reminder of your drinking. Most triggers are a lot smaller but just as powerful. For example, that playlist that always played in your car while you were using or drinking might have a strong enough association to make you crave. Something as simple as getting home after a treatment and your house smells a certain way could bring back memories, causing a substantial craving.

Internal Triggers

Furthermore, there are also internal triggers which are harder to prepare for. Certain emotions can trigger a desire to use. If you had a certain dynamic with a family member that caused you to feel resentful which lead to you fighting and eventually using, that dynamic will possibly happen again once you are home. Being aware of your dynamics in relationships might be the difference between you acting out or making the decision to do something differently. You only need to do something different once to see that there is another way.

Preparing for Triggers

Many people underestimate the force that these triggers and associations have on someone in early recovery and just how quickly they can lead to physical relapse. Here at Cherrywood House we make a point to go through triggers in our relapse prevention workshops and in our Transitional Workshops.

The question remains, how do we deal with triggers and associations so that we can be safe when we leave treatment?

TRIGGERS & ASSOCIATIONS: HOW TO DEAL WITH THEM

For most people, the transition will be difficult as not everyone can move houses or towns. You will be confronted with the same situations, with the same people most likely causing the same feelings.

The first step to combating these dynamics is awareness, we need to be prepared for this. Surprises will pop up but the more prepared we are, the less chance of emotionally acting out there is.

Trust your internal messages. Treatment makes us aware of ourselves and of our thought processing. If you think you are at risk, you probably are. Walk away; rather apologise one day for being rude, than apologise to your family because you sold the car again during a relapse. Being true to yourself is going to be far more rewarding than conforming to what others expect of you.

Next Steps

We hope that you found these tips on Triggers and Associations helpful and encouraging.  If you are struggling with an Addiction or know someone who is. Please feel free to contact us and we can help you with your next steps.

Cherrywood House is a rehabilitation centre for people suffering from substance and other addictive disorders. It is situated in the tranquil, semi-rural environments of Constantia, Cape Town, South Africa. We offer  Residential Programmes, Aftercare Support Services, Outpatient Programme, Family Support Groups. For more information. Visit our Website Here.

Relapse and what to look out for

Relapse can and does happen.

Relapse is more than just using alcohol or drugs.  It is the progressive process of becoming so dysfunctional in recovery that self-medication with alcohol or drugs seems like a reasonable choice.

The relapse process is a lot like knocking over a line of dominoes. The first domino hits the second, which hits the third, and soon a progressive chain reaction has started. The sequence of problems that lead from stable sobriety to relapse is similar to those dominoes. There are two differences. First, each domino in the line (i.e. each problem that brings us closer to substance use) gets a little bit bigger and heavier until the last domino in the sequence is ten feet tall, four feet wide, and a foot thick. As this 10,000-pound domino begins to fall on us, it is too heavy for us to handle alone. The second difference is that the dominoes circle around behind us. So when the last domino falls, it hits us from behind when we’re not looking.

So here we are, moving along in recovery. We tip over one small domino. No big deal! That domino hits the next, and then the next. A chain reaction gets started. The first dominoes are so small that we can easily convince ourselves that it’s no big deal. We look the other way and start doing other things. All of a sudden a huge domino falls on us from behind, crushing us to the floor, causing serious pain and injury in the process. We need to make the pain go away and we reach for old reliable – the magical substances that always helped us without pain in the past. We’ve now started drinking and drugging.

The answer to avoiding relapse is not to take up weight training so you will be strong enough to lift that last domino off of your now crippled body. Part of the answer is to learn how not to tip over the first domino. Another part of the answer is to develop an emergency plan for stopping the chain reaction quickly before the dominoes start getting so big and heavy that they become unmanageable.

The Relapse Process

The progression of problems that lead to relapse is called the relapse process. Each individual problem in the sequence is called a relapse warning sign. The entire sequence of problems is called a relapse warning sign list. The situations that we put ourselves in that cause or complicate the problems are caused high risk situations.

It’s important to remember that we don’t start drinking and drugging because of the last problem in the sequence. We start drinking and drugging because the entire sequence of problems got out of control. Let’s look at the steps of this process in more detail.

Step 1: Getting Stuck In Recovery

Many of us decide that alcohol or drugs is a problem, stop using, and put together some kind of a recovery plan to help us stay sober. Initially we do fine. At some point, however, we hit a problem that we are unwilling or unable to deal with. We stop dead in our tracks. We are stuck in recovery and don’t know what to do.

Step 2: Denying That We’re Stuck

Instead of recognizing that we’re stuck and asking for help, we use denial to convince ourselves that everything is OK. Denial makes it seem like the problem is gone, but it really isn’t. The problem is still there. It just goes under ground where we can’t see it. At some level we know that the problem is there, but we keep investing time and energy in denying it. This results in a build-up of pain and stress.

Step 3: Using Other Compulsions

To cope with this pain and stress, we begin to use other compulsive behaviors. We can start overworking, over-eating, dieting, or over-exercising. We can get involved in addictive relationships and distract ourselves by trying to experience the orgasm that shook New York City. These behaviors make us feel good in the short run by distracting us from our problems. But since they do nothing to solve the problem, the stress and pain come back. We feel good now, but we hurt the latter. This is a hallmark of all addictive behaviors.

Step 4: Experiencing A Trigger Event

Then something happens. It’s usually not a big thing. It’s something we could normally handle without getting upset. But this time something snaps inside. One person described it this way: “It feels like a trigger fires off in my gut and I go out of control.”

Step 5: Becoming Dysfunctional On The Inside: 

When the trigger goes off, our stress jumps up, and our emotions take control of of our minds. To stay sober we have to keep intellect over emotion. We have to remember who we are (an addicted person), what we can’t do (use alcohol or drugs), and what we must do (stayed focused upon working a recovery program). When emotion gets control of the intellect we abandon everything we know, and start trying to feel good now at all costs.

Relapse almost always grows from the inside out. The trigger event makes our pain so severe that we can’t function normally. We have difficulty thinking clearly. We swing between emotional overreaction and emotional numbness. We can’t remember things. It’s impossible to sleep restfully and we get clumsy and start having accidents.

Step 6: Becoming Dysfunctional On The Outside: 

At first this internal dysfunction comes and goes. It’s annoying, but it’s not a real problem so we learn how to ignore it. On some level, we know something is wrong so we keep it a secret. Eventually we get so bad that the problems on the inside create problems on the outside. We start making mistakes at work, creating problems with our friends, families, and co-workers. We start neglecting our recovery programs. And things keep getting worse.

Step 7: Losing Control: 

We handle each problem as it comes along but look at the the growing pattern of problems. We never really solve anything, we just put band-aids on the deep gushing cuts, put first-aid cream on seriously infected wounds, and tell ourselves the problem is solved. Then we look the other way and try to forget about the problems by getting involved in compulsive activities that will somehow magically fix us.

This approach works for awhile, but eventually things start getting out of control. As soon as we solve one problem, two new ones pop up to replace it. Life becomes one problem after another in an apparently endless sequence of crisis. One person put it like this: “I feel like I’m standing chest deep in a swimming pool trying to hold three beach balls underwater at once. I get the first one down, then the second, but as I reach for the third, the first one pops back up again.”

We finally recognize that we’re out of control. We get scared and angry. “I’m sober! I’m not drinking! I’m working a program! Yet I’m out of control. If this is what sobriety is like – who needs it?”

Step 8: Using Addictive Thinking

Now we go back to using addictive thinking. We begin thinking along these lines: ” Sobriety is bad for me, look at how miserable I am. Sober people don’t understand me. Look at how critical they are. Maybe things would get better if I could talk to some of my old friends. I don’t plan to drink or use drugs, I just want to get away from things for awhile and have a little fun. People who supported my drinking and drugging were my friends. They knew how to have a good time. These new people who want me to stay sober are my enemies. Maybe I was never addicted in the first place. Maybe my problems were caused by something else. I just need to get away from it all for awhile! Then I’ll be able to figure it all out.”

Step 9:  Going Back To Addictive People, Places, And Things

Now we start going back to addictive people (our old friends), addictive places (our old hangouts), and addictive things (mind polluting compulsive activities). We convince ourselves that we’re not going to drink or use drugs. We just want to relax.

A client in one of my groups said he wanted to go to a bar so he could listen to music and relax while drinking soft drinks. And old timer in the group asked: “If you told me you were going to a whore house to say prayers, do you think I’d believe you? Well, when you tell me you’re going to a bar to drink cokes I have about the same reaction!”

Step 10: Using Addictive Substances: 

Eventually, things get so bad that we come to believe that we only have three choices – collapse, suicide, or self-medication. We can collapse physically or emotionally from the stress of all our problems. We can end it all by committing suicide. Or we medicate the pain with alcohol or drugs. If these were your only three choices, which one sounds like the best way out?

At this stage the stress and pain is so bad that it seems reasonable to use alcohol or drugs as a medicine to make the pain go away. The 10,000 pound domino just struck the back of our head, breaking our bones, and crushing us to the ground. We’re dazed, hurt, and in tremendous pain. So we reach out for something, anything, that will kill the pain. We start using alcohol and drugs in the misguided hope it will make our pain go away.

Step 11: Losing Control Over Use

Once addicted people start using alcohol or drugs, they tend to follow one of two paths. Some have a short term and low consequence relapse. They recognize that they are in serious trouble, see that they are losing control, and manage to reach out for help and get back into recovery. Others start to use alcohol or drugs and feel such extreme shame and guilt that they refuse to seek help. They eventually develop progressive health and life problems and either get back into recovery, commit suicide, or die from medical complications, accidents, or drug-related violence.

Other Outcomes Of The Relapse Process

Some relapse prone people don’t drink. They may say “I’d rather be dead than drunk” and they either attempt or commit suicide. Others just hang in there until they have a stress collapse, develop a stress related illness, or have a nervous breakdown. Still others use half measures to temporarily pull themselves together for a little while only to have the problems come back later. This is called partial recovery and many people stay in it for years. They never get well, but they never get drunk either.

What I have just described is called the relapse process and it’s not rare. Most recovering people periodically experience some of these warning signs. About half can stop the process BEFORE they start using substances or collapse from stress. The other half revert to using alcohol or other drugs, collapse from stress related illness, or kill themselves.

It’s not a pretty picture. No wonder we don’t want to think or talk about relapse. It’s depressing. The problem is that refusing to think or talk about it doesn’t stop it from happening. As a matter of fact ignoring the early warning sing makes us more likely to relapse.

But there is hope. There is a method called Relapse Prevention that can teach us to recognize early warning signs of relapse and stop them before we use alcohol and drugs or collapse. That’s what my next article is about. There’s also a process called Relapse Early Intervention that helps us set up an emergency plan to stop relapse quickly should it occur. We’ll cover that in our third article.

References

Gorski, Terence T., Relapse – Relapse Prevention – A New Recovery Tool, Alcoholism & Addiction Magazine;; By Terence T. Gorski September 25, 1989