This article will not reveal dramatic news on the topic of relapse prevention. I will, however, attempt to create a birds-eye view of the chronology of relapse to unsafe behaviors, and suggest ways to interrupt the relapse. I use a graphic depicting the progression to help patients understand the importance of interrupting the relapse sooner rather than later.
When we view this progression, it is important to understand that the journey from the thought to the relapse can occur in weeks, days, or even minutes.
We need to give our patients permission to have “the thought.” For individuals with an alcohol or drug addiction, the idea of using will occasionally present itself, without warning. That’s normal—and it may continue for the rest of their lives.
A beer commercial, someone who resembles the old drug dealer, a song from the “using” days, a certain perfume—there always will be reminders of the “good old days,” when using was fun and consequences were tolerable. The addict is not responsible for having the thought, but is responsible for what he does with that thought.
Most addicts I know will “dance” with the thought, romancing the idea for just a little while. “I’m not going to actually relapse, but I’ll just play with the idea for a bit.” Although this might seem harmless, this is exactly the time to interrupt the relapse. Why? Because it is a lot easier to stop the train now than to wait until the locomotive has a full head of steam.
When does the dance turn into a craving? It’s different for everyone, and in my experience the addict will not recognize the transition. Because addiction is a disease of denial, the individual probably will say, “I shouldn’t be entertaining these thoughts, but I know I’m not going to relapse.” Substance use disorders are bizarre—absolutely absurd. Intelligent people, eager to remain sober, will be lulled into the illusion that “willpower” will keep them clean.
“All of a sudden, it just seemed like a good idea.” When did the addict lose control over the craving? Again, everyone is different. Was it a subconscious desire to sabotage sobriety? Was the individual hanging around unsafe people? Had the person become distracted by work, relationships or other pursuits? Whatever the back story, this is where the addict gives in.
This could be the old “I’ll just have one” self-delusion or the all-out “I’m gonna do it up right” bender. Either way, abstinence goes out the window and, as we all know, addicts usually are unable to use in safety. Whether experiencing the visible consequences (arrests, unemployment, financial ruin, physical deterioration, loss of relationships, etc.) or the equally painful emotional ones (self-loathing, depression, etc.), the addict usually ends up saying, “I did it again. How did that happen?”
Now that we have a roadmap of the relapse, let’s discuss when and how to interrupt it before it becomes a reality. The answer to the “when” question should be obvious: sooner is better. Once the thought picks up momentum and the addict starts remembering the pleasure associated with using (euphoric recall), it becomes increasingly difficult to stop the forward motion. The relapse can be stopped anywhere along the path, but it’s absolutely foolish for an addict to play casually with something so deadly.
Now, the “how” of interrupting the relapse. No magic here—just the time-tested practices found in 12-Step and other recovery programs. Asking for help doesn’t come easily to many, so I encourage patients to laugh at the absurdity of their disease and to tell someone about their thoughts immediately. It is generally agreed that addicts are as sick as their secrets, so we need to encourage our patients to be completely honest while building a defense against the next drink/drug.
Isolation is a killer, so individuals with an addiction should fortify their recovery program by socializing (obviously with safe, sober people), learning how to have fun, going to school or work, and doing service for others. Also, these individuals often need to be reminded about maintaining good nutrition and sleep hygiene.
Most important, our patients need to think through the drug—that is, to bring those consequences (of using) right up front and to remember how physically and emotionally sick they once were. Euphoric recall is where the brain wants to go, but recognition of consequences is where the brain needs to go.
The addict is not responsible for getting the thought, but is responsible for what he does with that thought. Addiction professionals can help patients appreciate how quickly and easily one can move from romancing the drug to actually using, and we can help them learn the skills necessary to interrupt the relapse before it happens.
Brian Duffy, LMHC, LADC-I, is a mental health counselor at SMOC Behavioral Healthcare in Framingham, Mass. His email address is firstname.lastname@example.org.
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