Sunday, January 9, 2011


"getting sober is a process; relapsing is a process, too
Alcoholics Anonymous saying

Patients are given the opportunity to work on a relapse prevention plan to minimize the risk of a return to use, however, it is only as good as the honest effort put into it.  Recovery needs a connection to the program, sponsor, support and structure.  Warning signs of relapse are change in thinking, going back to old ideas, looking good on the outside with a loss of feeling good inside, cutting out meetings, not as invested, mood swings, not admitting something is wrong and avoidance.  After the early recovery process, the middle stage of recovery is to establish a sober lifestyle which requires a sponsor, work steps and attending regular meetings. Relapse warning signs are not doing the Steps, stress build up, complacency, getting stuck and return of tactics for avoid accountability.  The last stage of recovery is personal growth which needs your life to be settled onto a routine and working with others.  Relapse signs are breaking routine, avoiding sponsor, focus shifts to others, not asking for help and having all the answers.

If the warning signs appear in a loved one who has undergone therapy, contact your support system, express your concern, listen, acknowledge what you have heard, ask how you can help, use check list and/or reality check, increase your utilization of support groups and systems and use natural and logical consequenses - detach with love.  Follow up is one of the most important keys to a recovery program.

There are six different stages of recovery with corresponding relapse warning signs for each.

Stage 0 - active addiction may be enforced abstinence such as in jail or in treatment - no relapse warning signs

Stage 1 - transition - recognize addiction and its problems; accept help; start recovery-treatment - relapse warning signs include return of Denial and Resistance

Stage 2 - stabilization - medical stabilization; crisis management; structured recovery program - relapse warning signs include return of problems with normal functioning, such as confusion, overreaction, poor managment of situations, stress cycles, self-condemnation and onset of denial

Stage 3 - early recovery - internal change - change in addictive thought, feelings and behaviors - relapse warning signs include return to thinking, feeling and behavior problems such as painful memories from addiction and crisis, ineffective thinking, self-defeating behaviors and lifestyle, overwhelming pain and problems, mental and emotional shutdown

Stage 4 - middle recovery - external change - establish sober and balanced lifestyle - relapse warning signs include return of self-defeating lifestyle patterns such as failure to repair lifestyle damage, unresolved issues, circular problem solving, build up of stress and pain

Stage 5 - late recovery - growth and development - relapse warning signs include over-confidence and complacency such as stop personal growth, focus on others instead of self, inability to cope or ask for help, activation of self-defeating behaviors

Stage 6 - maintenance - ongoing personal growth - relapse warning signs include any of the signs from stages 1 through 5.

Relapse prevention education is crucial to the treatment of addiction because addiction is a chronic disease.  It does not go away after the completion of treatment.  It is a disease that can be managed through the development of lifestyle changes, similar to diabetes.  Symptoms of addiction may resurface during any stage of your loved one's recovery.  These symptoms must be addressed to avoid complete resurgence of the disease process.

According to Terence T. Gorski, relapse prevention expert, there are 9 predictable steps to relapse.

Internal Change - Using old ways of thinking; the recovery program seems less important; mood swings; deep inside the person knows something is wrong, but he tries to cover it up

Denial - Stops paying attention to what he is thinking and feeling; does not want to talk about it and tries to convince himself everything is okay when it really is not

Avoidance and Defensiveness - Avoids people who will honestly point out the problems he does not want to see; gets defensive, scared and angry; blames others for making him bad; takes focus off himself by criticizing others' problems and faults instead of honestly looking at his own problems; using compulsive behaviors to keep his mind off of how uncomfortable he is feeling; creates problems for himself by using poor judgment and impulsively doing things; starts feeling uncomfortable around others and spends more time alone then begins to feel lonely and isolated

Crisis Building - starts having problems he does not understand; even though he wants to solve these problems and work hard at it, new problems pop up to replace every one he solves; unable to see the big picture and starts doing things that will not really help; feelings of depression set in; he stops planning ahead; things keep going wrong and feelings of nothing-is-going-his-way grows stronger

Immobilization - the feeling of being trapped in an endless stream of unmanagable problems; feels frustrated about the time and energy put into what feels like futile efforts at solving problems; he feels like a failure and experiences a loss of motivation to do things that will be productive; he experiences a desire to retreat or be rescued

Confusion and Over Reaction  - feels overwhelmed by all things; has difficulty organizing thoughts and ideas; experiences difficulty in focusing on tasks; makes mountains out of molehills and overreacts to issues or situations; has difficulty trusting others; switches from overreacting to feeling emotionally numb and inappropriately expresses feelings and gets angry at people for not understanding him

Depression - becomes so depressed and unable to do things that were normally accomplished; he feels that life is not worth living, and sometimes considers committing suicide; he is unable to conceal feelings from others; pays less attention to hygiene and personal needs; relapsing seems like a reasonable solution to the feelings of being helpless and hopeless

Loss of Control  - the individual starts doing things that violate his values and hurt those he loves; as a result there is a loss of self-respect; finds excuses to miss therapy and self-help group meetings; cuts himself off from others by ignoring them, getting angry or criticizing and putting them down; he gets so isolated that is seems there is no one to turn to for help; self-pity sets in and becomes a tool to manipulate and gain attention from others; he realizes he is out of control but continues lying, using denial and making excuses for behavior; as the feeling of self-pity grows out of the shame and guilt, relapse becomes a more likely end result

Thinking about Relapse - the individual begins to see relapse as a solution to problems and begins to feel relief at the thought of having a solution; things seem so bad or so out of control that there seems to be no reason not to return to the use of drugs/alcohol; he begins to minimize the perceived risks/consequences of relapse and the behaviors associated with a return to the using lifestyle; the compulsion experienced during this stage is significant

The Final Relapse - the recovering addict tries to solve his probems and feels better by relapsing; he rationalizes the behavior, despite an internal awareness that relapsing won't provide the solution and will only hurt him in the long run; when initially returning to use, there is typically an attempt to control behavior; the individual feels disappointed in himself as the loss of control increases; feelings of guilt and shame contribute to the continued out-of-control spiral; problems continue to get worse until he realizes that help is needed and at that point makes a decision; he may choose to continue to self-destruct or pursue recovery again

SLIP ~ Stupid Little Idiotic Plan
recovery saying

Relapse prevention planning minimizes the risk of a return to use.  The plan is only as good as the honest effort the individual puts into it.

stabilization ~ establishing abstinence

self assessment ~ finding out what is going on in one's head, heart and life

relapse education ~ learning about relapse and what to do to prevent it

warning sign identification ~ making a list of potential relapse warning signs

warning sign management ~ learning how to interrupt warning signs before losing control

inventory training  ~ learning how to become consciously aware of warning signs before losing control

review the recovery program ~ making sure the recovery program is able to help manage the warning signs

involvement of significant others ~ teaching others how to work with the recovering addict to avoid relapse

follow up ~ updating the relapse prevention plan regularly

People can and do recover from the impact of addiction.  If you fall down, dust yourself off, get back up and begin again.  We are never alone. Let go and let God. xo