Relapse Warning Signs

Recovery from any kind of addiction (both physical and psychological) occurs at five levels: abstinence, situation change, behavior change, emotional change and personal belief change.

Abstinence

The first level is abstinence. Addicts must stop using alcohol, drugs or addictive behaviors and stabilize from withdrawal before they can begin to recover. At this level, we have to make a decision to stop drinking/drugging, or using other addictive behaviors and reach out to get help.

Situational Change

Once abstinent, addicts move into the second level of recovery that focuses upon situational change. This level involves replacing an addiction-centered lifestyle with one that is sobriety-centered.

The stop our addictions, we have to get away from people, places and things that make us want to engage in our destructive addictions and patterns. If you keep hanging out with people who are using your drugs of choice, your changes of staying abstinent are nearly zero. To break this cycle of abuse and dependence, you need help. You need to put yourself around people, places and things that will encourage and support your abstinence and help you to learn a set of specific skills to keep yourself from drug/alcohol or other addictive usage, even if you feel like acting out at that moment.

Behavior Change

The third level of recovery is behavior change. Addicts must learn to identify and interrupt addictive behaviors that give short-term pleasure and relief, create long-term pain and reactive the urge to use drugs and behaviors that are addictive. At this level, addictive behaviors must be replaced with sobriety-centered behaviors that produce pain free pleasure by resolving the underlying issues that created the pain in the first place.

Change in Thinking

The leads to a fourth level of recovery, a change in thinking. Addictive thinking is based upon the irrational belief that addictive use can magically fix us, solve our problems and make us something we are not. We are thinking addictively when we believe that we can never feel whole, complete or have the good life unless we are engaging in our addictive behaviors. The antidote for addictive thinking is sober thinking that helps us recognize the destructive effects of our addictions and see the positive benefits and opportunities provided by sobriety.

Thinking about using alcohol and drugs and other substances or behaviors increases the risk of relapse. Thinking is a cognitive process controlled by the cerebral cortex or thinking part of the  brain. There are three ways of thinking about addictive use of drugs/alcohol and behaviors, which are particularly dangerous.

One: Euphoric recall. You remember and exaggerate the good times that you had when using alcohol or other destructive substances/behaviors while blocking out or minimizing the bad times.

Two: “Awfulizing” abstinence. You think about the awful parts of being abstinent while blocking or minimizing the good times.

Three:  Magical thinking about use of behaviors or substances. Cognitive therapists call this positive expectancy. We start to believe that using our substance or behavior will somehow magically fix us. We forget that addictive use made us feel good for a little while and then wipes our judgment and impulse control, setting us off into a cycle of self-destructive behaviors that destroy us and those that we love.

People who relapse often begin to spend most of their time cycling between these three ways of relapse-prone thinking. They remember drinking and drugging or other addictive use of substances and behaviors, exaggerating the good times while refusing to think about the pain and problems. They exaggerate all the pain and problems of living sober while blocking out any benefits. Then they begin thinking how alcohol/drug or behaviors could magically fix them and make everything in their life wonderful once again. This creates a strong desire to go back to mood or mind altering substances and behaviors.

Emotional Change

The fifth level of recovery is emotional change. By turning off our addictive thinking, we turn on our feelings. Initially, this is difficult because we must experience the pain of the past. The shame, guilt and nagging pain caused by the addiction, surface. There is an urge to stuff these feelings and run back to addictive or compulsive behaviors. The permanent way out is to resolve these feelings by recognizing, labeling, and communicating them to others. Then we can recognize the underlying thoughts, behaviors and situations that create feelings.

Effective emotional management involves learning feeling management skills. First, we must learn to recognize the inner experiences that tell us that we are having a feeling or emotion. We have to learn to calm down, get centered and pay attention to the sensations in our bodies. Whenever we feel tense, have a knot in our stomach, feel queasy, or start clenching our jaws or fists, or can’t calmly sit still, we are probably having a feeling.

The second management skill is to learn how to label the feeling with a word or phrase. This means that we need to develop an emotional vocabulary (see Positive and Painful Emotions) that will allow us to think about what we’re feeling on the inside and figure out how those feelings are connected with what we’re thinking and what’s happening outside of ourselves.

The third feeling management skill is to talk about our feelings with someone who will listen to us, try and understand our feelings, takes us seriously, and respects us. The best place to find someone like that is at Twelve Step meetings or by going to a counselor or treatment program. We can’t manage painful feelings without talking about them. It’s important to talk about our feelings before we try to block them out by using  addictive substances and behaviors.

A Change in Core Personal Beliefs

As we learn how to manage pain and unpleasant feelings we can enter the sixth level of recovery, a change in core personal beliefs. Here we confront the core mistake beliefs about ourselves, other people, and the world that makes us miserable in recovery and makes us want to use drugs, substances, or behaviors to block out the pain. These self-destructive were usually developed when we were children before the age of ten. If we came from a dysfunctional family, we have probably internalized a dysfunctional set of core beliefs. We believe that the world is a painful and difficult lace and we must always struggle in order to survive. Many of us, on a core level, that we are pretty hopeless and that there is no hope and no way we can ever learn to enjoy life.

These core-mistaken beliefs cause us to recreate our family of origin in sobriety. We begin to unconsciously set up the situations of our lives to create the same pain and dysfunction that we experienced as children. To combat this tendency, we must learn to identify these mistaken and irrational beliefs that we learned as children, to examine the logical consequences of continuing to believe these things, and to make appropriate changes in our belief systems and our actions. It is only when we confront our family of origin and learn to be free from the dysfunctional and irrational belief system that we can develop the kind of life in sobriety that will give us meaning and purpose.

The Development Sequence of Recovery

Notice the developmental nature of this recovery process: (1) stop using alcohol, addictive substances or behaviors, (2) replace addicted-centered living with sobriety-centered living, (3) interrupt addictive and compulsive behaviors, (4) replace addictive thinking with rational sober thinking, (5) learn to identify and manage emotions, and (6) change the self-defeating core beliefs about ourselves, others and the world that we learned as children.

This model of recovery suggests that relapse is more than just addictive use of substances or behaviors. It is a process that can occur at each level and progress from one level to the next.

For most people who relapse, the first step is a subtle return of the core self-defeating beliefs that we learned as children. Something shifts inside of us and we can no longer feel a sense of self-worth and self-confidence. We no longer feel worthy of living or having good things in sobriety, or we no longer feel capable of doing what we need to do in order to feel good about ourselves.

When our old, dysfunctional beliefs from children are reactivated, we begin to have negative and painful feelings. These feelings seem out of place in our newly found recovery and there is a tendency to repress them as we did in the past. We would rather not feel these feelings or think these thoughts and so we try to push them out of our mind. As a result, the emotional pain gets worse and we tend to reactive our irrational, addictive thinking to cope with the pain.

Our addictive logic tells us we must find something, anything that will make the pain go away. The urge to blot out the pain awakens the echoes of our addictive past. We begin to remember how good it was when we could medicate with alcohol, drugs or other mind and mood-altering substances or behaviors. We exaggerate the positive aspects of those memories while minimizing or denying the negatives. We then begin to “awfulize” sobriety. We take all the negatives of being sober and exaggerate them, while blocking out all the positives. Then, we begin using magical thinking about what our substances and behaviors could do for us in the future. The addictive logic goes like this: “Since alcohol/drugs/behavior worked so well in the past, and since sobriety is so terrible today, engaging in the substances or behaviors will somehow be able to fix me in the future.”

These irrational thoughts begin to mobilize addictive behaviors. We begin looking for something, anything that will make the pain go away. Since our sober friends are beginning to confront us by telling us that we are in trouble and we need help, we seek out “more supportive friends.” We want friends who won’t confront us with the fact that we’re backsliding into old behaviors. This means we begin surrounding ourselves with two types of people – co-dependents who won’t challenge our self-defeating behavior and people who are still actively addicted.

Relapse prevention is both pro-active and reactive. As a pro-active strategy, relapse prevention teaches us the importance of planning our recovery, moving through the various stages, and recognizing when we become stuck and need to take corrective action. Reactively, relapse prevention teaches us to recognize the warning signs that show us we are backsliding into previous stages of recovery. We can then take action to manage those warning signs before we return to our addictive substance or behavior use.

References:

Codependent No More, Melody Beattie

CENAPS-relapse prevention

Counseling Skills, Blythe Daniel, MA, Los Angeles City College

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