Warning Signs of an Alcohol or Drug Relapse Recognizing the Steps Leading to
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Relapse is so common in the alcohol and drug recovery process that it
is estimated more than 90 percent of those trying to remain abstinent
have at least one relapse before they achieve lasting sobriety. But a
relapse, sometimes called a "slip," doesn't begin when you pick up a
drink or a drug. It is a slow process that begins long before you
actually use.
The steps to a relapse are actually changes in attitudes, feelings and
behaviors that gradually lead to the final step, picking up a drink or
a drug.
Attitudes, Feelings and Behaviors
In 1982, researchers Terence T. Gorski and Merlene Miller identified a
set of warning signs or steps that typically lead up to a relapse. Over
the years, additional research has confirmed that the steps described
in the Gorski and Miller study are "reliable and valid" predictors of
alcohol and drug relapses.
If you are trying to obtain long-term sobriety and avoid having a
relapse along the way, it is important to recognize the following
warning signs and take action to keep them from progressing into a
full-blown relapse.
11 Steps to a Relapse
Change in Attitude - For some reason you decide that
participating in your recovery program is just not as important as it
was. You may begin to return to what some call "stinking thinking" or
unhealthy or addictive thinking. Basically, you are not working your
program as you did previously. You feel something is wrong, but can't
identify exactly what it is.
Elevated Stress - An increase in stress in your life can be due
to a major change in circumstances or just little things building up.
Returning to the "real world" after a stint in residential treatment
can present many stressful situations. The danger is if you begin
over-reacting to those situations. Be careful if you begin to have mood
swings and exaggerated positive or negative feelings.
Reactivation of Denial - This is not denial that you have a drug
or alcohol problem, it's denial that the stress is getting to you. You
try to convince yourself that everything is OK, but it's not. You may
be scared or worried, but you dismiss those feelings and you stop
sharing those feelings with others. This is dangerous because this
denial is very similar to denial of drug addiction or abuse.
Recurrence of Postacute Withdrawal Symptoms - Anxiety, depression,
sleeplessness and memory loss can continue long after you quit drinking or
doing drugs. Known as postacute withdrawal symptoms
these symptoms can return during times of stress. They are dangerous
because you may be tempted to self-medicate them with alcohol or drugs.
Behavior Change - You may begin to change the daily routine that
you developed in early sobriety that helped you replace your compulsive
behaviors with healthy alternatives. You might begin to practice
avoidance or become defensive in situations that call for an honest
evaluation of your behavior. You could begin using poor judgment and
causing yourself problems due to impulsive behavior without thinking
things through.
Social Breakdown - You may begin feeling uncomfortable around
others and making excuses not to socialize. You stop hanging around
sober friends or you withdraw from family members. You stop going to
your support group meetings or you cut way back on the number of
meetings you attend. You begin to isolate yourself.
Loss of Structure - You begin to completely abandon the daily routine or
schedule that you developed in early sobriety.
You may begin sleeping late, or ignoring personal hygiene or skipping
meals. You stop making constructive plans and when the plans you do
make don't work out, you overreact. You begin focusing on one small
part of life to the exclusion of everything else.
Loss of Judgment - You begin to have trouble making decisions or
you make unhealthy decisions. You may experience difficulty in managing
your feelings and emotions. It may be hard to think clearly and you
become confused easily. You may feel overwhelmed for no apparent reason
or not being able to relax. You may become annoyed or angry easily.
Loss of Control - You make irrational choices and are unable to
interrupt or alter those choices. You begin to actively cut off people
who can help you. You begin to think that you can return to social
drinking and recreational drug use and you can control it. You may
begin to believe there is no hope. You lose confidence in your ability
to manage your life.
Loss of Options - You begin to limit your options. You stop attending all
meetings with counselors and your support groups
and discontinue any pharmacotherapy treatments. You may feel
loneliness, frustration, anger, resentment and tension. You might feel
helpless and desperate. You come to believe that there are only three
ways out: insanity, suicide, or self-medication with alcohol or drugs.
Relapse - You attempt controlled, "social" or short-term alcohol
or drug use, but you are disappointed at the results and immediately
experience shame and guilt. You quickly lose control and your alcohol
and drug use spirals further out of control. This causes you increasing
problems with relationships, jobs, money, mental and physical health.
You need help getting sober again.
Relapse Is Preventable
Relapse following treatment for drug and alcohol addiction is common and
predictable,
but it is also preventable. Knowing the warning signs and steps that
lead up to a relapse can help you make healthy choices and take
alternative action.
If a relapse does happen, it is not the end of the world. If it happens, it is
important that you get back up, dust yourself off and get back on the path to
recovery.
Sources:
National Institute on Drug Abuse. "Principles of Drug Addiction
Treatment: A Research Based Guide." Revised 2007.
National Institute on Drug Abuse. "An Individual Drug Counseling Approach
to Treat Cocaine Addiction: The Collaborative Cocaine Treatment Study Model."
Accessed May 2009.
Miller, WR, et al. "A Simple Scale of Gorski's Warning Signs for
Relapse." Journal of Studies on Alcohol. 1 September 2000.
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