Preventing Relapse–Identifying Stages, Signals and Cues
Preventing relapse is one’s core priority in any recovery effort. It is the foundation and other benefits and pursuits of recovery depend upon this simple foundation. Treatment and skill building help prepare you for the tough times of sobriety. You can prepare well at the outset of your efforts, and continue to build your sobriety management skills as you go along.
The Stages of Addiction Relapse
Relapse doesn’t just happen as if everything is fine and then we trip. Although some experience it this way. Many people find themselves after relapse wondering what happened. It isn’t always clearly evident after a ‘bender’, or a more prolonged period of relapse because they weren’t mindful of the early warning signs and stages that lead to full relapse. Sometimes, too, it takes a moment to gather your thoughts. There is always the possibility of memory loss to complicate 20/20 hindsight, too.
Whatever you may have experienced after relapse, you can be sure that building up to use again after a period of sobriety didn’t ‘just happen’. Sobriety really isn’t that hard to lose ‘accidently’ if you’ve put a good deal of effort into becoming sober. It’s a painful process, and if you go to treatment, you especially invest a lot of time, money and energy into the work. So, given all that you don’t ‘magically’ find a drink in your hand, or a pill to swallow. Things happen that lead you there, and you participate every step of the way in some form or fashion.
Overall, there are 3 stages of a relapse process: the emotional, the mental and the behavioral (or physical). This means you go through a 3 phased process of having problematic emotional states that aren’t managed well, accompanying thoughts that cultivate and entertain the idea of using again, and then the behaviors that take you to ingesting an addictive substance. Also, within all these layers of a relapse process are multiple layers still. This is good news because if you are focused on preventing relapse, there are lots of places in these stages where you have the opportunity to take an exit and use healthy coping strategies.
The Warning Signs in the Body
Typically, the first warning signs of a relapse process will occur as bodily sensations of tension and/or distress. Learning to monitor muscular tension changes is very helpful. It increases body awareness, and you can use any changes to alert you to rising stress.
Learning to manage stress at the muscular tension level is an intervention you can do whenever the body signals that stress is rising. Methods such as deep breathing and conscious muscle relaxation can be practiced anywhere and in just a few moments. These interrupt the rising distress at the physical level and give you the opportunity to prevent them from escalating, as well as from becoming attached to emotions, thoughts, and behaviors.
Stress and evidence of stress in muscle tension occur when we are triggered in some way to become unbalanced. Triggers may be environmental or internal. For example, stress can build in response to fatigue, hunger, work or reminders of substance use and so on. For example, one may notice clenched jaw muscles, a tight neck, shoulder tension, facial tension, or tightening fists. Using body awareness and muscle relaxation is an effective method of preventing relapse at the earliest possible level of discomfort and imbalance.
Warning Signs of Relapse in the Emotions
Bodily reactions and changes such as muscle tension can be likened to the first ‘raw data’ of emotional shifts. As they occur, one is likely to attach emotions to them,
or to react in emotional ways. Also, emotional states such as anger, for example, give early warning cues such as the clenched jaw, or increased tension in the hands and arms, or fear that clenches the stomach or causes trembling.
Some of the early signals in the emotional realm can best be described as low level feeling such as a shift toward impatience, irritability or a ‘blue’ mood. Feeling states lie on a continuum and can progress to greater and greater unmanageability. For example, irritability can increase to hostility, resentment or anger, and a ‘blue’ mood to sadness or depression.
Stress management techniques as used for muscular tension is also useful at this level of distress and is effective. Additionally, using visualization and meditation is effective in emotional management, as are cognitive exercises that engage positive self-talk, and slow the impulse to action. Using helpful thoughts to soothe oneself, de-escalate rising emotions and engage mental control is also very effective.
Signals and Cues of Mental Distress in a Relapse Process
The third phase of an addiction relapse process is typically cited as the mental state in which thoughts begin to veer toward paths leading to the actual use of substances again. One may, for instance, begin to have ‘euphoric recall’. This is remembering only the good aspects of substance use. It is a strong form of denial in which the negative impact of use is forgotten.
Other mental aspects of relapse include obsessive thinking. Obsessive thoughts are recurrent ones that seem to have a mind of their own. They are persistent and resistant to efforts to break away from them. Obsessive thoughts can be focused on anything and still be problematic in sobriety. They often include obsessions about substance use, but many people in this stage of relapse also obsess about past injuries from others (even imaginary ones), or other love, sex or romance. Another common topic in obsessions in this stage is power and control, particularly through material gains.
Another common mental signal of possible relapse are thoughts that concern spiritual well-being. This can be negative thoughts about one’s spiritual or religious practices or faith; about others, self and the world, or even about health and wellness. Whatever concerns a sense of overall meaning, purpose and well-being can come into the focus of negative mental states. It is common, for example, for one to decide that daily recovery efforts aren’t needed, even though they are obviously causing good things in one’s life. It’s common, too, to have thoughts that you were misdiagnosed, never had an addiction and that treatment and recovery were unnecessary side trips in life.
Preventing Relapse with Use of Supports
Luckily, preventing relapse can be done from a variety of directions, and with a variety of methods. This is fortunate for us because we can choose among them to find what suits us as individuals. Also, we can have variety in our recovery efforts to keep things fresh and interesting.
One of the most enjoyable and effective methods we can use to prevent relapse is the use of our support systems. We have to set out to build support into our lives, actively pursuing connections and cultivating them. We can’t rely on others seeking us out. And, we are the ones in need, so it is our responsibility. The fortunate additional benefit of a support system is that it feels right and nice to belong to a group and to be accepted by others.
Preventing relapse through support isn’t the whole story, of course. We still have other things we have to do. However, supportive people in our lives can help tremendously. They give us people to confide in, spend time with, problem-solve and brainstorm with… they also can provide much need feedback and the valuable occasional ‘reality check’. Above and beyond all that benefit, we also receive the opportunity to correct our previous relationship problems from active addiction and even before if we’ve had traumatic interactions with others.
Preventing Relapse with Good Self-Care
Good self-care is the basis of a good relapse prevention plan of action, and of life in general. While recovery requires us to manage emotions, thoughts, and behavior, sometimes at very complex levels, some things we need to do are very concrete and repetitive. Every day, for example, we must eat, rest, hydrate and exercise for optimum health.
It is common for people in early recovery to struggle with these basics. That is due in large part to the slow healing of the brain and nervous system after prolonged toxic exposure in addiction, but also many have never learned these routines.
Sleep and appetite are frequently difficult to regulate in early sobriety, and people seem to go to either extreme–from insomnia to oversleeping, and from eating too little to overeating. Finding a healthful balance is partly beyond our control, especially early, and many benefit from non-addictive medications until the brain and nervous system heal. It is important to keep tabs on basic needs and to not allow one’s self to be too far out of balance for too long.
The Ultimate Goal of All Your Efforts
Of course, having a happy and successful life is what we all want, and sobriety is certainly a foundational requirement when we have been actively addicted. However, at the nuts and bolts level of all our work to get and stay sober, is the ever-present need to prevent relapse. In fact, you can very well say that is the ultimate goal of all our treatment and recovery efforts after we detox.
A good, sustained and solid recovery is possible. And, despite our all too keen awareness that addiction is frequently a chronic and relapsing illness, relapse is not mandatory or inevitable. Many people relapse, but many do not. It is always wise to err on the side of caution, however. One benefits by assuming that relapse is possible for them. That prompts us to maintain vigilance and to work consistently toward preventing relapse in all realms it can occur–emotionally, mentally, and behaviorally.