A common answer from my patients is a bad event is to blame. “My father passed away. I got laid off from my job”. In recent times, the Covid-19 epidemic is to blame. “I was working from home and started drinking more and more.” Usually a series of external random events, out of their control resulted in the relapse.
Often I hear another answer. “I have no idea, doc, it just happened.”
The actual drug or alcohol use occurs much later than the relapse starts. It usually starts with the thought of using in the future, sometimes a few days in the future, sometimes months. Use of the drug or alcohol is the endpoint and not the beginning of the relapse.
In my case, the desire to get high was always there, every day it crossed my mind. I tried to be good and stay sober but if the opportunity came I always went for it. I didn’t need a reason or an excuse, I simply just wanted to get high, that’s it.
A very typical story I hear goes like this: “I knew my husband was going to be out of town and the planning started. I didn’t want to relapse but something in my brain started planning for when he was gone. I mean it was 3 months away, yet, slowly but surely my plan was formulated and came to fruition.” When the true nature of the addict meets the opportunity, relapse occurs.
This is why I advise my patients to not have any alcohol in the house. Cut your dealer off, block his number or delete his contact from your phone. Avoid parties or gatherings where your drug will be available. For many alcoholics this is so true that they choose to avoid weddings or new years parties.
The most common reason for people to go back to rehab is this: “I stopped working my program.”
By “program” they are referring to a 12-step group of some sort.
Often times there are multiple warning signs of an impending relapse. A person may go to less and less AA or NA meetings. A person may indulge in less harmful behaviors more and more like smoking cigarettes. They may gamble or play video games more often. They often start neglecting small things like personal hygiene or keeping their home in order.
This is why I encourage my patients to try to control even the smallest of vices. If you are trying to abstain from alcohol for example but smoke cigarettes, try to decrease the amount you smoke. Try to increase a good habit like meditation or exercise.
So what exactly is a relapse?
I get this question often. Is it one sip of alcohol or drinking a whole bottle?
It depends on what is the goal. In addiction recovery we define two different goals. Alcoholics Anonymous defines the first goal as Abstinence. No drink at all forever, period. In the medical community we define a different goal as Harm Reduction. Early on in recovery someone may not be willing to give up the drug just yet. We hope that eventually they will but will not dismiss them from treatment if they can’t. Instead we try to help them minimize the negative impact the substance has.
A drink is considered relapse if abstinence is the goal, but if the goal is harm reduction then relapse may be defined as a harmful consequence of drinking. If the drinking resulted in a bad event it is definitely a relapse. I’ve had patients who get tempted and even get a beer and drink just half of it and immediately get an overwhelming feeling of failure or regret or even shame and are able to pour out the rest of the beer.
In my case it happened so often. I would get cannabis again and after the first inhale and onset of a buzz I would immediately feel a sense of shame and guilt. The worst was the paranoia induced by the THC. This mix of emotions sometimes caused me to flush the rest of my stash down the toilet with an instant sense of relief.
I do encourage all my patients to completely abstain as this is the only way their life will completely change for the better.
Stagnation is another reason for relapse. Have you heard the saying: The idle mind is the devils playground? Many of my patients who are unemployed find it very challenging to sit at home all day and not think about substance use.
I strongly encourage them to seek employment or at least try to stay busy at home. Everyone has that one closet or drawer full of junk. Most men have a garage that is begging for attention. Most families with a lawn have weeds that could be pulled. Most homes have paint chipping somewhere. There are always projects to be done.
Addiction causes disorder in one’s life. Recovery is bringing that order back. When you bring order to your life i.e. clean your house, pay your bills or organize your belongings it actually provides intrinsic reward. In contrast to extrinsic reward which you used to get from a substance, by beautifying your humble abode you will experience pleasure.
Intrinsic reward is also obtained from creating something. Making music, cooking a recipe, building something or simply by writing down your thoughts will help.