RELAPSE PREVENTION

It is not possible to stress enough that relapse for the alcoholic/addict is a life and death question. Any relapse is a gamble with death. One or two drinks or drugs inevitably leads back to massive drinking/using within a short period. People who relapse can often die from accidents, overdose, suicide or medical problems. For example, if you have a damaged liver, your liver will return automatically -and not gradually- to the level of damage it was at when you were drinking. Some people are lucky to halt the relapse quickly (a lapse), but any (re)lapse is a mortal danger, which at the very least causes psychological pain and at worst can lead to a path from which there is no return. Having said that, we have to face the reality that relapse is an ever-present threat and part of the general recovery process for the majority of us. Many alcoholics and addicts experience one or more relapses before achieving a lasting sobriety. A minority manage to have none at all. The best policy is learn from those who have never relapsed, AS WELL AS those who have relapsed, about how to guard against and avoid a relapse. Having no relapse is the best scenario for all of us and while accepting the reality of its potential we should not use the fact that it may happen as an excuse for actually having a relapse or not trying desperately to avoid one. The first relapse or the next relapse may be your last !

Once we have detoxed our bodies and got sober, the key issue in our minds is STAYING SOBER. But, in order to do this, we need to understand and accept that we are alcoholics/addicts and can NEVER drink or use again. However, we also need to realise that years of chemical dependency and learned habitual behaviours have programmed our bodies and minds to react instinctively to emotions, feelings and situations by drinking/using. Many people who relapse say that when they took the first drinks/drugs, it seemed that they were on « automatic pilot », as though they were in a film and couldn’t even seem to watch themselves disinterestedly from outside as they walked in the bar, opened the bottle or reached for the joint/needle.

There is a truth in this. We have trained ourselves, often for years and decades, to reach automatically for the drink/drug as THE means of finding pleasure and relief from the troubles of everyday life. Other non-alcoholic people find other ways of dealing with these issues, but we know no different than drinking or drugging. When we relapse we are rerunning the alcoholic film, playing out our addict part and then, only once the act is done, reality returns with a hard thud in terms of the painful consequences of intoxication and withdrawal.

In order to stay sober we have to untrain ourselves, deprogram ourselves, so that recoiling from temptation and not taking that drink/drug becomes an automatic response to the life-threatening consequences which drinking/using means. We have to first pinpoint the dangerous triggers and stimulants which can provoke the temptation to drink/use, in order to immediately avoid them at any cost. Then, gradually, we have to learn new coping strategies and methods to deal with everyday life on a sober basis.

One might classify at least 3 main avenues down which the road of relapse can arrive. These are :
1) internal feelings and emotions, which overwhelm us and can lead to drinking/using ;
2) external situations, places and people which can trigger drinking/using ;
3) Unhealthy patterns of behaviour and habits which can lead to drinking/using.

There are no hard divisions between the three and, in practice, all three of these tend to overlap, but the direction you come from may tend to lie more in one of these areas than another.

1) External Situations, Places and People
We all found our own particular situations, places and social relationships in which we habitually drank or used. These can be bars, parties, dinners, after-work socialising, sport events, isolation at home, concerts, clubs etc. It can be the company of certain people - drinking buddies, colleagues, partner or, alternatively, being lonely at a bar stool or in front of the TV at home. Certain music, even smells and foods can be associated with drinking/using. These situations are associated with strong negative and positive emotions of pleasure and relief . Physical memory circuits have been established in the brain, which light up automatically when you find yourself in such circumstances and trigger the behavioural response circuits of drinking/using. They may do so consciously, or they may work deep down in the subconscious or unconscious and creep up on you unexpectedly - often when it is too late.

Therefore, avoiding their activation is obviously the first and best policy. Recognising and then avoiding places, situations and also people who might activate these drinking networks in the brain, is the first step to preventing relapse, especially in early sobriety. Later, once owns sobriety is more solid, one may be able to handle such situations without being tempted to drink, however, even then one must always be on guard and conscious of the dangers. Warning - do not play Russian roulette and gamble in your early sobriety. Avoid places, give excuses, cancel appointments - remember sobriety is your N° 1 PRIORITY !

2) Internal Feelings and Emotions
These can be bad emotions and feelings, like anger, sadness, grief, jealousy, hate, loneliness, boredom and depression, from which we search for relief through alcohol/drugs. On the other hand, they can surprisingly also be good feelings like jubilation, euphoria, happiness, exaggerated self-confidence, etc., which are linked to celebration and reward, and which can equally lead us to drinking without thinking. Both negative and positive feelings and emotions can be equally dangerous to our sobriety, if left unrecognised.

Of course, it is not so easy to avoid emotions and feelings. One cannot cancel depression, not turn up for anger, avoid feeling sad, etc. Therefore, one needs to explore what are the most dangerous emotions which you may associate with drinking. Then to realise that these are SEPARATE ISSUES from drinking/using and which are part of « the human condition », which everybody faces (alcoholic or non-alcoholic) and which non-dependent people do not use as an excuse for drinking or turn to bingeing for relief. Having recognised these emotions as separate issues from your Sobriety Priority, you need to find ways for dealing with and expressing these emotions and feelings in a SOBER healthy way

3) Unhealthy Patterns of Behavior and Habits
When we first get sober, we often feel like a fish out of water. We don’t know what to do with ourselves or our time. If we don’t begin to plan and structure a new way of life, then we are at risk of falling back into old patterns and routines. This could be visiting the same bars, restaurants, clubs, staying at home feeling isolated, depressed and lonely, hanging out with old drinking/using friends, etc. Initially, we may not drink or use, while doing these things. We take a Coke or coffee, but, nevertheless, we are essentially acting like an alcohol/addict, a dry drunk/addict, where just the substance has been temporarily displaced.

Of course, it is a good thing to drink non-alcoholic beverages and it is not always possible to avoid places where alcohol or drugs are being used. Staying sober then is a great achievement and one cannot and should not cut oneself from life and live like a hermetic shaman (unless that is your route). The difference, however, is the degree to which you put yourself habitually in places, situations and gatherings which you previously drank/used and/or similar circumstances. Furthermore, you may not realise yourself, but by being in these situations, you are fermenting habitual modes of thought, feelings and emotions which you had when you were drinking/using. By encouraging the growth of such addictive behaviours and thoughts, you are then only one step away from the act of drinking and using itself. By getting back into the old habits and patterns you are only rehearsing your role before actually going on stage.

Of course, addicted or not, human beings are creatures of habit who tend to fall back on old routines and habits, especially in times of difficulty or stress. The alcoholic/addict is not only the ultimate creature of habit, but is also chemically dependent on a substance and physically drawn to it. Our tendency to fall back on old patterns and habits is, therefore, ten times stronger than the average person. The chemical dependency is like some implanted magnet which is attracted to a bottle or drug. Acting in behaviours previously associated with drinking or using draws us more and more closely into the « magnetic field » of active addiction. If one keeps moving in these circles of addictive behaviours, it is only a matter time before one connects and gets stuck again.

In the earlier period and in times of difficulty, it is, therefore, essential to break away from old habits and behaviours as much as possible. Firstly, spend a many of your evenings as possible in recovery meetings. This is especially so a we don’t often notice what is happening and recognise warning sign in our thoughts or behaviours. Others, however, may be able to recognise this and warn us and forewarned is forearmed !
Make a list of place, people and situations to avoid and prepare excuses to not go. Don’t give in to pressure from others to be somewhere you shouldn’t be. If you can’t say the truth, say you are ill. Indeed, remember you are ill. You are recovering from a life-threatening illness ! Your life comes first ! Your priority is Sobriety. Draw up a day plan - hour by hour. Think of new, SAFE, places and people. Go swimming, cinema, get videos, go to the library, start a hobby, join a club, etc. And do things you like. Sobriety is not a penance. Reward yourself with fun for having saved your own life and having a second chance. Build a new life.

Building a new life is not an easy thing. We often have to deal with the left over problems from our past and we suffer mood swings, up and downs, depression, etc., in the course of sobriety. But then so do non-alcoholic people. Like them, however, we, NOW, do not drink/use whatever the situation. By remaining sober, a new sober and rewarding life will gradually emerge. But that doesn’t mean it will be without all the problems and tragedies, as well as great moments and good times that the rest of humanity faces. That’s sober life, and that’s just life.

With time and practice, you will find you are able to subdue and, to a degree, deactivate those old knee-jerk alcoholic/using reactions. The longer one is sober, then the more these mental associations and neurological pathways become dormant. New more healthy associations linked to sober life take their place and become more automatic. We learn how to deal with negative and positive emotions without reaching for the bottle/drug. We grow in self-confidence and value through our accumulated ability to deal with the world on its terms and not that dictated by the drink or drug. We learn to establish more healthy patterns of behaviour, based on a new life style, habits, new places, friends and activities. Life becomes richer and more worth living. You grow and develop more sides to yourself and your place in society and life at large.

However, dormant associations never totally die. The « sleeping vampire » can always potentially be reawakened under certain circumstances and conditions. Therefore, we must never be complacent. However long our sobriety we must always be on guard for life’s unexpected challenges and the need to arm ourselves against possible relapse. Below you will find some suggestions which may help you. You may also wish to read books and take therapy as an adjunct to recovery. Above all use your SOS group to talk about your problems and to find practical help and support from others in recovery who face similar problems.