NOTE: While the focus of relapse prevention is on alcohol relapse, The relapse prevention model may be applied to drugs, gambling, over-eating and other behaviors, and may be suited to aspects of Mental Health such as depression, anxiety and other self destructive behaviors as well. Interesting.
(note: for simplicity’s sake, alcohol will be the chosen drug of choice but you may substitute as appropriate). Just looking at this page may be one of the steps in a person's decision to stop alcohol or drug use for the first time. Or, it may be one of the first steps taken when a return to use has occurred and that person wants to "get back on the bus". The bottom line to relapse prevention is that there are 26 events, thoughts or behaviors, that occur before a relapsing alcohol abuser takes that first drink. Same would hold true for anyone dependent on a drug or chemical although some drugs, such as cocaine are so powerful that one can go right from #1 to #26 in the blink of an eye, or snort of a line. There is nothing that occurs that will help someone recognize a problem between #26 the first drink or use and # 27 drinking or using out of control. There is only a repeat of the first 25 warning steps. Relapse starts with wondering "if I'm ever going to use" and then even as the decision made to not use this time, the thought has been planted. But we firmly state, “Not me, this time I'm serious”. But an “I wonder” moment has been created”. At that moment the Guardians of the Gate of sobriety begin to nod off and the path to relapse goes down hill from there unless this or the first few warning signs are recognized and acted upon. One of the best places to help confront this slide to relapse is with a support group like AA. Doesn't have to be that specific group, but whatever group or individual you choose make sure they have walked the walk. Your life depends on it.
Relapse from alcohol or drug problems doesn’t just happen. Years ago I was an outpatient counselor working at a AODA rehabilitation hospital. Every Monday morning I would stop by detox to see if any of my folks had come in over the weekend. Sometimes I would see someone and I’d ask, “What happened?” I expected to hear that they got another DUI or their partner kicked them out, or they lost their job. And sometimes that was the answer. But, often they said they didn’t know why. They said something like: “I was doing great, going to meetings, doing things with my family, doing really well at my job. All good. So I quit taking Antabuse (an alcohol antagonist, a person could get really sick if they drank on it). Then I cut back on my individual counseling and recently I quit going to AA - I got sick of hearing all the loser talk. I was going to my old bar to shoot pool and have a soda and reconnected with some of my old buddies. But they understood I didn’t drink, so I didn’t think it would be a problem. The next thing I knew, I was right back where I was, only worse”.
I wondered, then why did they drink?
At the time I was running an outpatient group of cowboys - you know, the ones with their hat on backwards, driving a pickup truck with beer cans thrown in the back. The truck with the dents. They collected DUI’s, divorces, jobs. They reported that cops were picking on them and their bosses were jerks and their partners didn’t understand them and nagged at them all the time. They weren’t very interested in stopping their drinking. They were in the group to get the judge/spouse/employer off their back.
Groups like that gave me a very tired and empty feeling. I knew where this was going, but not how to stop it. On the way to group one night I noticed my alcohol counselor magazine had just arrived. I was paging through it and found this short article and chart by a fellow named Terrence Gorski. Never heard of him, but I had heard of relapse (falling off the wagon). I copied the article and chart and took it to group. As I shared it with the group I recognized a pattern. As I thought of the obvious next step to relapse, Terrence had identified it and it was the next item on the chart. The further I read and related, the more obvious it became., but I hadn’t recognized it before. Apparently no-one else had either. There was a process involved. Returned to drinking didn’t just occur. And these were the steps that, if not taken, can begin to guard against future problems. I’ve shared this chart with hundreds of people in the initial stage of recovery. I consider it worth a million dollars. It can save lives if attention is paid and action is taken.
Here it is. Now these are negative (-) numbers. Working your relapse prevention, recovery plan are positive (+) and are above these numbers. I'll give a couple examples:
3. Making plans and following through
2. Telling the truth - always
1. Finding a support group and keeping contact
0. Making a commitment to stay sober by following a plan
-1. Lack of confidence in ability to stay sober
-2. Reactivation of the alibi system
-3. I’ll never drink again”
-4. Self-righteous sobriety
-5. Defensiveness of alcoholism and recovery
-6. Over-control and over-doing
-7. Impulsiveness and over-reaction
-8. Loneliness and isolation
-9. Tunnel vision
-10. Minor depression
-11. Wishful thinking replaces planning
-12. Plans begin to fail
-13. Feel like nothings working
-14. Strain and conflict with others
-15. Sleep and appetite disruption
-16. Anxiety, depression and breakdown of life structure
-17. Irregular attendance at AA
-18. I don’t care attitude
-19. “Poor little me” syndrome
-20. Thinking about drinking
-21. Conscious lying
-22. Complete loss of self-confidence
-23. Angry at the world
-24. Stops AA
-25. Overwhelming loneliness and tension
-26. Start of attempt at social drinking (or recreational drug use)
There is a space between 26 and 27, but there's nothing here except time more of numbers -1 thru -26.
The thought that you will recognize the problem and be able to stop is long past.
As Father Martin said, " I hope I spoiled your drinking. But if you want, you can have all of your misery back"
-27. Drinking out of control
Past clients would come to me and say: “You are the best counselor ever! I don’t know if I’ll ever drink again, but if I do I’ve learned so much that I know I’ll recognize the problem before it happens”. If they do take that first drink (or drug), it’s way too late. There are no new problems between 26 and 27. Just time. Wait for it. yep, there it is. “when an alcoholic goes back to drinking they don’t go back to where they were when they quit. They go back to where they would have been if they had never stopped drinking” (Father Martin, Chalk Talk)
Advice: Put this on your fridge, tape it to your bathroom mirror. Pay attention to the initial three of four items on the list. If you find yourself doing one or more of them STOP. In case you missed the point: STOP and go back to your recovery plan.
Advice #2: If you don’t take the first drink you won’t have to worry about the second or the tenth. AA wisdom
ALCOHOL/DRUG RELAPSE CHART
Author: Terrence Gorski
Printed in EAP Digest
Thanks Terry for saving my life and the lives of so many others,