How relapse can happen

And what to look out for

When someone is in abstinence-based recovery there are often identifiable signs that a relapse is approaching long before it happens.

In our recent YouGov poll looking into addiction during lockdown, 39% of people surveyed who said they were in recovery from an addiction prior to lockdown said they had experienced a relapse or a re-occurrence of their addictive behaviour since lockdown. On a national scale it may mean more than one million people have experienced some form of relapse during lockdown. This is a large number and quite naturally has been a cause for concern. It’s important to contextualise this figure and remember that recovery is a very personal state of mind and being, is not easily defined, and nor is relapse. 

For many, being in recovery does not mean being abstinent; perhaps it means gaining some form of control over their use of a substance or behaviour, being able to work or take care of children, being functional on a day to day basis – and therefore losing that control and returning to previous patterns is considered a relapse. For others it means choosing abstinence from only certain substances or behaviours, or the substitution of one substance for another. In these instances, and many more a relapse, or lapse, doesn’t just have to constitute a breach of abstinence.

At Action on Addiction, we work to provide the opportunity for abstinence-based recovery, so that more people are able to access a life free from addiction whether they can afford treatment or not. We always welcome people who wish to continue the journey they have started with non-abstinent recovery and move into abstinence-based recovery.

In this article, we will be talking about relapse during abstinence-based recovery, where the individual is free from all substances (other than those prescribed by a doctor and taken in conjunction with their specific instructions) including alcohol, and/or free from destructive addictive behaviours such as gambling, where the bottom line has been defined as not engaging in that behaviour at all.

The most important thing to note when discussing relapse is that there is nothing to be ashamed of. By its very nature an addiction is hard to stop and easy to return to. Although it is avoidable, people in recovery do relapse..  However, a relapse can be addressed; people do move on, learn from it and return to abstinence. They can also use this experience to avoid relapse in the future and by sharing their story with others, they can help others avoid relapse as well.  A person’s recovery constantly changes and evolves, it’s an ongoing process rather than a destination, encompassing so much more than not using alcohol, substances or engaging in certain behaviours. Being in recovery requires commitment and constant vigilance. 

Crucially, when someone is in abstinence-based recovery there are often identifiable signs that a relapse is approaching long before it happens.

Clouds House Treatment Consultant Michael Rawlinson has put together a helpful guide to some what is often experienced before and during a physical relapse, and some tried and tested methods to help avoid relapse.

Emotional Relapse: Feelings

For many people an indication of an approaching relapse is where an individual is not actively thinking about using again but is falling into a pattern of unhelpful actions that do not support recovery. For example, when someone in recovery becomes secretive and stops talking about their emotional realties - the ‘I am fine’ state of mind. Most commonly reported are defensive patterns, stepping back or not emotionally connecting with a 12 Step programme by missing meetings, not talking to sponsors and other fellowship members. There can be an increase in painful feelings such as fear and anger.  If you recognise any of this then you may well be in the process that can lead to using substances or engaging in an addictive behaviour again. At this point it is vital to reach out to your support network and community to prevent further escalation.

Mental Relapse: Thoughts

Thoughts like ‘I could have just one! Nobody will find out, or care, and it will be OK. I can get away with it’ may occur. These will be swift and brief thoughts. However, these thoughts can quickly lead to cravings which, in turn, can become overwhelming. Clients who have relapsed and returned to Clouds House often talk about how quickly the horrors and despair of a rock bottom can be forgotten just before starting again.

There may be a self-destructive decision to pick up again with a substance or behaviour. A split second decision that is influenced by thoughts of: ‘It’s not worth it’ , ‘I’m not worth it’ , or ‘I’ll show them’ which can sometimes be used as a vehicle to hurt someone you are feeling angry or resentful towards. 

These are all examples where the thinking has got out of hand and led to strong, destructive feelings and urges. Good active relapse prevention enables you to have a barrier of actions between those sudden and destructive thoughts and the physical act of a relapse. The stronger the barrier, the less chance of physical relapse. Strong recovery is like taking out a daily insurance policy against the possibility of relapse – but it’s only valid for 1 day and needs to be renewed every morning with a re-commitment to being in active recovery. In a recent interview about managing his recovery in lockdown, Tony Adams told us how having structure allows him  time to take stock, to reflect and make healthier decisions about the day. Watch the full interview here.

If these brief thoughts or cravings are happening to you, then reach out now to your supporters. It happens to more people than you may realise and is nothing to be ashamed of. A thought is just a thought and does not have to lead to action. You haven’t “done it” just by thinking about it.  You can act now to stop this leading to relapse.

Often what seem like  ‘seemingly irrelevant decisions’ can be a subconscious path to relapse. Ideas that present themselves and appear on the surface totally unrelated to your recovery. Yet without careful examination, seemingly innocuous day to day decisions can put you into a position where relapse is more likely. Examples of this are going to the shops for a pint of milk that actually leads to buying a bottle of vodka, meeting friends who just happen to be taking drugs ends up with you using,  going online to look for a holiday that actually turns into online gambling. With hindsight though, it often becomes apparent that the potential for relapse was deeply embedded in that initial decision.

Always check your motives and remain vigilant Triple check. “Why am I actually doing this? Is it going to put me in danger?”

Physical Relapse

Often, picking up the drink, substance or behaviour is the last thing to happen in the process of relapse that started weeks or even month earlier.  When the thinking, emotions and cravings combine they can feel overpowering and the temptation to relapse may be very strong. Even at this stage, when it may feel like someone has no defence left, it is possible to avoid relapse. The overwhelming sensation to act out can be managed before relapse occurs. If you are experiencing this then, please pick up the phone and get help now. 

Once the first physical act of relapse has occurred, a phenomenon called “abstinence violation” can occur. This is where having relapsed, the individual concerned believes that all their previous efforts at recovery, their identity, everything they have learned, their clean and sober time, the progress they have made and the life they have built has been automatically eliminated.  They believe that they will have to start again from the beginning – and therefore may as well relapse as dramatically as possible before having to start their recovery process again.

Please remember that it is possible to stop a relapse before it turns into a catastrophe. Returning from a relapse is an act of strength and courage. The building blocks are already there, just where you left them.

No matter where someone might be in their recovery, having the added benefit of relapse prevention techniques and plans for every potential stage can help avoid this process entirely, or to pause it long enough to get the help that is needed in a practical manner.

However, the longer the relapse lasts, the more potential there is for decline and possible life-threatening consequences. If you are having a relapse, please contact support immediately. Starting substances again after a period of relapse can be life threatening.

RELAPSE PREVENTION TECHNIQUES.

At Clouds House and SHARP Liverpool and Essex relapse prevention skills form a crucial part of our treatment. There are workshops, discussions and groups all focussing on how to develop skills and strategies to prevent a relapse. 

Most importantly avoid previously “appealing” circumstances and tempting situations. For example, don’t go to places where substances are available, including alcohol. As lockdown eases this can become even more tempting. Stay away. Delete dealers or suppliers’ number from your phone/tablet. If friends want to meet up, and lifted restrictions allow this, stick to coffee bars.

Identify your triggers. Use your experience of recovery and treatment to find out what makes you tick. What inspires you? What frightens you? What do you enjoy? Avoid “euphoric recall” which is when you remember your drinking or using through rose tinted spectacles. Think of the reality and the consequences. Knowing what makes you not want to go back to using is often enough to prevent you from collapsing back into powerlessness. Remember the expression “always watch the film through to the end credits” which means think about the consequences rather than the fantasy of what “just one” might be like. What did your last consequence look like? Do you really want to continue from there?

Remember the all important HALT acronym: Hungry, Angry, Lonely Tired. A combination of these can feel truly overwhealming. Take action. 

Make yourself a timetable. One of the most valuable skills taught at the relapse prevention workshops is how to develop a to do list, timetable or schedule.  Keep away from chaos. If you are in a 12 Step Programme, you will remember that the 2nd half of Step 1 is about unmanageability. You didn’t get clean and sober to carry on living in physical or emotional chaos, that is what active addiction was like, and chaos can easily lead you back there. This timetable can include to-do lists for each day, goals that need to be accomplished by a certain time, attendance at 12 step meetings, calls to a sponsor or a member of your peer support group.

Have a support system up and ready.  Staying clean, sober or stopping gambling, without the support of others, is incredibly difficult. Addiction wants you to stay isolated and alone as much as possible. Do everything you can to avoid this. Be overactive in making connections with others who understand and appreciate your situation. Usually members of the fellowships and recovering people all trying to do the same things as you.

Above all if you have relapsed, remember that relapse can happen to anyone and is nothing to be ashamed of. Reach out for help.  You can get back to active, fulfilling, abstinence-based recovery no matter how you may be feeling right now.

If you need further support or treatment, then the Clouds House team will be happy to talk to you. Our advice page also outlines how to access support and urgent help. Remember a physical relapse can be a medical emergency, do not delay if you have physical symptoms, call 999, 111 immediately. Help is available, reconnect and draw on your community resilience.