Relapse

A relapse is when you return to using alcohol (or drugs) in the manner you did before you quit.

Slip

This is when you drink but put an end to it right away.

Slips are generally not planned and happen because of some external trigger. Relapse seem to come from internal triggers and therefore are usually planned. Although a slip can turn into a relapse if you let it. Especially if you see the slip as a defeat, as something to be ashamed of, instead of using it as a learning experience to harden you against future triggers.

A slip might be that you run into an old friend, he is drinking, asks if you want one too, you say yes,  and BOOM, you have had a slip before you even knew what hit you. Even if you drink the night away with your buddy, it is still a slip.

It doesn’t become a relapse until you return or are obviously returning to your old drinking patterns. That return usually happens pretty quickly if you are new to recovery. It does not take long before you wind up back in the spot you wanted to get out of. If you are a drunk you know what I mean; heavy drinking, humiliation, relationship problems, money issues, etc

So you need to be aware of what is happening. To know when a return to drinking is part of the process (I won’t go so far as to call it healthy) and when it is something you or your loved ones should be scared of.

Anyway, the NIAAA reports that:

approximately 90 percent of alcoholics are likely to experience at least one relapse over the 4-year period following treatment (1). Despite some promising leads, no controlled studies definitively have shown any single or combined intervention that prevents relapse in a fairly predictable manner. . .

Similar relapse rates for alcohol, nicotine, and heroin addiction suggest that the relapse mechanism for many addictive disorders may share common biochemical, behavioral, or cognitive components.
http://pubs.niaaa.nih.gov/publications/aa06.htm

So relapse and slips are quite common. We can really only try to find what triggers us and avoid it until we are strong enough to overcome it.

 

Triggers

Relapse triggers can be external or internal. They make us think that it is alright, or even a good idea to drink again. Most alcohol triggers are classically conditioned. They are learned.

External relapse triggers happen when you put yourself in situations that make you want to drink.

 

• When you visit certain people do you feel like drinking? When you hang out with your old buddies do you feel like you should be doing the things they are? Especially if they are drinking.
• When you visit certain places do you feel like you should be drinking? The bar is a good one. Poker night. Bowling league.
• Does the time it is make you feel like drinking? “It’s five O’clock somewhere”. Maybe after you get off work.
• Do certain songs or movies make you feel like drinking. Jimmy Buffett songs, etc.. (I’m a huge Jimmy Buffett fan and I don’t listen to him sometimes because I associate Buffett with good times, romanticism, and alcohol)
• Do you usually drink when at family dinners with your brothers and sisters? It is hard to avoid family. You can stop drinking but you cannot stop being a brother or sister.

Internal triggers, however, can happen from out of nowhere. You may see a commercial on Television. (They are designed to make you want to drink.) Or hear a song on the radio that glorifies drinking. .

Internal relapse triggers are inner ideas that drive you to a certain behavior.

• Maybe you are feeling down and depressed about things. A “woe is me” attitude.
• Maybe things are going too well and you just want to party. Maybe you are a superstar and a superstar deserves a drink.
• Boredom is a major threat

These relapse triggers can and will work together against you. Maybe things are going good and you run into an old friend. Next thing you know you’re intoxicated. Triggers are things that we learn to deal with in the maintenance stage of change.

Avoiding Relapse

Research says that

Unpleasant emotions and physical discomfort was the most important reason for relapse and testing personal control and pleasure emotions the least important reason. Interpersonal factors have also a great role in this regard.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080483/

Here are some interesting graphs they made of relapse stressors for the 609 people in the study. (the study was on Opium users, not alcoholics, but relapse across addictions is very similar. See section 4. Results)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080483/

Here is a long list of triggers stolen from Project Know. I tried to put them in order so the top of the list has the most dangerous triggers. This prioritizing may not be right for your situation.

• Frequenting old using grounds or hanging around drug-using friends
• Constantly thinking about using drugs
• Quitting therapy, skipping scheduled appointments, or veering away from your addiction treatment program
• Replacing drugs with other obsessive behaviors such as gambling
• Thinking that “just one time” won’t hurt
• Keeping drugs in your home for any reason
• Isolating yourself from friends or support groups
• Overconfidence or feeling as though you no longer need support
• Relationship conflicts
• Being too hard on yourself or setting impossible goals
• Abrupt or sudden changes in eating or sleeping habits, personal hygiene, or energy levels
• Feelings of confusion, depression, uselessness, anxiety, stress, or being overwhelmed
• Boredom or irritability, usually stemming from a lack of structure
• Refusing to deal with personal problems related to daily life events
• Major life changes that cause intense emotion such as grief, trauma, or extreme elation
• Physical illness or pain
  http://www.projectknow.com/

Trying to avoid all of those will be nearly impossible. How are you supposed to avoid “relationship conflicts” or “physical illness or pain”? If you brother is still using drugs, how are you going to “not” be around him. You may avoid him at first but eventually you will need to get comfortable with him. You can’t dodge some bullets.

The best you can hope for is that life won’t throw all of the above at you at once.  The other thing to know is that everyday you will get stronger, more able to deal with these triggers.

I didn’t just stop going to bars when I was kicking. I went so far as to avoid the beer section at the grocery store. I did this for a few months until I got stronger and it didn’t bother me. Before you know it you will be able to eat lunch at the local pub with your co-workers without caring.

The trick is to remember that being exposed to several triggers at once is dangerous. So don’t break your leg, get bored with sitting around and having nothing to do, get into a fight with your girlfriend, have excused time away from work, and then think you can drink because you can deal with the hangover because you don’t need to work. That is too many triggers at once. At least it is for me. I did this.

So pain was an external trigger, all the rest were internal. Be careful of these combinations.

After a Relapse

Get back in the saddle. After an alcoholic relapses look at the following suggestions, figure out which will be useful, and use it. The most important need, of course, is to stop using and start recovering as soon as possible. A relapse or slip is not the end.

• You can always return to recovery. Slips don’t have to become relapses. Remember, 90% of recovering addicts have one within the first 4 years.
• .Slips or Relapses can be a learning experience. They can help you find hidden triggers or combinations of triggers.
• The faster you stop using once you have one, the sooner you can get better and the less damage you will do to yourself and those around you
• If it is a loved one who has fallen back into drinking. If they feel guilt, don’t rub it in. If they don’t feel guilt (this is uncommon), do not try and make them feel guilty.
• Be compassionate to a person relapsing, most addicts feel horrible about this, they see it as a personal failure
• Realize this is the addict’s problem, you can help but only they can provide the solution

do it yourself alcohol cessation

Neuroplasticity and Addiction