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Thursday, April 19, 2018

Relapse Prevention


Relapse is not a sudden process that happens without warning. Most addicts and alcoholics in recovery that are at risk for relapse experience predictable and progressive warning signs that typically cause so much distress that self-medication with alcohol or drugs seems like the only option. This is often not a conscious process and can happen subtly and slowly over time. These warning signs can develop automatically and unconsciously. Since most recovering individuals have never been taught how to identify and manage relapse warning signs, they don't notice them until the pain becomes too severe to ignore.

Terence T. Gorski is internationally recognized for his contributions to Relapse Prevention Therapy. A renowned cognitive behavioral therapist, Gorski has a wide range of experience and expertise in the chemical dependency field. Through extensive research he has identified specific predictable relapse phases and how to intervene when one recognizes that he or she is on the path toward relapse.
The phases and warning signs of relapse according to Gorski include:

• RETURN OF DENIAL
• AVOIDANCE AND DEFENSIVE BEHAVIOR
• CRISIS BUILDING
• IMMOBILIZATION
• CONFUSION AND OVERREACTION
• DEPRESSION
• BEHAVIORAL LOSS OF CONTROL
• RECOGNITION OF LOSS CONTROL
• THE RELAPSE EPISODE

During the return of denial phase, the addict or alcoholic typically is unable to recognize honestly what he or she is thinking or feeling. This phase leads to avoidance and defensive behavior characterized by the individual not wanting to address anything that may lead to painful or uncomfortable emotions. As a result, he or she begins to avoid people and situations that would challenge an honest look at the self. The individual may become defensive when asked direct questions about wellbeing. Common symptoms include distortions in thinking and the beginnings of compulsive and/or impulsive behaviors. Following a period of denial and avoidance, the individual often finds him or herself building up toward a crisis situation as they begin to experience more and more life problems resulting from extreme denial and avoidance. The individual may begin to experience minor depression and have difficulty seeing realistic solutions to life problems. If left unaddressed this inevitably leads to a phase of immobilization.

During the immobilization stage, the addicted individual becomes incapable of initiating proactive action. They may be going through the motions of day to day living, but they tend to feel helpless to solve problems and may begin to spiral out of control. Thinking becomes clouded and the individual grows increasingly confused and distressed.

An inability to think rationally characterizes the next phase of confusion and overreaction. The dependent individual naturally becomes frustrated with self and others growing increasingly irritable, over reactive, and easily angered. Ultimately, the individual can sink into a depressive phase without proper help and intervention. During the depression phase, the individual may have difficulty managing simple daily routines. Thoughts of suicide, drinking, or drug use begin to arise as a means to cope with the depression. It becomes more and more difficult to ignore or hide the severity of the depression at this point. The dependent person progressively loses the ability to control behavior and regulate emotion.

Once the individual has reached the behavioral loss of control phase, he or she is unable to control behavior and continues to lack awareness of being out of control. Life becomes increasingly chaotic as problems pile up. The individual may stop attending 12 step or treatment meetings or completely reject help altogether at this stage.

Ultimately by the time the individual reaches this stage in the relapse process, their denial erodes and he or she begins to recognize the severity of the problem, how unmanageable life has become, and how little control he or she has at this point. This awareness can be incredibly painful and frightening. By this time, the individual has typically become isolated from his or her support network and may feel as though there is no one to turn to. Self-pity, thoughts of drinking and/or using, dishonesty and manipulation, and a loss of self-confidence characterize this relapse phase.

During the option reduction phase, the person tends to feel trapped and completely incapable of managing his or her life. Drug and alcohol use often seem to be the only options to manage feelings of pain and loneliness. The individual may believe that nothing can help him or her and has typically lost all behavioral control. At this point they have discontinued participation in all treatment and 12 step involvement and may be overwhelmed by resentment, loneliness, and frustration.

Ultimately, these progressive relapse phases result in a relapse episode if left unaddressed. This is when the individual begins to use alcohol or drugs again, usually struggling to regain abstinence. Feelings of shame and guilt characterize this phase when attempts to stop or control use fail. Eventually all control is lost and problems rapidly progress. 

This relapse progression can be summarized in the following way: 

THE RELAPSE SYNDROME

 INTERNAL
--Thought Impairment
--High Stress
--Emotional Impairment
--Sleep Problems
--Memory Problems
--Coordination Problems

EXTERNAL
--Denial Returns
--Crisis Building
--Avoidance and Defensiveness
--Immobilization
--Confusion and Overreaction

 LOSS OF CONTROL
--Depression
--Loss of Behavioral Control
--Recognition of Loss of Control
--Option Reduction

It is important for the dependent individual and loved ones to recognize signs and symptoms of relapse early on so that appropriate interventions can be applied. Some common warning signs and behaviors to look out for might include negative thinking, poor self-care, increased conflict, feelings of fear and anxiety, neglecting spirituality, internalizing emotion, not asking for help or listening to suggestions, isolation, complacency, and self-destructive behaviors and attitudes.

Healthy responses and interventions for these warning signs include having an established routine, engaging in positive affirmations and thought stopping techniques, utilizing conflict resolution skills and assertive communication, recognizing irrational fears, applying anxiety management techniques, having a daily spiritual routine, practicing healthy expression of wants and needs, reflecting on behaviors, taking suggestions, attending meetings and remaining involved in treatment, raising awareness of motives, and having positive rewards for successes throughout the recovery process. 

Most addicts and alcoholics in recovery will find themselves somewhere in the relapse phase process at some point in their recovery. It is important to be aware of the phases, warning signs, and common symptoms of relapse so that the individual can intervene before relapse occurs. Intervention and redirection are possible with support, awareness, and skills training. Relapse prevention planning and related therapies can help the dependent individual to recognize his or her unique relapse warning signs so that he or she can create a comprehensive plan to address each phase and related behavior. Having this knowledge and proper coping skills can empower addicts, alcoholics, and loved ones as they continue on their path toward recovery.


Marie Tueller, MEd, LPC

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