One of the elusive difficulties in overcoming addictions is the problem of relapse. This is a common pitfall and obstacle in the recovery effort to stop using drugs, alcohol, smoking, and other substances in the intoxicating and harmful habit of excess. Relapse is the reversion to using after a period of abstinence.
Though it’s very difficult to break addictions, success stories are legion. There are multiple methods for deterring addictions, but it’s rare for sudden “cold turkey” quitting to sustain without the recurrence of relapse. Most addicts who kick their addiction have endured multiple relapses. Going straight is seldom a straight path.
Along the journey of recovery, people follow different patterns and paths. Depending upon their patterns of use, some individuals binge and stop (heavy use, followed by days or weeks of sobriety). Some quit and stay sober or clean for varying lengths of time. For someone who chronically uses, even a day or two of sobriety is a significant accomplishment. Often, addicts devolve to such a helpless state that inpatient treatment is required to sequester them and halt the rampant self-destruction. Some people reach a point of psychological and neurophysiological dependence where they are unable to cope with withdrawal and make a dent in the cycle (craving, indulgence, withdrawal, and repeat) known as the anxiety-addiction connection.
For experienced addicts who have made strides in their recovery, relapse is a familiar and mysteriously uncanny problem that may recur even after years of abstinence. I have worked with people who have maintained decades of abstinence, only to fall back suddenly into steady use. The mercurial descent into relapse is hard to predict and almost unfathomable. In advance and in retrospect, one can identify triggers, take pains to avoid them, and build a health adaptive lifestyle that minimizes the chances of regression. Still, it’s confounding how frequently people who are doing well for years suddenly relapse.
What happens in this enigmatic process of relapse, and how might recovering addicts avert its haunting recurrence?
A look at several aspects of relapse may shed light on how it occurs and provide insight on avoiding it.
Whether sober for days or years, relapse is always preceded by temptation. The lure of indulging may be triggered by an unprovoked internal craving, a neurophysiological state of stress, deprivation, or need (think HALT: hungry, angry, lonely, tired), a memory of the reward provided by using, or simply the presence of opportunity or an invitation to participate. Previous resistance or sublimation can fall by the wayside, even after lengthy periods of abstinence. It is a baffling phenomenon.
Relapse is invariably accompanied and facilitated by a self-induced illusion that justifies the temptation and yielding to indulgence.
“One drink won’t hurt.” “I can indulge this time without falling back into old habits of excess.” “I’ve had a really hard day.” I’ve been good for so long, I deserve it.” In retrospect, the relapse victim knows better and cannot understand how he reasoned to fallaciously (and repeatedly) under the sway of false thinking. In the moment of capitulation, past history and repeated mistakes mysteriously disappear.
A significant contributing factor to relapse is the phenomenon of psychological reversal.
Psychological reversal is a state in which a person thinks, feels, and/or acts in a manner counter to his best interests and usual intent. You can liken it to self-sabotage, yet it is more than a “psychological” phenomenon. Psychological reversal is actually measurable by various methods, including physiological polarity testing by voice, neurological, or electronic measurements. The nature of psychological reversal is that, in a state of reversal, the person does not know he is reversed. That’s why specific intervention is needed to correct the reversal and align intention with behavioral direction. This condition can be detected by counterproductive behaviors, as well as by scientific assessment. The correction takes only seconds, and is explained in the theory and practice of Voice Technology and Thought Field Therapy.
While in a state of psychological reversal, normally effective treatments and motivations are blocked. Think of taking a shower while wearing a raincoat! Or, imagine that you are embarking on driving from San Francisco to Los Angeles—but, you’re on the freeway headed north to Oregon: the intention is true, but the direction is reversed, and you don’t know it.
Everyone is beset by psychological reversal at times: you walk over to the refrigerator to put away a hammer. You leave the house without keys or wallet, etc. However, those with chronic illnesses or addictions are generally reversed more massively and chronically. I believe that psychological reversal lowers the threshold for relapse in vulnerable individuals.
There is no specific way to predict when psychological reversal will throw a monkeywrench into otherwise successful and sustained recovery. It’s prudent for those vulnerable to be aware of this phenomenon, to take precautions and protection by developing a healthy and intoxicant free lifestyle, and to be conscious of both intensified stressors and temptation bound thinking that persists. These are clues that psychological reversal may be about to wreak its destructive influence. It’s wise to be prepared with both self-treatment and/or professional intervention.
Regardless of the length of abstinence or the pattern of the addiction cycle, relapse is common. For many, particularly those new to sobriety, relapse occurs after brief abstinence. Daily drinking or drug using may be interspersed with hopeful and well-intentioned clean days, only to revert to more ingrained patterns of use. Some, whose abstinence stretches for years or decades, are suddenly overtaken by a skulking and overwhelming relapse.
Many an addict has complained to me that when reversion to a relapse incident occurs, it throws them into a case of the F— its. This is a condition of surrender to prolonged indulgence with little or no motivation to resume sobriety and its attendant struggle. No doubt, the F— its are also triggered and maintained by protracted psychological reversal. The addict gives in to old behaviors, basking in self-loathing and self-pity, rationalizing and assuming the futility of sustained recovery. In this state of psychological reversal and reduced self-love, the F— its creep and pervade other facets of self-care, ambition, and general functioning. The F— its are a sad and helpless partner of relapse. They are also an excuse for giving up and giving in.
Eventually, the struggling addict manages to climb back on the wagon and resume the familiar process of battling the addictive menace. Cravings, withdrawal, entrenched habits, impacted health, poorly resolved mental health problems, and environmental influences and temptations tease and chip away at the efforts and resolve of the recovering individual.
Nonetheless, the resumption of abstinence begins anew, whether punctuating long stretches of sobriety or dappled by occasional breaks in routine indulgence.
For many in recovery, the process is a well-worn grind, accompanied by renewed hope and momentum, but also saddled with the fear of repeated relapse. After all, this happened… so, what happened? How is relapse to be avoided?
I have a suggestion that can add motivation and confidence to the recovery process. It is based on the nature of probability and its influence on the tracking, planning, and occurrence of behaviors.
When working with patients trying to overcome addictions, one of the first questions I ask is: “What is the longest period of time you’ve gone without using in the past (week, three months, year, depending on the person’s pattern of use and recent usage)?”
Depending upon the answer, I’ll then ask, “What would it be like if you didn’t use for just (again, depending upon the answer to the previous question.)?”
For example, if the patient has only gone one or two days without drinking, I’d say, “What would it be like if you didn’t drink for three days?” Or, perhaps a smoker has not been without a cigarette for more than six waking hours, I’d ask “What would it be like if you didn’t smoke for twenty-four hours?”
Most of the time, I’ll get an answer that indicates or projects hardship or anguish when anticipating restraint. Common responses are:
“Oh, that would be difficult.”
“I’d be thinking constantly of using (drinking smoking).”
“I can’t see myself doing that.”
Every so often, a patient will respond with a more positive answer, one I’m looking for:
“If I didn’t smoke for two days, that would be awesome.”
“Wow, that would be quite an accomplishment.”
If the patient does come up with a positive projection, I’ll reinforce that. If not, I’ll plant the accomplishment suggestion, an alternative to focusing on the negative anticipation. This is not for the purpose of promoting positive thinking, although that could be helpful. Rather, the focus on the achievement of small increments of abstinence is preparation for establishing increasing periods of abstinence as the new normal, both in mind expectations and behavioral outcomes and probabilities.
For addicts who indulge regularly, using is the normal or expected pattern, whereas abstinence is a deviation (a desired one). Thus, reversion to using is the accustomed expectation of body and mind. However, when abstinence increases, especially over prolonged periods of time, abstinence becomes the norm and indulgence becomes the deviation.
In probability terms, the longer the periods of abstinence, the more durable that condition becomes. Thus, relapses—though problematic and deflating—are interruptions in abstinence or sobriety. Recovery is easier and more likely when the abstinence periods greatly outstrip indulgences.
At the beginning of recovery, small steps of short abstinent periods are important, as they provide encouragement and a chance for the body and mind to adapt to not using. Gradually, these abstinent periods can be stretched and increased, and the addict is well on the way to better recovery. With longer periods of abstinence, the probability is that abstinence will continue or resume, even when interrupted by relapses (which will also tend be shorter or more curtailed).
Reinforcement is any consequence that strengthens a response or the likelihood that a response will occur. This applies to any behavior, whether desired or unwanted, intentional or otherwise.
Recovery requires the reinforcement of abstinence and supporting behaviors. Unfortunately though, it’s easy and natural to also reinforce unwanted behaviors simply by paying attention to them. Thus, withdrawal cravings, tempting surroundings and opportunities, and even thinking about using are powerful reinforcers, especially for the novice in recovery. Addicts know this, and endemic to recovery are methods and supports to avoid or counteract temptation. The problem with relapse is that it is hard to predict and when it happens, the attention and negative emotions tend to reinforce the relapse and the F— its often tied to it.
Since it is important to reinforce the desired behaviors (abstinence, confidence, encouragement) and not reinforce the unwanted behaviors (relapse, F— its or tossing in the towel), there is a useful tool in this regard.
Documenting both abstinent periods and days without the F— its is an extremely helpful way of shifting attention to desired behaviors (already in play). Paying attention (keeping written records helps) increases the probability of continuation of positive behaviors.
Even in the event of behavioral relapse, the user can reinforce and document a curtailment of the incidence and extension of the F— its. This will counteract self-pity and rationalization that facilitates relapse and its entitlements.
So: you made a mistake and backslid. It’s not the end of the world. But, you don’t have to toss in the towel and allow yourself the self-pity and fragility of the F— its. Just because you erred, it’s not the end of the world. You can turn back and restart. Don’t re-enact in your heart and attitude Shakespeare’s tragic Macbeth line:
I am in blood
Stepped in so far that, should I wade no more,
Returning were as tedious as go o’er.
Meaning: I have come this far (in relapse), so I might as well finish the job. There’s no turning back. (Shakespearean version of the F— its.)
Focus on and document how long you allow these doldrums to envelop you and how and when you are able to turn the tide, at least in attitude and intention. Thus, you are carefully, separating relapse mistakes from the overwhelming accompaniment of the F— its. And, when abstinence resumes, you can reinforce yourself for lack of self-pity as well as for renewed sobriety.
Reinforcing the opposite of unwanted behaviors is a strategic and effective way of not reinforcing the problem behaviors. As a comparative example, to reduce a child’s tantrums, you reinforce or reward short periods of good behavior. This not only helps you avoid reacting to misbehavior, but it gradually shapes and extends period of good behavior that become the new normal.
Besides shortening episodes of capitulation, there’s an additional benefit to reinforcing abstinence and lack of the F— its: this will tend to alert you to the presence of or proneness to psychological reversal, where your intent misaligns with your actions.
The description and suggestions herein for dealing with relapse are tools to help in the battle to conquer addictions. This can be achieved, yet recovery is often dappled with setbacks and regression. Imperfect though the tools and methods are (as we are also imperfect), commitment and persistence are key. As in many life endeavors, failures are instrumental to eventual achievements and successes.
Relapses are problematic, mysterious, elusive, and difficult to predict. Don’t let them deter you from becoming the person in control of who you want to be.
Don’t give up and don’t give in.
Don’t resign to a life of sin.
If you persist again and again,
Your better self will eventually win.
— Mark Steinberg, PhD
