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37 Symptoms of Relapse
Transcript of 37 Symptoms of Relapse
Relapse does not begin with the first drink or use of a drug. Relapse begins in a behavioral dynamic which reactivates patterns of denial, isolation, elevated stress and impaired judgement.
Relapse is a process, it's not an event. Possible relapse starts weeks or even months before the physical relapse.
There are 3 stages of relapse:
37 Symptoms of Relapse
The recovering alcoholic or addict is not thinking about using but emotions and behaviors are setting up for a possible relapse.
Some of these emotions or behaviors are:
Not going to meetings
Poor eating habits
Poor sleeping habits.
Part of the recovering alcoholic or addict wants to use, part of them doesn't.
Signs of mental relapse are:
Thinking about people, places and things associated with your addiction.
Glamourizing past use.
Hanging out with old friends that use.
Thinking or Obsessing about relapse. ("Maybe just one...")
This stage occurs after the emotional and mental relapse. Relapse can be avoided before reaching the physical relapse, also known as the return to active use.
Signs of physical relapse are:
Contacting your dealer.
Driving to the liquor store.
Going to a bar.
Driving to your dealer.
The 37 symptoms were compiled through clinical interviews of 118 patients who have:
Completed a 21 or 28 day treatment program.
Been discharged with the intention to remain abstinent from chemical use and in recovery from addiction.
Eventually lost control of consumption in spite of initial comments to remain clean and sober.
Most Commonly Reported Symptoms:
1.) Apprehension About Well Being
Initial sense of fear and uncertainty returns.
Lack of confidence in abilities to stay clean and sober.
This apprehension can be extremely short lived.
Denial system returns in order to cope with anxiety and stress.
The denial system is similar the one used to deny the use of intoxicants when treatment began.
3.) Adamant Commitment to Sobriety
The addict or alcoholic convinces themselves they will never drink or use again.
This self persuasion is sometimes overt and blatant but most often is a very private decision.
Once an alcoholic or addict convinces themselves they will never drink or use again, the urgency of pursuing a daily program of recovery diminishes. "I can do it on my own."
4.) Compulsive Attempts to Impose Sobriety on Others.
Generally involves private judgements about the drinking or using of friends and family as well as the quality of program of others in recovery.
When dealing with issues of recovery the alcoholic or addict begins to focus more on what others are doing than on what they should be doing themselves.
The alcoholic or addict recognizes an increase in their defensive behaviors when talking about their problems or recovery programs.
6.) Compulsive Behavior
Defensive behaviors become rigid and repetitive.
The alcoholic or addict seeks out control in conversations either through monopoly or silence.
Self defeating learned behaviors begin to appear, (Workaholic, Perfectionist, Baby, Abuser etc.)
7.) Impulsive Behavior
Impulsive reactions become prevalent due to overreaction of stress.
This leads to impulsive decision making in life areas and commitments to ongoing recovery.
8.) Tendencies towards loneliness
Patterns of isolation and social avoidance increase.
Short episodes of intense loneliness with increasing frequency.
These episodes are generally dealt with by reactivating addictive behaviors.
9.) Tunnel Vision
Addicts and alcoholics tend to focus exclusively on one area of their lives and avoid looking at others areas.
Some can focus on the positive aspects of early recovery creating a delusion of security and well-being. ("I'm feeling great today, I don't need to talk to my sponsor or go to a meeting.")
Others focus on the negative aspects of early recovery thus assuming a "victim" position which confirms their beliefs of being helpless and treated unfairly. ("I have been working so hard and things still are not changing...no point in going to a meeting they aren't helping.")
10.) Minor Depression
Symptoms of depression begin to appear and persist.
Flat emotions, Oversleeping, Poor eating habits become common.
11.) Loss of Constructive Planning
The alcoholic or addicts life skills begin to diminish.
Attention to detail subsides.
Wishful thinking begins to replace realistic planning.
Procrastination of responsibilities become common.
12.) Plans Begin to Fail
Due to lack of attention to detail, poor planning or the pursuit of unrealistic objectives, the plans begin to fail.
13.) Idle Daydreaming and Wishful Thinking
The ability to concentrate diminishes and fantasy sets in.
The "If Only Syndrome" becomes common.
The fantasies are generally of escape or of "being rescued from it all" by some unlikely set of circumstances.
14.) Feelings that Nothing Can be Solved
A "failure" pattern begins to develop.
In some cases the failure is real.
In other cases it is imagined and based upon intangibles.
The generalized perception of "it's not working out" begins to develop.
15.) Immature Wish to be Happy
Conversations and thought patterns become vague and generalized.
The desire to be happy or have things worked out become more common without knowing what is necessary to be happy or have things worked out.
16.) Periods of Confusion
The episodes of confusion increase in terms of frequency, duration and the severity of the behavioral impairment.
17.) Irritation with Friends
Social involvements with friends and intimates, treatment relationships with therapists and AA members become strained and conflicting.
The conflicting nature increases as confrontation of the alcoholic's or addict's degenerating behavior increases.
18.) Easily Angered
Episodes of anger, frustration, resentment and irritability increases.
Overreaction becomes more frequent.
Often the fear of extreme overreacting to the point of violence increases the individual's level of stress and anxiety.
19.) Irregular Eating Habits
The addict or alcoholic begins to over or under-eat.
The regular structure of meals is disrupted.
Well-balanced meals are often replaced with junk food.
Extended periods of inability to initiate action develops.
These periods are marked by inability to concentrate, anxiety and severe feelings of apprehension.
Alcoholics and addicts often say it is a feeling of being trapped or of having no way out.
21.) Irregular Sleeping Habits
Episodes of insomnia are reported.
Episodes of sleeping marathons of 12-20 hours are reported from between 6 and 15 days and results from being exhausted.
22.) Progressive Loss of Daily Structure
Daily routines become haphazard.
The inability to sleep results in oversleeping.
There is no meal structure.
Inability to keep appointments or follow through on plans becomes common.
The alcoholics or addicts know what they should be doing but are unable to due to feelings of tension, frustration, fear and anxiety.
23.) Periods of Deep Depression
Depression becomes more severe, frequent, disruptive and lengthy.
Depression generally occurs during non-structured times and are amplified by fatigue and hunger.
The alcoholic or addict will prefer isolation and may become irritable and/or angry with human contact then complain that nobody cares.
24.)Irregular Attendance at Treatment Meetings
Attendance at AA meetings become sporadic.
Therapy appointments are scheduled and missed.
Rationalization patterns develop to justify their actions.
The effectiveness of AA is discounted and treatment loses priority.
25.) Development of an "I don't care" Attitude
The alcoholic or addict will use the "I don't care" stance to mask a feeling of helplessness and an extremely poor self-image.
26.) Open Rejection of Help
The alcoholic or addict will cut themselves off from viable sources of help.
This is sometimes accomplished through fits of anger or open discounts.
Other times it may be accomplished through quiet withdrawal.
27.) Dissatisfaction with Life
Rationalizations, tunnel vision and wishful thinking give way to harsh reality of how totally unmanageable their lives have become in the course of this period of abstinence.
"Things are so bad now I might as well get drunk because they can't get any worse."
28.) Feelings of Powerlessness and Helplessness
There is a marked inability to initiate action.
Thought processes are scattered and judgement is distorted.
Concentration and abstract thinking abilities are impaired.
The alcoholic or addict begins to indulge in self-pity.
Often called PLOM syndrome which stands for "Poor Little Old Me".
Self-pity is often used as an attention getting device at AA meetings and with family members.
30.) Thoughts of Social Drinking
The alcoholic or addict realizes that drinking or using can normalize many of the feelings and emotions they are experiencing.
The hopes of being able to drink or use in a controlled fashion begins to emerge.
Sometimes the thought is challenged and other times it is entertained.
Often they feel as if they are facing a choice between insanity, suicide or a return to drinking or using.
31.) Conscious Lying
Denial and rationalization become such an extreme process that even the alcoholic or addict begin to recognize the lies and deception.
In spite of this recognition, they are unable to interrupt the pattern.
32.) Complete Loss of Self-Confidence
The alcoholic or addict feels they can't get out of this trap no matter how hard they try.
They become overwhelmed by their inability to think clearly or initiate action.
33.) Unreasonable Resentments
The alcoholic or addict feels severe anger both at the world in general and at their own inability to function.
This anger is at times generalized, other times focused at a particular scapegoat or themselves.
34.) Discontinues all Treatment
Attendance at AA stops completely.
Alcoholics or addicts who were taking Antabuse or Suboxone "forget" to take prescribed dose or manipulate to avoid taking it regularly.
They stop attending counselling sessions or appointments that are treatment related in spite of the realization that they are acting irrationally and need the help.
35.) Overwhelming Loneliness, Frustration, Anger and Tension
The alcoholic or addict is overwhelmed and feels their only options are to return to drinking or using, suicide, or insanity.
There is intense feelings of helplessness and desperation.
Often drinking or using were impulsive behavior with little or no conscious pre-planning.
36.) Start Controlled Drinking
The efforts to control drinking or using takes one or both of these patterns:
A. The effort to control quantities while drinking or using on a regular basis.
B. The effort to engage in one short-term and low consequence binge.
37.) Loss of Control
The ability to exercise control is lost, sometimes quickly and others after various attempts at controlling the drinking or using.
The alcoholic or addict has ultimately returned to addiction which just as severe or more so than the last episode of drinking or using.
At this point it is vital for the alcoholic and addict to get back into a treatment program.
As families we do have power to help. When you notice that your loved one is experiencing any of these symptoms it is important to call them out of these behaviors as they may not notice them by themselves.
Example: "If I saw you doing something that was hurting me, would you want me to tell you?"