Slips and Relapse as Part of Recovery

Sometimes when I am in the hallways at work I am amazed how it can seem like "Old Home Week" or like a high school reunion. People are rushing around from group to their counselling appointment or outside for their afternoon break. So many people know each other and are happy to see each other knowing that they are back on track.

It is unfortunately quite common for people to slip or relapse while working on recovery. Not everyone does and it is certainly not a requirement but it does happen. The best one can do with this is to learn what went wrong and then specifically work on that trigger so it does not "take them out" again. The shorter a relapse (if it's only a day or so it is sometimes called a slip) the easier it is to get right back on track. When a real relapse does happen it can last for a month or two, or for many years.

Each attempt at recovery is not necessarily the same as the one before. Sometimes people find it much harder the second or third or fourth time around, but not always. The path to recovery is not necessarily a straight line and can be very unpredictable. Unfortunately some people actually die when they relapse. This can happen sometimes due to a change in tolerance for the drug, where they unintentionally overdose even though they used the same amount they used to use. This is tragic and so very hard to deal with.

Even though this may make us want to yell "Danger, danger" to the addicted people we know, fear is not always a good motivator. It is human nature to think, or at least strongly believe, that the worst will not happen to us. Instead success requires actually wanting to change ourselves. It is change of behaviour, change of thinking, change of how one handles emotions, that makes the difference to achieving a solid recovery. 

People go through stages of readiness to change. The Transtheoretical Model of Change is the model  we use to explain this. The six stages of change are pre-contemplation, contemplation, preparation, action, maintenance and termination. If someone has not even begun to think about whether they have an addiction or not, they are said to be pre-contemplative. If they are thinking about it but have not yet decided, then they are contemplative which also looks a lot like ambivalence. Once a decision to change has been made a person is said to be in preparation. This is the planning stage of how they will go about their change. Next people are in action when they are actually changing their behaviour. Finally maintenance is when the change is quite solid and is not so much active hard work anymore. Termination is when the change is "done" as in the smoker who is now at heart a non-smoker. In the world of alcohol and drugs many believe that termination is never reached, and that maintenance of  recovery is as good as one can do.  This might be true, as for many if not most, relapse is only a drink away no matter how much time has passed. It seems as if the addiction is only "asleep" rather than really gone.

The very good news is that there are people who succeed.There is a movement growing in the States where more and more, those who are successful in beating addiction are willing to let themselves be known openly.  I am excited about this trend and believe these brave people can offer so much inspiration and hope to those who are still stuck in the relapse/recovery cycle.

Source: Prochaska, J. O. & Di Clemente, C. C., (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research and Practice, 19(3), 276-288. Figure 2, p. 283

People, Places and Things

One of the most foundational ideas in working on one's recovery from addiction is to avoid the people, places and things that might "trigger" you or tempt you to use the substance you are trying not to use. For instance if your usual route home leads you by a liquor store it can be very helpful to find a different way home so you are not throwing temptation so directly in your way. Places to avoid are places where you used to use or that remind you of using.

People are sometimes the triggers and that can be quite hard to cope with, especially if they are friends or family. If possible it would be great if those friends or family would not use around you. That can mean a very different interaction but it can work well. Unfortunately sometimes friends and family have addictions of their own and they have trouble stopping for themselves let alone for you. There are a lot of people in recovery who have had to distance themselves from some of their friends or family in order to be "safe" from temptations to use.  This can definitely create some loneliness and is a good reason to get connected with non-using groups or people.

In most communities there are "twelve-step" groups like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) and sometimes there are also groups like LifeRing and Smart Recovery. There are also often government programs dealing with addictions. All of these groups can enable people to get support and companionship in recovery. It really helps to feel like you are "not alone" on this journey.

Money can also really be a trigger for people. For some, availability of cash makes it very hard to resist spending it on the substance. Sometimes people buy grocery store or other gift cards so they know they will maintain some money for food and other necessities. The financial repercussions of addiction can be quite amazing. Some drugs are very expensive and it is more common than one might think for people to lose their homes, cars and other assets within only a couple of years.

Boredom is another tough trigger. Addiction is actually very time-consuming so without it people do not know what to do with their time.  All the time formerly spent getting, using and recovering from the substance is now freed up for other activities.  Probably less than half of the people I have worked with have former hobbies and interests that they can go back to. If they did play guitar or write or garden, they can try that again. For others it time to start experimenting with different activities and hobbies and trying to find things they like. Sometimes this is kind of fun but sometimes it is just necessary!

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Diary of an Addiction Counsellor

Many things come up in the day of an addictions counsellor. Sometimes the breadth of topics covered is hard to imagine. It can range from discussions about sleep and what time the client got up in the morning, to how to set a boundary with their spouse, to how to grieve the unexpected death of a friend, and that might take you to lunchtime. It is varied and often unpredictable but therefore also interesting.

I imagine that there are many people dealing with addictions and/or working on recovery who do not actually make it in to talk to a counsellor and maybe some of the topics covered here might be helpful. Sometimes I will write about relevant recovery topics and sometimes I will just write about my own thoughts on what I see and experience. Maybe other addiction counsellors will be able to relate.Maybe family members or loved ones of a person with addiction will find it interesting.

I think one of the major premises of recovery from addiction, and possibly any change, is that people do not change unless they are somehow motivated to do so. What makes one person motivated may not make any difference to another. Will a DUI do it or loss of a job or an ultimatum from a spouse. For some it is a health issue like liver disease or pancreatitis that finally hits home. I have often heard people say that they are no longer using to have fun but rather are only using to stop withdrawal. It is no longer fun for many by the time they make it in to the office.

Working with people in addiction and recovery can be very inspiring and real and even fun. There can be lots of laughter along with the tears. In my experience many clients are smart and attractive and most are very emotionally sensitive (although they may not realize it.) There are some days when what is happening seems so meaningful and essential that I think "Wow, what could be more important than this conversation with these people right now?"

In some ways having an addiction, if it leads a person to treatment, can be a blessing in disguise. That may seem an odd thing to say but for those who get a chance to really focus on themselves and their lives in counselling, the opportunity is there to learn and change and thereby avoid much future pain. Of course I am not recommending that addiction be the chosen way to begin the journey of personal growth and change, I am just saying that it can be.

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