When you pull the addiction trigger, the disease of addiction fires off addictive thinking, automatic addictive or drug seeking behavior, and a craving or urge that pulls you toward high risk situations. (Terence Gorski)
The term “trigger event” is used to describe what turns on the addictive thinking, drug seeking behavior, or the craving (a strong need or drive) to be involved in high risk situations (See “The Yin-Yang of High Risk Situations”). Using the metaphor of a loaded gun, Gorski said addiction in early recovery is very much like holding a loaded gun—with a hair trigger.
The problem is that events and circumstances act as powerful triggers for some people, while they have no effect on others. What can be even more confusing is that some days a circumstance can activate a powerful trigger. But on other days the same situation does nothing to pull the trigger and activate the craving.
Mistakenly, triggers are often seen as only external to the person. So the focus in managing triggers becomes one of identifying and avoiding external situations related to drug use and drinking. But triggers can be internal as well as external. Gorski defined a trigger event as “any internal or external occurrence that activates a craving (obsession, compulsion, physical craving, and drug-seeking behavior).” By internal occurrences he means thoughts or feelings. External occurrences involve the five senses: sight, sound, smell, taste and touch.
For these events to become triggers, they have to be connected to the person’s use of alcohol or drugs. The trigger is stronger if the event happened just before or while using. This is what makes needles, when drawing blood, a trigger to the IV drug user. Years ago I knew someone who couldn’t listen to “The Wall” by Pink Floyd in early recovery because he always did so before when he was high.
Gorski then said there were three phases in “disempowering” a trigger. Phase 1 was Avoidance. Here the person is to make a list of the most powerful triggers associated with his using and avoided them. The ubiquitous recovery mantra to avoid people, places and things (PPT) associated with addiction fits here.
The second phase was to gradually re-introduce some “trigger” events, along with good recovery support. This would not include returning to a bar where you used to drink. But it could mean going to a restaurant or party where alcohol will be served. There could be a local bar and grill that is known for its wings. Going there in early recovery is not a good idea, but with support later on might be acceptable. Maybe try getting takeout a few times first.
Alcohol is such a part of our society, total avoidance would mean a very sheltered and limited life. “Therefore, in order to lead any kind of normal life, gradual introduction is necessary.” There is an Italian restaurant, with an attached sports bar near a local N.A. meeting. After the meeting, some members go there for pizza; others don’t. This gradual re-introduction is just that—GRADUAL. And it shouldn’t be practiced when the person’s sobriety is unstable. Stress or instability in sobriety means that phase 1 avoidance should be instituted.
The third phase is extinction, meaning that the using trigger’s ability to activate a craving is eliminated or extinguished. A woman habitually sat in one particular barstool at home when she drank. In early recovery she learned to avoid sitting there, because it activated her “stinking thinking.” Through repeated times of sitting in the barstool when doing other things like drinking her morning coffee and reading a book, paying her bills, etc. she extinguished sitting in the barstool as a trigger event of her cravings to drink.
This is a process of retraining your mind or desensitizing it to what used to be stimuli (triggers) to get high. You may recognize the principles of operant and even classical conditioning incorporated within Gorski’s process of disempowering triggers. But these principles alone aren’t always enough to bring about successful extinction of a trigger. The above comments drawn from Gorski’s article suggested this—when the sporadic nature of some triggers was mentioned. “Without a clear understanding of the psychobiological dynamics of a trigger event, the only way to learn to [manage] them is through trial and error.” Why is this?
I’d suggest that humans are psychosomatic unities of body (soma) and soul (psyche). See another article, “We Are But Thinking Reeds,” for greater discussion of this concept. Existing within the soul are not only the internal events of thoughts and feelings, but deeper desires, wants and loves. In recovery you see this expressed by the phrase “I want what I want.” The ‘psychobiological dynamics’ of a trigger event engages these desires as well as the thoughts and feelings.
Disempowering triggers can extinguish the reinforcement pattern of the thoughts and feelings to the external event, but they cannot eradicate the deep desires. One of these desires is the “loaded gun” of wanting to get high. Here is where self-control in recovery comes in—learning to not act on the thoughts and feelings that stem from it; not giving into the desire to get high. At best, this desire will go into hibernation. Practicing a program of recovery will help keep it there.
I have read and used Terence Gorski’s material on relapse and recovery for most of my career as an addictions counselor. I’ve read several of his books and booklets; and I’ve completed many of his online training courses. He has a blog, Terry Gorski’s blog, where he graciously shares much of what he has learned, researched and written over the years. This is one of a series of articles based upon the material available on his blog and website.
We’d discussed a plan to keep Andrea as safe as possible. Her brother had urged her to come to the family Christmas celebration and she didn’t feel she could say no. Many of her family members were drinkers, but she was going with her fiancée and neither one of them would be drinking. Most family members knew she’d just got out of rehab at the beginning of December and were supportive of her abstinence. Her brother had vowed to tell their heavily drinking uncle to keep his distance from her. She also wanted to show her family what the sober Andrea looked and acted like. Last Christmas has been a disaster.
She had talked ahead of time to her sponsor about going and agreed to call her at least once during the celebration and after she had returned home. She arranged with Chad, her boyfriend, and Matt, her brother to approach them and say she had to leave if she felt triggered by anything. Andrea and Matt rode together to the party, so they could leave whenever they needed. Her sponsor had also told her about a late night meeting she could get to as well. The party was great. She wasn’t triggered. Even Uncle Al seemed to have been more sober than usual.
A few days later, she had a phone call from a friend’s mother telling her that the woman’s niece had overdosed the night before. Andrea had known the woman, and even talked to her when they met at the grocery store, just after Andrea had got out of rehab. Although she was freaking out on the inside, she felt she had to listen to the friend’s mother and try to comfort her. Andrea still felt guilty that she had introduced the woman’s daughter to heroin. The first anniversary of the girl’s death from a car crash had come while Andrea was in treatment.
When Andrea got off the phone fifteen minutes later, she was shaking. She didn’t want to call her sponsor again; they’d talked earlier in the day and she knew her sponsor was going to be at a family dinner. She told Chad what had happened and said she was going to take a walk to clear her head—alone. Down the block, she decided to walk to the convenience store for a pack of cigarettes; she was almost out. Standing in line with her back to the front door and replaying the conversation with the friend’s mother in her head, she didn’t see a drug dealer she knew until he tapped her on the shoulder and called her name.
Andrea was in two situations that could be dangerous to her recovery. The first was one of her choosing; the second she didn’t see coming. Nevertheless, they both fit what Terence Gorski would describe as a High Risk Situation (HRS). Gorski said that a high risk situation is: 1) any experience that causes you to either move away from support for your recovery; or 2) leads to you going around people, places and things that would support your return to addictive use. He then specified this yin-yang of people, places and things and addiction further by giving a list of ten criteria:
To be more specific, a high risk situation can be described as any experience that meets one or more of the following criteria. The more criteria that are part of the experience, the higher the risk of starting addictive use.
Andrea’s first situation, going to the family Christmas party, would have met numbers 2, 3 and 4 on Gorski’s list. She was around people who would support her return to drinking (Possibly Uncle Al, maybe others who didn’t understand why she couldn’t just one drink to celebrate). She had easy access to alcohol. She was around other people who were acting out on their addiction (at least Uncle Al). But she had a plan to minimize the high risk criteria.
As Gorski noted in his article, having a plan to extract yourself from a high risk situation and then getting in contact people supportive of your abstinence can help you get away from it without using. Andrea went with her fiancée, who also wasn’t drinking. Her brother and others at the party knew she was abstinent and were supportive of her recovery. She had a plan to get to a meeting if indeed she did start to have thoughts or cravings to use. She told others of her planned emergency exit strategy. She went into a high risk situation with a plan and got out without using.
The second situation is less obviously a high risk situation because of the chance encounter Andrea had with the drug dealer. Does this mean she can never be out alone? Gorski said that in relapse prevention there are “Apparently Irrelevant Decisions that put people in high risk situation that seem to happen by chance.” In Andrea’s case, she felt she needed to try and comfort her friend’s mother even though she was freaking out inside. She should have ended the conversation or had Chad try and console the woman. She also chose not to call her sponsor—even though it made sense not to do so at the time. She went out alone and then decided to go for cigarettes—again alone—while she was still upset by her phone call.
These seeming irrelevant decisions on her part led to Andrea being alone while she was around a person who would support her drug use and even supply what she needed to get high. All the while she was still struggling to control strong feelings and emotions from her phone conversation. She also had limited options available to cope with or get out of the situation. The scenario doesn’t say what she did, but even before we speculate how she could respond, Andrea has met five of Gorski’s ten criteria. And remember, the more criteria that are part of the experience, the higher the risk of using.
Andrea are her situations are fictional, but the various pieces of each of them have really happened to people I’ve known in early recovery. Sometimes it can almost feel like an improbable scene scripted in a bad Hollywood movie. So how does Andrea keep herself prepared for the unexpected high risk situation? Simply reverse Gorski’s two yin-yang criteria—move away from people, places and things that support your return to addictive use; and put yourself around the people, places and things that support your recovery. Apply it to Andrea’s situation and see what you think she should do.
I have read and used Terence Gorski’s material on relapse and recovery for most of my career as an addictions counselor. I’ve read several of his books and booklets; and I’ve completed many of his online training courses. He has a blog, Terry Gorski’s blog, where he graciously shares much of what he has learned, researched and written over the years. This is one of a series of articles based upon the material available on his blog and website.
