Tag: relapse

10/31/17

Mistaken Beliefs About Addiction Relapse

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The coroner’s report on Carrie Fisher’s death listed sleep apnea as the primary cause of death with drug intake as a contributing factor. In addition to the medications prescribed for her bipolar disorder (Abilify, Lamictal and Prozac), toxicology results found cocaine, methadone, heroin, oxycodone, and MDMA (ecstasy) in her system at the time of her death. Fisher’s family objected to a full autopsy, so the coronor’s conclusions were based on the toxicology results and an external examination of her body. “Based on the available toxicological information, we cannot establish the significance of the multiple substances that were detected in Ms. Fisher’s blood and tissue, with regard to the cause of death.”

The above information was from an article in Variety, but several media outlets were citing the coroner’s report and the same information. People said the coroner’s report indicated Ms. Fisher used cocaine sometime in the 72 hours prior to her death. During her 10-hour flight, she had multiple apneic episodes, which her personal assistant said was normal for her. Towards the end of the flight, she could not be roused. The report also noted she suffered from atherosclerotic heart disease, but then said: “The manner of death has been ruled undetermined.”

Although the official coroner’s report listed the manner of death as undetermined, it seems reasonable to assume from the toxicological information that Ms. Fisher had relapsed into active substance use. Billie Lourd, her daughter, said in a statement to People: “My mom battled drug addiction and mental illness her entire life. She ultimately died of it.” The cocktail of substances in Carrie Fisher’s system at the time of death, along with her history of heart disease, coupled with the increased risk of sudden cardiac death due to the medications used to treat her bipolar disorder lends credibility to Ms. Lourd’s statement.

The use of psychiatric medication to treat her bipolar disorder may have been a contributing factor to Ms. Fisher’s heart failure. See the article, “Blind Spots with Antipsychotics” Part 1 and Part 2 for more on the health problems with antipsychotics. But the range of substances she used just before her death may also have been enough to precipitate a sudden cardiac death, particularly since she already suffered from heart disease. Struggling with a concurrent bipolar disorder and a substance use disorder is a double whammy to anyone in recovery. Instability with either issue is a serious risk factor for relapse. I knew of someone with a bipolar diagnosis and cocaine dependence. They bounced back-and-forth between active cocaine use and inpatient psychiatric treatment for depression ten times within a single year.

Ms. Lourd said her mother would want her death to encourage people to be open about their struggles, and to seek help for them. Historically, Carrie Fisher talked openly about her proneness to relapse. She told People in 1987: “I couldn’t stop, or stay stopped. It was never my fantasy to have a drug problem.” She would stop for a couple of months and then celebrate her abstinence by using again. “I got into trouble each time. I hated myself. I just beat myself up. It was very painful.” With that in mind, let’s assume the immediate cause for her untimely death was due to an apparent relapse into active drug use, and then discuss some mistaken beliefs about addiction relapse.

Terrance Gorski is a leading expert on addiction relapse prevention. He’s written several books on the subject, many of which are available through Herald House Independence Press at relapse.org. He also has a blog, Terry Gorski’s Blog, where he has made a significant amount of his material available for free. Here we’ll concentrate on his article, “Relapse Does not Mean Failure?”

Gorski said there were three mistaken beliefs that often interfered with helping relapse prone individuals. They are: (1) Relapse is self-inflicted; (2) Relapse is an indication the person is a failure who doesn’t want to recover; and (3) Once relapse occurs the patient will never recover.

In most cases, relapse is not self-inflicted. There isn’t a fully conscious, willful decision to throw over abstinence and return to active drinking or drug use. Relapse-prone individuals “experience a gradual progression of symptoms in sobriety that create so much pain that they become unable to function in sobriety. They turn to addictive use to self-medicate the pain.” They can learn to stay sober by recognizing these symptoms as early relapse warning signs. Next is identifying the self-defeating thoughts, feelings and actions used to cope with the symptoms and then learn more effective coping mechanisms, more healthy ways of responding to them.

Unfortunately, most relapse-prone patients never receive relapse prevention therapy, either because treatment centers don’t provide it or their insurance or managed care provider won’t pay for it.

Relapse is not automatically a sign that treatment has failed or the person really doesn’t want to recover. It is more likely that the root-cause of the person’s problems wasn’t addressed by the “standard package of treatment offered.” If this is the case, the risk of relapse increases dramatically. Learning to recognize relapse warning signs and how to cope with them would minimize this risk.

Gorski said that between one half and two-thirds of all individuals treated for alcohol and drug use problems will relapse. At least one half of those who relapse will establish long-term recovery within five to seven years of their first treatment experience. Believing that relapse means both the person and the treatment failed ignores the reality that for many, recovery involves a series of relapse episodes. “Each relapse, if properly dealt with in a subsequent treatment, can become the a learning experience which makes the patient less likely to relapse in the future.”

Chemically dependent people can be grouped into three types based upon their recovery and relapse histories. The first type is recovery prone and maintains total abstinence from their first serious attempt at change. Another type is relapse prone, with a series of short-term, low consequence relapse episodes before finding long-term abstinence. The third type is chronically relapse prone, who can’t seem to find long-term sobriety regardless of what they do.

Recovery prone individuals tend to be dependent on a single drug. They also have higher levels of social and economic stability. They may have steady employment, friendships and stable living situations. And they don’t have coexisting mental health issues, as Carrie Fisher did, or physical health issues, like chronic pain problems. These “garden variety addicts” have chemical addictions with few additional serious personal or social problems.

The second type of transitionally relapse-prone individuals, seem to have more severe addictions that are complicated by other problems. However, they learn from each relapse episode and take steps to modify their recovery programs to avoid future relapses. For example, they may downplay the risks of going around good friends who still drink or use drugs until they find themselves actively drinking or drugging again. Afterwards, they set and keep boundaries with those friends that better support their recovery.

The third type— chronically relapse-prone individuals—not only have the primary addiction for which they are being treated, but also a combination of the following coexisting issues. They may have multiple drug addictions, especially with opiates and methamphetamines. They can have an undiagnosed physical condition, a personality disorder or other mental health problem. There could be issues with severe post acute withdrawal (PAW), which becomes even more severe when the person is under high levels of stress.

Many relapse-prone patients fail to recover because these coexisting [issues] are not properly diagnosed and treated and they interfere with the primary treatment being given.

The third mistaken belief sees recovery as an all-or-nothing process—you either have it or you don’t. And if you relapse, you just don’t want recovery bad enough. Actually, recovery is a learned skill, acquired mostly by trial and error.  Rarely does someone with long-term recovery get there without one or more short series of relapse episodes. “They learned from these experiences and figured out how to put together a meaningful and comfortable long-term recovery.”

So when you think about Carrie Fisher’s toxicology report, don’t assume she threw away her sobriety like it was an old, worn out Alderaan gown. Her relapse was likely the result of a gradual progression of symptoms occurring in her life. In time, they created so much pain in sobriety that she wasn’t able to function. So she tried to self-medicate. She also wasn’t a failure who didn’t want to recover. The openness in her life about her struggles with addiction and mental health belie such an assessment.

Like thousands of others each year, she died with multiple psychoactive substances in her system. But that doesn’t mean she would have never made it back to abstinence. Remember, she was Princess Leia; and Leia Organa never gave in to the tyranny of the Empire. Carrie Fisher would never have given up fighting against her addiction and mental health demons.

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.

05/26/17

Preventing the Relapse Process, Part 1

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Relapse is a terrifying experience for an addict or alcoholic to go through. And what seems to be most terrifying, is not being able to see it coming. Hindsight will recognize a few obvious mistakes, but often there is a haunting question: “What am I missing?” Learning to understand relapse and how to prevent it are essential pieces to the recovery puzzle. Relapse doesn’t have to be part of recovery, but recognizing the process when it occurs is essential.

Gerald finally agreed to admit himself to an addictions treatment center. He had relapsed into active drug and alcohol use two years ago after having eight years of abstinence. At the time of his relapse, he was the manager of a sober living residence that housed 10 to 12 men who needed a supportive living environment in early recovery. He didn’t recognize any one thing or event that triggered his relapse. But the guilt after picking up was more intense then he imagined was possible. He was the guy at meetings who always said he put his recovery first.

He acknowledged he had been going through the motions for a while. But that had happened to many others he knew who didn’t pick up. There was the usual recognition of slacking off on going to meetings and growing more impatient with others asking him if he was “all right.” But he honestly couldn’t pick out any one thing or a series of events that led to his relapse.

He had wracked his brains trying to think of what he should have done differently, but he couldn’t see where he went wrong. Privately he was terrified. What if it happened again and he didn’t see it coming that time either? He was afraid he wouldn’t make it back again.

There is no better place to start helping Gerald than with the resources developed by Terence Gorski for understanding and preventing relapse. His Relapse/Recovery Grid has been one of my most regularly used tools when I work with individuals to address their alcohol or drug problems. You will find it in at least two places. The first is within his book, Passages Through Recovery and the second is in his booklet, The Relapse/Recovery Grid. Another helpful resource is Terry Gorski’s Blog, where Terry has made a wealth of his material available. I haven’t seen a reproduction of the 8 ½ by 11 inch Relapse/Recovery Grid available on his blog, but in several articles like “Understanding Relapse and Relapse Prevention,” you will get a good synopsis of the Relapse Process summarized on the bottom half of the Relapse/Recovery Grid.

Gorski said relapse is like knocking over a line of dominoes. It is a process of one unresolved problem leading to another, and then another and another—until you have a major crisis, where using alcohol or drugs to deal with the pain seems like a reasonable choice. “The answer to avoiding relapse is to learn how not to tip over the first domino, and take care of the little problems in life.” If the dominoes have already begun to fall by the time you realize what’s going on, then you want to stop the chain reaction quickly, “before the dominoes start getting so big and heavy that they become unmanageable.”

One way the domino analogy is not always accurate is in the amount of time involved in a relapse process. Someone with stable recovery can take a long time to move through the stages of a relapse process before they ultimately use drugs or alcohol. By stable recovery, I mean someone who is in what Gorski calls the Maintenance Stage of the recovery process. This is where the person is maintaining a recovery program, coping effectively with day-to-day issues in life, continuing to grow personally and spiritually, and coping effectively with the crises and transitions that occur in life. I’ve known an individual who said her relapse process started four years before she actually used drugs again.

Perhaps a bit counter intuitively, this longer time for relapse to result in active drinking or drug use can be helpful IF the person recognizes the problem (or stuck point in Gorski’s discussion of the relapse process) and copes effectively with it. This necessitates the use of RADAR to address the stuck point: Recognizing there is a problem; Accepting that it’s normal to have problems and get stuck in recovery; Detaching or backing off to gain perspective on an unsolved problem; Accepting help from others—asking them for help with your problem; and Responding with positive action will help you get over the stuck point and avoid a further slide into the relapse process.

Failing to address a stuck point leads to ESCAPE: Evading or denying the problem or stuck point; failing to cope with the Stress that comes with evading the problem; turning to Compulsive behaviors to cope with the pain and stress; Avoiding others, especially those who see and tell you about your ineffective strategies for dealing with the problem; developing new Problems from the process of stress, compulsive behavior and isolation; and ultimately Evasion and denial of the new problems—see how it’s been working so well for you so far.

Instead of recognizing you are stuck and need help, you try to tell yourself everything is okay; you are coping effectively. But there is a buildup of pain and stress that can result in using other compulsive behaviors to cope.

To cope with the pain and stress, we begin to use other compulsive behaviors. We may begin overworking, over-eating, dieting, or over-exercising. We can get involved in addictive relationships and distract ourselves with sex and romance.  These behaviors make us feel good in the short run by distracting us from our problems.  But they do nothing to solve the problem.  We feel good now, but we hurt later.  This is a hallmark of all addictive behaviors.

Then something happens. Usually it’s something you would handle without getting upset. But this time you’ve had it; you’ve hit your limit and something snaps inside. Gorski said one person said it was like a trigger going off in your gut and you go out of control. But this is not actively drinking or using … yet. “When the trigger goes off, our stress increases, and our emotions take control of our minds. . . . When emotion gets control of the intellect we abandon everything we know, and start trying to feel good at all costs.”  There was just one too many stressors that weren’t addressed, so a trigger event initiates the internal dysfunction of the Relapse Process.

The Relapse/Recovery Grid lists several high-risk lifestyle factors that increase the likelihood of something triggering the Relapse Process. “These high-risk factors don’t cause relapse; they simply increase the likelihood that it will occur” by making you vulnerable to trigger events. The high-risk factors include personality stressors (perfectionism; or controlling); high-risk lifestyles (trying to do too much or doing too little; or doing the wrong things); social conflict and change; poor health maintenance (poor nutrition, a lack of exercise, relaxation or socializing) or other illness; an inadequate recovery program. “The ‘wrong things’ could be occupations, activities, and people that don’t fit with natural preferences and talents.” Gorski said these high-risk factors were identified from research into the lifestyles of people who had relapsed.

The trigger events listed in the Relapse/Recovery Grid include: high stress thoughts, painful emotions, painful memories, stressful situations and stressful interactions with others. Gorski said that just about anything could become a trigger event, but these five things trigger internal dysfunction more than others.

Some recovering people put themselves under increasing amounts of stress, and they keep adapting to it as they go along. As their tolerance goes up, they block their awareness of stress. Suddenly they hit their limit. They experience one stressor too many, and become dysfunctional.

Irrational thinking is the most common trigger. All-or-nothing thinking, black-and-white thinking fits here. When something goes wrong, you think Nothing ever goes right. If there is a risk of failure in doing something, you quit before it happens. This kind of thinking is irrational.

Emotional pain can point to something wrong with how you are thinking or acting. It signals “a need to examine what is wrong.” If you dismiss painful emotions for too long, they often come back with a vengeance.

People will often experience stressful or traumatic events in an active addiction that cause them extreme emotional or physical pain.  Being reminded of these events can lead to disorientation, confusion, anxiety or other symptoms for no apparent reason. This will then increase stress and trigger internal dysfunction.

“Any situation that a person is not prepared to cope with may be stressful.”  Recognize this reality and seek to avoid them, if at all possible, by being prepared. The level of stress is inversely related to your preparation: it goes down as your preparation goes up. In situations where you can’t be prepared, learn some stress reduction skills, such as relaxation breathing. See “Using Stress Management in Relapse Prevention Therapy (RPT)” and  “Stress Self-Monitoring and Relapse” for more on this.

Stressful interactions with others are common for recovering addicts and alcoholics. They often have high stress people in their lives, meaning people who cause them stress. Often these high stress interactions occur with family members or people the addict or alcoholic is close to. Their stressful behavior, ironically, is often caused by their fear of a relapse with the addict.

This is the first part of my article, “Preventing the Relapse Process.” Part two will describe the four phases of the Relapse Process and it can be found here.

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 websites.

01/19/15

The Yin-Yang of High Risk Situations

Jin and yang mask by sognolucido
Jin and yang mask by sognolucido

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.

08/11/14

Déjà Vu All Over Again

Copyright: kmiragaya / 123RF Stock Photo
kmiragaya / 123RF Stock Photo

Leo (not his real name) walked into our outpatient clinic with a daypack over his right shoulder smelling strongly of booze. He would later show us the half-empty bottle of vodka he carried inside of it. Three of the treatment staff did an impromptu “intervention” and at one point he almost gave us the bottle. Sadly the vodka was more alluring to him at the time. He kept the bottle.

We knew and liked Leo. He had been in our partial treatment program at least 2 or 3 times before. He demonstrated personal change; helped others with their own drug and alcohol use problems; and usually completed the treatment program. But he repeatedly lapsed or relapsed into active drinking.

He wasn’t angry or belligerent. He didn’t even get upset when we told him if he walked out of the office we would call the local police. He just quietly got up and left—with his daypack. I followed him outside and watched him walk away. The last time I saw him that day he was fifty yards away; slinging his daypack off of his back as he disappeared behind some trees.

Sarah (not her real name) had completed her third or fourth outpatient treatment few months after she turned twenty. This time she had a very good sponsor; had several other women with solid recovery in her sober support system; and seemed to really be trying to remain abstinent. Then we heard that she had announced to everyone that she intended to celebrate her 21st birthday with a pub-crawl. Several people tried to talk her out of this crazy idea, but she wasn’t budging.

I got permission to hold a birthday party for her at the aftercare group I oversee. And then I invited Sarah and anyone in her sober support system that wanted to come. We had a quarter-sized sheet cake and ice cream. Sarah didn’t come, but I saved her a piece of cake and put it in my freezer. About a month later on her birthday, she went on a pub-crawl with her friend. The friend ended up in the hospital with alcohol poisoning. Sarah kept drinking and using drugs for another six or seven months.

When she came back to the Aftercare group, I told her I had a piece of birthday cake for her in my freezer.  When she achieved one year of abstinence, I’d give her the birthday cake. She returned after her one-year anniversary and I gave her the piece of cake. I haven’t heard from her for a few years, but the last news I had was that she was still sober.

Relapse into active drug or alcohol use is, sadly, a common occurrence in recovery. But it doesn’t always have to be. Like the new Tom Cruise science fiction movie, “Edge of Tomorrow,” persistence and repeated battle against addiction can be an opportunity to eventually overcoming this personalized alien invader. But if it’s addiction and not the Mimics that you battle, I suggest you trust in Terence Gorski and not Tom Cruise for your deliverance.

Among the many tools developed by Gorski for this battle is the AWARE (Advance WArning of RElapse) Questionnaire.  It was designed and refined as a measure of the warning signs of relapse. It is simple to use and interpret: the higher the score, the greater the number of relapse warning signs being reported. It was developed through research funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). So it is in the public domain and may be used without specific permission; so long as the proper recognition is given as to its source.  You can read Gorski’s original blog post on the AWARE Questionnaire. And you can download a printer-friendly version of it that I’ve put together here.

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 blog posts based upon the material available on his blog and website.

07/7/14

Never Give Up Hope

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eric1513 / 123RF Stock Photo

Adam’s lead was one of those powerful tales of riches-to-rags-to-riches of drinking and drug use leading to a “low bottom” and then recovery. His bottom included being homeless; losing his job; jail; the whole works. And then he got sober. He always concluded by saying: “And I know that if I ever were to pick up again, I’m never coming back.” He meant what he said. His audience believed him. And when he did pick up, he never came back.

When I was an intern at an outpatient drug and alcohol clinic, I heard the tale of Adam’s relapse. That wasn’t his real name; I don’t think I ever knew it. But Adam’s story was my first lesson in mistaken beliefs about relapse: His mistaken belief about relapse created a self-fulfilling prophecy.

In his booklet Mistaken Beliefs About Relapse, Terence Gorski said: “A mistaken belief is something that you believe to be true and act as if it were true when, in fact, it is false.” Within it, he listed seventeen separate mistaken beliefs. Adam seems to have believed numbers 16 and 17.

Number 16: “Once you begin using it is impossible for you to interrupt your relapse before you have ‘hit bottom’ again.” Many addicts program themselves for a destructive relapse. They believe that it is better to be dead than drunk or high. This seems to be what Adam had buried in the concluding statement to his lead. Once he started, he believed there was no way he could stop. His first bottom was so low, that next was death.

It is true that once you again begin to use addictively, you can never be sure of what is going to happen. But you can have periodic moments of sanity; times where you “regain control of your thinking, your emotions, your memory and your behavior and judgment. . . . It is your responsibility to yourself and those whom you love to get help to interrupt the relapse during these moments of sanity.”

Number 17: “Successful recovery from addiction requires continuous abstinence from the time of the initial commitment to sobriety.” It is a fact that most addicts and alcoholics are not able to maintain permanent abstinence the first time they try. But this is NOT MEANT to be permission to periodically drink or use. There is a difference between a lapse—the initial return to addictive use, and a relapse—the destructive return to loss of control, addictive use.

There are two choices. The person can get help from others to return to abstinence (call your sponsor or others people in your support system; get back into treatment). Then they need to learn from the experience what went wrong; and what they need to do to stay sober in the future. Or they can convince themselves that staying sober is hopeless and continue to use destructively. “If they believe they are hopeless or that they have failed totally because they have lapsed, they will give up and not continue in their efforts to recover.” Sometimes they are lucky enough to have the right set of circumstances re-engage them in treatment or other help. Sometimes they die in their addiction like Adam.

In his blog post on Mistaken Beliefs About Relapse, Gorski discussed what he called the three most common mistaken beliefs about relapse: 1) that it is self-inflicted; 2) that it is an indication of treatment failure; and 3) once relapse occurs the person will never recover. These mistaken beliefs are differently worded than those in his booklet, Mistaken Beliefs About Relapse, but still worth reading and thinking about in their own right.  Adam seems to have fallen prey to the third one.

There are two additional mistaken beliefs I hear a lot: First, that relapse is a part of recovery. Relapse is often a part of someone’s recovery journey, but it doesn’t have to be. Second, some people are “constitutionally incapable” of recovery. Here, Gorski said it best: “The consequence of believing you cannot get well is despair. Without hope there is no motivation to try again and you are condemned to a life of despair.” Never say never. And never give up hope.

What other mistaken beliefs about relapse or recovery have you encountered? 

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 blog posts based upon the material available on his blog and website.