Anatomy of a relapse...

It's been three days now since I have received a phone call from a person I sponsor in the 12 Step program. As his sponsor, he and I agreed I would work with him to help him maintain abstinence from alcohol...he had ben clean for just over 30 days when he stopped calling me.

Clearly, he has relapsed.

Now, some may wonder how I can be so sure he has relapsed given the many different reasons that exist for why a person might not call. It's true, he might have been in a very bad accident and now be in a hospital bed somewhere. But, the chances of that being the case for a chronic alcoholic are slim to none. Usually, when they stop doing something that is inherently good - like calling their sponsor - they do it because they have relapsed.

It is very possible that he has not had a drink yet. By that I mean, he may very well have relapsed without yet taking that first drink. How does that happen?...It's the nature of the disease of addiction that a relapse does not happen simply by a person putting a drink of a drug into their bodies. Rather, a relapse happens when there is an interruption in a pattern of health that has helped maintain abstinence.

In that case, he has undoubtedly relapsed.

Classic relapse theory does not disappoint us when we study how it is that a person relapses on a drink or a drug. There are usually three reasons for a relapse: 1) that there is some critical life event that has taken place causing a negative emotional state (death of someone close, eviction), and this accounts for about 30% of the cases; 2) interpersonal conflict that accounts for about 15% of the cases; 3) social pressures that account for about 20% of the cases. The remaining 35% of the cases are attributable to a wide diversity of causes and one can easily imagine them.

In this young man's case I suggest it is probably the first condition that has caused this relapse...he is in some negative emotional state. This is probably brought on by a common occurrence with him: He has a tendency to take on an enormous number of projects that place a severe obligation on him, and, when he gets to a certain point of frustration and pain with them all, he drinks in order to reward himself for suffering through them. In other words, this man is so burdened by pressure to perform in so many different spheres - family, work, finances, and internal need for achievement - that he cracks at some point and needs the quick fix of instant pleasure that a cocktail will bring him. He is incapable at that point of reasoning to the downside of taking that cocktail and sees nothing but the relief of the short term pain.

So, he's relapsed...he has probably had a drink, but he has certainly not taken care of the essential processes he must go through daily in order to prevent drinking, and, therefore, has relapsed. What should be my response? This is the art of sponsorship. First, it would be wrong for me to call him. He needs to make that call to me when he is ready, either before he takes that first drink or shortly after it, because for me to call him first will only increase the amount of shame and guilt and further move him away from me. Second, when he does call (as they most often do when they regain their composure and can admit to the relapse) I need to accept him with positive regard and encouragement...something I may not be willing to muster right now because of my disappointment.

There is a lesson in this for all of us. We need to recognize that relapse back to an old habit or addiction starts with small and seemingly insignificant events (no phone call) and can bloom into a full-blown series of problems that take us right back to where we started. The secret to not having this happen is to do what we do when we consider fire prevention...we run fire drills. In this business, we need to run drills about high risk situations, negative emotional situations, interpersonal problems or social pressures to prepare ourselves for the inevitable relapse that will come if we don't succeed in working through them in a healthy way.

In this case, when he calls, we'll start all over again with a fire drill...and hope we never get to this point again.

All the best, Roger W.

A Useful Metaphor...

When I am trying to explain the power of the disease of addiction to one of my patients, I sometimes use an escalator as a metaphor to describe how relapse works in the lives of recovering people.

Have you ever tried to walk up a "down" escalator? Most of us have tried this when we were kids. There's a certain thrill as we run up the moving steps and try to beat the constant flow of stairs moving against us.

In every respect, this is like the disease of addiction.

An escalator going down can easily represent the disease of addiction: It is constantly moving and changing and going in only one direction...down. It is trying to take us from a high place to a low one. It is trying to use its considerable power to transport us, change us, from one condition (being someplace we might not want to be) to another place (someplace we think is better).

So too, the disease of addiction is pulling at a recovering person to change his or her place in recovery. The disease is going only in one direction...down...and its considerable energy will transport us from someplace where the disease does not want to be (in recovery) to another place (relapse). And, this energy pushing down is relentless, powerful and aggressive.

Now...what happens when you start walking up this down escalator? When you jump on you immediately recognize that you must either keep up with the downward pressure or move faster than it in order to not be dragged down to the bottom. So, most people find the pace of the escalator and climb with a steady gait. The trouble with this solution is that sooner or later you notice that you are not going anywhere, get bored or fatigued, and generally give in soon to the pressure and give up. There are adventurous souls who want to climb to the top by going faster than the speed of the stairs, and they begin their ascent. They run up the stairs by leaps and bounds, or they make steady headway with a pace faster than the escalator, and sooner or later, they end up at the top having beaten the system arranged against them.

So too with recovery. If you generally just try to keep pace with the forces of relapse that are arrayed against you, sooner or later you realize that this is boring, you get fatigued and give up to those pressures and let them drag you down. If your strategy after a period of time of trying to keep pace is to rest for a moment and stand still on the stairs, you soon notice that the pressure of relapse keeps moving you down...you cannot stand pat in your recovery. But, if your strategy is to move continuously forward in recovery, you will move at a pace that is faster than the forces that would bring you down and you will eventually beat out some of those forces by reaching the goal of serenity.

I mention this to people who seem to be stuck in recovery, or listless and drifting, or even those who want to take a break from the rigor of striving against the powerful relapse warning signs, triggers and high risk situations that are arrayed against them daily. It's not enough to just keep pace with these signs of relapse, and it's certainly not sufficient to stand pat for a while when just trying to gather yourself together enough to figure out what is going on. Regrettably, a recovering person must always be moving forward in their recovery lest the forces of relapse surrounding them take over their recovery pace and push them down into full-blown chaos again.

I think this metaphor is useful to describe the forces of any addiction that is working against a person's recovery. Whether it be alcohol or other drugs, food, sex, gambling, spending, hoarding, or any type of compulsive behavior, there are forces that can drag a person down and spur a relapse. The solution is to have a child-like approach to life and scramble forward at a pace greater than these forces.

So long as I follow that way I have nothing to fear.

All the best, Roger W.