The steps to a relapse are actually changes in attitudes, feelings and behaviors that gradually lead to the final step, picking up a drink or a drug.
Attitudes, Feelings and BehaviorsIn 1982, researchers Terence T. Gorski and Merlene Miller identified a set of warning signs or steps that typically lead up to a relapse. Over the years, additional research has confirmed that the steps described in the Gorski and Miller study are "reliable and valid" predictors of alcohol and drug relapses.
If you are trying to obtain long-term sobriety and avoid having a relapse along the way, it is important to recognize the following warning signs and take action to keep them from progressing into a full-blown relapse.
11 Steps to a RelapseChange in Attitude - For some reason you decide that participating in your recovery program is just not as important as it was. You may begin to return to what some call "stinking thinking" or unhealthy or addictive thinking. Basically, you are not working your program as you did previously. You feel something is wrong, but can't identify exactly what it is.
Elevated Stress - An increase in stress in your life can be due to a major change in circumstances or just little things building up. Returning to the "real world" after a stint in residential treatment can present many stressful situations. The danger is if you begin over-reacting to those situations. Be careful if you begin to have mood swings and exaggerated positive or negative feelings.
Reactivation of Denial - This is not denial that you have a drug or alcohol problem, it's denial that the stress is getting to you. You try to convince yourself that everything is OK, but it's not. You may be scared or worried, but you dismiss those feelings and you stop sharing those feelings with others. This is dangerous because this denial is very similar to denial of drug addiction or abuse.
Recurrence of Postacute Withdrawal Symptoms - Anxiety, depression, sleeplessness and memory loss can continue long after you quit drinking or doing drugs. Known as postacute withdrawal symptoms these symptoms can return during times of stress. They are dangerous because you may be tempted to self-medicate them with alcohol or drugs.
Behavior Change - You may begin to change the daily routine that you developed in early sobriety that helped you replace your compulsive behaviors with healthy alternatives. You might begin to practice avoidance or become defensive in situations that call for an honest evaluation of your behavior. You could begin using poor judgment and causing yourself problems due to impulsive behavior without thinking things through.
Social Breakdown - You may begin feeling uncomfortable around others and making excuses not to socialize. You stop hanging around sober friends or you withdraw from family members. You stop going to your support group meetings or you cut way back on the number of meetings you attend. You begin to isolate yourself.
Loss of Structure - You begin to completely abandon the daily routine or schedule that you developed in early sobriety. You may begin sleeping late, or ignoring personal hygiene or skipping meals. You stop making constructive plans and when the plans you do make don't work out, you overreact. You begin focusing on one small part of life to the exclusion of everything else.
Loss of Judgment - You begin to have trouble making decisions or you make unhealthy decisions. You may experience difficulty in managing your feelings and emotions. It may be hard to think clearly and you become confused easily. You may feel overwhelmed for no apparent reason or not being able to relax. You may become annoyed or angry easily.
Loss of Control - You make irrational choices and are unable to interrupt or alter those choices. You begin to actively cut off people who can help you. You begin to think that you can return to social drinking and recreational drug use and you can control it. You may begin to believe there is no hope. You lose confidence in your ability to manage your life.
Loss of Options - You begin to limit your options. You stop attending all meetings with counselors and your support groups and discontinue any pharmacotherapy treatments. You may feel loneliness, frustration, anger, resentment and tension. You might feel helpless and desperate. You come to believe that there are only three ways out: insanity, suicide, or self-medication with alcohol or drugs.
Relapse - You attempt controlled, "social" or short-term alcohol or drug use, but you are disappointed at the results and immediately experience shame and guilt. You quickly lose control and your alcohol and drug use spirals further out of control. This causes you increasing problems with relationships, jobs, money, mental and physical health. You need help getting sober again.
Relapse Is PreventableRelapse following treatment for drug and alcohol addiction is common and predictable, but it is also preventable. Knowing the warning signs and steps that lead up to a relapse can help you make healthy choices and take alternative action.
If a relapse does happen, it is not the end of the world. If it happens, it is important that you get back up, dust yourself off and get back on the path to recovery.
National Institute on Drug Abuse. "Principles of Drug Addiction Treatment: A Research Based Guide." Revised 2007.
National Institute on Drug Abuse. "An Individual Drug Counseling Approach to Treat Cocaine Addiction: The Collaborative Cocaine Treatment Study Model." Accessed May 2009.
Miller, WR, et al. "A Simple Scale of Gorski's Warning Signs for Relapse." Journal of Studies on Alcohol. 1 September 2000.