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Alcohol Relapse Prevention and the Three Stages of Relapse

Dr. Jeffrey Berman, MD By November 1, 2019
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Alcohol Relapse Prevention

A common misconception about relapse is that relapse captured in a single moment of weakness. However, this isn’t true at all. Relapse isn’t an event you can pinpoint; it’s a process, and you have to fully understand it to understand relapse prevention. Specific alcohol relapse prevention techniques have been developed over time to combat each of the three stages of relapse: emotional, mental and physical. We at the Discovery Institute want to help you navigate the three stages of relapse.

 The Three Stages of Relapse

Below we will be discussing the three stages of relapse. However, before we begin there are a few important things we need to understand regarding addiction before we go into detail on the topic of addiction. Many people associate guilt, moral failure, and shame with relapse. This only serves to increase relapse and decrease the chances of recovery. Hopefully, the following discussion will educate you and help you understand addiction better.

The Disease Model of Addiction

Before we can properly understand relapse, we need to better understand how addiction works. The thing about addiction is that many assume it is a choice. “Just stop,” or “you can quit anytime you want to,” are common phrases. This leads to the assumption that recovery is a sheer amount of willpower. This, unfortunately, is uneducated and harmful for individuals who are struggling with addiction. It also prevents individuals from developing a proper understanding of how relapse works and how to avoid it.

Our brains are wired by evolution to crave things that make us happy. The sweetest fruit was probably also the healthiest for our ancestors. Now, with the rise of chemical modifications, that is not always the case. Yet, our brains still think that whatever produces the best sensation is best. Thus, when we indulge in these substances they produce so much chemicals our brains can hardly keep up, and then we crash. This leads the user to become dependent. Their brains are literally rewired and recircuited so that our memory, pleasure, and motivation centers do not function the same as they did before. 

The dependent person no longer feels normal without the substance, be it alcohol or narcotics. This is why many (like the surgeon general) have been led to believe addiction is not a choice but a disorder. Furthermore, since recovery is a lifelong process; addiction is a chronic disorder. This deeply changes the way we view relapse. 

Just because addiction is a chronic disease does not change our solution for it. If a person has cancer, you suggest they go to the hospital. If someone has diabetes, they should probably modify their diet. In the same way, one should not feel ashamed of their disease. Instead, they should get treatment.  Viewing addiction as a moral failure only puts another block in the way of treatment (since only 10% of addicts receive the treatment they need). It is also more effective to use this language to avoid triggers. Triggers are something that are inherently linked with the three stages of relapse, and will be discussed further in the following segment.

What are Triggers, and What Do They Have to Do With Relapse?

Triggers are the moods, emotions, thoughts, people, and situations that potentially cause us to relapse. As previously stated, they come in many forms. Different triggers fall into the different stages of relapse. However, continuing with our discussion of the disease model, it is important to understand triggers in this way. Seen through the mindset of the choice model of addiction; triggers are simply tests of willpower. While there is some truth in this, we must recognize that there is an inherent difference in the way the disease model sees triggers. The idea that addiction is a choice would assert that triggers should be overcome like the rest of addiction, just by pushing through. However, if we acknowledge that addiction is a chronic illness, then we have a more defined view of triggers. 

The three stages of relapse are usually started with our triggers. These triggers remind our brains of our dependency, thus triggering our illness to flare up. This is a radically different concept than simply pushing through. It also helps us to give a more dynamic understanding of how to manage our triggers. This will be discussed more after we talk about the three stages of relapse. 

Emotional Relapse

During an emotional relapse, you’re not necessarily considering drinking again. However, the thoughts and feelings you experience in this stage of relapse may escalate into risky behaviors that jeopardize your progress in alcohol abuse recovery. Emotional relapse can be characterized by:

  • anxiety
  • anger
  • depression
  • frustration
  • irritability
  • mood swings
  • defensiveness
  • short-temperance
  • feelings of isolation
  • loneliness
  • fatigue
  • sleeplessness
  • changes in appetite

What to Do During an Emotional Relapse

Alcohol relapse prevention at the first stage requires acknowledging that your mood and behavior is changing. The best thing you can do is to take better care of yourself. By doing this, you can go on to practice successful methods of relapse prevention that might include:

  • eating a balanced, high-protein, low-sugar diet
  • getting regular exercise
  • getting a sufficient amount of sleep
  • attending support group meetings
  • surrounding yourself with supportive friends

This is a brief list, but it is possible to change our emotions using our thoughts. Since our thoughts precede our emotions, we need to rationally think the following: “I am being triggered by emotional stimulus, and I need to change my thoughts.” Perhaps you are recalling the good memories associated with addiction. It is also necessary at this part of the stages of relapse to remember the bad parts. In addition, if we are being triggered due to negative feelings of shame, depression, or anxiety; perhaps we should speak to a profession or loved one who can calm us down or comfort us in our time of need. This can be as simple as a friend from recovery, a spouse, or a family member you can trust. Failing to adjust your behavior in the event of emotional relapse will trigger the next stage: mental relapse.

Mental Relapse

A mental relapse, like an emotional relapse, does not mean that you’ve actually abandoned your sobriety. Rather, you’re thinking about it. Your mind is at war with itself at this stage. One part of you wants to pick up the bottle again, but the other part of you reminds you not to. Common indications of mental relapse include:

  • actively spending time with friends who still drink
  • constantly thinking about the people you drank with
  • constantly thinking about the places where you used to drink
  • fantasizing about drinking
  • romanticizing your past alcohol abuse
  • considering a purposeful relapse

What to Do During a Mental Relapse

If you’re putting serious thought into drinking again, you might be thinking, “just one drink won’t hurt.” But one drink usually leads to two, or three, or more.

If you find yourself having a mental relapse, tell someone about it. You can call a parent, a sibling, a friend, or someone from your support group or support system. Additionally, you can:

  • practice ways to quiet the mind, like meditation
  • pick up a new hobby, like writing, painting or music
  • find healthy ways to distract yourself, like reading a book
  • attend alcohol relapse prevention counseling sessions for advice
  • consult with your doctor to manage any potential disorders that may be influencing your recovery

One recommendation we have at the Discovery Institute for this stage of relapse is to engage in Cognitive Behavioral Therapy. The mental relapse is the stage of relapse mostly governed by thoughts; which is exactly what CBT specializes in. Alongside this, practices like Holistic Care are designed to give your mind peace, alongside your body. In this stage your mind is usually racing, and the thoughts are not your own. It is important to find a practice that centers you. You, the person, know that returning to alcohol will only cause problems. However, your brain is tricking you. That is why finding a practice that brings you back to your center of being will help you at this stage. Once you start considering drinking again, you could easily transition into a physical relapse if you don’t take any steps to address your urges.

Physical Relapse

The third and final stage of relapse is what most people think of; the conscious decision and act of drinking. Physical relapse is triggered when the early stages, emotional and mental relapse, go untreated. However, slipping up once or twice does not in any way invalidate your hard work to get sober. You can still get back on track in your personal alcohol relapse prevention plan.

What to Do After a Brief Physical Relapse

Pick up where you left off. Continue your plan and your self-care one day at a time. To avoid any future physical relapses, you should:

  • get regular exercise
  • find alternative or holistic means of managing stress, like yoga
  • cut ties with people who pressure you to drink
  • avoid places where you used to drink
  • never be afraid to ask for help

It is also important at this stage to reach out to a loved one. This person should be someone you trust who can support you in a way that helps, and does not hurt. If you have this person, they most likely are educated in how to handle an addiction. However, if you are a loved one, you may be at this page wondering what to do for someone who just relapsed. We at the Discovery Institute want to help you. We have an intervention guide that will equip you with what you need to get your loved one back on track.

How To Manage Your Triggers

Holistic Care

Holistic care focuses on treating the whole person, not only part of the illness. In regard to triggers, Holistic care can help with each of the stages of relapse. That is because (just like the stages) it focuses on the mind, the emotions, and the body. It uses alternative treatments like reiki and acupuncture and it suggests practices like meditation and yoga. Consider utilizing Holistic care in your stages of relapse.

Cognitive Behavioral Therapy

CBT focuses on our thoughts. It identifies our thought patterns and has a specialist work through the ways our life, emotions, and thought patterns may lead us to poor coping mechanisms. This can be extremely beneficial as a therapy that deals with the stages of relapse. In recovery, you will have to unlearn harmful coping mechanisms and relearn a lot of ideas regarding what to do in times of need. This is because we who struggle with addiction often use alcohol or other substances to cope. CBT wants to fix that.

Finding a Community

Recovery was never a road that was meant to be walked alone. If you are struggling with addiction, you need a community that knows you and can rally around you in times of need. This can be group therapy, AA, or any of the other programs we offer groups at the Discovery Institute. It is especially helpful to go on outings with these groups. If you are struggling with the stages of relapse, consider finding a community. 

Advice from Discovery Institute

Contrary to popular belief, relapsing is actually a normal part of addiction recovery and should not be considered a failure. It is merely a block on the road to recovery— not a dead end. Relapse should be read as an indication that your treatment needs to be adjusted. Again, the stages of relapse are simply part of dealing with a chronic disease. When an illness flares up, you do not beat yourself up; you see a doctor. It is very important that instead of wallowing you seek help immediately.

Contact Us

 It is never too late to start treatment. Whether this is your first relapse or your 100th, the road to recovery is waiting for you. We at the Discovery Institute want to help you with everything going on in your stages of relapse. We have specialists available all around the clock. If you or someone you know is currently struggling through the early stages of relapse, call Discovery Institute at (844) 433-1101.

References:

https://www.healthyhkec.org/SCE14/presentations/seminar-2-talk-3.pdf 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441185/ 

Article Reviewed by Dr. Jeffrey Berman, MD

Dr. Jeffrey Berman, MDDr. Jeffrey Berman is a psychiatrist in Teaneck, New Jersey and is affiliated with Robert Wood Johnson University Hospital. He received his medical degree from State University of New York Upstate Medical University and has been in practice for more than 20 years. He also speaks multiple languages, including French and Hebrew.

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