Researchers estimate that that 90% of those who recover from addictive behavior experience at least one relapse along the way. We can increase the odds in our favor through awareness of the warning signs, along with the process of examining the underlying beliefs.
In 1982, two researchers, Terence T. Gorski, and Marlene Miller, identified a set of warning signs that typically lead to relapse. Further research has validated these changes in attitudes and behaviors, and proven they are accurate predictors. As you read this list, realize these changes occur gradually. Recognizing them early in the cycle will allow you to see beneath the behaviors, and modify the beliefs that drive them.
- Change in attitude — Something isn’t quite right. You’re doing fine, but you notice recovery is not as important to you as it once was. You are drifting, and something is wrong, but you cannot identify a good reason for it. You are unsure of yourself, and your ability to overcome your addictive behavior.
- Elevated stress — It seems you have many problems in your life, and your stress level is rising. You tend to overreact to the stress or act impulsively. Watch carefully for mood swings and exaggerated positive or negative feelings.
- Denial — Not a recurrence of your old denial of addictive problems, this is a denial of the elevated levels of stress you are feeling. You do not manage the stress well because you are denying it in the first place. What is worse, you dismiss your worries and don’t talk about them with others. Denial of reality is always dangerous for addicts, especially in early recovery.
- Recurrence of withdrawal symptoms — Anxiety, depression, sleeplessness, and memory loss don’t necessarily stop a few days after we quit. Sometimes they can continue for months, and other times they disappear for a while only to reoccur in times of stress. These symptoms add to the stress we are already feeling, and of course, the danger is that we could decide to self-medicate these feelings with our drug of choice. Sometimes we make these feelings even worse by telling ourselves we “have been sober long enough that we shouldn’t be feeling like this.” This could lead directly to a feeling of “what’s the use, why am I bothering?”
- Behavior change — When you quit, you probably made changes in your daily routine to make it easier to replace your compulsive behaviors. Now you start deviating from your healthy routine and drifting back into your old behaviors. Instead of honestly evaluating your behavior, you either avoid or become defensive when someone calls it to your attention. You may begin to use poor judgment, and act without thinking things through.
- Social breakdown — You begin to feel uncomfortable around others, and you find yourself making excuses not to socialize. You stop hanging around with non-using friends, and you may withdraw from supportive family members. If support meetings are part of your program, you cut down the meetings or stop going altogether. You begin to isolate yourself. You may experience the fear of being found out and banished.
- Loss of structure — You begin to abandon the changes you made in your daily routine. You may sleep late, ignore personal hygiene, and stop eating regularly. The plans you do make do not work out, so you overreact and stop making constructive plans. You may focus on one small part of your life to the exclusion of everything else, and you may feel listless and depressed.
- Loss of judgment — you have trouble making decisions, and the ones you do make are unhealthy. You have difficulty managing your feelings and emotions. You stop using ABC’s, or any other method of changing your beliefs. Perhaps it’s hard to think clearly, and you confuse easily. You feel overwhelmed, and you anger easily. It may be hard for you to relax.
- Loss of control — You make irrational choices, and are unable to interrupt or alter those choices. You actively cut off or avoid people who can help you. You begin to think you can return to, and control your drug use. “This time will be different!” You lose confidence in your ability to manage your life, and you may begin to believe there is no hope.
- Loss of options — You stop attending all meetings, including those on-line and with therapists; and may stop taking any prescribed therapeutic drugs. You feel helpless and desperate. Feelings of loneliness, frustration, anger, resentment, and tension overwhelm you. You might start thinking how foolish you were to believe you could beat your addiction; and you cannot imagine life without the drug.
Not a pretty picture, but it’s not destiny either. You can stop the progression at any point along the line, by recognizing the symptoms and taking action.
A questionnaire, developed under a grant from the National Institute on Alcoholic Abuse and Alcoholism, is extremely accurate in predicting relapse. Called AWARE, for Advance WArning of RelapsE, it consists of 28 questions you can score yourself. If you suspect you may be on the road, you might want to try it. If you do try it, pay careful attention to the scoring on the individual questions, as not all score the same. The questionnaire is available here.
As important as it is to watch for the behavior changes above, it’s just as important to correct them when we recognize them. That should go without saying, but unfortunately, experience has shown it cannot. We are people who have lived most of our lives in denial, both of our true situation and of reality itself. Perhaps when we decided to quit, we looked back on our lives and believed we were just ignorant of what addiction had done to us.
If we examine the situation honestly, we must admit that what kept us in the dark for so many years was really closer to willful ignorance. In other words, we had plenty of clues; we just chose to ignore them. I know a man who once had all the symptoms of a heart attack: pain in the chest, arms numb, profuse sweating, nausea, gray complexion, and weakness. Instead of calling an ambulance, he lingered at home for nearly six hours before he finally let his wife take him to the hospital. I know all about the power of denial.
The best defense against relapse is to not start down the road in the first place. If we continue to practice the tools we select on a daily basis, dealing with our irrational beliefs as soon as we recognize them, we will never slip into the type of thinking that begins the process. The more we practice the tools, the more ingrained the program becomes. We begin to think, believe, and act like recovered addicts.