The blog

Is Relapse Preventable?

In the 25 years that I have been working as an addiction professional in his field, I am always interested in one thing, ” How did the relapse happen?”

Typically, my client will explain their relapse in this way,

” I don’t know how it happened, all of a sudden I was around my drug of choice and I took it. The relapse happened so quick I couldn’t stop it. I thought I could handle it this time, as I have been sober for 3 months.”

Well when I hear this from my client, I immediately think that the client has not taken responsibility for their own health and has turned the concept of being powerless into the idea that I have no control over my relapse, so they give in to the craving and use the substance.

The next step is to perform a relapse autopsy.

I have the client go through the exact steps that happened. The client explains in great detail all their behaviours and decisions that lead them to the place where their drug of choice was present.

This accomplishes three very important things for the client once they understand the process.

1. The client realizes that had made conscious decisions to put themselves in these situations.
2. The client usually stops working their own recovery program which has kept them sober or clean up until this time.
3. The client has the power to stop the relapse and intervene on themselves in a high risk situation before they take their drug of choice.

My experience in conducting these relapse autopsy’s has lead me to one overall flaw in their recovery.

They fail to protect their recovery at all costs.

So then we put together a high risk strategy that outlines the exact steps when they find themselves around their drug of choice, either by choice or unintentionally.

Usually the resistance is that they explain they can’t live in a bubble and not be around their drug of choice for ever. I agree, but that does not mean they give in to the craving, but rather work their recovery plan in those situations so they do not use.

My question to you is , “Do you have a recovery plan that will work in a high risk situation, or are you flying by the seat of your pants and hoping for the best outcome?”

You should outline or have your clients outline their high risk situation recovery plans.

In my experience, relapse is preventable with the proper plan in place and commitment to cope with the craving.

What is a Craving?

When I am in session, usually early on in the clients’ treatment, we always end up discussing cravings.

The two most common themes from my clients is, “ I don’t have cravings, I am stronger than that” and “I have no idea what a craving looks like”

If you are in recovery and are reading this, most likely you have experienced cravings and may not know it.

Let me explain.

Perhaps the best text I have read that explains a craving comes from the text book The Human Brain, p 128., by Rita Carter, DK Publishing 2009, New York, New York.

In the above text book the craving is explained in a 6 stage model. The model is based on the Stimulus and Reward function within the brain.

  1. A stimulus is registered by the brain, which can originate outside the body, i.e., sight, smell or touch.
  2. It is registered in the limbic system as an urge.
  3. Then the urge is registered as a desire in the cortex so the body can act.
  4. Then the cortex ask for an action, usually to use the substance to achieve the desire.
  5. The using creates the reward within the limbic system through opioid like neurotransmitters released in the brain.
  6. This raises dopamine levels and a feeling of satisfaction.

So in easy terms, the person will see their drug or something that reminds them of their drug, the brain says use it because a reward is coming, and then they use and receive the reward, or the effect of the drug. They become satisfied. This cycle continues on forever and is the basis of addiction. Active addicts and alcoholics give in to their cravings constantly and go deeper into addiction.

So how does this impact recovery?

Simple, if your addicted, you will receive stimulus that starts a craving or urge, because it is a normal function of the brain.

The first point I want to make is that having a craving has nothing to do with your strength, your willpower or the quality of your recovery. I have had countless clients believe that if they experienced a craving then something was fundamentally wrong with their recovery efforts.

This couldn’t be further from the truth. The fact is, if you are addicted to a substance or are an alcoholic, you will experience cravings no matter how hard you work in recovery or how may sessions you attend or meetings you go to.

What to do when a craving occurs?

  1. The most important thing to realize, is that cravings are a normal part of recovery.
  2. You do not have to give in to the craving, no matter how strong the urge.
  3. You need to acknowledge that you have a craving and tell yourself, its ok it will pass.
  4. All cravings pass, sometimes quickly, sometimes slowly.
  5. When you experience a craving, engage in a healthy recovery behavior, I.e, talk to someone, remove yourself from the stimulus, read, journal, exercise or seek support somewhere.
  6. Above all, realize that you are having a craving and are in control of yourself and can overcome this.

As you successfully deal with cravings, they become easier to recognize and lose their strength over time.