By David Fawcett PhD, LCSW
Slip. Lapse. Relapse. Each describes behavior that brings us out of integrity with our stated goals of recovery. While not inevitable, slipping and relapsing can be expected for a significant portion of recovering addicts, especially early on. That said, slips and relapse are emotionally and physically painful, and, tragically, sometimes fatal.
A relapse may appear to emerge from nowhere, but its roots lie in patterns that are long-evident, described as relapse mode.
The constellation of warning signs for “relapse mode” varies from individual to individual, but stress is a universal component. Living stress-free is unrealistic, but managing stress well is achievable.
While levels of stress tolerance may vary greatly depending on life events, it is important to know our baseline stress profile. When we are under high stress, our capacity to manage our reactions is diminished, requiring that we move closer to our recovery groups. It is important to monitor any change in our “normal” baseline stress level, which can serve as an early warning indicator of relapse mode.
Most of us are familiar with our own most-common physical reactions to stress, and in relapse mode these will escalate. Sleep may be disrupted, and appetites (including sexual desire) may fluctuate wildly. Tension may course through the body resulting in stiffness and discomfort. Other stress reactions may occur, including shortness of breath, gastrointestinal issues, racing pulse, headaches, and even suddenly becoming drowsy.
Negative emotions in relapse mode are also nearly universal. These include anxiety, which may take the form of a generalized dread for which no specific triggering concern or fear can be identified. Additionally, our tolerance for annoyance may shrink and we may begin to react more harshly and with irritability. Depressive symptoms are also common in this state, with classic symptoms like extreme disruptions in mood, appetite, or sleep, as well as an inability to experience pleasure. This last symptom is especially likely in the early months of recovery when the dopamine system is under repair. This is especially true for stimulant and sex addicts.
In relapse mode we also tend to disconnect from others. Our connections with others are vital to our sobriety because they create the accountability necessary for living in integrity. For example, if our meeting attendance becomes inconsistent and people stop expecting us, we become less accountable for our whereabouts and behavior, creating an opportunity for relapse.
We may also begin to disconnect internally. Strong feelings of shame, self-judgment, and even self-hatred can be triggered, resulting in a desire to dissociate by fantasizing or numbing. Thus, we lose touch with our goals, our values, and our selves.
Finally, negative thinking is a hallmark of relapse mode. This may be evident in critical self-talk filling our ears, reminding us of old negative beliefs about ourselves. Such thinking may result in us keeping secrets, sometimes to avoid being judged or shamed, and sometimes to set the stage for slips and relapse. Secrets undermine transparency, which is essential for our recovery and integrity. We may also start to rationalize as a way to justify bad behavior, claiming an accumulation of problems or special circumstances that somehow make relapse a reasonable choice.
It is important to remember that when we are in this headspace it is very difficult to break out of that bubble and get an objective perspective. That is exactly when we need feedback from the people who know us best. When we are in relapse mode, it will probably be evident to those around us even before we realize it ourselves.
Two primary tools can be utilized to monitor ourselves for relapse mode and to catch it before it progresses too far and relapse becomes inevitable. The first is self-awareness, which doesn’t concern observing our behaviors alone. It also includes an awareness of our inner lives – the ability to notice what is happening emotionally and physically and take steps to regain balance. Any changes should be noted and intervened upon.
The second tool is to maintain a robust social network. The negative thinking patterns characteristic of relapse mode can diminish our responsiveness to any alternative except ultimately relapsing. Social connection is essential to counteract this distortion. We need other people to reflect back to us what they are observing, and we need to be able to hear and internalize this feedback from them.
While there should be no shame in relapse, every person in recovery wants to avoid it. Once in relapse mode, the sooner we can let go of our pride and ask for help, the better off we’ll be.