Relapsers need to identify the problems that caused relapse. The goal is to write a list of personal warning signs that lead them from stable recovery back to chemical use. There is seldom just one warning sign. Usually a series of warning signs build one on the other to create relapse. It’s the cumulative affect that wears them down. The final warning sign is simply the straw that breaks the camel’s back. Unfortunately many of relapsers think it’s the last warning sign that caused the relapse back to Alcohol and Drugs. As a result they don’t look for the earlier and more subtle warning signs that set the stage for the final disaster.
When Jake first came into relapse prevention therapy he thought that he was crazy. “I can’t understand it,” he told his counselor, “Everything was going fine and suddenly, for no reason at all I started to overreact to things. I’d get confused, make stupid mistakes and then not know what to do to fix it. I got so stressed out that I got drunk over it.”
Jake, like most relapsers, didn’t know what his early relapse warning signs were and as a result, he didn’t recognize the problems until it was too late. A number of procedures are used to help recovering people identify the early warning signs relapse.
Most people start by reviewing and discussing The Phases and Warning Signs of Relapse (available from Independence Press, www.relapse.org). This warning sign list describes the typical sequence of problems that lead from stable recovery to alcohol and drug use. By reading and discussing these warning signs, addicts/alcoholics that have not been able to stop relapsing will learn and develop a new way of thinking about the things that happened during past periods of abstinence that set them up to use. They learn new words with which to describe their past experiences.
After reading the warning signs they develop an initial warning sign list by selecting five of the warning signs that they can identify with. These warning signs become a starting point for warning sign analysis. Since most relapsers don’t know what their warning signs are they need to be guided through a process that will uncover them. The relapser is asked to take each of the five warning signs and tell a story about a time when they experienced that warning sign in the past while sober. They tell these stories both to their therapist and to their therapy group. The goal is to look for hidden warning signs that are reflected in the story.
Jake, for example, identified with the warning sign “Tendency toward loneliness.” He told a story about a time when he was sober and all alone in the house because his wife had left with the children. “I felt so lonely and abandoned, he said. I couldn’t understand why she would walk out just because we had a fight. She should be able to handle it better than she does.”
The group began asking him questions and it turned out that Jake had frequent arguments with his wife that were caused by his grouchiness because of problems on the job. It turned out that these family arguments were a critical warning sign that occurred before most relapses. Jake had never considered his marriage to be a problem, and as a result never thought of getting marriage counseling.
Jake had now identified three warning signs: (1) the need to drink in order to feel like he belonged, (2) the need to drink in order to cope with stress, and (3) the need to drink in order to cope with marital problems. In order to be effectively managed each of these warning would need to be further clarified.
The next Gorski Blog on the Challenges Website (https://challenges-program.com/) will review each of these nine steps in more detail. By Terence Gorski, Director of Relapse Prevention Service, Challenges, F. Lauderdale, FL © Terence T. Gorski 2009
Remember, Challenges in the only drug treatment center in the country where Terry
Gorski personally supervises the relapse prevention plans of all clients. (https://challenges-program.com/)