Tuesday, February 9, 2010

The Relapse Cycle

Phase 0: Core Attitudes/Beliefs
Phase I: The remission phase (life is good)
Phase II: Intense stress phase (stress is rising)
Phase III: Negative mood phase (acting out on stress)
Phase IV: Pre-relapse phase (setting up self/others)
Phase V: Destructive behavior phase (actual relapse)
Phase VI: Rewards phase (what you got from use)
Phase VII: Conscience phase (guilt)
Phase VIII: Defense Mechanisms (cover up feelings)

In treatment we were shown a video by Terrence Gorski about the relapse cycle that many people with addiction fall into. Mr. Gorski stated that mistaken beliefs about this cycle create massive discrimination against relapse-prone addicts. When he said that, a flood of tears began to fall from my eyes. I realized that someone understood what had been happening to me and I figured if someone understood then someone could help me find my way out of it.

I saw this video the last weekend I was in treatment, in other words I almost missed the damned thing after being there for six weeks.

Mr. Gorski has determined that relapse is the process of becoming dysfunctional in sobriety and using or drinking is usually the end phase of the process rather than the beginning. Mental disorders and moderate to severe Post Acute Withdrawal contribute to relapse susceptibility. Of the people who enter treatment 1/3 stay permanently sober (this is much higher than 10-15 years ago), 1/3 will have periodic relapse before attaining long-term sobriety and 1/3 will be relapse-prone, meaning they will continually be challenged by relapse potential. I am, unfortunately or not, one of the final third. It's estimated that addicts that enter treatment have an average of 60-75% moderate to severe brain dysfunction which will drastically improve with continued abstinence. When I have days like I've had yesterday and today I continually remind myself of both PAWS and the improvement with abstinence factor.
Basically what happens (and I can't tell you how many times it's happened to me) is that you're going along in phase I, things are going well, you've been feeling better physically and mentally, making all treatment activities, etc., and something throws a kink in the system. Something causes an undue amount of stress that is then denied unconsciously. The unconscious denial activates the brain dysfunction which eventually becomes external dysfunction. This has commonly been known as being on a "dry drunk", BUD (building up to drink), neurotoxicity, alcoholic fog and protacted withdrawal.

Phase II is the best point to nip the process in the bud. You'll know you're entering Phase II when appointments or meetings are missed (not consciously), defense mechanisms are activated, depression or anxiety becomes uncomfortable, a physical illness sets in or you just begin to feel not quite right in your recovery.

Phase III will be punctuated by arguments with spouse/friends/employer, sleep dysfunction, lack of ability to concentrate, hanging out in slippery places and consciously not participating in recovery activities.

In Phase IV things are getting really dangerous as preparation is made for use. This phase is highlighted by fantasy, selection of drug and place to use and dishonesty with others, ususally by omission, about plans to use.
There's a common term for Phase V in recovery circles - it's called the fuck-it switch, when we finally reach the point where use actually seems like a good idea. Oftentimes we are so dysfunctional by now that suicidal thoughts are common and life feels pretty hopeless. It's important to remember that it's not - it's a phase and when we get here it's time to reach out for that helping hand and recommit to our recovery.


Anonymous said...

It really helps to understand what's going on behind the scenes, doesn't it? Well, I don't know about you, but I find analytical breakdowns like this one very helpful. Like when my Jungian analyst taught me how to recognize when a complex had been triggered. I learned to wait until I was no longer "complexed" before speaking or making any decisions.

Laura Wright said...
This comment has been removed by the author.
Laura Wright said...

The relapse cycle is viscous! I was just reading about halfway house owners and treatment center owners are actually aiding in the relapse process!! Drug Treatment Abuse