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.

PAWS - It's not your kitty's foot

Post Acute Withdrawal Syndrome is the period of time after acute withdrawal from alcohol or drugs. Acute withdrawal occurs within 3-10 days while post acute withdrawal can last anywhere from 3 months to 2 years and some forms may even cause permanent, if intermittent, symptoms.

Terrence Gorski was the first to coin the term and identity the syndrome. Mr. Gorski is a pioneer in the field of addiction and especially relapse prevention. Studies now show that it takes a minimum of one year for the brain to heal from addiction and often much longer.

The symptoms of post acute withdrawal can include any or all of the following:

Inability to think clearly which includes an inability to concentrate, an inability to solve problems and rigid, repetitive thinking.

Memory problems.

Emotional overreaction or numbness.

Sleep disturbances.

Difficulty in managing stress and day-to-day life circumstances.

Depression.

Anxiety.

The major challenge for a person newly recovering is discovering how many of these symptoms will go away with continued abstinence and how many may be due to co-occurring disorders such as anxiety and depression.

The amount of stress encountered in early sobriety directly affects how severe a person’s symptoms will be. That’s why it’s so important in the first couple of years of sobriety to keep stress levels at a minimum and do everything we can to take good care of ourselves – mentally and physically. This is also why it’s advised to stay away from certain people, places and things in early recovery and why it helps so much to be around people who understand addiction and recovery from it.

When I got sober in 1988, PAWS was not known about, but I certainly suffered from it and would’ve been helped at the time by a better understanding of what was happening with me. For the first two years of my sobriety I had all of the above symptoms and most of the time felt like I was going nuts. At two years, I finally sought help for what had become debilitating depression and anxiety and was placed on medication that, along with continued abstinence, brought a lot of relief.

I’ve come to believe that my history of chronic relapse has been in great part due to untreated PAWS and I’m grateful for the work that Mr. Gorski has done in this field.

Now that we know what it is, how do we deal with it? Not surprisingly, the things that help PAWS are those same good lifestyle habits that reinforce sobriety and a life worth living. They include:

Good nutrition.

Exercise.

Relaxation.

Interpersonal coping skills.

Talking it out – therapy or group support.

Writing it out – journaling.

If the symptoms make it extremely difficult to maintain sobriety or to maintain a normal daily life, medication may be necessary and you should, of course, consult with an addiction professional.

It’s fortunate that we now know the biological causes of post acute withdrawal and don’t have to be strapped with labels like “dry drunk”. I believe my PAWS was worsened by the guilt I felt that I wasn’t working the program properly, that my character defects were unchecked and that I didn’t have enough conscious contact with my higher power. The truth is, guilt on top of PAWS will only exacerbate the problem.

Today I know that my daily program must include good nutrition, exercise and relaxation and that I should try and keep my stress levels to a minimum. Next I’m going to write about the Relapse Cycle as Terrence Gorski describes it and talk about how I think PAWS kept me going through that damned thing over and over again.

The Foundation

While I was in treatment I had lots of time to think about the things that continually trip me up in my quest for sobriety. I targeted PAWS (Post Acute Withdrawal Syndrome), depression/anxiety, lack of assertiveness and ability to effectively deal with daily problems and an ambiguousness when it comes to defining the illness. What I mean by that is that I fluctuate between thinking/believing it's a disease over which I have no control except abstinence and thinking/believing it's something that with enough personal, psychological and/or spiritual growth, I can overcome, meaning in my mind that I will be able to drink normally.

They talk about this very thing in the Big Book of Alcoholics Anonymous when they say that the great illusion of all alcoholics is that they will someday be able to drink like normal people. Many, they say, pursue this illusion to the gates of insanity and even death.

The first time I went through treatment, in 1988, I was taught about the disease concept and it made a lot of sense to me at the time. I held on to that belief during all the six years I was sober, but after I relapsed I wanted to think there was a way I could drink. I just wanted to be like other people; I just wanted to be able to take it or leave it, but I never could. And because the drug had re-entered my system, the insanity of the addiction returned. I spent many years trying to find a loophole - maybe if I do this drug and just don't drink, it'll be okay; maybe if I only drink wine with dinner it will be okay; maybe if I just ignore it it will go away or if I read just the right book or pray just the right prayer. . .

I can't do any of it because it's a disease that causes my body to react differently to alcohol and drugs than "normal" people's bodies do. It's not caused by a psychological or spiritual condition, it creates psychological and spiritual problems. I got a double whammy with having clinical depression/anxiety along with alcoholism and they will both need to be treated for me to live a whole and fulfilling life.

So the foundation of my recovery is accepting that alcoholism is a disease and that I have it. It's accepting that I can't drink or use no matter what if I want to live. It's accepting that the majority of people in the world will still think it's a character weakness and there's not a damn thing I can do about that. It's also being grateful that I've made it this far and that I still have a chance. It's being grateful that maybe my story will stop someone else from making the same horrible mistakes that I've made. It's realizing that I still have time to put this disease into remission and keep it that way.

I think it's a good foundation. Tomorrow I will write about PAWS which I believe made it very difficult for me to get out of the relapse cycle. I underestimated its power; I underestimated a lot of things about this disease.