Everything that I have learned about relapse over the last 18 years of dealing with my addicted son and those that his addiction have led me to can be summed up in a single statement.
If the addict is going to relapse, there is not much anyone but the addict can do about it. But please read on, it is not quite that simple.
That is not to say that others close to the addict should not, or cannot, be aware of changes in attitudes and behaviors throughout the relapse process leading up to the beginning of a new cycle of use. Those close to the addict should attempt to be acutely aware of those tell-tale signs, and make every effort to encourage their addict to get back to the tools that they have found to effectively help them in their sobriety, such as avoiding “triggers” (people, places and things), attending and participating in meetings, working with a sponsor, 12-step programs, etc. This “encouragement”, be it positive or negative, should take every form, short of violence or the threat of violence, anything within practical reason, including any consequences that might help in blocking the relapse. However, it is the addict that must make the decision, and the addict that must do the work. Just as it was only the addict that could first choose to be clean and sober, it is now only the addict that can choose to remain clean and sober.
So, what if, after all efforts, they choose to go back to active use? Consequences, consequences, consequences—this is where those close to the addict must “turn up the heat”. Reasoning with them, bargaining, rewards—that is all wishful thinking. Addiction has never been known to respond to a soft approach. On the contrary, the soft approach will generally only lead to manipulation by the addict, conveying to them the message that they can get away with unacceptable behaviors. In other words, the soft approach is, in effect, just another form of enabling.
I have been privileged over the years to view a number of times a video on relapse by Dr. David Ohlmes, the noted psychiatrist from St. Louis specializing in addictions. It is from that excellent video that I have learned the most about the relapse process in addiction. I will attempt to summarize Dr. Ohlmes messages on relapse, as I understand them, and then add some observations of my own.
Importantly, in order to relapse one must first be in recovery, and abstinence does not equal recovery. Abstinence plus change equals recovery. In other words, just not using or just not drinking is not enough for an addict to be considered in recovery. In addition to abstinence, a person in recovery has made or is in the process of making important changes in their lives relative to people, places and things, and applying the tools of recovery mentioned above.
In his video, Dr. Ohlmes sites the three apparent most common causes of relapse, overconfidence, resentments and cross-dependency. Overconfidence leads the recovering addict to believe that they have beat their addiction, and no longer need to continue to use the tools mentioned above that they have used previously to remain clean and sober, thus leading to relapse. Resentments come in two varieties, reasonable and unreasonable, and the recovering addict must learn to properly differentiate between them and appropriately deal with or let go of them in order to maintain their sobriety. Cross-dependency encompasses the concept that once addicted to a mood or mind-altering substance, one is automatically addicted to all mood and mind-altering substances, and must learn to carefully guard against ingesting any of them in any form, whether it be medications, dental health products or whatever.
The highlight of the video is Dr. Ohlmes explanation of his view of the underlying cause of relapse that leads up to the addict falling into the traps provided by the three causes sited previously. He emphasizes that the addict who relapses is the addict who loses conscious touch with the memory of the pain of their addiction. That is to say that the relapse process begins when the addict can no longer remember how bad it felt when they were at their bottom. Of course, the best way to restore that memory is for the addict who is drifting away from their sobriety to get away from the triggers, to get back to their meetings, to get back in touch with their sponsor, to get back to their 12-setp program, etc. Or conversely, the addict in recovery with the highest likelihood of maintaining a clean and sober life style and accumulating significant clean time is the addict that most effectively remembers the pain of their addiction through the diligent use of their tools of recovery.
I will never forget the first time that I saw Dr. Ohlmes relapse video some years ago. Toward the end when he was explaining his underlying cause theory, a light went on. It occurred to me in an instant that this is the same reasoning that affects those of us who enable those addicts who are close to us. We also fight a disease-- the disease of co-dependency--a disease that causes enabling behaviors that we must accept, just as the drug addict or alcoholic must accept their disease of addiction, and take the proper steps to control each day. Knowing that I had a son that was definitely addicted, it was then and there that I decided to continue to educate myself relative to addiction and how to deal with it.
That decision has proved to be a Godsend for me. I have continued to regularly attend and participate in support groups and meetings, talking with many newcomers to and veterans of what are, in effect, our AA or NA meetings. We strive to stay in touch with the memory of the pain of our addiction—co-dependency. So, I suppose that our groups and meetings could be termed CDA.
Ed A.
"If the addict is going to relapse, there is not much anyone but the addict can do about it. But please read on, it is not quite that simple." -Ed A.
When a relapse seems imminent.
There seems to be two basic categories for parents when they feel that a relapse for their teen is around the corner. Which category do you fit in?
One approach can be described as the "It's up to him now. He has to decide what he wants." In this approach, the parent does not deny that there are signs. Backing off of meetings, no calling sponsor, hanging out with old friends, having a chip on the shoulder day in and day out, feeling like you are starting to walk on egg shells around the teen again, seeing a lack of gratitude, noticing a strong sense of entitlement, overconfidence, the teen talking about how the treatment program they are in is "holding me back, " acting like a victim, talking about how the 12-step meetings don't help anymore, not taking suggestions and countless other signs are apparent. However, the parent has decided that the teen has to make their own decisions, that we can't work their program for them, and that they might even need to learn from a relapse. Often the belief is strong in the parents that "relapse is part of recovery."
The second approach is the category of "I'm not going to wait until you pick up to take action." In this second category, the parent believes that while they do not have the power to make their teen want recovery, they do have a responsibility to send action-based messages to their teenager that not working a strong recovery program is unacceptable. Just how the parent chooses to send this messages will vary depending on the circumstances. For example, does the teenager live at home or is he in an institution or half way house? If the teen lives at home, the powers of the parent are stronger. However, is the teen lives in an institution or half way house, then the parent can involve the staff of such places in the action-based message sending. In fact, involving the staff from whatever program is an action that can help send the message.
Let's examine more closely the action-based messages that you might send to your teen who still lives at home. Consider everything that your teenager does that requires a certain amount of trust. Driving a car. Getting to meetings on his own. Being on the phone with whomever and whenever. Managing his own money. Having his own mobile phone. Having a door or having a lock on his bedroom door. Having unsupervised access to an Internet connection. These are some ideas that can be used but there are no doubt many other good ones that you can think of because you know your child.
But how do you explain to your teen that you are restricting him from privileges because of a relapse that has not yet happened? Easy. It's about trust. If you don't trust him anymore then tell him that. Don't feel that you have to keep it a secret. You don't. Just tell him that you wish you had more trust; that you hope to have more trust soon, but that right now you are having a problem trusting him. This make it something that you as a parent "own." You aren't blaming him exactly although it is all related to what he is and to what he is not doing. The bottom is that you DO NOT FEEL COMFORTABLE letting him drive (for example.) No one can argue with you when you stake out your position based on something that you feel. It is your feeling- but the trick is to go with it.
You are powerless to create in your teen a willingness or a desire to recover. However, you are not powerless as far as sending action-based messages. The rule of thumb to follow is this one: doing something to send an action-based message is better than doing nothing. And generally, it will do one thing for you right away. You will feel better right away. You will feel better because you are not doing nothing. Doing nothing creates extreme anxiety. Doing something helps ease the pressure.
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