Understanding Substance Use Relapse

adapted from material from Terence Gorski

Presented by Joan E. Huss; LIMHP, LADCAssociate Director of Clinical Services

Catholic Charities - JOURNEYS

Relapse is the progressive process of becoming so dysfunctional in recovery that self-medication with alcohol or drugs seems like a reasonable choice.

Definition: a reactivation of the symptoms of addiction after those symptoms have gone into remission◦ Irrational thoughts◦ Unmanageable feelings◦ Destructive behaviors

Principles of Relapse

In order to relapse, you first have to be in recovery ◦ Understand addiction◦ Apply knowledge to self ◦ Accept the painful feelings due to addiction◦ Stop using◦ Work a recovery program

Principles of Relapse

Relapse is a process not an event Relapse is unconscious and automatic

Either relapse or recovery Relapse is common and predictable Relapse is preventable

◦Rule of thirds Relapse stages are cumulative and progressive

Principles of Relapse

Sobriety vs. abstinenceBrain studies on relapseRole of choiceRole of motivationRole of will power and self-discipline

Hitting “rock bottom”

Discussion Points

1. Internal Change2. Denial3. Avoidance and Defensiveness4. Crisis Building5. Immobilization6. Confusion and over-reaction7. Depression8. Loss of Control9. Realization of Loss of Control10. Option Reduction

Ten stage relapse warning signs

Increased stress Change in thinking Change in feelings Change in behavior

Stage 1 Internal Change

Concern about well-beingDenial of the concern

Stage 2 Denial

Believing that I will never use againWorry about others instead of myself

DefensivenessCompulsive behaviorImpulsive behaviorTendencies towards loneliness

Stage 3 Avoidance and Defensiveness

Tunnel visionMinor depressionLoss of constructive planningPlans begin to fail

Stage 4Crisis Building

Daydreaming and wishful thinking

Feeling that nothing can be solved

Immature wish to be happy

Stage 5 Immobilization

Difficulty in thinking clearlyDifficulty in managing feelings and emotions

Difficulty in remembering thingsPeriods of confusionDifficulty managing stressIrritation with othersEasily angered

Stage 6Confusion and Overreaction

Irregular eating habitsLack of desire to take actionDifficulty sleeping restfullyLoss of daily structurePeriods of deep depression

Stage 7 Depression

Irregular attendance at recovery activities

I don’t care attitudeOpen rejection of helpDissatisfaction with lifeFeelings of powerlessness and helplessness

Stage 8 Behavioral loss of control

Self-pity. Thoughts of social drinking. Conscious lying. Complete loss of self-confidence.

Stage 9Recognition of Loss of Control

Unreasonable resentment. Discontinues all treatment activities Overwhelming loneliness, frustration, anger and tension.

Loss of behavioral control.

Stage 10Option Reduction

Initial use (the lapse). Shame and guilt. Helplessness and hopelessness. Complete loss of control. Bio-psycho-social damage.

Return to Use

Terence Gorski

GORSKI-CENAPS model http://www.tgorski.com

References