- Mental Health
Alcoholic Recovery. Is Relapse Necessary?
It is the rare alcoholic indeed who is able to put the plug in the jug and leave it there permanently.
So why do people relapse? And more important, what can you do to keep from relapsing?
The Sickness/The Medicine
The first thing to understand is that alcoholism is an illness.The alcoholic is a sick person, although he typically doesn't know that. He treats his illness by drinking, because drinking makes him feel better.
Alcohol is his medicine.
For the alcoholic, being drunk is the natural, "treated" condition. To not drink is to be ill, uncomfortable, shaky, crazy -- and possibly dead.
Of course, the opposite is also true. Continuing to drink alcoholically will lead to premature death.
I know it sounds bizarre. It definitely is bizarre.
Obsession of the Mind/Allergy of the Body
The difference between alcoholics and so-called "normies" (normal drinkers) is that alcoholics react to alcohol physically and mentally in an abnormal way.
Normal drinkers do not spend their waking hours plotting how/when/where they will get their next drink. That's the mental obsession part of alcoholism.
Normal drinkers may pour vast quantities of alcohol down their throats. It's possible to be a "heavy" drinker without being an alcoholic. But alcoholics' livers actually process alcohol in a different way. Besides the mental obsession there is a parallel physical craving/rejection mechanism at work here, also.
When an alcoholic is, as they say, "in his disease" he suffers from this combination of obsession of the mind and allergy of the body. To put it in layman's terms, where once he used to "live to drink" he now "drinks to live."
A Gross Analogy
For the alcoholic, trying to resist the urge to drink with sheer willpower is like taking a laxative and trying not to shit.
Before I go any further I will say this: NOBODY had better DARE to write in the comments that alcoholics are weak-willed. Do not presume to tell me that quitting drinking is a simple matter of fortitude.
There are some budding alcoholics who are able to"catch" their disease before it takes complete control. For the full-blown alcoholic, the brain and the body conspire to keep him drinking. As miserable as drinking makes him, he loses the choice to pick up or not. Drinking is an imperative commanded by a body and a brain over which he has lost control.
Stopping and Staying Stopped
Having said all that, it is possible to quit drinking. Alcoholics do it every day -- in jails/prisons, in rehabs, in churches, in AA meetings, and yes, even on their own.
There is a broad spectrum here. Some people (the lucky ones) are able to withdraw from alcohol with a mimimum of physical pain. For others, the physical detox is hell.
But once the demon/medicine alcohol is out of the physical equation, then what?
The real work of removing it from the mental equation begins. It's time to get to work keeping that old "obsession of the mind" at bay.
This is where you'll hear many alcoholics tell you, "I have no trouble stopping. I've stopped more times than I can count.I just can't stay stopped."
Sobriety Takes Work
A sober alcoholic is often referred to as being "on the wagon." If he relapses, he's said to have "fallen off the wagon."
I personally do not like this analogy. It implies that sobriety is a vehicle moving forward of its own accord, and all the drinker needs to do is "hop on and hold on" so as to not "fall off." That is a bit too simplistic in my view.
It's true that recovery from alcoholism (and addiction) is a journey. The road is steeply uphill in some places (especially early on, but also many times in later sobriety, as life challenges inevitably pop up). It is flat in some places, but still requires effort to keep moving forward. And it actually has small dips, where you can feel the happy breeze of serenity in your face.
The key points here are:
1. In sobriety you are not on the wagon. You are the horse pulling your recovery like a wagon behind you.
2. Getting the alcohol out of your system is not the crest of the hill. It is not a downhill ride from there.Oh no! If you treat it that way, and try to coast on the physical freedom from alcohol, that old wagon's gonna come down and smash right over you!
Relapse Can Happen Any Time
As stated above, the alcoholic's brain and body crave alcohol. Being drunk is his natural state. To maintain statis, his body and brain command him to drink through irresistible cravings.
To become sober is to interrupt the craving. To live in recovery is to establish and maintain a vigilant defense system that:
a) lifts the craving
b) provides effective tools to resist the obsession, which can recur at any time
Among other life benefits (a subject for another hub, another day), the goal of recovery is to provide "a mental defense against the insanity of the first drink."
In truth, relapse is a very real and highly likely occurrence for any alcoholic. In my observation, there seem to be three distinct times in recovery when people are especially vulnerable to relapse. These are discussed below.
Disclaimer: There exist academic studies and statistics about alcoholics, relapse and recovery. I will include links to some here. However, the phenomena discussed in this hub are all based on my own observations. Could they be extrapolated to the general alcoholic population? Perhaps. Does it matter? Not really. We're not talking about the general alcoholic population!
If my words are able to help you or someone you care about, that's what really matters.
Relapse in Early Recovery
The first year in recovery is hard. The first 90 days in recovery are really hard. The first 30 days in recovery are really, really hard. The first 24 hours in recovery are excruciating.
Many alcoholics find it difficult, if not (seemingly) impossible to string together more than 30, 60 or 90 days of continuous sobriety. That old siren alcohol keeps calling them back. The song is not only in their ears, but in their their brain, their nervous system, even their fat cells!
And they are too new in active recovery to have established a solid defense system. So,despite their best intentions, they succumb.
You may hear people blithely dismiss this phenomenon as "field research." As in, "Obviously you just weren't ready to get sober yet. You had to go out and do more field research."
I suppose this applies to some people, maybe even most people. Accepting that you are really "alcoholic" is not easy. It's sobering (no pun intended) to have to FINALLY admit you can no longer control your drinking.
I don't wanna be sober!
We hear about people who are sent to rehab through a family intervention, or perhaps by the justice system. They do their time. Or I should say, they "mark" their time. The minute they get released they find the nearest liquor store. These people truly do not want to quit drinking.
I don't know what I'm doing wrong!
Some who relapse in the first few months may be sincerely trying to stop drinking. But they mistakenly believe that's all they have to do: not drink. Everything else in their life continues status quo. They continuing going to happy hour with their old drinking buddies, where they drink soda or faux beer.
For whatever reason, they resist making the sweeping life changes required to embrace a life of sobriety. As a result, they go "in and out, in and out" of recovery.
Is there hope for these "revolving door" alcoholics? Absolutely.
10 Signals You're Heading for a Relapse
1. You forget what craving alcohol feels like.
2. You forget what a hangover feels like.
3. You forget how completely demoralized and miserable you were in your last days of drinking.
4.. The wreckage you caused in your drinking life is a distant memory.
5. You get bored listening to the same old people in the same old AA meetings. So you stop going to meetings.
6. You begin to isolate. You spend more and more time alone, up in your (alcoholic) head.
7. You stop calling or spending time with your sober friends.
8. Your life is good. You're busy. You're enjoying the fruits of your hard work in recovery.
9. Nothing bad happens. You're just fine, thank you very much!
10. Maybe you're not an alcoholic after all/anymore. What harm could one little drink do....?
Relapse in Middle Recovery
Before last week I would have said years 2-5 seem to be reasonably safe ones for sober alcoholics. During this timeframe sobriety is no longer a novelty. It has become a lifestyle. Drinking friends have been replaced with sober friends. The "firsts" are behind you (e.g., first Christmas sober, first birthday sober, first company BBQ sober, etc.).
In these middle years the rewards of being sober outweigh any positive memories of drinking. In fact, the awful memories of the last drunk are still reasonably fresh. The alcoholic is likely still cleaning up the wreckage of his past. In other words. He is making strides toward a happy new life.
A Tale of Three Relapses
Case #1: I can't stand the pain
This first example is not that uncommon. In fact, it's a situation all alcoholics fear: "What will I do when my (father, mother, significant other) dies? How will I make it through the funeral without drinking?"
In this particular case the man had close to 4 years of sobriety. His father was in hospice and so death was expected. The son was there to assist with his father's spiritual transition.
Unfortunately, it also fell on him to dispose of his dad's cancer medications. I was not there, nor have I talked to the man directly, so I really don't know how it happened. I got the story from his sister, who is 2+ years sober.
For whatever reason, the otherwise sober man decided it would be a good idea to drink an entire bottle of his dad's methadone. A rather frightening and dramatic way to lose his sobriety. He ended up in the ER, then ICU, and has now been "graduated" to rehab.
- Study Links Receptor To Stress-induced Alcohol Relapse
Relapse to uncontrolled drinking after periods of sobriety is a defining characteristic of alcoholism. Relapse is often triggered by stress and is influenced by genetic factors. This study used rats bred for high alcohol intake. It demonstrates that
Case #2: Remember to HALT
In recovery they teach us a very simple self-care tip. It's to never let yourself get too Hungry, Angry, Lonely or Tired (HALT). It's amazing how effective this can be.
My second story involves a couple. They met in another state (through AA), moved in together, and were very happy. She has 10+ years of recovery. He had 2.
They recently moved to a different city, where she had lived previously. She owns a home here and has a network of sobriety sisters. She also has a new job that requires her to travel.
On her first major trip out of town she sensed something amiss at home. She was right. She returned to find him hopelessly f-d up.
What caused the relapse? Only the man knows for sure... or not. It's entirely possible he has no insight into what happened.
We do know that he was under an immense amount of stress -- as was she. Moving to a new state, making the commitment to move without having work necessarily waiting at the other end -- yeah, that's off-the-charts stressful.
Being alone in this new city, with his sober partner away for several days?Yep, I can see where "angry" and "lonely" could come into play.
I honestly do not know who, besides his girlfriend, this man knows in town. I don't know if he had anyone he could call. I don't know if this was an intentional act of rebellion or unconscioius sabotage (something we alcoholics are very good at).
Whatever the reason(s), she's still got 10+ years. He's starting all over again with detox and rehab.
Case #3: It's all good, but too much!
My final example is perhaps the most disturbing of all. It shows what can happen when too many good stressors occur at one time and the alcoholic becomes distracted.
The woman in this story had been actively turning her life around. She was completing a master's degree. She had just bought a house. She had been active in AA since becoming sober 15 months before. In fact, she'd just been elected to an important service position (one which requires a minimum of 6 months' continuous sobriety).
Then one day she walked in and raised her hand as having 4 days. No one saw that one coming.
Just goes to show that good things can be just as overwhelming -- and dangerous -- as bad things.
Relapse in Long-Term Sobriety
When I hear of people "going out" (meaning, drinking again) after many years in recovery, it scares the shit out of me. But then I look around at some of the people I know who have lots of years (like decades worth) and I realize that we never fully recover. Maintaining sobriety is a lifelong process.
A progressive, fatal disease
Why would someone invest 10, 15, 20 years or more in living sober and then drink again? The answer is disturbingly simple. Even without drinking, the disease of alcoholism is still there. It is progressing in the alcoholic's brain. Sobriety arrests it, but does not stop it.
So even after years without alcohol, your brain still thinks like an alcoholic.
As near as I can figure, there are two main types of relapses that occur in this timeframe.
#1. Relapse by Attrition
Basically, the alcoholic stops identifying himself as an alcoholic. He gradually stops doing the things that kept him sober all these years. I've heard this time and time again.
What I've also heard -- from those who are fortunate enough to make it back -- is how quickly their drinking disintegrated/accelerated once they went out.
#2. Relapse as Conscious Decision
When we're talking about alcoholics who have been sober for many years, I don't think we can chalk up relapse to "more field research." These people know they're alcoholic. That is not in question.
And yet, they make a conscious decision to drink. I heard of one 20-year-old (20 years sober, not 20 years of age) announcing her intent to drink on her 50th birthday. She was quite calculated about it.
As far as I know, she did it.
We have not heard from her since.
Is that field research? Or a death wish?