15 Mar

Warning signs of relapse



Terence Gorski, an expert in relapse prevention, has made a list of thirty-seven common warning signs of relapse, which make up the relapse process. These are in a progressive order – going from the least significant ones to the more crucial ones. The sooner you recognise what is happening, the easier it is to turn around.

Once you understand and identify those that are of danger to your recovery, work can begin on setting up a relapse prevention plan to deal with life without a return to using.

  1. Apprehension about Well-being: Initial sense of fear; uncertainty, lack of confidence in ability to stay clean.
  2. Denial: Reactivated to cope with apprehension, anxiety and stress. Almost identical to that felt during the early stages of treatment. Most people are aware of this when looking back, but not during.
  3. Adamant Commitment to Recovery: Convinced that they will never use again. This is sometimes blatant and upfront, but mostly a very private decision. Many are anxious/hesitant to share this with counsellors or fellowship members. Once convinced that they will never use again, the urgency of a daily programme fades away.
  4. Compulsive Attempts to Impose Recovery on Others: Generally in private judgements about friends/spouses’ using and the quality of AA/NA programmes. More focus on what others are doing than oneself.
  5. Defensiveness: Increased defensiveness regarding problems or recovery programmes.
  6. Compulsive Behaviour: Behaviour becomes more rigid and repetitive. Control conversations through monopoly/silence. Overwork and get compulsively involved in other activities. Non-structured involvement with people is avoided.
  7. Impulsive Behaviour: Compulsive behaviour gets interrupted by impulsive behaviour. Overreaction to periods of stress. These can affect major life decisions and commitment to ongoing treatment.
  8. Tendencies Towards Loneliness: Isolation/avoidance increase, usually with valid excuses. Compulsive/impulsive behaviours rather than responsible involvement with others.
  9. Tunnel Vision: Viewing life in fragments. Focusing exclusively on one area, avoiding looking at others – pre-occupation with the negative, seeing themselves as being treated unfairly.
  10. Minor Depression: Symptoms of depression appear and persist. Listlessness, feeling flat and oversleeping become common.
  11. Loss of Constructive Planning: Skills of life-planning fade. Attention to detail decreases, wishful thinking begins to replace realistic planning.
  12. Plans Begin to Fail: Lack of planning, failure to follow through, lack of attention to detail or being unrealistic – plans begin to fail.
  13. Daydreaming and Wishful Thinking: Concentration fades, is replaced by fantasy. ‘If only’ syndrome becomes more common. Fantasies of escaping or being rescued.
  1. Feeling that Nothing can be Solved: Failure pattern develops when plans fall through, feelings become overgeneralised. Thoughts of “I’m trying my best and it still isn’t working out”.
  2. Immature Wish to be Happy: Conversations/thoughts become vague. Desire to ‘be happy’ without defining how to attain it.
  1. Periods of Confusion: Confusion periods increase in frequency, duration and severity.
  2. Irritation with Friends: Social involvement with friends, family, NA/AA contacts and counsellors get strained and full of conflict. This increases when the recovering person is confronted.
  3. Easily Angered: Anger, frustration and irritability increase. Overreaction/fear of overreacting becomes more frequent.
  1. Irregular Eating Habits: Overeating or undereating. Regular meal structure stops, well-balanced meals are replaced with junk food.
  2. Listlessness: Inability to initiate action, to concentrate; strong feelings of anxiety and apprehension develop. Feelings of being trapped.
  3. Irregular Sleeping Habits: Insomnia, restless nights or sleeping marathons.
  1. Progressive Loss of Daily Structure: Daily routine becomes haphazard – irregular hours of sleeping/getting up; no set mealtimes, poor social planning, frequent missing of appointments. Feeling rushed, overburdened at times and at other times having lots of idle time.
  2. Periods of Deep Depression: Depression more frequent/severe, usually during periods of non-structured time. True isolation; complaining that nobody cares, yet reacts angrily/irritably towards anyone that tries to help.
  3. Irregular Attendance at Treatment Meetings: NA/AA attendance erratic. Therapy sessions cancelled/missed. Rationalisations used; effectiveness of treatment questioned.
  4. Development of an “I Don’t Care” Attitude: Usually masks feelings of helplessness and poor self-esteem.
  5. Open Rejection of Help: Cut themselves off from help, either openly/angrily or by withdrawing from it.
  6. Dissatisfaction with Life: “Things are so bad I might as well use – it can’t get much worse.” Defences are failing; sees how unmanageable their lives have become, AGAIN!
  7. Feelings of Powerlessness and Helplessness: Inability to action. Thought-processes scattered, judgement becomes greatly impaired.
  8. Self-pity: Often used as an attention-seeking device.
  9. Thoughts of Social Use: Thoughts that using might normalise feelings/emotions. Idea that they might be able to use in a controlled fashion start. Some ignore this while others obsess on it.
  10. Conscious Lying: Denial and rationalisation become outrageous, even the addict recognises them, but feels unable to stop.
  1. Complete Loss of Self-confidence: Feeling that there is no way out of where they are/how they feel. Often become overwhelmed by inability to think clearly.
  2. Unreasonable Resentments: Anger at the world, but nothing can be done about it. Sometimes anger focuses on scapegoats and then on themselves.
  3. Discontinuing all Treatment: Stop attending NA/AA, counselling; non-appearance at aftercare, alienation of all help from friends/family.
  4. Overwhelming Frustration, Anger, Loneliness and Tension: Totally overwhelmed by feelings: no option but to go crazy, commit suicide or use. Intense fear of insanity. Feel very desperate, using is usually impulsive.
  5. Start of Controlled Use: Effort to control using – usually quantities; or change drug of choice.
  6. Loss of Control: Control is usually short-lived. Returns to full-blown addiction with consequences as severe/more severe than their last episode of active using.

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