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On the last track, we discussed the importance of an addict taking risks in a relationship and the three main risks that an addict will need to face.
On this track, we will be discussing the three main causes of relapse in addicts, which I have found are: leaving a recovery programs prematurely, "dry drunk" behavior, and a lack of self-trust. Do you agree? Or do you have three others?
I have noticed, probably like you, that many clients in recovery programs find that they must work through the program more than once to reach recovery. Beth, age 32 is a good example. Beth, recovering from an addiction to heroin, was considering working full time at a flower shop.
She had had a number of experiences with relapse but felt that she was recovered enough to change jobs from working 20 hours a week bagging groceries to 40 hours a week arranging flowers. You can probably guess what happened. As the floral job took more time and had more responsibility, it added to Beth’s stress. This caused her to stop going to her 12-Step meetings.
Three Common Causes of Relapse
Let’s analyze the three most common causes of relapse. As I read through the list, think of your Beth.
Cause #1 - Decision to Leave Recovery Program Early
Because Beth never reached the later steps of the program, based on my experience, with other clients, I feel she may have increased the chance that she would have a relapse. Her denial regarding the all-encompassing nature of her heroin addiction had caused her to think she was cured before she had completed each step.
As you can probably guess, after four weeks, Beth had returned to her heroin addiction. She stated, "I realized I was just looking for a quick solution to a problem I didn’t think was that serious."
Cause #2 - A 'Dry Drunk'
Some traits of a dry drunk that Beth exhibited were: grandiosity, judgmentalism, intolerance, impulsivity, indecisiveness, dishonesty, controlling, and self-centeredness. Sound like a client of yours? Beth stated, "I just wanted to be able to say I wasn’t addicted anymore. I was in recovery, but the problem was I still acted like I was addicted."
Cause #3 - Lack of Self-Trust or Self-Confidence
However, when they stop using the group for support prematurely, they may begin to feel guilt and insecurity without the group’s encouragement. This guilt for not attending meetings is often cause for a relapse. Thus a paradox is created where the help agent actually increases the likelihood of relapse due to guilt trips laid on members with spotty attendance.
Beth stated, "I felt guilty and afraid of relapse. After I stopped going to meetings, my friends from those meetings started telling me that I was making a big mistake and I needed to come back to the meetings. But then they stopped calling entirely! They doubt my ability to work at the flower shop and stay clean and sober without the group. I started overeating and binging and thought this is the first step starting back using heroin again."
For Beth, her situation could be looked at from two different points of view, depending on your philosophy regarding 12-step versus rational recovery. Either
Thus, according to the 12 steppers the concept of group members guilt-tripping her is just a symptom of her dry drunk behaviors of grandiosity, judgementalism, intolerance, impulsivity, indecisiveness, dishonesty, controlling, and self-centeredness. I felt the "Ready to Leave Treatment" exercise might be beneficial.
For the "Ready to Leave Treatment" exercise, I gave Beth the following list of questions:
I told her, "You are only allowed to use yes and no answers. ‘Maybes,’ ‘sort ofs,’ and ‘I don’t knows’ don’t count." Once she answered all 12 questions with no gray "maybes" or "sort ofs", the majority of her answers were no. I asked Beth, "Are you sure you no longer need treatment?" Beth looked uncertain and said, "I don’t know."
I told her that ultimately, of course, it was her decision, but that she could consider some options, such as a support group that met at a different time with different people, if she felt at odds with the current group she was attending. I explained to her each group has a personality. Beth considered the options, and decided to try attending a support group at a different time, location, and day of the week.
Do you have a client like Beth who is struggling with the possibility of relapse? Has he or she been in and out of recovery before? If so, would doing the "Ready to Leave Treatment" 12 questions help him or her? Would it be appropriate to play this track during you next session?
On this track we have talked about three main causes I have observed regarding relapse in addicts. These causes from relapse are leaving recovery programs prematurely, "dry drunk" behavior, and a lack of self-trust.
On the next track, we will discuss the Dream of Dependency and the three reasons addicts have this dream. The three reasons for the addict’s Dream of Dependency are that their parents led them to believe someone would take care of them as adults, that their parents failed to teach them the skills necessary to take care of themselves, and that they never learned to feel capable of being responsible for themselves.
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