A random poll among newly sober clients, recovery counselors, and people who have achieved years of clean time would probably produce a varying consensus about the most pressing need for successful recovery.   Most respondents, however, would likely agree that relapse is often an indicator of stress.

The process of recovery, like the process of grief, is fluid and dynamic.  Exploring relapse before it happens is a good way to identify potential problems so you can be prepared for them.  Thorough preparation can help you minimize or even avoid issues may hinder your recovery.

Most people don’t think though the actions which eventually bring them to the point of relapse .  They simply had a desire to drink, and acted upon that without any thought for the consequences.  If they did indeed have any thoughts and feelings about the consequences of use, those thoughts and feeling were ignored or rationalized away.

In the recovery process, your recognition of that lack of forethought and insight should be a powerful lesson.  You can learn that anticipating the ultimate results of your behaviors will help you make much better choices.

With that in mind, try to see your past drinking/using behavior as a learning experience. Guilt and shame are a waste of time.  Having negative feelings about relapse (or anything) is can be very instructive in that you are reminded that your actions are in conflict with your values, and with the lessons you have gained from your experience.

When we talk about relapse we’re looking at the thoughts, feelings, and behaviors that precede a using episode, and what we can do to minimize or avoid their effects.

Let’s explore a model of relapse and break it down into manageable steps.  We’ll assume, for the purposes of this discussion, that you have committed to recovery and are facing a relapse into using.  While there are many models of recovery, the focus of this article is total abstinence.

Step one – People around you may mention that your behavior is weird or dysfunctional, or that your priorities have reverted to those of your “using” days.  Our natural tendency is to brush off such comments.  You may not even be paying attention to the signs or symptoms of relapse.

Step two – You start to feel restless and agitated, irritated and discontent. Your focus shifts from internal to external, from you to someone else.  Your focus shifts to blaming others  and feeling like a victim.   You find yourself thinking that outside forces affect your actions, rather than taking responsibility and looking at your own behaviors.

Step three – These “victim” thoughts may surface and manifest in destructive ways.    You may start to isolate yourself.  You seek emotional and physical withdrawal, avoiding friends or failing to return their calls.  You become very self-centered and dismiss any outside suggestions.  As you become isolated, you may find yourself discounting recovery, or even seeing it as impossible.  You may seek to understand your situation by magical or “if only” thinking.

Step four – You find a way to rationalize a justification to resume using.    You may even feel that you can give yourself permission to have one or two drinks a day.  One or two drinks quickly turn into three, then four or more, and so on.  You ease back into your old, using lifestyle while you revert to your former views of yourself and the world.  Often, life events accelerate this process and demonstrate that your behavior is no longer subject to your own control.

It is important to understand that the process of both recovery and relapse are separate things.  Sustaining recovery takes an ongoing concentrated effort which can be a difficult habit to build.  Part of a sustained recovery requires the ability to look at your behavior with an unbiased opinion, inclusive of the ability to not only identify the stages of relapse, but the ability to change your behavior.  These tendencies  do not come naturally nor are they gained without effort.  The anatomy of relapse tends to be a part of recovery, but it doesn’t have to be.

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›› When an alcoholic considers his drinking, he tends to focus on what isn’t wrong with it.

While addictions to drugs and alcohol are bound to come to light after a certain amount of time, there is one addiction that can remain hidden for a lot longer.

Self harm, or cutting, burning, punching or otherwise hurting yourself is pretty much like an addiction, but it’s one that often has fewer obvious consequences than drug or alcohol addictions and can be harder to detect.

It can be easier to hide simply by wearing long sleeves and clothing that covers you – and the consequences only tend to show up when trips to the hospital are required.

Just like other addictions, self harm is usually a form of mood regulation when you lack other coping skills. It can be a form of dealing with unbearable emotions or thoughts caused by a traumatic past. It can be an outlet for expressing pain in a physical way when you just can not deal with it in an emotional way.

Like any other addiction, the emotions when cutting can follow the cycle of a high during the action and the guilt and remorse when it’s over. It can also be progressive in nature, starting out from pinching or punching and leading to serious cuts and burns that require stitching and treatment.

I have every sympathy with self harmers as I used to be one too.

While infections, nerve damage and other serious blood-related illnesses can result from cutting, some people may not see it as quite as serious as say drug or alcohol use.

But the emotional misery that can be caused by self harming is just as serious as the hollowness and despair caused by other addictions and it can be a very lonely world to live in. And it can be even more painful when loved ones do discover it and find it hard to understand.

The good news is that you can recover from self harm with the right support and help.

Most effective are therapies that teach you distress tolerance, emotional regulation and interrupting old patterns with more healthy coping strategies. And while you find a better way to deal with your emotions, finding a new sense of self worth and self esteem will help you to break free of the self harm cycle.

These days my sense of self worth is so solid that I forget about the scars all over my arms. I don’t wear long sleeves anymore, so occasionally a particularly curious soul in the supermarket will comment or ask about the scars. These days I like to wink and tell them I used to live with an untamed tiger. The people who believe it always amuse me. But then, in a sense it is true – that untamed tiger was me.

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This song makes me wish I would have been able to meet my father..

I love this song, it makes me happy

You know the drill: you have spent countless hours in meetings, on the phone with your sponsor asking endless questions about your desire to use.  You have worked the steps and you’ve even consulted specialists.  In a moment of desperation you found help by attending treatment. You’re able to rack up six to twelve months, but eventually you find yourself in the throes of your addiction. None of this seems to work.  You find yourself questioning your commitment and ability to stay sober.  Maybe your sponsor was right when he said you lack willingness.

Not so fast….

What you are likely experiencing is Post Acute Withdrawal Syndrome or PAWS.

PAWS consist of a set of impairments that occur immediately and at times simultaneously after the withdrawal from alcohol or other substances.  These impairments affect three distinct areas of functioning and last six to eighteen months from the last use of alcohol or drugs as your brain tries to regain homeostasis.

Some of these impairments include cognitive problems like racing thoughts, rigidity, numbing of emotions, difficulty with abstract thinking and poor attention span, all of which are prevalent during this time. Emotional difficulties include shame and guilt, as well as difficulties with resentments. Depression is common during this time and may lead to relapse as the addict is generally not prepared to deal with the wealth of emotions they experience. The dearth of emotions can lead people close to the addict to believe they might have relapsed.

While some counselors and organizations support 100% abstinence as the only way to resolve addictive behaviors, this approach tends to come across as a ‘one size fits all’ solution to dealing with these impairments.  While recovering from addictive behaviors it is remiss to not include an alternative approach without the mention of anti-craving medication as a treatment for PAWS.

Anti-craving medications may be appropriate for some individuals.  The use of medication does not represent a weakness in one’s ability to recover from addictive behaviors.  If anything, it should represent the idea that there is ‘another way’.

There are various medications that have been found to have efficacy in dealing with alcohol/drug cravings:

Prazosin is often prescribed to deal with PTSD and night terrors. It has been found to be successful among Opiate addicts and individuals using Cocaine and Methamphetamine.

Acamprosate is used to treat Alcohol cravings.  In addition to its apparent ability to help patients refrain from drinking, evidence suggests that Acamprosate is neuroprotective. It has been shown that it can protect neurons from damage and death caused by the effects of alcohol withdrawal.

Naltrexone has been prescribed for Opiate cravings but is largely recommended as a treatment for alcohol abuse. It is also available in a monthly injectable form under the trade name of Vivitrol.

Baclofen and Topiramate have found therapeutic utility for Cocaine and Alcohol cravings.

While Methadone and Antabuse have found success in treating addictive disorders, they are not seen as anti-craving medications.  Antabuse is a deterrent to drinking as it prevents the breakdown of alcohol. Some 5–10 minutes after alcohol intake, a person will experience the effects of a severe hangover for a period of 30 minutes up to several hours.

Methadone is a synthetic Opioid and has been used as part of an Opiate substitution regimen. The drug has found success in supporting long-term Heroin addicts to wean off the drug.  In addition, Methadone has been used as a pain management protocol due to its long duration of action.  There is a fair amount of controversy around Methadone for Opiate substitution as the detractors point to length of time a patient uses the drug, suggesting that addicts are essentially substituting one drug for the next. Conversely The Addiction Recovery Institute points out the following benefits of Methadone Maintenance Treatment:

Reduced or stopped use of injection drugs

Reduced risk of overdose and of acquiring or transmitting diseases such as HIV, hepatitis B or C, bacterial infections, endocarditis, soft tissue infections, thrombophlebitis, tuberculosis, and STDs

Reduced mortality – the median death rate of opiate-dependent individuals in MMT is 30 percent of the rate of those not in MMT

Possible reduction in sexual risk behaviors, although evidence on this point is conflicting

Reduced criminal activity

Improved family, employment and pregnancy outcomes

It is important to reinforce the notion that an approach of 100% abstinence as a singular modality is not for everyone.  Medications can provide additional support but they should not be seen as a complete solution.  The goal of the medication should be to offset cravings and free up “emotional space” for the newly recovering person to add support in the form mutual aid groups, group or individual therapy, connection with a community of faith, exercise or involvement in an alcohol and drug treatment program.