The Eight Stages of (Holiday) Relapse

This month time we’ll hear a lot of good information about taking care of ourselves at holiday events: office parties, family gatherings, spontaneous get togethers with Friends. We are warned to watch out for the spiked eggnog and the fruitcake with brandy and the fancy Bourbon cookies.

If our addiction is food we’ll be on super alert for sugary snacks offered at every stop along our way.

But it’s not just the drinks or treats we have to worry about, and it turns out, it’s not just the newcomers who have to worry.

The greater triggers toward a slip or a relapse are more likely to be our thoughts and our moods. So what should we be watching out for that is inside of us?

I recently heard another recovery coach talking about relapse: How it begins and what to watch out for. His list of the eight stages can work as a daily or weekly checklist. And it’s a perfect holiday inventory getting us to the New Year:

Here are the Eight Stages of Relapse:

1.  Beginnings of secret dissatisfaction.

2.  Boredom or frustration at work or at home.

3.  Relationships change.

4.  Return of denial.

5.  Emotional drift—(away from our program, or friends, or sponsor, or supports.)

6.  Anger and Resentment.

7.  Depression and Dishonesty.

8.  Then—picking up the substance:Relapse.

Share this list with your recovery friends and agree to use this as a check list throughout the holidays.

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I write more about relapse in my book, “Out of the Woods—A Guide to Long-term Recovery” published by Central Recovery Press. Think about a copy of “Out of the Woods” as a holiday gift for your recovering friends.

Philip Seymour Hoffman Dies

LOS ANGELES (AP) -- Philip Seymour Hoffman suffered from a chronic medical condition that required ongoing treatment. An admitted drug addict who first sought professional help more than two decades ago, Hoffman apparently succumbed to his illness with an overdose despite a return to rehab last March.

"Here you have an extraordinarily talented actor who had the resources, who had been in treatment, who obviously realized the problem of drugs and had been able to stay clean," she said, adding that Hoffman's case shows how devastating addiction can be.

Success has no more bearing on drug addiction than it does on heart failure, doctors say: Both can be fatal without consistent care. And while rehab may be part of treatment, it's no antidote. Amy Winehouse and Cory Monteith had both been to rehab before eventually dying from overdoses.

"Addiction is a chronic, progressive illness. No one can be cured," said Dr. Akikur Reza Mohammad, a psychiatrist and addiction-medicine specialist who works as a professor at USC's Keck School of Medicine and is founding chief of Inspire Malibu Treatment Center. "If someone is suffering from addiction, they cannot relax at any time.

"Addiction does not discriminate, the same way high blood pressure and diabetes do not discriminate," Mohammad said, adding that 100 people die in the U.S. each day from drug overdoses. Those numbers are increasingly fueled by prescription painkillers, which tend to be opiates, like heroin.

Questions About Women and Relapse

Always as I am writing about women and recovery, and especially about women in long-term recovery, the big question is about relapse. There is a certain comfort that comes from having many years and there is a certain confidence too—that is, I think, deserved.

If we are working a good program and benefitting from therapy and other forms of “outside help” we will be safer and stronger. “But,” there is always that caution, “but there are no guarantees” and recovery continues forever.

I had the chance to ask an expert about women and relapse. Here are my questions and some very helpful answers from Erin Goodhart, Clinical Supervisor of the Primary Care Women’s Unit at Caron Treatment Centers. Take a look at Erin’s very helpful answers and perspective:

1. Do women relapse more than men? Why?

Relapse is a long and tricky process for anyone in recovery. It is difficult to discern if women relapse quicker than men; however, it does seem that men have significant consequences sooner than women. This would indicate that when women relapse, it is minimized by their significant other, circle of friends or employer. In addition, men seem to seek treatment quicker after a relapse than women do. Research indicates that the longer someone is involved in treatment, the better the chances of continued, long term sobriety.

2.  When women relapse is there a central reason? We often hear that it is because of relationships/romance issues. Is this true?

Many times when someone relapses, whether male or female there is a combination of changes in thoughts, attitudes and beliefs that lead them back to active addiction. For women, relationship issues do play a major role in the relapse process. This can be for several reasons; a main reason being the expectations of the relationship may not be met. Secondly, when a woman is in recovery and is also a mother, there are high expectations. She must be able to take care of the children, home, her work responsibilities and engage in a healthy recovery program. If the relationships in her life are not supportive, it may feel like she is juggling glass plates and begin to think that the recovery process is too time consuming.

In addition, unresolved family of origin issues can be a part of the relapse process for women. In recovery, women are encouraged to engage in healthy relationships with other women. For some, this can be the first time they are having healthy relationships with women and if they have unresolved issues from their childhood with significant female figures in their life, it can be difficult to trust other women. Thirdly, some women have love or relationships “addictions” that have never been addressed. When they put down their drug of choice, they may begin to use relationships as a tool to cope.

Finally, the culture we live in expects women to be nurturing and to take care of others. This can add to the stress that a woman experiences in recovery, and can contribute to relapse as they begin to feel depleted.  

3.  Is relapse prevention different for men and women?

Relapse prevention for all addicts has similar characteristics including a sober support network, alternative activities and continued therapy. The importance of finding other women in recovery is critical as they may also be navigating the difficult map of early recovery in terms of balancing home life, work, leisure and recovery. Additionally, women in recovery also need to deal with the issues of relationship issues, childhood trauma and increasing internal self-esteem in order to avoid relapse. This allows women to have internal self-worth and not need validation from those around her.

4.  Many women find recovery support in "social" ways: lunches, walks, exercising together. Is this valid support?

Social supports can be helpful for women in recovery. However, ideally women would have a support network of other women in a 12 Step recovery program. Research shows that one of the most effective forms of treatment for chemical dependency is involvement in a 12 Step program. As a woman builds a support network of other women in her program, the social events can turn into lunch before a 12 Step meeting, a walk after a 12 Step meeting and can evolve into a healthy friendship that also acts as a support system.

Many thanks to Erin Goodhart, Clinical Supervisor of the Primary Care Women’s Unit at Caron treatment Centers.