13 Mar 5 Didn’t-See-It-Coming Relapse Triggers (and How to Avoid Them)
Some relapse triggers, such as stress, job loss, isolation, the death of a loved one, and other distressing events or feelings, get a lot of attention during treatment, and rightly so.
But sometimes it’s the happy moments (or the seemingly neutral ones) that sneak up and trigger a return to drug use. Here are five triggers that often take unsuspecting recoverees by surprise:
#1 Sex and Relationships
An oft-repeated (and oft-ignored) cardinal rule of early recovery is to avoid dating for at least the first year. This advice is not intended to punish, but to give the recovering addict time to focus internally – to figure out who they are, what they want and how to cope without using drugs or alcohol – before trying to be a source of support for someone else.
At a time when recovering addicts are most likely to want a relationship and least likely to be prepared for one, they are at high risk of falling into the familiar pattern of looking outside of themselves to fulfill emotional needs, escape or relieve stress. Some people rely on the “high” of a new relationship as a substitute for drugs or alcohol. Cross addictions to sex, love, romance or relationships are a major cause of relapse among the newly sober.
In addition to the obvious emotional strain when the relationship falters or comes to an end, few addicts in early recovery are in a position to judge whether someone will be a good match – or to be a good partner for someone else. Diseased thinking and tenuous self-esteem make them more likely to attract someone who is infatuated, controlling, addicted or unavailable than to achieve genuine intimacy.
Relapse Prevention Strategy: Follow the sage wisdom of AA and recommend that all recovering addicts avoid dating for at least the first year of recovery. They should use this time to focus instead on family relationships and friendships before diving back into the dating world.
#2 A Promotion or New Job
Finding a new job or getting a promotion is a time for celebration, which for most people in recovery was at one time synonymous with indulging in drugs or alcohol. A promotion can be a double-edged sword – a confidence-builder as well as a temptation to use their increased financial resources for drugs or alcohol.
Relapse Prevention Strategy: In many cases, there is no need for recovering addicts to turn down a job offer or a promotion to protect their sobriety. Like any other employee, they may need to ask for help if work demands become a threat to their health or productivity. Following a significant change in income, recovering addicts may benefit from hiring a financial advisor or life coach, or spending time in a structured sober living environment that offers training in budgeting, time management and other life skills.
#3 Complacency or Over-Confidence
When life begins to feel more manageable, many recovering addicts start thinking, “My addiction wasn’t that bad” or “I’m stronger now – I can have just one drink and stop.” They may stop taking care of basic needs such as sleep, physical activity and a healthy diet and start returning to people, places or things that remind them of their drug-using days. Feeling strong and confident, they stop attending 12-Step meetings and calling their sponsor.
Relapse Prevention Strategy: No matter how strong the recovering addict feels, they must continue working a program of recovery. Twelve-Step meetings will remind them of where they were just a few weeks or months earlier and offer a support network that can help identify high-risk attitudes. Keeping a journal or finding another way to routinely monitor their emotions can also be helpful. Those who feel capable can share their strength with others by volunteering at meetings or performing community service. Giving back is a wonderful way to build self-esteem and at the same time stay humble.
Drugs and alcohol are the organizing principle of an addict’s life. When those are removed, there is a void that needs to be filled with healthy pursuits, or boredom and isolation can set in. It takes time to figure out the balance between having enough free time to relax and enjoy life, but not so much that the old lifestyle begins to look more desirable.
Relapse Prevention Strategy: Preventing boredom requires self-awareness and vigilant monitoring. If an individual is prone to boredom, they should consider creating a list of the activities and situations that prompt the need for distraction or escape, as well as a list of novel ideas for sober recreation that are available in their area, such as sports teams, art or fitness classes, or volunteer opportunities. For some, old passions should be revisited while others may thrive trying something new every week.
#5 Undiagnosed and Untreated Physical or Mental Health Problems
Undiagnosed mental health disorders, such as depression, anxiety and personality disorders, are among the leading causes of drug relapse. More than half of all adults with severe mental illness have co-occurring substance use disorders. If all disorders are not identified and treated simultaneously, the addict may end up in a cycle of chronic relapse without knowing why.
Recovering addicts struggling with pain, anxiety or other conditions may be prescribed addictive medications by a physician that doesn’t realize they are in recovery. Taking any mind-altering substance, even for a legitimate medical purpose, may threaten the addict’s recovery.
Relapse Prevention Strategy: If an underlying mental health disorder is suspected, the most effective course may be specialized dual diagnosis treatment from a multidisciplinary team of professionals that provides comprehensive psychiatric assessments and care. Relapse prevention planning for those with dual disorders is complex and often includes long-term treatment and monitoring.
If a doctor prescribes an addictive medication, the recovering addict must explain that they are in recovery and ask for non-addictive alternatives. Because not all doctors receive adequate training in addiction, it can be helpful for the recovering addict to get educated about addictive drugs and learn to advocate for their own needs, even if that means finding a new doctor.
Relapse is harder to prevent when you don’t see it coming. By learning about individual relapse triggers and taking precautions, the recovering addict will be in the best position to get through not only the tough times but also the happier ones with their recovery intact.
By David Sack, M.D.