Revisiting Rock Bottom: The Stages of Relapse
Addiction is easy to think of as an abstract concept, something that only happens to people in movies and on the news- until it touches your own life. It’s simple, as an outside observer, to look at an addict or alcoholic who is killing themselves with substances and think, “why don’t they just stop?” In fact, that was my reaction until addiction crept into my own life and slowly took over every aspect of it. What I understand today is that addiction is a brain disorder; a progressive disease that is ultimately fatal unless arrested. It took me six years of treatment to get 3 years sober, and that’s because of one of the most insidious and dangerous aspects of the disease of addiction: the often subtle stages of relapse, which set recovering people back to square one- if we are lucky enough to get another chance at sobriety.
The Stages of Relapse: A Process, Not an Event
Relapse was an aspect of addiction that I didn’t understand until it consumed my life. Like many people unfamiliar with the horrors of this disease, I thought of relapse as a single event. In my mind, a sober person had a drink or a drug, and that was the relapse. When I began attending treatment centers, I was educated on the stages of relapse.
Relapse is, in fact, not a solitary event that happens out of nowhere, but rather a process that occurs over a period of time. People in sobriety who are working strong, healthy programs of recovery generally don’t pick up a drink or a drug randomly, with no precipitating event or emotion. Prior to the physical act of drinking or drugging is a series of behavioral, emotional, and even physical changes in the individual that comprise the stages of relapse. This process can happen over a short period of time- in one case it took 48 hours for me- or on an extended timeframe, sometimes even years.
What are the Stages of Relapse?
Obviously, the act of using a substance is what is generally referred to as a relapse, but it’s actually the culmination of a variety of factors and changes within the sober individual. Addiction researchers Terence Gorski and Merlene Miller identified eleven stages of relapse as they occur in the recovering population. According to Gorski and Miller, these stages are:
- Unhealthy or negative emotions
- Denial of addiction or reality
- Compulsive behaviors
- Experiencing triggers
- Internal dysfunction (inability to function normally at an emotional level)
- External dysfunction (return of unmanageability in aspects of external life, such as work, school, or interpersonal relationships)
- Loss of control
- Return to addictive thinking
- Making choices that place oneself in high-risk situations
- Acute relapse (the actual use of the substance)
- Relapse aftermath (the consequences)
These stages can happen in a day or in a year, but they represent a gradual unraveling of a recovery program. Gorski is generally regarded within the treatment world as an expert on relapse and relapse prevention, who began his work in the 1970s. His relapse prevention model is still widely used today.
The Stages, Simplified
Dr. Steven Melemis, a Canadian addiction, and mental health researcher expands upon Gorski’s process. The three stages allow patients and laymen to better understand this clinical model. These stages are:
At this point, the addict or alcoholic is not consciously thinking about using. This is the stage at which emotions become intolerable and create inner turmoil. The individual may experience mood swings, anger, or depression. As a result, they may start making subtle behavioral changes. Meeting attendance may drop, sleeping and eating patterns may change, and the addict/alcoholic may lash out at work or at home. For me, this stage is marked by a creeping depression that starts slowly and then begins to affect every aspect of my life. I’m not yet thinking about drinking or using, but I’m starting to isolate and sleep too much, which causes the emotional turmoil to build. At this point, it’s possible to recognize the signs of relapse and reverse the process.
This is when the idea of using or drinking enters the recovering person’s mind. They may start fantasizing about relapse or planning it. This is accompanied by the internal and external turmoil that Gorski identified, which makes the life of the addict or alcoholic unmanageable. Relapse triggers also exacerbate this stage and set off a series of ideations about using or drinking. In my experience, this is the point at which I begin planning how to “get away with it.”
I may isolate from recovery supports or begin lying about where I am or how I feel. I start to justify why I “deserve” to use. Also, I may set aside money or plan a time to find and consume drugs secretly. In my experience, if I don’t tell someone how I am feeling at this point or get honest about my program, I am well on my way to relapse.
This is the “acute relapse” in Gorski’s explanation; the point at which the addict or alcoholic physically uses a substance. This can be a single “slip,” or an extensive binge. Regardless, if the addict/alcoholic does not receive immediate help and intervention and get back on the sobriety track, the consequences are grave: jail, institutions, and death, as the literature of 12 step programs warn.
Relapse prevention begins with understanding the stages of relapse as they show up in an individual’s personal life. For me, I know that isolation and depression are serious warning signs. When I am at this emotional stage, I have to reach out to my sponsor and my supports. I do it even though the depression makes that seem unappealing.
Sometimes, to get what I really want — long-term sobriety — I have to put in the footwork and do things I don’t necessarily want to do. However, it has paid off. I was a “chronic relapse” for years, and it was only when I stopped following my own plan and started listening to suggestions that I sustained abstinence and sobriety. This began with recognizing that relapse didn’t “just happen to me” out of the blue. It was a process marked by distinct changes in my behavior, attitudes, and emotions.
By shedding my denial and getting honest about my internal state and taking responsibility for how it affected by actions. Most importantly, by following my treatment center’s suggestions and my sober support network, I was able to break the cycle of relapse. In doing so, I avoided the inevitable consequences of active addiction. I continue to reap the many benefits of my long-term sobriety.