Risk Factors for Relapse
Risk Factors for Relapse
Over the course of time I’ve observed several sets of circumstances that seem to increase the risk of a person with an addictive problem to sustain a relapse – that is, falling back to the former behavior. I must honestly state that this is an observational piece and I am not sure that there is any science behind my ideas. Nevertheless, it makes sense that some of the circumstances do heighten the risk for falling back or a temporary or even permanent stepping out of the stages of change process, which we call recovery.
There are seven of these circumstances:
- Persisting frustration
- Intense emotion
What follows is a short description of these seven circumstances:
Fantasy — By this I mean thinking about the possible future experience in which, based on memories of the past, your behavior of choice will feel rewarding to you. Also falling into this category is “romancing” the use of a substance or engaging in the behavior. All entail forgetting the negatives and remembering the positives of the using are doing experience.
Rumination — This is the opposite of fantasy in some ways. It is thinking about the past in a circular fashion reinforcing any negative thoughts and emotions. Continuing feelings of guilt or shame about one’s previous behavior falls into this category.
Boredom — Boredom is self-explanatory. When one is bored one is also prone to ruminate or fantasize.
Persistent frustration — By this I mean a situation which is ongoing and for which there seems to be little opportunity or choice to make a change. For example, feeling “trapped” in a job that you do not like or responsible to a supervisor who is consistently and persistently difficult.
Intense emotion —Defined here as any emotion that is extremely intense and tends to persist for a while. Some examples of circumstances and ensuing emotions are grief over a loved one’s death, various negative feelings over the loss of employment or a divorce.
Detachment — This is a slightly harder circumstance or state to understand. By this I mean being cut off or isolated from our usual activity or community. Man is a social animal and, even though we do not need be with people all the time, to be separated can be painful and cause suffering. This might occur because of self-imposed isolation, or conversely it might be the result of rejection, ostracism or shunning. Self labelling with a demeaning term like “alcoholic” leads to isolation.
Opportunity — This may be the biggest risk of all and certainly adds to any of the previous circumstances should it arise. By opportunity I mean having the time or space where you feel that you can safely resume your previous behavior without being noticed or “caught”.
Suffice it to say that more than one of these circumstances and ensuing extreme emotional responses can present itself at any point during the recovery process. I think that being aware of these possible pitfalls is key. Armed with this knowledge, and noticing if one is experiencing one or more of these circumstances, can arm one for taking action. This can aid in avoiding increasing the risk of relapse.
Many SMART tools can help here such as:
- Identifying cognitive distortions
- Creating a Change Plan Worksheet
- Doing an ABC
Perhaps the most invaluable “tool” is sharing your very human experience and ensuing thoughts and feelings with the members of your meeting. In the meeting you are safe to express what is happening. There you will be reminded that you are not alone, aided in regaining perspective and shown where you do indeed have choices within your circumstance and in how you respond to your thoughts and feelings to these circumstances.