Anatomy of a Relapse
~Josh King, PsyD, Center for Motivation and Change
Relapses (and lapses and slips, whatever you want to call a return to old behavior) are frustrating events. Sometimes it feels like you’re (finally!) on the path you want to be on, and then, out of the blue, you fall off of that path and feel like you are back at the beginning (and that is sometimes what people tell you!). While it can feel like a lapse happens without much warning, it’s best to think of it as a process that happens over time. The reality is that people tend to drift towards a relapse, like a boat that has lost its mooring and is drifting out to sea. The movement can be slow and can go almost unnoticed until you are already adrift. By knowing what is “mooring” you to sobriety, or the changes you want to make, you can be more aware of when the “mooring lines” are getting cut and you are drifting into a lapse to old behavior.
When you change your use of substances (either stopping or reducing), you might notice that there is often a lot of time to kill. Time that was formerly spent getting drugs/alcohol, using, and recovering from use. Now, it’s all just free time. When people first change their substance use, they tend to fill that free time with different activities. Some people go to self-help recovery meetings. Others start exercising and getting in shape. Perhaps the time is filled by reconnecting with or strengthening ties with family and friends. However that time is filled, it tends to get filled up with “change-supporting activities.” These activities take up space (emotional, intellectual, spiritual, and physical) and help you to maintain the changes that you want to see in your life.
As you embark on making significant life changes, you should make note of and track your change-supporting activities. Maybe it’s going to the gym every day, or talking to your close and supportive friend once a week. Maybe it’s seeing your therapist and going to a group, maybe it’s talking to your sponsor, maybe it’s going to church on the weekend. As you think about the activities that keep you tethered to your goals, be very specific about the frequency and people involved. You want to be specific so that you can later on identify if you are moving away from the activities that are competing with your old behaviors (use of substances).
Relapse drift occurs when you start skipping/missing your change-supporting activities. It usually starts in a seemingly harmless manner. You grab pizza because you’re running late to a meeting and then skip the gym because the meeting ran long and you want to get home (because, naturally, you’re exhausted from the day!) This, however, breaks two mooring lines for you of eating healthy and going to the gym daily. On its own, it doesn’t mean that you’re going to relapse. But, when that happens three times the next week, and you later stop going to the gym altogether (because it doesn’t fit into your schedule), you’re drifting further and further from your change-supporting activities and increasing the odds that a return to old behavior is in your future (e.g., because when you feel sluggish and bad about yourself, a substance might be the perfect thing to tune it all out and help you relax.)
How to Identify Relapse Drift
Identifying relapse drift requires a lot of self-discipline but it’s worth it!!! First, define your change-supporting activities and then create a log or calendar where you track your engagement in these activities. “Going to the gym” is a good change-supporting activity, but “exercising for 30 minutes every day” is a measurable change-supporting activity that you can easily track. There are a number of great tracking apps you can find, but paper and pencil also works! At the first signs of missing your defined change-supporting activities, try to re-establish your routine and keep away from the drift!
Noticing when you have stopped or reduced your engagement in change-supporting activities can alert you to the sign that there is now more room in your life for negative behaviors to reappear. If you can identify relapse drift, you may be able to stop it, return to shore, and continue on your path to change.
Source: Center for Motivation and Change, used with permission.
Dr. Josh King is a psychologist at the Center for Motivation and Change (CMC) who has specialized training in Dialectical Behavior Therapy (DBT), Mindfulness based therapies, and Cognitive Behavioral Therapy for Insomnia (CBTI). In his position as Director of Clinical and Digital Service Integration, Dr. King oversees CMC’s social media presence and website, and is working to develop ways to expand CMC’s digital services with the specific goal of increasing access to CMC’s services to all people. You can find out more about CMC and their digital resources at http://motivationandchange.com and you can get free updates and digital content at CMC’s Facebook page or on twitter.