Originally published on www.counselormagazine.com
In part 4 of the series, we defined relapse triggers and explored common trigger events which lead to entering the craving cycle. Remember that, despite its danger, many addiction professionals focus merely on teaching the tools of recovery to utilize once craving hits, rather than on how to avoid falling into the craving cycle in the first place. In this series, we are doing just that – demonstrating how to help our patients minimize the frequency of entering the craving cycle. We are accomplishing this by focusing on set-up behaviors and trigger events, two primary criteria that contribute to the craving cycle. By utilizing this information, patients can significantly reduce its frequency.
Trigger Events (cont’d)
Recovering from Triggers
According to Gorski, there are three phases in the trigger recovery process. Phase I is to “eliminate as many of them as you can, for a limited period of time, until (you are) stable” (Gorski, 1988). Again, in very early sobriety, our patients should not go to bars or other using places, they should avoid people who use and drink, and they should avoid any other triggers we have helped them become aware of. A list of common triggers can be found at the end of this section.
“The second phase is a gradual reintroduction of the triggers so that the person can learn how to cope with them” (Gorski, 1988). This does not mean to gradually re-introduce Bob into the crack house or his favorite watering hole, but there are some trigger situations that I should be able to eventually participate in. As stated earlier, alcohol permeates our society, and a person would have to live a very sheltered life in order to avoid it over the long term. Therefore, in order to lead any kind of a normal life, gradual re-introduction to some trigger situations is necessary. This re-introduction process is best done with a sponsor’s involvement or with a counselor or group if they have one. Following is an example of this process in my sobriety.
When I was about 90 days sober and still involved in the aftercare portion of my treatment program, we were invited to the wedding of my wife’s cousin in Chandler, Arizona. I thought I’d really like to go. However, I had learned from past experience that decisions I made on my own in relation to my sobriety were typically bad ones. So, I decided to leave it completely up to my group. So, I attended my next group session and put it out to them. The consensus was that since I was still working a very strong sobriety program, going to daily meetings, and going with my supportive wife, I could probably stay sober if I created a sobriety plan. The group then proceeded to help me put this plan together.
First, they suggested that I carry a Big Book onto the plane. The thinking was that since flying on an airplane was a trigger for me to drink, it would be difficult to order a drink while holding a Big Book in my hand. The book has an embossed cover so nobody would know what it was and, if they recognized it, they probably have one and I might meet someone in the program.
The next suggestion was to go to 12-Step meetings each day I was in Arizona. They had me call the downtown Los Angeles Central Office of AA to get the number of the central office in Chandler, Arizona. I was to get a meeting scheduled for each day I was there and, if possible, schedule a meeting for the time of the reception so if I got into trouble, I could simply leave the reception and go to a meeting. In fact, this actually happened:
At the reception, I found myself talking to my wife’s uncle next to the wet bar at his home. All of a sudden, someone plopped down a bottle of my favorite whiskey onto the bar right in front of me. After recovering from my slight panic, I excused myself and informed my wife that I was going to a meeting. Fortunately, and I suggest this highly, I got the address and directions from the AA Central Office which made it easy for me to go.
I went to the meeting and took a 90-day chip in celebration of my sobriety time. As opposed to meetings in California where a key chain or a coin is usually given in acknowledgment of various lengths of sobriety, their chip was actually a marble. I asked them if there was any significance to using a marble. I was told to carry it with me all the time and if I get the urge to drink, take it out of my pocket and throw it as far as I can. The thinking was that by the time I found it, I might not want to drink anymore. I asked someone else, and I was told that if I want to drink, go ahead and pour the drink and put the marble into it. When it dissolves, I can drink it. So much for Arizona humor!
After the meeting I ended up going back to the reception where everyone was having a great time dancing. This really looked fun to me, but I had never danced sober before. I always had to have at least a few drinks in me before I could dance because I was not a very good dancer and cared too much about what other people thought of me. When I had a few drinks, I felt like I danced like John Travolta and I didn’t give a damn what anyone thought. So, I concocted a plan to wait for a fast song that I liked, run and slide onto the dance floor while playing “air guitar” and, hopefully, begin dancing. So, a Van Halen song came on and I was off and running. Little did I know that just after I left for my meeting, the bride and groom arrived, walked across the portable dance floor, and everyone followed tradition by throwing rice at them. You can imagine what happened next. As I attempted to slide onto the dance floor, my feet hit the rice and came right out from under me. I hit the floor, followed by two of my wife’s female cousins (one of them the bride!) who I managed to take down with me – one of them right onto my lap. As I rose to my feet, my face must have been beet red and, as I looked around the dance floor, I could see my wife’s family’s reaction which I perceived as, “There he goes, he’s drunk again” – and I was probably the only sober person there!
Anyway, other elements of my sobriety plan consisted of calling my sponsor each day I was there and reading the Big Book for a half-hour each evening. Upon returning, my group and I processed what worked, and what additional program tools I might have used, so I could use them the next time I might have to expose myself to triggers.
Through such a process, I was able to participate in increasingly more activities in my sobriety to the point that I can now do almost anything without being triggered. This is due to the third phase of the trigger recovery process called the “extinguishing process” (Gorski, 1988). As mentioned earlier, triggers become extinguished when repeated exposure to them is connected with not drinking, rather than drinking. As noted in Part 4 of this series, in relating it to Pavlovian theory, it would be like: ring the bell no meat powder; ring the bell no meat powder, etc. Eventually the dog comes to learn that the bell doesn’t mean anything, and it is not affected by it anymore.
In a simple relapse prevention education series I developed, patients are educated on triggers with the information above and then I ask the group to come up with what they think might be common triggers. I stand at the whiteboard writing down what patients come up with. In each such lecture, we usually come up with about 30 to 40 triggers that are written on the board. A member of the group (hopefully with good handwriting) writes these triggers down on paper, and it is photocopied and distributed to all patients. The group members are then asked to highlight about 6 or 8 triggers they think especially apply to them. I then recommend reviewing this list of triggers on a daily basis. Here is a list of common triggers compiled over the years during my trigger education sessions (Tyler, 2005):
Shame Paraphernalia Hunger/thirst
Fear Work Neighborhoods
Cash Time of day, week, month, year Pornography
People that drink or use Holidays Taste
Drinking or using places Vacations Happiness
Social engagements Grief/loss Chemical withdrawal
Anxiety Change Weather
Sporting events Birthdays Dishonesty
Sex Music Police
Family Self-pity Payday
Depression Using memories/fantasizing Gambling
Boredom Fatigue Other addictions
Accomplishment Glamorizing use Flying
Anger/resentments Mouthwash Travel
Financial problems Advertisements Concerts
Comfort Old behavior Illness
Laziness Using dreams Physical pain
Isolation Telephone Violence
Loneliness Drinking/using “war stories” Pagers
Negativity Games Seeing others loaded
Movies Using rituals Insomnia
Smells Purchasing places Anniversaries
Seeing drugs or alcohol Caffeine Smoke
Excitement Work quitting time Sounds
Books/magazines Commercials Billboards
School Clothes Driving
Idle time Hobbies Failure
Rejection Marital problems Doctor’s office
Meals Dieting Television
Refrigerator Pawnable items ATMs
Using or drinking lingo Certain foods Spiritual emptiness
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(In the 6th and final part of this series, we will explore Relapse Warning Signs and provide a simple 3-part Relapse Prevention Education Series that is easily administered by any addiction professional.)
Gorski, Terence T. (Speaker). (1988). Cocaine craving and relapse: A comparison between alcohol and cocaine (Cassette Recording No. 17 – 0157). Independence, Mo: Herald House/Independence Press.
Gorski, Terence T. (1989, April). Cocaine craving and relapse. Sober Times: The Recovery Magazine, 3 (4), pp. 6, 29.
Gorski, Terence T. (2001). Cocaine, craving, and relapse. [On-line].
Available Internet: http://www.tgorski.com/gorski_articles/co
Gorski, Terence T., and Merlene Miller. (1986). Staying Sober: A Guide for Relapse Prevention. Independence, Mo: Herald House/Independence Press.
Tyler, Bob. (2005). Enough Already!: A Guide to Recovery from Alcohol and Drug Addiction.
Humble House Publishing: Long Beach.
Bob Tyler, BA, LAADC-CA, ACRPS, SAP
While working in Inpatient, Residential, and Intensive Outpatient levels of care, Bob Tyler has been working in recovery since 1990. He serves as Compliance Officer at L.A. CADA, is owner of Bob Tyler Recovery Services (consulting, CD private practice, public speaking), is Past President of CAADAC, and is on faculty at LMU Extension in the Alcohol and Drug Studies Program. He authored the EVVY Award-winning book, Enough Already! A Guide to Recovery from Alcohol and Drug Addiction and has produced several educational DVD’s shown in over 1000 treatment centers across the country, including Craving and Relapse. Please visit our website at www.bobtyler.net.