Relapse Prevention: Psychological Set-ups
The following I have found very useful in helping people toward relapse prevention:
“When we are in euphoric recall, we remember and exaggerate pleasurable memories of past chemical use episodes. Then we block or repress our bad memories of drug use or deny the pain associated with them” (Gorski, 1989). This makes sense because, when you enter into craving, you are not thinking about how bad it will be – you are thinking about how good that first drink, hit, or pill will be. So it is very important to recognize when you are engaging in the positive thoughts of using and begin focusing on the negative aspects. If recognized soon enough, it is often just that simple.
In practicing this relapse prevention tool in my own sobriety, I have found that the sooner I recognize my euphoric recall, the easier it is to shift my focus. If it continues unnoticed by me for any significant period of time, it becomes difficult to simply switch my thoughts from the positives of using to the negatives. At such times, I utilize one of my favorite tools of recovery – thinking the using episode through. This is a systematic way of moving my thoughts from the positives to the negatives of using – from romancing to reality. (An example of this relapse prevention tool can be found in Enough Already!)
While it is importance to recognize when you are engaging in euphoric recall, I believe it is just as important to recognize when you are engaging in what Gorski calls: awfulizing sobriety. According to Gorski, “(This) is euphoric recall in reverse… We look at our current sober life and focus upon and exaggerate all of our current pain and discomfort. ‘Isn’t sobriety awful?’ we complain” (Gorski, 1989). Such thoughts arise as: “This sobriety thing isn’t all what it’s cracked up to be. I don’t feel like anything is exciting anymore. All those AA people are a bunch of phonies. I still feel terrible and nothing seems to be improving.”
Along with focusing on the negatives of early sobriety, “we repress or block out all of the comfort, pleasure and satisfaction that is available to us” (Gorski, 1989). As with euphoric recall, it is very important to recognize when you are awfulizing sobriety so you can divert your attention to the positives aspects of recovery. Even if you have just started in recovery, there are many positives that you can pay attention to: maybe you are starting to feel better physically; maybe you are starting to patch up some of your relationships; maybe you are starting to develop new and positive relationships in your life; maybe you are starting to gain some hope because you are rubbing elbows with others who have been where you are and now appear to be doing much better. The list goes on. It may be as simple as you don’t have to experience the physical and emotional hangovers anymore? Many 12-step program sponsors have their sponsees write a gratitude list in which they write ten things they are grateful for. This is a very effective relapse prevention tool because it creates a positive frame of mind regarding your sobriety. Again, if you can recognize you are focusing on the negatives of recovery, you can simply change your focus to the positives.
At this point, I want to introduce the term anhedonia to you. Anhedonia is the inability to experience pleasure. This is very common for people in early recovery. My theory is that it results from measuring your current pleasure or excitement level to that which you experienced when you were using. The life of most addicts and alcoholics is exciting. This excitement can result from the rush of the first hit, drink, or pill, the anticipation of it, and the camaraderie that might accompany it. Much of it may be negative excitement like securing your stash, hiding your use, or cleaning up the consequences of it. However, it is excitement all the same. When you get sober, nothing in your sober life comes close to measuring up to that excitement level. A constant feeling of boredom results and you are disillusioned by the fact that you don’t have such excitement or pleasure in your life anymore. This loss of ability to experience pleasure or excitement is very dangerous to sobriety because you will say to yourself: “at least when I was out their using, I had a little excitement in my life.”
The good news is that, as you are removed in time from the memory of the high level of excitement and pleasure in your disease, it becomes easier to get excited and experience pleasure about normal life events – you are again able to experience excitement and pleasure out of everyday life. The importance of bringing this to your attention is to let you know that the inability to get excited or experience pleasure in early sobriety is time limited and your excitement/pleasure level will increase as you are removed in time from the memory of your using days. This is such an important point, I want to use a couple of personal examples to demonstrate how this works:
When I was only a few days sober and still in a treatment center, my fellow patients and I were taken by hospital van to the Alumni Christmas party. I remember being bored out of my mind. I could not believe that any of the alumni could possibly be having as much fun sober as they were exhibiting. I concluded that they either were not sober (because I didn’t think anyone could have that much fun in sobriety) or they must have been putting on an act for us newcomers so we would want to stay sober. I wondered whether such an event could ever possibly give me pleasure unless I was loaded, and remembered thinking: “if this is what sobriety is all about, I don’t want any part of it.”
Approximately eleven months later, I was at my grandmother’s house for Thanksgiving. In the past, such gatherings at Grandma’s would include my grandfather when he was alive, my father before my parents divorced, my uncle before his divorce, and my uncle’s brother when he was alive. They would all play dominoes while some of us kids watched or played on the floor with one of Grandpa’s gadgets. The moms would all be talking together and my grandmother would typically be playing the piano while bouncing one of us grandchildren on her knee. In a very spiritual moment, I started looking around the room. Now it was my brothers and I playing dominoes, now it was our wives yakking away, and my grandmother was still playing the piano bouncing one of the great-grandchildren on her knee. I got tears in my eyes and thought, “Isn’t this great? It is like old times, but a generation later.” For the first time in my sobriety, I realized that I could get excited about one of life’s simple pleasures. Now, had I experienced this event at Grandma’s early in my sobriety, where the memory of the pleasure of smoking cocaine was fresh, by comparison it would not have produced any real excitement. However, I was removed in time from the memory of the excitement produced by cocaine, so it gave me great pleasure.
To further demonstrate, it might come as a surprise coming from someone who is in his 25th year of sobriety, but there is still a large part of me that would love nothing better than a big fat hit of cocaine. In fact, if I could do so and not have any consequences, I would! I didn’t stop using because I didn’t like it – I quit using because it was killing me and those I love. There was absolutely nothing that made me feel better than that hit. In my sobriety, I’ve also had the pleasure of witnessing the birth of my four wonderful children. As incredible as that was, I can’t tell you for sure that it gave me more pleasure than that hit. However, since I was removed in time from the memory of that hit, it seemed just as exciting as anything I’ve ever experienced.
To summarize, you need to notice when you are locked into the positives, and blocking out the negatives of early sobriety (euphoric recall.) It is just as important to recognize when you are awfulizing sobriety so you can shift your focus from the negatives to the positives of early sobriety. Additionally, it is very important to know that the inability to get excited or experience pleasure in early sobriety is temporary. As you get removed in time from the memory of the positive and negative excitement of your use, you will once again experience great pleasure and excitement from your life.
Bob Tyler, BA, CADC II, ICADC
From Enough Already!: A Guide to Recovery from Alcohol and Drug Addiction – Chapter 5: Relapse Prevention
Gorski, Terence T. (1989, April). Cocaine craving and relapse. Sober Times: The Recovery Magazine, 3 (4), pp. 6, 29.