Triggers And Relapse Signs

If you start to sneeze, you think you might have allergies or a cold. If you start to itch in a particular spot, you might have gotten bitten by a mosquito, stepped into some poison ivy, are healing from an injury, or are possibly having an allergic reaction to something. If you feel your heart rate go up, you might be about to blow a gasket, you might be getting ready to go on stage and perform, or you could be nervous about something. Our body gives us signs that something is wrong or could be wrong, or that we might need to prepare for something about to happen. In a similar way, for someone working on recovering from addiction, there are usually a number of signs along the way that give warning that a relapse could occur.

In a similar way, if you kiss someone with a cold, it could trigger you getting a cold. And if someone flips you off while you’re driving, it could result in any number of angry responses. We get triggered. Things set us off. We can either be exposed to something that makes us susceptible to getting ill or we can relive a memory that triggers all kinds of emotional responses. The reality is, when someone is in the midst of recovery, any number of circumstances can be a trigger to returning to use. And any number of indicators can be warning signs that someone is susceptible to a relapse. For good recovery, knowing those triggers and signs is vital.

As we review triggers and signs, it is important to mention something here. If you are fighting for sobriety, just reading about these things could be a trigger for you. One of the common issues for support groups is that the telling of war stories, hearing someone share about use, or hearing someone’s relapse story has been known to cause others to feel pulls to use. Stories can be enticing. I work with individuals who are in recovery from an eating disorder or who have had challenges with disordered eating, and when they read certain self-help books, the stories contained in the books trigger their problematic eating behaviors. I had an individual in a group I led share that when he went to an NA (Narcotics Anonymous) meeting, when he heard a participant of the meeting tell the story of his relapse, just having those pictures in his head led to pictures of his own use flashing into his head, and he could smell the substance he used. So, be aware of this as you read below. You may need to read this together with your mentor or sponsor. Or at least let them know you’re about to read it so that you can tell them afterwards how it was for you.

You could also be the partner of someone with a use background or who could possibly be in the midst of a relapse. There are a lot of details shared below. Some of them might apply to your situation and others might not. However, it is not uncommon for my clients who have partners that use to tell me that when they hear talk about triggers, this triggers the trauma and emotional distress they have endured. They can become very upset, feeling sad, angry, and scared. For those of you in this situation, it may help to think about it this way - understanding triggers is often like knowing how to prepare; knowing what kind of medications or chicken soup you may need if you end up hanging out with someone who starts sneezing.

TRIGGERS AND SIGNS FOR RELAPSE

There are different types of triggers. Some triggers are what you might call high risk situations; circumstances that are full of access routes to use. Others might be interactions with people or various feelings and emotions about something that happens in life. Smells, sights, memories, and places can be triggers. Let’s look at some of these.

HIGH RISK SITUATIONS

High-Risk Situations for Drinking

Special Events. Terry was hanging out with friends to celebrate someone’s birthday. They opened a bottle of wine and the smell wafted over to Terry. Though he had no plans to drink, the smell brought up a lot of memories of enjoyable and relaxing times. Eleanor was so excited for her cousin to get married. During the reception, there was an open bar and so many there were having quite a bit to drink. Talking with people during the reception was awkward because unlike everyone else, she did not have a drink in her hand. Eduardo loved being with his family during the holidays, but at his grandmother’s house, the family began as usual to bring out a number of different drinks. Each time he turned the offer down to have something, someone would ask why. Drew loved his family, but whenever he went home, he felt overwhelmed by the level of pain he felt about some of the tragic things that had happened in his family.

There are some common high-risk situations that can lead to drinking. If you have been sober for any length of time, going to a bar is most definitely going to be a trigger. Whether or not you respond to that trigger may be a reflection of the length and solidity of your recovery. However, it is still a trigger. Going to a wedding or a family holiday get-together can be particularly challenging triggers. Each of the circumstances described above are what you would call a high-risk situation for drinking. What are yours? And when you know you are going to be walking into them, do you have a plan ahead of time and have you shared it with those you trust, making sure to talk to them afterwards to share how it went?

High-Risk Situations for Sexual Addiction

Late at night. Patricia often stayed up at night when she couldn’t fall asleep. She had been sober for a while but she’d been having trouble sleeping lately and found herself up alone at night when everyone was asleep. Sheng’s wife was a nurse working late hours, 7:00pm-7:00am. The late evenings with no one around were a considerable pull to just turn his computer on.

One of the most common high-risk times for people to struggle with using pornography is when they stay up late on their electronics. Putting safeguards on electronics (i.e. where they shut down at a certain time) can be a simple step in addressing these situational triggers. It would also strengthen recovery if these tempting situations were talked about regularly and openly during a support group or with a sponsor.

Being Alone. Beth hadn’t looked at pornography in months but when her roommates all happened to be gone for several days, she could feel the thoughts go through her head of going onto her computer. Carlos had done a lot to win back his wife’s trust, but her trips out to see family members left him home a bit, especially on weekends when he wasn’t working. He could literally feel the pull to use his phone to search and he had even thought about going and buying a burner phone that his wife wouldn’t know about.

When family or a partner is gone for the day, for the weekend, or for the week, the pull to use is stronger especially when it is accompanied by the feeling that one is free to use without anyone walking in and discovering anything.

High-Risk Situations for all Use

Early Sobriety. The time period immediately after someone has stopped using can be a particularly high-risk period for returning to use. With alcohol and certain drugs, the post-acute withdrawal can be very challenging and can include problems with thinking and memory, strong emotional reactions, sleep disturbances, and acute sensitivity to stress. Having help with riding through withdrawal symptoms is vital, medically, socially, spiritually, emotionally, psychologically, and physically. It is vital to make sure that you have a much greater amount of support during this period when triggers for relapse can be particularly high.

Isolation. When Miyoke was working on her masters, she had so many relationships and such great support. But now that she was a working professional, it had been hard to build friendships and she had never been super comfortable in crowds as it was. Since his divorce, Trent only had time with his children every other weekend and all of the couple friends he used to hang out with were no longer around. The loneliness had become overwhelming. Andrea’s husband travelled quite a bit. She ended up home alone regularly and felt both bored and lonely.

Each of these circumstances of isolation and others can be perfect set-ups for use and relapse if someone is not vigilant. When friendships are few, and when it feels that the only opportunity to build relationships is with a drink in your hand after work, the common thoughts of “only once” can creep back in. This can be especially true if someone has entered a new circumstance (new city, new job). Never being alone is not necessarily the cure for the trigger of isolation, but a good plan for times of isolation and someone to share that with is key to solid recovery.

Sudden influx of cash. Eduardo got a big bonus on his last check. The thoughts of “you deserve it” tugged at him. LaTasha’s grandmother left her money and when she got the check, she kept looking at the amount, thinking how much fun she could have. The amount Dave received from his insurance claim was unexpected. He could feel the desire to make that quick phone call to a dealer. Without realizing it, each of these individuals could begin to have thoughts like “things have changed”, “nobody needs to know”, or “no need to share that I thought this”. This trigger can be very subtle.

Challenges with work. Camila had been working hard at her job and so her negative review came as a complete shock and she felt incredibly discouraged. Robert began noticing that since he had been working at his job, most of those in his department that had started around the same time he had had already been promoted. Whenever he brought this up to his boss, his boss just told him to keep working hard. Emily had a great executive level job, however the pressure to maintain the high level of employee performance for the divisions she oversaw was taking its toll. The issues of conflict between employees at Anaya’s job had become increasingly challenging and some issues had become very personal attacks. Dalton had lost his job several weeks ago and was finding that few stores were hiring. Bridget‘s school kept moving her into different classrooms and the continual learning curve had become a source of great anxiety. Elias was in his mid 50s and had just been laid off for the second time in a year. It was becoming difficult finding new positions at his age.

Challenges with work can come in many different guises and can leave someone feeling a high amount of discouragement, anxiety, and fear. These kinds of changes can be a trigger to relapse. This is especially true when someone does not share the stress and fear they feel with someone they trust.

Changes. There can be so much transition in life. And each transition comes with its own challenges. Transitions can include a new job, a new city, a new baby/child, a move, or close family or friends moving away. Those in the process of recovery share how challenging it can be even when their support meeting undergoes changes like changes of location or a change of leadership. Even basic changes in life’s daily routine can be stressful. For solid recovery, it is vital that these kinds of stressors are shared with a friend, a confidante, or a sponsor/mentor in order to recognize the power they have to trigger use.

Situations associated with use. Reina loved going to the county fair. However, anytime she was in that kind of atmosphere, with those friends, the habit of use was a strong pull. Malik had been sober for over 2 years, but whenever he spent time with his long-term friends, he could feel the lure of going ahead and taking something. Ethan had an apartment situation he was really happy with but when his roommate pulled out his stash and started smoking, he could feel a stronger and stronger desire to say yes to the offer to join him.

Hanging with friends that someone used to use with, or hanging out with those who not only support use but encourage it, can have a subtle influence on the desire to use. This can be incredibly true for those who live with someone who uses. A particularly difficult situation can be when someone that is very trusted, a mentor or a sponsor, relapses, this can be very challenging for their mentee/sponsee. If this person is also a close family member, a good friend, or a trusted spiritual advisor, the desire to give up the fight can be very strong.

Physical challenges. Andrew had serious chronic pain in his knees. Surgery allowed him to function but pain continued incessantly. The hopeless about this ever getting better was often accompanied with thoughts of just taking something to blot it out. Chan’s back injury made driving, sex, walking, and sitting at his desk at work challenging. Sometimes the only idea of peace or relaxation that would come to his mind was tied to thoughts of drinking.

Chronic illness, surgery, chronic pain, and injuries can yield circumstances that make it hard to resist the pulls to use. Physical pain can color every aspect of life and make everyday life difficult. The hopeless of chronic illness and pain can lead to feeling that going ahead and using doesn’t seem so negative.

Relationship challenges. When Aaron and Elizabeth fought, he found himself having more to drink than he planned on. Darya’s husband rarely was interested in having sex, and when there had been a long stretch since they’d had sex, she felt a strong pull to return to viewing pornography. As the level of distance between he and his wife increased, Derek had more thoughts of calling his dealer and going by the massage parlor.

One of the primary challenges that get brought up in my office in working with couples in recovery is the impact that relationship problems have on the desire to use. Stress, conflict, anxiety, sadness, hopelessness, lack of connection, and lack of sexual intimacy can lead to the desire to just give in. Though these challenges can never excuse use of any kind, it does help to identify that these are high-risk situations for relapse. Preparing ahead of time how to respond and planning how to cope if some of these things do not change is integral to the process of good long-term recovery.

SIGNS OF RELAPSE

Signs of relapse can either mean that a relapse has already happened or someone is in danger of relapsing. In either situation, it is important to take a careful look to see if any of these things are happening in order to strengthen the road someone is on toward recovery. The next several sections include lists of various actions, behaviors, thoughts, attitudes and feelings. One way you can use these lists is to write in a journal if any of these apply to you and then share them with a sponsor/mentor/friend. Or just circle all those that apply. Don’t get overwhelmed if there are a high number of things you circle. The reality is that each of these things can be a great opportunity for growth and change. Openness is the key to good recovery. Prepare yourself before you read them so that you can make an honest assessment of where you have been at in the past, where you are right now, and how you can prepare for challenges in the future.

Actions

Certain actions are a very strong sign for possible relapse or for recovery not going well. If you are experiencing any of these, or if someone you love is, it may be time to have some blunt, loving but confrontational conversations.

1. Missing meetings: This isn’t the rare miss but rather a pattern of missing or having a laissez faire attitude about going.

2. Not working a program: It doesn’t matter as much what program someone decides to get help from in recovery. It is more important that whatever program they are in, they work it well. This includes having someone hold you accountable and working on whatever “steps” or processes are used in that program.

3. Not talking regularly to a sponsor/mentor: calling and talking with an accountability partner less and less, avoiding a sponsor, not reaching out to a mentor/sponsor when stresses or pulls are high, not returning a mentor’s call.

4. Lying: Hiding bills, not sharing mistakes, not sharing things that you have forgotten to do, telling lies about where you have been or who you have been with, not admitting to triggers and pulls.

5. Minimizing or denying addictive behaviors, triggers, or pulls: Calling relapses a “slip” or a “phase” or saying things like “it was not that big of a deal.” Refusing to admit to using if someone asks.

6. Anger: Angry responses when someone corrects you (at work, at home, etc.). Feeling impatient, irritated, and annoyed by someone, especially a partner or family member, and then lashing out in anger when the irritation overflows.

Behaviors

You may be in the process of recovery and wanting to solidify your sobriety. You may be feeling like you’re on the verge of a relapse but cannot quite put your finger on what is bothering you and why you’re feeling concerned. You may have someone you love in your life that you are concerned for in regard to how their recovery is going. Like the actions listed above, there are certain things that people do, behaviors they either engage in or do not engage in, that can be signs to pay attention to. See if anything below looks familiar.

1. Compulsive and/or impulsive behaviors (loss of control):

• I start using one or more of the following- food, sex, caffeine, nicotine, work, gambling, etc. often in an out of control fashion.

• I make choices or react to something without thinking of the consequences of my behavior on myself and others.

2. Life is out of balance: 

• I work too much or too little

• I get too much exercise or very little or none

• I overeat or don’t eat enough • I never do anything to have fun

• All I do is have fun • I have a chaotic daily schedule

3. Isolating Behaviors:

• I am isolating physically or emotionally

• I openly reject help from others

• I start avoiding people who will give me honest feedback

• I am experiencing anger and resentments that I keep to myself

• I sit in the back of meetings and I don’t participate

4. Unrealistic Plans/Goals:

• I make unrealistic plans

• I want too much too quickly

• I set unrealistic goals

5. Lack of working a program:

• I don’t talk with my sponsor

• I haven’t been working the steps

• I don’t have anyone who holds me accountable

6. Lack of Productivity or Motivation:

• I lack energy and sleep excessively

• I have a hard time taking positive action to improve my circumstances

• I lack structure to my days

7. Social Life

• I am hanging around drinking or using friends and “wet places”

• I’ve been spending large amounts of time with people or groups who have an abundance of character defects they are not truly working on

• I consciously lie to others

• I quickly jump into intimate relationships

• I withdraw from family activities: family meals, holidays, celebrations

8. Use Behaviors:

• I drive by places that I could buy liquor or drugs

• I haven’t emptied my house of drugs or alcohol or use paraphernalia

9. Health (mental, emotional, psychological, spiritual)

• I don’t eat regularly and nutritionally

• I’m not taking care of myself physically, mentally, emotionally, spiritually

• I don’t pursue healthy coping skills

• I don’t exercise

• I haven’t been paying attention to my appearance or hygiene

10. Resistance to working through things:

• I feel resistant to identifying what led to a relapse

• I feel resistant to examining emotional challenges that might underlie use

• I feel resistant to examining my life history and/or drug use history

11. Chemical loss of control (drinking/using):

• I find myself drinking/using again to solve my problems.

• I start to believe that “it’ll all blow up when I hit bottom, so I may as well enjoy this relapse while it’s good.”

• My problems with use continue to get worse.

Feelings and Attitudes

Good recovery is founded on an honest assessment of internal feelings and attitudes. Look at the feelings and circumstances below and do an honest appraisal of whether these kinds of emotions or attitudes are happening for you.

1. Return to Denial: Minimizing or denying addictive behaviors, triggers, or pulls. I stop telling others what I’m thinking/feeling and start trying to convince myself or others that everything is all right, when in fact it is not.

2. Boredom: I have more free time than is best. Whatever I am doing feels boring. I feel like I want something more exciting to pick me up. I feel like there is nothing interesting to do. My schedule is completely free with nothing planned. I feel restless and discontent.

3. Loneliness: Feelings of loneliness and isolation. I feel like I don’t have anyone to talk to. I look around and see everyone with someone and I feel like I don’t have anyone. I don’t feel like I have any close friends. I feel like no one would miss me if I were gone. I don’t feel like I have anyone who really knows me or loves me. There is no one to hold me or hug me. I miss being touched. I am lonely.

4. Defensive Attitudes: I start becoming irritable and angry with people who will give honest feedback. I get offended if someone questions my sobriety. I feel easily angered or irritated by people, things, or circumstances. I find myself thinking a lot about how others have wronged me. I experience anger when I am expected to follow rules, complete duties or assignments, or hold commitments. I feel I need to defend addictive behaviors. I get angry or defensive when someone asks me how I am doing or questions my process of recovery.

5. Blaming Others: I struggle with feeling like he/she/they are the cause of my problems. I find myself blaming others.

6. Starting to Crisis Build: When ordinary everyday problems become overwhelming. I feel like no matter how hard I try, I can’t solve my problems. I start believing that there is nowhere to turn and no way to solve my problems.

7. Feeling Immobilized (stuck): I feel trapped and start to use magical thinking. I have overly rigid thinking. I feel like I have tried everything, and nothing is working.

8. Becoming Depressed: I start feeling down-in-the dumps and have very low energy. I may even become so depressed that I start thinking of suicide. I feel apathetic. I don’t care what happens.

9. Emotional Swings: Emotional or personality swings. I am normally energetic and outgoing and have become depressed and non-communicative. I have had sudden swings of inappropriate happiness or hostility.

10. Urges and Cravings (Thinking about Drinking/Using): I begin to think that alcohol/drug use is the only way to feel better. I start thinking about justifications to drink/use and convince myself that using is the understandable/valid/logical thing to do. I believe I could drink or drug again and control it this time. I think about seeing a doctor to get a prescription for mood-altering drugs. I am thinking about tranquilizers or sleeping pills. Feeling the desire to find something to get rid of the pain.

11. Relationships/Social Life: Feeling like I’m more fun to be around when I’m using. Feeling like I can’t date or be romantic without a buzz. I feel resentful that the fun to be had around town with friends is so limited I resent the people closest to me. Feeling critical and judgmental thoughts of others. Feeling persecuted or victimized. I like my old friends.

12. Unrealistic/Irrational Thinking: I’ve been thinking if I move, everything will change. I unrealistically think I should be happy all the time. I’ve had thoughts like “I will never use again.” I am feeling “cured.”

13. Negative Thoughts and Emotions: I have been experiencing feelings that are perceived as negative, particularly anger, but also sadness, loneliness, guilt, and fear. I don’t believe I’ll every have fun sober. I act happy as though everything is OK, though I feel miserable

14. Strong or Positive Emotions: Positive feelings that make you want to celebrate. I owe this one to me. I overreact emotionally.

15. Complacency: Believing that you no longer have to worry (complacent). That is, that you are no longer stimulated to crave drugs/alcohol by any of the above situations, or by anything else – and therefore maybe it’s safe for you to use occasionally. I can handle it.

16. Stress and Anxiety: Overreacting to stressful situations. I have been feeling anxious most of the day. I have noticed an increase in anxiety about a number of things. People are saying I seem anxious and worried. I can feel my tension level being high much of the time.

17. Avoidance: I avoid taking on responsibilities for things. I avoid dealing with family problems. I start avoiding people who will give me honest feedback. I start avoiding gatherings and people.

Thoughts and Words

There can be any number of phrases that cross someone’s mind that are important to pay attention to primarily because our thoughts often lead to choices and behaviors. Many different emotions and experiences can trigger these thoughts (see the section above about circumstances), however, the words coming out of someone’s mouth, the tone they say them with, and the thoughts going through their head can be some of the clearest and most obvious signs of a relapse that has either already occurred or may be imminent. Be smart, and let your words be a red flag to getting more help and support. Be aware that not every comment listed below is a sign of relapse, but it is something to pay attention to, especially if there is any pattern.

Here are some common phrases to watch out for:

• Sobriety is boring

• I’ll never drink again/use again

• I can do it myself”

• I’m not as bad as…

• Things have changed

• I can substitute

• They don’t know what they are talking about

• There’s got to be a better way

• Nobody needs to know how I feel

• I’ll just let everyone else share their feelings/problems and there’s no need to focus or think about my own

• I can be abstinent without recovery

• I feel very confident in my recovery

• If my husband would just… If my wife would just… If my partner would just…

• I can’t relate to anyone in my recovery program

• Yes, I think about drinking and drugging, or experience cravings, but I don’t need to share this in my recovery circles

• It’s no one’s business if I skip meetings

• I don’t see any benefit in talking with my sponsor or working the steps

• I don’t need to get to know anyone in recovery

• It’s no big deal if I get to meetings late and leave early

• I’m too young or too old for recovery

• I am not like the people that come to these meetings

Feelings of Depression

Depression or depressed thoughts are very connected to relapse. Here are specific thoughts and feelings that need to be shared and addressed in order to maintain recovery and avoid a relapse.

• My problems can’t be solved

• I wish I was happy

• I don’t care

• If nobody else cares, why should I?

• I can’t change the way I think

• I’m depressed

• I feel hopeless

• I can’t do it. Why try?

• I doubt my ability to stay sober but keep this a secret

• I’m afraid, but I deny it

• I find myself ruminating about the past

• I don’t think I’ll ever be able to rebuild my life

• I feel hopeless

• I have lost interest in meaningful things like volunteering, clubs, hobbies, sports, etc.

Conclusion

As I mentioned earlier, this entry can provide a lot of food for thought and a lot of opportunities for growth. It can also be an entry that feels discouraging. “How can I ever overcome?!” Psalm 139 can be an important source to remember how God would call us to respond to some difficult realizations. “Search me O God, and know my heart. Test me and know my anxious thoughts. See if there is any offensive way in me and lead me in the way everlasting” (Psalm 139:23-24). God wants to lead you in a great journey of victory. So, let Him search you. Ask Him to show you how to stay on that path. I heard a metaphor recently that is very applicable. It has been said that when you fly a plane, you set a course and schedule but 99% of the time you are continually bringing the plane back on course. Use this entry to figure out where you need to get back onto a good course to ensure a good flight.