The Phases and Warning Signs of Relapse

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Relapse Warning Signs are progressive. Once they begin they cascade like a a row of falling dominos.

Below are the Phases and Warning Signs of Relapse that I originally developed from working with 117  chronic relapse done alcoholics in the mid-1970’s. These warning signs are available in a a pamphlet that can be easily carried in a shirt pocket or a purse.

Phase 1: Return Of Denial: During this phase the dependent person becomes unable to recognize and honestly tell others what he or she is thinking or feeling. The most common symptoms are:

  1. Concern about well being.
  2. Denial of the concern.

Phase 2: Avoidance And Defensive Behavior: During this phase the dependent person doesn’t want to think about anything that will cause painful and uncomfortable feelings to come back. As a result, he or she begins to avoid anything or anybody that will force an honest look at self. When asked direct questions about well-being, he or she begins to become defensive. The most common symptoms are:

  1. Believing “I’ll never drink again.”
  2. Worrying about others instead of self.
  3. Defensiveness.
  4. Compulsive behavior.
  5. Impulsive behavior.
  6. Tendencies toward loneliness.

Phase 3: Crisis Building: During this phase the dependent person begins experiencing a sequence of life problems that are caused by denying personal feelings, isolating self, and neglecting the recovery program. Even though he or she wants to solve these problems and work hard at it, two new problems pop up to replace every problem that is solved. The most common symptoms are:

  1. Tunnel vision.
  2. Minor depression.
  3. Loss of constructive planning.
  4. Plans begin to fail.

Phase 4: Immobilization: During this phase the dependent person is totally unable to initiate action. He or she goes through the motions of living, but is controlled by life rather than controlling life. The most common symptoms are:

1. Daydreaming and wishful thinking. 3. Feeling that nothing can be solved. 3. Immature wish to be happy.

Phase 5: Confusion And Overreaction: During this phase the dependent person can’t think clearly. He or she becomes upset with self and those around her or him and is irritable and overreacts to small things.

  1. Periods of confusion.
  2. Irritation with friends.
  3. Easily angered.

Phase 6: Depression: during this phase the dependent person becomes so depressed that he or she has difficulty keeping to normal routines. At times there may be thoughts of suicide, drinking, or drug use as a way to end the depression. The depression is severe and persistent and cannot be easily ignored or hidden from others. The most common symptoms are:

  1. Irregular eating habits.
  2. Lack of desire to take action.
  3. Irregular sleeping habits.
  4. Loss of daily structure.
  5. Periods of deep depression.

Phase 7: Behavioral Loss Of Control: During this phase the dependent person becomes unable to control or regulate personal behavior and daily schedule. There is still heavy denial and no full awareness of being out of control. His or her life becomes chaotic and many problems are created in all areas of life and recovery. The most common symptoms are:

  1. Irregular attendance at AA and treatment meetings.
  2. Development of an “I don’t care attitude.”
  3. 3. Open rejection of help.
  1. Dissatisfaction with life.
  2. Feeling of powerlessness and helplessness.

Phase 8: Recognition Of Loss Control: The dependent person’s denial breaks and suddenly he or she recognizes how severe the problems are, how unmanageable life has become, and how little power and control he or she has to solve any of the problems. This awareness is extremely painful and frightening. By this time he or she has become so isolated that it seems that there is no one to turn to for help. The most common symptoms are:

  1. Self-pity.
  2. Thoughts of social drinking.
  3. Conscious lying.
  4. Complete loss of self-confidence.

Phase 9: Option Reduction: During this phase the dependent person feels trapped by the pain and inability to manage his or her life. There seem to be only three ways out–insanity, suicide, or drug use. This person no longer believes that anyone or anything can help him. The most common symptoms are:

  1. Unreasonable resentment.
  2. Discontinues all treatment and AA.
  3. Overwhelming loneliness, frustration, anger and tension.
  4. Loss of behavioral control.

Phase 10: The Relapse Episode: During this phase the dependent person begins to use alcohol or drugs again, typically struggling to control or regain abstinence. This struggle leads to shame and guilt when the attempt ultimately fails. Eventually all control is gone and serious bio-psycho-social problems develop and continue to progress. The most common symptoms are:

  1. Initial use (the lapse).
  2. Shame and guilt.
  3. Helplessness and hopelessness.
  4. Complete loss of control.
  5. Bio-psycho-social damage.

This list if fully explained in the book Staying Sober – A Guide for Relapse Prevention

The list is available:

 

3 Responses to The Phases and Warning Signs of Relapse

  1. […] As a result of impaired judgment or impulse control it is easier to rationalize going back to the use of their drug of choice. Using Kava is the start of active drug use episode. It is usually preceded by many early relapse warning signs. […]

  2. c Montagu says:

    I love these cards. I have worked in a treatment centre in uk for 7 years and we help service users identify their relapse process using these cards. They can take the cards home when they leave and it appears to help them to be able to structure their relapse process around a framework like this. They state they get a lot out of it.
    I only knew the Marlatt model before this and I think its too complicated for some clients to take in, you can only teach parts of it at a time, like high risk situations and SIDS. They don’t get to see how it all comes together individually for each one.
    With the gorski model it’s all personal and individual for them, very good. Thanks

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