Trigger Events

IMG_0441.JPG

The term “trigger even” is commonly used by people struggling to understand what turns on their addictive thinking, ear lying warning signs (drug seeking behavior), and the strong attraction or need to bet involved in high risk situations. Recovering people intuitively understand the idea of relapse because it is linked to the metaphor of a gun. When you are holding a  load gun and pull the trigger it fires. Addiction, especially in early recovery, is very much a like a loaded gun with a sensitive trigger.

When you pull the addiction trigger, the disease of addiction fires off addictive thinking, automatic addictive or drug seeking behavior, and a craving or urge that pulls you toward high risk situations. One you are in a high risk situation you have put yourself in a HIGH RISK SITUATION which takes you away from recovery support, puts you around people, place, and things that support addictive use and make it easy for you to use. The high risk situation also provides social support to start using and social criticize if you refuse to start using. In a high risk situation there is also usually the false promise that goes like this: “I can use my addictive substance just this once, no one will know, and I can just renew my sobriety tomorrow. That, of course, is a very dangerous way from a recovering addictive to be thinking.

Most recovering people intuitively understand what a trigger is, and can describe exactly what pulled the trigger and what happened after the trigger fired off the movement toward addiction.  The problem is that very few recovering people or professional can tell you what a trigger is.  Events and situations that act as powerful triggers for some people have no effect on others. Even more confusing, on some days a certain situation, like have lunch in a restaurant that serves alcohol, activates a powerful trigger. On other days, haven lunch in the same place with the same people does nothing to pull the trigger that activates craving. Why is this?

Many people mistaken believe that the trigger lives in the external person, place or thing that sets it off. As a result addiction professionals teach recovering people to identify and avoid common trigger events. Rarely do recovery people get a clear explanation of psychobiological dynamics that that make triggers so powerful. Without a clear understanding of the psychobiological dynamics of a trigger event, the only way to learn to many them is through trial and error.

Bob Tyler, in his book Enough Already!: A Guide to Recovery from Alcohol and Drug Addiction, explains it this way:

“If we don’t know what makes a trigger a trigger, the only thing we can teach patients to do is to avoid them. Now, how much success do you think our patients will have avoiding triggers living in this society which is permeated by alcohol and drugs? Probably not very much! Therefore, it is essential that we are knowledgeable about how a trigger actually becomes a trigger so we can teach our patients how to recover from triggers?” Although Bob Tyler talks about “recovering from triggers, and I talk about identifying, managing, and disempowering triggers, our basic concept is the same. Recovering people can learn to identify avoid, manage, and eventual, turn off the ability of the trigger to activate craving and drug seeking behavior. This happens spontaneously as people get into long-term recovery. There are techniques and methods for pan aging and disempowering triggers that can make the process a lot easier.

Trigger Event – Defined

A trigger event as “any internal or external occurrence that activates a craving (obsession, compulsion, physical craving, and drug-seeking behavior)” (Gorski, 1988). let’s break down this definition:

  • “internal” occurrences are thoughts or feelings;
  • “external” occurrences involve the five senses: sight, sound, smell, taste, and touch.
  • In order for something to be a trigger, such an event must be connected in some way to the person’s using alcohol to other drugs.
  • The trigger is stronger if the event happen just before, or simultaneous to, the actual use (Gorski, 1988).
  • The most important thing to know about what makes a trigger a trigger is its connection to the use.

Bob  Tyler explains it this way: “A simple way of explaining this is by relating it to classical (or Pavlovian) conditioning. Ivan Pavlov was a Russian scientist who won the Nobel Peace Prize in 1904 for his research in digestive processes. While studying the relationship between salivation and digestive processes in dogs, he would show a dog meat powder and measure the resulting salivation level of the dog – they did this repeatedly. One day, Dr. Pavlov noticed that when he walked into the lab, that the dog started to salivate even before showing it the meat powder. There appeared to be some connection made for the dog between Dr. Pavlov and the meat powder which caused it to salivate. To study this phenomenon, he added a third variable (a bell) and rang it just prior to showing the dog meat powder and measured the resulting salivation level. He did this repeatedly: bell à meat powder à salivation, bell à meat powder à salivation, etc. He eventually found that he could ring the bell, not present the meat powder, and the dog would still salivate. Thus, there was a connection made for the dog between the bell and the meat powder that prompted the salivation (PageWise, 2002). For our purposes, the bell is the trigger for the dog’s drug of choice – meat powder, which caused the dog to salivate for, or crave, the meat powder. The challenge for the addicted is to identify the bells (triggers) that cause them to salivate (crave) their drug of choice. This will allow them to avoid or manage such triggers until the time in their recovery comes to start recovering from them.”

Disempowering (Recovering from) Triggers

There are three phases in disempowering  a trigger:

  • Phase 1: Avoidance: Make a list of the most powerful triggers that were associated with you drinking and drugging and plan to avoid them.
  • Phase 2: Gradual re-introduction with adequate recovery support: If consciously exposing yourself to a trigger it is best to have a friend in recovery to help you prepare, go through the experience with the trigger, be their to help you get out, and then talk about the experience and the thoughts and feelings that it stirred up.
  • Phase 3: Extinction. Phase I is to “eliminate as many of them as you can, for a limited period of time, until stable” (Gorski, 1988). As stated previously, in very early sobriety, you do not go to bars or other using places, you avoid people who use and drink, and you avoid any other triggers you identify.

“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 the addict into the crack house or their favorite watering hole, but there are some trigger situations that you should be able to eventually participate in. As stated earlier, alcohol permeates our society and you 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 normal life, gradual re-introduction to some trigger situations is necessary. This re-introduction process is best done with the addict’s sponsor or with a therapist or group if they have one. Following is an example of this process in my own sobriety.

The following story reported by Bob Tyler gives and excellent example:

“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 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.

  • Suggestion 1: Carry a Big Book (Alcoholics Anonymous) onto the plane and read it: 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.
  • Suggestion 2: Keep you recovery support system close. If traveling, find out where the lo=cal meetings are and make telephone contact with one or more local members. Have a written plan to go to 12-Step meetings each day and have an accountability system built-in.  I was in Arizona. They had me call the downtown Los Angeles Central Office of Alcoholics Anonymous (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 – here’s a funny little story:
  • Suggestion 3: Have an Emergency Escape Plan if Craving Is Triggered: Bob Tyler went to the reception.  “I found myself talking to my wife’s uncle next to the wet bar at his home.” Bob said.  “Suddenly, 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. She was supportive because I had talked with her about this emergency plan before we left.   Fortunately, I got the address and directions to the from AA’s Central Office before I left. This made it easier for me to go.”

After the meeting, Bob went back to the reception where he noticed “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 first 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 you didn’t think so – too bad!” It’s amazing how many recovering people won;t dance in recovery because they fear it will make them feel stupid and activate a craving. Bob is not alone here. So Bob developed a plan:

He waited for a fast song that he liked, and slid onto the dance floor while playing “air guitar” and, and starting to  dance. “A Van Halen song came on,” says Bob, 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. I rose to my feet with my beet-red face 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!”

Alcoholics and other addicts carry with them a reputation for doing stupid things when they are drinking or using. AS a result, any time they make a mistake or try to have fun by being silly, many people with just assume they have stated drinking or drugging again. This can activate shame and guilt and bring back painful members. It’s also easy to feel unfairly judged and to question the value of your sobriety. “If this is how people will always react to me, why bother to stay sober?” Needless to say, this kind of thinking a serious warning that needs to be discussed with your therapist and sponsor.

The other elements of his sobriety plan helped Bob get though this situation sober. He called his sponsor each day discussing everything that happened and how he felt about it. He read the Big Book for a half-hour each evening to keep is sober-thinking brain circuits alive and active., and not going anywhere alone. 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 this process of gradual re-introduction, Bob was able to participate in increasingly more activities in my recovery to the point I can now do almost anything without being triggered. This is due to the third phase of the recovery process called the “extinction process” (Gorski, 1988). As mentioned earlier, triggers become extinguished when repeated exposure to them is connected with not using, rather than using.

Addiction professionals can learn to prepare recovering people for living in a society that is alcohol and drug centered.  The trigger management process, or as Bob Tyler Describes it, Trigger Recovery, can help many recovering people improve the quality of their sober life and reduce the fear and risk of relapse.

References:

Gorski, Terence T. (Speaker). (1988). Cocaine craving and relapse: A comparison
between alcohol and cocaine (Cassette Recording Number 17 – 0157).

Independence, Mo: Herald House/Independent Press.

Pagewise, Inc. (2002). This study in classical conditioning is one of the most renown for its incredible results. Learn about Pavlov’s dogs [Online]. Available Internet: http://ks.essortment.com/pavlovdogs_oif.htm.

Tyler, Bob. (2005) Enough Already!: A Guide to Recovery from Alcohol and Drug Addiction

Books by Terence T. Gorski

Gorski’s book Straight Talk About Addiction describes trigger events in detail.

Gorski, Terence T., Addiction & Recovery Magazine, April 10, 1991

Gorski, Terence T.,  Managing Cocaine Craving, Hazelden, Center City, June 1990

One Response to Trigger Events

  1. […] term “trigger event” is used to describe what turns on the addictive thinking, drug seeking behavior, or the craving […]

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: