So often I am asked, “Why do I keep relapsing?” by individuals who suffer from the disease of addiction and have trouble maintaining abstinence. These individuals really want to stay sober, but they have a terribly difficult time staying away from drinking and using. This is a very frustration and dehumanizing cycle that leads many addicts down a road of despair and hopelessness. But there is hope! All you need do is realize how addiction is working inside of you, and then take the necessary steps to arrest it. It all begins with a willingness and information.
So, why do you keep relapsing? Well, because addiction is individualized, there is no one answer that fits all: however, there are certain aspects that do apply to most relapsers. This article will attempt to address each of the most common aspects of addiction relapse in terms that are simple to understand, and are directed to the relapser. The understanding of common relapse aspects is the foundation upon which an individual must begin their recovery effort in order to maximize the probability that they will maintain a quality lifestyle of fulfilling long-term sobriety.
To oversimplify; your brain has a mind of its own.
The nucleus accumbens is located in your mid-brain and operates as your pleasure center. When mood altering addictive substances are introduced to the body, the synapses in the neuropathways located in the nucleus accumbens release neurotransmitters such as dopamine, norepinephrine and serotonin which make you feel euphoric, happy, and content. Your brain believes these feelings are advantageous for your survival, so it releases glutamate to construct a hard-wired memory circuit attached to the use of the addictive substance. This chain of events is partly responsible for your cravings.
Moreover, there are two changes that happen inside the nucleus accumbens that directly impact your ability to stop using addictive substances. Over time, the brain develops tolerance to the addictive substance because the synapses in the neuropathways mutate. The mutation is a direct result on the onslaught of addictive substances causing an abundance of neurotransmitters such as dopamine, norepinephrine and serotonin to reside in the synaptic cleft. Because your entire body is constantly seeking balance (aka. homeostasis), the body’s reaction is to create more neuroreceptors to handle the excess neurotransmitters. As soon as this happens, you have created tolerance, and the disease of addiction has taken hold. The unfortunate side effect of this mutation is that your nucleus accumbens now has too many neuroreceptors designed to handle dopamine, norepinephrine and serotonin. As a result, when there is a lack of these neurotransmitters in your nucleus accumbens, your brain tells you to get more the addictive substance so your body can be in balance once again. When this happens it is called withdrawal and is another reason for your cravings.
There is yet another change that happens in the nucleus accumbens that is thought to possibly account for the chronic nature of the disease of addiction. Recent research has shown that with prolonged use of addictive substances there is a genetic aberration created in the DNA structure within the nucleus accumbens.
The aberration occurs when certain genes are turned on within the DNA that are not supposed to be turned on. With prolonged use of addictive substances, the genes that are turned on do not turn off again. This genetic aberration could be the reason why your addiction will be with you forever, and why we have been unable to develop an effective medication to eliminate the effects of addiction.
There is another physiological effect of addiction that contributes to stress which is a primary cause of the relapse process: anhedonia. With prolonged use of mood altering addictive substances, your brain’s pleasure center has reset itself in a way that has elevated your hedonic threshold. An elevated hedonic threshold means that in order to feel pleasure, it takes a great deal more stimulation than it would if the hedonic threshold was normal. For example, if going to view a funny movie is very entertaining for a normal person, an addict would simply not think the movie was very funny or enjoyable. Your brain is somewhat numbed to the sense of pleasure. This can lead to depression and other forms of stress: additionally, it can lead to using alcohol and drugs to catch a glimpse of a pleasurable experience.
With prolonged use of mood altering addictive substances, the likelihood of chronic stress mismanagement and depression is increased. If you have mismanaged chronic stress and depression, your body will react by turning on a gene that will create an impulse to take unnecessary risks in order to get a thrill. Your thrill seeking and risk taking behavior will naturally lead you right back to using mood altering addictive substances.
As you can surmise, there are many factors involved with the disease of addiction and how addiction influences your brain physiology. It is important to understand that these effects will only improve with complete abstinence from all mood altering addictive substances. That means when you relapse, even after a few months or more of abstinence, your brain physiology goes right back to nearly where it started. But physiology is only part of the picture, there is far more going on with regard to why you continue to relapse.
The single most important contributing factor to your habitual relapsing behavior is stress. Stress comes in many forms, from momentary and intense stress to chronic lingering anxiety. Your stress may be caused by external factors you have no influence over to cognitive factors for which you are entirely empowered to change. Regardless of the type or causes of your stress, it is a relative certainty that your stress launches your relapse process.
You can do something about most forms of stress because the root cause of the personal impact on you is provoked by how you think about your world and yourself.
The disease of addiction is most often associated with cognitive distortions which are exaggerated and irrational thoughts about the people, places and things around you. For example, you might think that a couple of people across the room who are giggling and laughing are making fun of you: however, the reality is that they don’t even know you are in the room. Cognitive distortions warp the way in which you deal with life, and therefore cause a great deal of stress and anxiety because you believe that your warped perception is reality. Cognitive distortions are remedied through guided therapy over a period of time.
Another stress related factor in relapses includes how you deal with naturally occurring stress. Everyone is exposed to stress in the course of living life. However, if you are relapsing, you are most likely not managing your normally occurring stress well. Coping mechanisms are learned responses when dealing with life stressors: there are both conscious and subconscious coping skills. Chances are that you have not had the opportunity to learn appropriate coping skills in your life, and you are simply repeating the same old ineffective methods of trying to cope with life stress. When these old habitual methods of coping do not work well, you eventually begin to turn to mood altering addictive substances to mask the stress instead of managing it.
In order to break the cycle of stress mismanagement it is necessary for you to learn new coping mechanisms. The process of learning new coping skills is usually led through therapy, however friends, family and other mentors can also have a significant impact.
The propensity to relapse after gaining some amount of abstinent time can often be linked to sociological factors in your life. Cultural influences such as everyone drinking at the bar or at family gatherings are very difficult to break away from. Furthermore, some cultures simply do not understand that addiction is a problem, or may think that drinking and using a little bit is perfectly acceptable just as long as you do not take it to the extreme. Obviously, if you are trying to remain 100% abstinent, these types of attitudes around you will not help.
Furthermore, family systems play a very important part of your sociology. A family system that is rigid, has many rules that are difficult to follow, or has virtually no rules, will perpetuate deviance within the family. You may experience this in adulthood through defiant behaviors and belief systems that prevent you from accepting yourself as an addict. This lack of acceptance will lead to acting out in avoidance and denial which will inevitably lead back to drinking and drugging.
Family systems can also provide you with the ability to drink and drug by enabling your unacceptable behaviors. Very often family systems think they are helping by giving you food, money, or shelter when all they are really doing is helping you to stay addicted and slowly kill yourself with excessive drinking and drugging. Enabling behavior is understandable because most people want to help out other people. However, when it comes to addiction, traditional methods of help are often times destructive.
There are many other sociological factors that contribute to your relapsing. Factors such as your environment, education, race, religion, and even your workplace can have a significant impact on your recovery effort. The most important thing to remember about your sociology is that you are empowered to change it: all you need to do is be willing to make difficult decisions that will steer you in a healthy direction. The process of making those decisions is usually led through therapy or self-help organizations.
Your sense of being, the essence of yourself, is likely misunderstood or entirely missing as long as you are participating in addictive behaviors and using mood altering addictive substances. It is nearly impossible for you to intimately connect to any power other than yourself as long as you are drinking and using: this includes other individuals as well. If spirituality is the way in which people find their deepest values and meanings for being, then being isolated from spirituality is bound to pull you back into relapse mode.
One of the challenges with spirituality and relapse is that a spiritual connection with others must be formed in order to create a support system for you. Without the spiritually connected support system you will be isolated when stresses mount and relapse thinking occurs.
Additionally, a spiritual sense of belonging to the world is very useful in creating an understanding of purpose as well as a grasp on humility. Without humility you will likely continue to fight your addiction with an attitude of win or lose. It you must win or lose, there is no room left for being human and making occasional mistakes. Being humble must become a way of life, and a spiritual connection is the best way.
|If one of the legs of the stool is weak, short, or missing – the whole stool may fall.|
Life and living life are concepts you may not think about too often. Contemplate the terms now: what does it mean to live life? It is a hard question to answer. When joyous people are asked this question their response always contains a sense of spiritual connection with others and with a higher power. Spirituality is highly individualized, yet connects us all as human beings.
You keep relapsing because your recovery effort is lacking in one of three areas that are designed to monitor and address high functioning in the physiological, psychological, sociological, and spiritual aspects of your recovery. The three areas that your recovery program absolutely must contain and be worked on a continual basis include:
- Self-Help Support
- Clinical Support
- Family Support
It may be helpful to view the early recovery program as a stool with three legs:
Self-help support includes group meetings such as Alcoholics Anonymous, Al-Anon, religious institutions, treatment facilities, community programs, and other self-help organizations. These networks are valuable resources for you to share thoughts and behaviors and receive feedback you’re your peers who have similar experiences.
The clinical support ads a very different dimension to the recovery effort. It can be dangerous for you to attempt to deal with psychological issues without the guidance of a clinician. A psychiatrist or psychologist with addiction accreditation, a chemical dependency therapist, an addiction counselor, or community mental health services will be able to confront irrational addict self thinking and link the distortions to recognizable behaviors.
The family system support plays and extremely important role in your recovery program. The family can be defined as any person that has a close connection to you by genealogy, friendship, or romanticism. It is common for the family system to be unhealthy when there is an addict involved, and that is why it is so important to include the family system in your recovery effort. When the family system is also working on their own recovery effort, the communication between you and them is very poignant and valuable.
The purpose of the three legged stool is to provide you feedback and loving support from individuals from diverse aspects of the your life that understand the disease of addiction and will interact with you in helpful and compassionate communication when they recognize addict self behaviors and thought processes.
So, after all this information being absorbed into your open and willing mind, ask yourself the question again: “Why do I keep relapsing?” Do you have a different answer now? Perhaps you can take a different, more healthy, approach and try to arrest your disease of addiction today. I wish you the best of luck and success.
By Andrew Martin, MBA, LAADC, SAP, CA-CCS