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Identifying Stages of Relapse and the Relapse Dynamic -08th April 2015

The following stages of relapse, outlined by Terry Gorski, can be a very helpful tool when working with addicts as they track the effects of this overconfidence, and can help avert them from the perils on the recovery road.

For some, relapse is part of recovery, but for others, long-term continuous abstinence is definitely achievable. If they can also recover from the effects of their childhood trauma and learn to build their self-esteem, develop personal boundary systems, and gain a better understanding of their reality, it will allow for the ability to self-care in an appropriate adult moderate fashion. It is then that we truly see the miracle of recovery!  

Gorski (1982) summarised the stages of relapse into 11 significant warning signs that reflect a gradual sequence of behavioural, psychological and social shifts towards a loss of control. By recognising these stages, it is possible to interrupt their progression.

They are listed below:

1. Change

  • Changes in daily structure
  • Significant stressors
  • Work pressures
  • Relationship difficulties
  • Attitude shift

2. Elevated stress

  • Change introduces more stress (distress)
  • Sleep disturbances
  • Short fuse
  • Work performance deterioration
  • Relationship / communication issues

3. Denial Reactivation

  • Denial of excessive stress (distress)
  • Presence of a defensive system
  •  People asking “What’s going on with you? Or are you OK?”
  • If you are in a relapse pattern you may find such questions uncharacteristically irritating or intrusive – leading to cranky remarks like, “I’m fine! What’s wrong with you!

4. Fragmentation or “falling apart slowly”

  • Elevated stress eventually causes significant impairments in the individual’s ability to think, feel and act with any clarity or confidence
  • Thinking patterns begin to narrow and become difficult to break, and a growing sense of “feeling scrambled” interferes with daily functioning
  •  Memory problems are frequently seen in this stage
  • Emotional inability or reactivity increases as can a general or global sense of numbness
  •  As the cognitive and emotional processes become more disorganised – behaviour begins to reflect this gradual breakdown
  • Panic, anxiety, increased worry; empty feelings, agitation and fatigue may be experienced as indicators of a gradual relapse pattern

5. Behaviour Change

  • Action and behaviour reflect the final sequence in the above example
  • Although the individual may be going to the same places and associating with the same people, their behaviours will invite unnecessary stress and confusion
  • Some will experience irritability, and agitation, whilst others may withdraw and isolate. What is of importance is that what we would normally do begins to drop off, leading to inconsistencies and routines and commitments

6. Social Breakdown

  • Associated with behavioural changes are subtle differences in the individual’s “social feel”; or the sense one gets from being around them
  • As a result of this breakdown, the individual may lose contact or cause conflict with regular supports

7. Loss of Structure

  • Life structure begins to show signs of alteration and degeneration
  • Abandonment of recovery plans, daily routine and habits
  • Far more inconsistencies than behavioural change alone
  • Frequent missed appointments
  • Increased incidences of sleeping in and avoidance of work, social and relationship commitments

8. Loss of Judgment

  • Increased disorganisation across thinking, feeling and behavioural dimensions individual’s increasing inability to make decisions, solve problems or continue in recovery behaviours
  • What would normally be completed with little difficulty might now be impossible to begin.
  • Simple decisions become increasingly difficult to make

With all these stages of relapse, with awareness and good guidance, it is possible to make the necessary changes to re-establish the client’s commitment to their recovery program. The art of good therapy is to be able to identify as early as possible when a client has started a decline into relapse. These 11 stages of relapse can make the observations more structured and helpful.

9: High-risk situations: By this step our emotional state is in such turmoil and our thinking is so distorted that we disregard all our recovery tools and suggestions. We put ourselves in high-risk situations, convinced that we are not going to use drugs. We may believe it is ok to see our using friends, or to visit places where we used to use drugs. 

10: Relapse: Having reverted to our old ways of feeling, thinking, attitudes and behaving. Having abandoned all recovery tools and support and putting ourselves in high-risk situations that trigger us, eventually we pick up drugs again – have a physical relapse. The way we see it, our choice was to collapse, commit suicide or use drugs. We could collapse from all the physical and emotional stress of our problems

11: Aftermath of relapse: Once we have a physical relapse, we tend to follow one of two paths.  Some of us have a low-consequence relapse. We realize we have made a mistake by reverting to our old ways of dealing with life, so we reach out for help and get back into recovery.  Others continue using drugs, feeling such guilt and shame that they refuse to seek further help.