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A while back ( https://www.sjdpsych.com/post/cut-down-your-alcohol-now ) I mentioned
that some people can just cut back on their drinking and do fine. For example, maybe they decided they were having too many of their everyday calories being from beer and needed to cut back.
But then there are people who just shouldn’t drink at all for whatever reason. Maybe they're pregnant. Maybe they’re getting health problems that are worse because of drinking. Maybe they’re starting to get social or employment problems related to their drinking.
Regardless of the reason, there are just some people who shouldn’t use alcohol and really try to be alcohol-free. But once they’ve stopped, it can be pretty hard to stay quit (https://www.sjdpsych.com/post/i-stopped-drinking-now-what ).
What I’m writing about today is for people who knew they needed to stop drinking, did so, and want to or have already, started again. I’ll be talking about things to watch for and suggestions for how to stay sober.
Which is it – lapse or relapse?
It kind of sounds like splitting hairs, but most of us in the helping biz make a distinction between a “lapse” and a “relapse.” Both refer to going back to using alcohol after being without it for a while.
But the difference is how long the alcohol use goes on. We think of a lapse as being a brief episode of drinking. It could be one drink, a few drinks or a lost weekend. But when the person stops that episode of drinking, they don’t go right back to using alcohol.
A relapse is when you start drinking and keep right on going. And I don’t mean you drink all day long. I mean you start making alcohol an everyday part of your life again, like it was before you quit.
It’s not unusual for someone who has had a lapse to just feel hopeless. Like a failure. Like they’re never going to get past this problem.
Sometimes they get to the point of thinking they might as well drink since they started already.
But I point that you can use a lapse as an excuse to just keep on drinking and have a full-blown relapse. Or you can use is as a warning to be more careful. Beware of your thoughts and of ‘cues’ that should have told you to stop.
What causes lapses and relapses
There are probably more reasons for returning to drinking than there are people who have done it. It can be anything or nothing.
Craving can play a part in this, as I mentioned before ( https://www.sjdpsych.com/post/i-stopped-drinking-now-what ). And we know that craving occurs for a variety of reasons, one of these being that alcohol rewires the part of the brain that gives us enjoyment.
But there are a lot of things other than craving that can spur people on to return to drinking. These are ‘cues,’ warning signs that alcohol is looming. And cues can be different for different people.
Alcoholics Anonymous tells us, and science agrees, that among the very most common reasons people relapse is exposure to “people, places, and things.”
People, places, and things: reminders to drink
Most of us have had the experience of hearing a song and suddenly remembering something that happened when we heard it playing .
Lots of people talk about music they shared with someone they love. They call it “our song.”
Maybe a certain event took place when we heard it the last time. Maybe it reminds us of a particularly happy or particularly sad time in our lives.
But when we hear that song, we’re back in that moment. And in the same way, things around us will remind us of our drinking days.
People - We know that relapse to drinking can be triggered by being around certain people. Running into old drinking buddies each with a drink in his hand could do it, for example.
Running into an old love after a bad breakup and feeling the pain again could be a warning. Think about the people you know who remind you to party.
Places – If you always had a few beers at football games, returning to cheer for your team could be a trigger to start drinking.
Likewise, going by the beer aisle in the grocery store or passing the liquor store where you always bought your bottles can bring on powerful urges to drink.
Things - an empty whiskey bottle, commercials for your favorite drink, just not wanting to feel the hurt after being passed over for a promotion, or a fight with someone important to you.
These and many other cues can all signal that relapse is near.
You can't avoid all the cues -
- So what do you do?
I'm really big on making concrete plans for what to do when... So I'm gong to say the obvious: have a plan for what to do when cues make it really hard to stay alcohol-free.
Chances are you're going to run into a person or hear a song that reminds you of using. What are you going to do when that happens? Well, like I mentioned, https://www.sjdpsych.com/post/playing-the-what-if-game , write out a plan - don't just 'make a mental note' of things you could do. You probably won't remember them at the highest risk times.
For instance, if you run into someone you used to drink with or who encourages you to drink, have a number on auto-dial for someone you can immediately talk to. If the old drinking buddy won't let you politely refuse to join them, walk away. Write down the addresses and times of local twelve-step meetings.
Places, things, people - have a list of some of the cues that increase the chances that you'll
drink. Write down some ideas for what to do in each situation.
You probably won't think of all the times that can be hard, but it's likely you'll come up with the ones that have the highest risk for you.
Setting yourself up to fail ...
...or planning your relapse
If I just have a sip of wine at the wedding it’ll be okay.
I’m going to go to the bar and sit there but not drink, just to test myself.
I keep forgetting my medicine to help me stop drinking. Since I’m fine, I might as well just quit them.
I’m just going to be out with the guys for a while, nothing’s going to happen.
I’ve heard all of the above and many more from people early in their recovery. For individuals who have gone without alcohol for years, some or all of these statements may be true. (Actually there are a couple I think means the person is kidding himself).
But when you've only gone a few months or a year or two after admitting you were one of the people who HAD to stop drinking, and especially if your craving is high, we call this “planning” your relapse. It’s setting yourself up to fail.
If you do return to drinking, don’t try to convince yourself that you didn’t expect to be drinking when you put yourself in a high risk situation. Many people tell me this at first, then admit they had some thought or even hoped there would be alcohol.
If you don’t want to continue to drink, go through the steps I gave in the previous post. Call someone in AA. Ask for help.
If you haven’t yet returned to drinking but are thinking about it, consider these points:
Not everyone has to quit drinking completely, but you decided you did. Why did you decide to stop in the first place?
- Health?
-Relationships?
-Employment?
-Just felt it was time to stop?
Whatever the reason(s), are those things still important? Is it worth risking those
things just to have another drink?
Consider why you want to return to drinking.
- Craving?
- To ‘prove’ something to yourself?
- Belief that it’s no longer a problem?
- Not caring anymore?
- No reason not to?
- Why?
If you feel strongly that you’re going to start drinking again or have already tried it a
time or two
- If you don’t care or have no reason not to drink – could it be depression?
Should you see a professional to help with this before you decide to drink?
- Make a list of pros and cons about whether or not to drink alcohol.
- Have an ‘exit strategy.’ Have a plan for stopping again if you find it was a mistake.
There are a couple more things I often tell my patients who haven’t yet gone back to drinking but are considering it. I also mention it to people who have started back but are concerned that it could get out of control again:
When in doubt – DON’T, and
DON'T DO NOTHING. It may not be your fault that you have a drinking problem, but who should you blame if you do nothing about it?
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